My phone rang with a FaceTime video, and my cousin’s face popped into view. We spent the first few minutes expressing our mutual disbelief and shock over Covid-19, acknowledging the insanity and underlying terror of these unprecedented circumstances. We joked about how our anxious mothers, with their endless reminders of dressing warm and staying indoors, had prepared us for this moment.
Then my cousin stood up and closed the door to her room. “I want to talk to you about something more serious,” she said. We both burst into laughter: What could be more serious than the end of the world?
She took a deep breath and I watched her face crumple as she asked if, in the unlikely event that she and her husband both ended up extremely ill — or worse — I would be willing to drive the 300 miles to her house and get her young sons. Around the globe, Covid-19 has made people like my cousin realize their own mortality, bringing about difficult, but necessary, conversations regarding their end-of-life wishes.
My cousin got her planning done in advance, but a friend of mine wasn’t so lucky. Her husband, having tested positive for the coronavirus, was texting her instructions for accessing their finances while being wheeled into a Boston intensive care unit for worsening shortness of breath.
So many of us have intentions of one day writing out our plans and instructions for end-of-life care, but most of us put that task off, for when we’re older or sicker. But the truth is, none of us knows when we will die.
As the proverb goes, “The best time to plant a tree was 20 years ago. The second-best time is now.” The same goes for end-of-life plans: The best time to make them is now, when you’re healthy and of sound mind.
In America, only one out of three adults has taken the time to complete an advance directive. This form — which varies by state — allows you to identify a person who would speak for you should you be unable to communicate, whether because of severe illness, sedation or having a breathing tube in your mouth. It also allows you to indicate your general wishes regarding life-prolonging interventions, including breathing machines and artificial feeding. And as my cousin and my friend realized, planning for the possibility of death should consider not only your health care preferences, but your family situation as well.
Without Covid-19 breathing down our backs, most of us look the other way from death. Even those of advanced age or with serious illness. We humans have a fantasy of perpetual life, clinging to the belief that our hospitals and our Dr. McDreamys will always be able to rescue us.
But we are suddenly receiving a communal bucket of water in the face. Sobering visuals of ventilators rigged to accommodate two bodies instead of one, corpses being loaded into refrigerated trucks, and the sudden cessation of patient visitation in most hospitals — it all feels so dystopian, so nightmarish. This lack of options. This presence of death.
But in many ways, it was always true. We will all die someday. Whether sooner, or later. And it pays to make the best plans while you still can. So now is an excellent time to assess your own situation and choose the best approach should the worst happen. Complete an advance directive. Make sure there is a plan for who would care for your children and your pets if you were rushed to the hospital. Make sure your spouse knows the passwords for your bank accounts.
If you are feeling sick, consider having an emergency bag ready with a list of essentials to add at the last minute — such as glasses, dentures, phone and charger — since it is unlikely that anyone will be able to bring them to you if you end up in the hospital. Download the Covid-specific tip sheet at Prepare for Your Care for strategies for planning.
And for those of you with advanced age or serious underlying illness, you might actually consider whether you would prefer to go to the hospital if you become seriously ill with coronavirus, or stay at home with the support of hospice or palliative care services. The National Hospice and Palliative Care Organization has published a new tool to help with that decision in the era of Covid-19. It factors in age, comorbidities and current symptoms, and helps determine your likelihood of survival should you contract the virus. It may also get you thinking about your preferences even if you aren’t infected with the coronavirus.
Having a plan in place, one that doesn’t sugarcoat reality, is the best preparation for ensuring that you are treated as you would wish. It also provides needed clarity to your loved ones, as we all navigate this pandemic together.
Covid-19 is a dreadful scourge on humanity. But as my cousin realized, planning ahead for the worst-case scenarios will provide a somber yet comforting peace of mind in these uncertain times. Just because something was previously unimaginable doesn’t mean it won’t happen. If we have the time to take on projects like cleaning out our kitchen pantries and doing 1,000-piece puzzles, then we can surely take on one of the most important to-dos on our list — preparing for the end of life.
Jessica Nutik Zitter (@JessicaZitter), a palliative medicine and critical care doctor in Northern California, is the author of “Extreme Measures: Finding a Better Path to the End of Life.”
