Would you like COVID to be on the Certificate of Death?
Just after midnight, a 24-year-old man was shot for unknown reasons. He was taken to the hospital before police arrived, with what were described as serious injuries. He walked to the car and was speaking with others as he sat himself down in the front seat.
At 12:20 a.m., dispatchers were notified of a vehicle accident. It turns out the very same gunshot victim was involved in the crash. He was soon pronounced dead at the scene.
Based on what you know, is the man dead from the gunshot or the car accident?
How many questions immediately come to mind? What details might deliver the epiphany to assuage your indecision? I wish I could provide some insight, but there is none to offer. Time’s up: you have to pick a cause of death.
That was practice… on to the actual exam.
My father’s death
A few weeks back, I was asked to provide the cause of my father’s death by the doctor signing his death certificate. Initially, it seemed like an easy enough question. I had an opinion.
Upon being presented the question, my immediate thought was “why are you asking me?” I have no medical training. The doctor explained that he has changed several death certificates over the past few months, and he’s learned the hard way that it’s easier to do it once with the family’s approval versus having to revise the document when the family objects. He noted that the changes have gone both ways. Some are adamant it was COVID, some don’t want it referenced as some sort of final statement on the life of their relative.
As a buffer against family dissension, I decided to take a few hours to build consensus before finalizing any documentation. Much to my surprise, I was immediately challenged by everyone I spoke with. Those I had assumed would agree were quick to argue, and many who I thought might object were the most aligned with my thoughts. I was struck wondering if my assumptions were wrong based on my presumption of their ethics, or was it their politics? I believe it’s best to leave politics out of this discussion, but is that possible? The more I thought about the question, the more I appreciated the doctors focus was solely on me. What would help me to explain, rationalize, and accept the passing of my father?
How is it that my father dying raised more questions about me than him?
On Tuesday the 10th of November, my father received test results indicating he had contracted COVID. The results were confirmed 3 days later by a second test. Over the next week, he had a slight cough and some occasional dips in the oxygen levels to 92/93. By the second week the cough was gone, as were the oxygen fluctuations. He never received supplemental oxygen. Eating and drinking were generally good the entire time, but he was very tired.
On the first of December, he had breakfast, met with the doctor, and ordered lunch. By the time they returned with his food, he had passed.
My father was 83 years old. He played basketball and football in college, and was active his entire life. His health was generally very good, until he announced his retirement. Parkinson’s and a battle with Non-Hodgkin’s Lymphoma ensued. The cancer was conquered; the Parkinson’s persisted. By the start of 2020, mobility was a problem. He could pivot in and out of a wheelchair, but he wasn’t walking more than a few steps. He was constantly falling, refusing to accept his lost mobility. He remained cognitively sharp to the end, recalling a few months ago the price he paid to scalp tickets to the women’s compulsory figure skating event at the Lake Placid Olympics in 1980 ($10 each, and we watched 3 minutes of figure-eights and 60 minutes of the Russian ice hockey team practice…but I digress).
Gunshot or car accident?
I can’t imagine anyone who visited with my father over the past year or two would be surprised at his passing. There have been a few times over the years when we were summoned to “come, quickly”, but he always recovered. He was stubborn and resilient.
But he did have COVID. He may not have needed a ventilator or lost his appetite, but we’ve come to realize that the moment we believe we know how the virus operates, it proves us wrong. Did it wear him down? Did he have a blood clot that caused a heart attack or a stroke? There are dozens of questions for which I have no answer.
So you know what I knew. An 83 year-old Parkinson’s sufferer with COVID passes away…was it the gunshot or the car accident?
The discussions with family eventually centered around a very specific question: If he hadn’t had COVID, would he have been alive on December 2nd?
If you believe the answer is yes, then logically don’t you have to concede that he was killed by COVID?
I don’t know the right answer. What I do know is that I don’t want to use his death to prove the dangers of the virus, nor do I want to engage with those who believe the virus is over-hyped and riddled by irregularities in the reported deaths associated with COVID. Both are important factors, but hold no interest for me.
Ultimately the decision required balancing my personal beliefs with those of my family. For all of my apolitical desires, did the politics of the virus influence or override my final response to the doctor? In the end, I spent a lot more time thinking about my own issues and those of my living relatives than the ones that took my father.
Gunshot or car accident? What does this discussion say about us?