FOR BREAKING NEWS VISIT WWW.QNS.COM APRIL 16, 2020 • THE QUEENS COURIER 19
сoronavirus
‘It’s never been harder’: Palliative care dir.
discusses end-of-life care during pandemic
BY JACOB KAYE
jkaye@schnepsmedia.com
@QNS
Dr. Stella Rubina has spent a lot of time
around death.
Having been the director of palliative
care at Mount Sinai Queens in Astoria
for the past fi ve years, Rubina is an expert
in caring for those approaching the end
of their life. But the COVID-19 crisis is
unprecedented — even in a fi eld where
sickness and death are the norm. “It’s
never been harder,” Rubina said.
Th e COVID-19 outbreak has been a
challenge for medical workers because
of both its scale and because of how rapidly
the disease attacks the human body.
Before the outbreak, Rubina said she typically
would see about one to three deaths
a day. Now, as the city and Mount Sinai
Queens approach the potential peak of
the outbreak in New York City, Rubina
says about six to 12 people are dying in
the hospital daily.
“Th is is the fi eld we chose,” Rubina said.
“But we were never prepared that this is
the number of people we would not be
prepared to save because of how aggressive
the virus course is.”
Changing the conversation
While ventilators are an important tool
in the fi ght against COVID-19, they present
their own medical challenges and
only act to buy medical personnel and the
patient more time. Th ey are not a cure.
Because the disease progresses so quickly
in some cases, the patient may not be
aware of what’s happening to them and
might be unable to make decisions about
their treatment, Rubina said. Putting a
patient on a ventilator also means putting
them into a medically induced coma.
Rubina encourages the conversation about
securing more ventilators for patients, but
also urges others to talk about what going
on a ventilator means for a patient.
While the medical staff will do all they
can to save a patient’s life, there are potential
complications to treatments like being
put on a ventilator.
“As much as I think it’s important to
talk about the breakthroughs in medicines
and what treatments are available
to speed up recoveries, it’s just as imperative
to talk about what care level and
what treatments are available when there
is irreversible decline of the illness and all
resources have been exhausted and provided,”
Rubina said.
However diffi cult the conversation,
families making treatment decisions on
behalf of a loved one should think fi rst
of the patient, who might be progressing
poorly and unable to advocate for themselves.
“Families think just because something
exists in medicine that we can throw
it on somebody, but it doesn’t mean that
it will be most medically benefi cial to
the quality of life that the person himself
or herself ever wanted,” Rubina said.
“Sometimes, there comes a moment when
the families need to take a step and think
about what those treatments might represent
to that person in the center of it all.”
Rubina recommends having the diffi -
cult conversation about treatment before
anyone gets sick. Th is way, everyone
can make their wishes known, she said.
Rubina had the conversation with her
own father when she was in fellowship
training.
When she asked him what he would
want for himself if he was put on life support,
he dodged the question.
“His response to me was, ‘I already told
you, you and your sister are going to have
everything split 50 percent,’” Rubina said.
“I said, ‘I’m not talking about the fi nances.’”
Despite encouraging others to have such
conversations as part of her work, she still
understands how diffi cult it can be.
“I know that none of us ever feel comfortable
having these very diffi cult conversations,”
she said. “But during this situation
now, giving up sometimes is the
most loving gift , out of unconditional love
and a true gift of courage on behalf of the
family — to allow a peaceful, dignifi ed
way of passing when all the resources have
been exhausted.”
Saying goodbye
Due to the isolating nature of COVID-
19, once a patient enters the hospital, their
family will likely not have the opportunity
to say goodbye in person. Additionally,
hospitals like Mount Sinai Queens are so
inundated with patients that making a
phone call to get an update on a loved one
inside can be diffi cult.
Rubina recommends designating one
person from the family to call the hospital
for updates. Th at way, nurses and doctors
are able to fi eld as many calls for as many
patients as possible. In addition, Rubina
has begun to challenge her friends, colleagues
and her community of healthcare
workers to make time for at least one call
a day between a patient and their family
or loved ones.
She calls it the “one call at a time challenge.”
“It’s called the ‘one call at a time challenge’
because I truly believe that it’s one
win at a time, one family at a time that is
getting their closure,” Rubina said. “Th ose
who are in the hospital need to hear from
their loved ones that they are OK. Even
though they know that they might not
be OK themselves, the patients, in their
hearts, want to hear that their family will
be okay when they leave them behind.”
But Rubina acknowledges that still,
even with one phone call a day, families
will likely feel disconnected from their
loved one in the hospital. Still, Rubina
off ers the promise and sacrifi ce so many
medical providers have made in this time
of crisis.
“At least they know that there is dignity
and support and comfort that we’re
able to cater to our community and their
loved ones to at least assure them that we
are there, and we are doing everything,”
Rubina said. “We have a mission to provide
that there is no suff ering, there is no
pain that comfort at every level is provided.”
Photo courtesy of Mount Sinai Queens
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