On Redeployment to Palliative Care
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THE LEARNER'S VOICE
On Redeployment to Palliative Care Felipe Castillo 1 Received: 4 June 2020 / Accepted: 20 October 2020 # Academic Psychiatry 2020
“the virus is not that deadly you know” “sabemos que la mayoría de nuestros pacientes con este cuadro al ser intubados no vuelven al mismo estado de salud y muchos no sobreviven” (“we know that the majority of our patients who are intubated with this clinical picture do not return to the same level and many do not survive.”) For the past few months, the contrast of opposing ideas above made it difficult to navigate extremes, mainly because the COVID-19 pandemic has challenged our ability to resolve the ambivalence surrounding them. It has been both the end of the world and business as usual. Nothing has happened yet everything has happened during this time. I bore witness to this conflict play out when I transitioned from the role of researcher working on the national opioid overdose epidemic to the front lines of the pandemic, providing palliative care. Like many trainees, I was redeployed when my hospital could not keep up with staffing demands due to increased patient volume [1, 2]. I paused my own training in addiction psychiatry to join the palliative care service, as we needed physicians capable of supporting patients and their families and conducting conversations to elicit goals of care in the emergency rooms and ICUs. My tasks turned out to be much more than that: I assisted in repositioning patients into the prone recovery position, held an iPad at the bedside for last goodbyes, and grieved deaths with primary teams. As a native Spanish speaker, I provided care in patients’ preferred language, as phone interpretation quickly became challenging and impractical in the setting of noise interference from oxygen flow and other factors [3, 4]. Native language gifts were in high demand for navigating difficult discussions about
* Felipe Castillo [email protected] 1
Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
advance directives under circumstances extraordinarily pressured by lack of time and severity of symptoms. As soon as I got called in, I experienced my own internal conflict: I wanted to head in, and I also wanted to stay safe at home. I was ambivalent. I asked for an extra day before starting because I was afraid of getting sick. It was fortunately granted. Once in the hospital, I saw how extensive the redeployment was: researchers from cardiology and endocrinology were taking care of patients with COVID, away from their labs and back on the wards as well. Our patients have been largely from uptown Manhattan and the Bronx, immigrant and Latino, struggling to find help in the face of such uncertainty and injustice evidenced by the unequal death toll in our communities [5]. How dangerous is this virus? What are the options when facing the choice of whether to intubate or not and to resuscitate or not? These choices, presented in a loud, foreign, isolated room, possibly abruptly, and
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