This is what the Lord says: "About midnight I will go throughout Egypt. Every firstborn son in Egypt will die, from the firstborn son of Pharaoh, who sits on the throne, to the firstborn of the slave girl, who is at her hand mill, and all the firstborn of the cattle as well. There will be loud wailing throughout Egypt—worse than there has ever been or ever will be again."
— Exodus 11:4–6
Not so many thousands of midnights ago, the mark of lamb’s blood on the door spared the innocent from the Angel of Destruction come to kill those whom families hold most dear.
1.5 million people around the world infected with the new pandemic. 75,000 dead. This terrible plague of vaporous foul air has enveloped our globe in an ominous cloud of killer RNA particles seemingly determined to wipe out humankind.
So many dead bodies so suddenly… where could they all be buried? Who would be there to attend the funerals? What dark eyes will be left to cry the farewell tears?
Right now, for many of us sitting up late at night, it doesn’t seem like this virus is containable. Exploding out of Wuhan on the supersonic jets of commercial airlines, the disease at first seemed to target rich gray-haired guys with shiny shoes and international passports. But this miasma of venomous RNA droplets was a worse nightmare than any video on demand feature film could ever imagine.
The Airport epidemic. The Baby Boomer plague. The Netflix contagion.
The great coronavirus epidemic of 2020 has fashioned itself several pugilistic nicknames, none of which will ever endear itself any adoring fans. Unlike Manny “Pac-Man” Pacquiao, Tommy “the Hitman” Hearns, or even “Iron Mike” Tyson, the not so novel coronavirus that we have all come to hate will never be remembered fondly for its cunning dexterity in the sweet science of human annihilation.
With Guam now under lockdown, social distancing to fight the spread of coronavirus is leaving both the sick and the dying to each face death alone. The pandemic has changed the way people live, the way they die, and the way their loved ones are able – or unable – to say goodbye. For a glimpse of Guam’s future, we turn our dark eyes to Italy.
When someone dies of coronavirus in Italy, “relatives see them enter the hospital, and then no more,” says Elisa Banelli, a nurse at Bergamo’s Papa Giovanni XXIII hospital, on the front line of Lombardy’s fight against coronavirus. Death by Covid-19 is inhumane, she says – not only because of how it happens, by asphyxiation, but mostly because “it is a death far away from every loved one, and from every human contact.”
In a country where many of the elderly live with, or close to, their children and grandchildren, tens of thousands of relatives and friends of the dead are being denied closure. “Let us pray for the many people who are dying alone, without being able to say goodbye to their loved ones,” Pope Francis tweeted. “Let us pray also for the families who cannot accompany their loved ones on that journey,” he added.
Many of our patients, especially those who know where they are going, are not afraid of death but they are afraid to die alone. Many of our patients are not afraid of the truth but they are afraid of suffering alone.
In order to control the surge of desperately sick Covid19 patients who will soon overwhelm the Guam Memorial Hospital, we island physicians must meaningfully engage our sickest, most vulnerable patients and their families in an immediate and frank discussion about end-of-life care.
I believe that a significant number of these patients will choose comfort measures only. No life support, no mechanical ventilation, no tube shoved down their throat. I believe a significant number of man’amko have already made their choice Do Not Resuscitate/Do Not Intubate. Now is the time for families and their physicians to have this important discussion.
The best way to deal with big problems is to deal with it today. Most of our families will care about what we know about coronavirus when they know that we care about them and their loved ones as fellow human beings. For most people this is not so much about how you want to die but rather, how you want to live your final moments, your final days.
A non-GMH hospice option should immediately be stood up to absorb critically ill DNR/DNI patients and provide sympathetic comfort palliative care that does not overwhelm our extremely limited hospital resources.
No one should expect complete COVID19 disease eradication any more than we have eradicated tuberculosis or the flu. We must plan to return to the normal human existence of ever watchful vigilance against all infectious diseases and the constant maintenance of a robust, healthy personal immune system.
We all need to understand that the Government of Guam’s current plans are designed to address the ongoing medical disaster, mitigate human loss, and eradicate disease. The plan must be a comprehensive effort to accelerate epidemic disaster mitigation, enhance proactive epidemic disease management, and aggressively promote economic and societal recovery. Although things will be dark tomorrow and thru most of next week, we all must plan what we will do after the Surge. Along with burying the dead, we must rebuild.
Gov. Lou Leon Guerrero has done her job optimistically projecting confidence that Guam as a community will persevere in spite of any challenges ahead.
The great British leader Winston Churchill himself worried privately about the details of surviving World War II while in public projecting indefatigable optimism. We need to fix what we can fix so that Governor Lou's words will not turn out to be lies. There is nothing false about hope. Indeed, in this time of the Coronavirus, Hope is the dividing line between helpless panic and courageous perseverance.
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