mahtani and goldman were two of the physician leaders who helped manage the outbreak after mount sinai hospital partnered with the long-term care home on april 15. the following day, mahtani and goldman helped arrange the evacuation of 15 residents to the hospital’s emergency department, where physicians and nurses could provide “the kind of intensive comfort care that these people needed,” says don melady, the leader of geriatric emergency medicine at mount sinai hospital, who was working in the emergency department when residents arrived.
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the palliative care physicians had stopped being on-call consultants or experts brought in only when it became clear that a patient no longer wanted curative or life-prolonging medical treatment. instead, they became a fixture of the emergency department. there was a longstanding view that palliative care should be more integrated into the emergency department, melady says, but it took the chaos of covid-19 to disrupt the institutional inertia that kept them apart. this “model might be a paradigm shift for how we deliver palliative care,” says darren cargill , a clinical co-lead for the ontario palliative care network. mahtani and others, like a group of palliative care physicians in new york , have finally “been able to create a model of integrated palliative care.”
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palliative care is not just for patients who are dying, however, but for anyone who is very sick – and therefore, everyone hospitalized with covid-19. during ontario’s third wave, that meant mahtani and her team cared for many young or pregnant patients , largely from disadvantaged socioeconomic backgrounds, who were overwhelming the icu. the palliative care physicians found themselves working alongside obstetricians. there were pregnant patients sick with covid-19 who had suffered stillbirths and others at risk of having one. when some of these patients regained consciousness, mahtani and her colleagues told them that their babies had died, or that they had survived but were now between life and death in the icu. the doctors broke the news of other family tragedies too, like the brother who had been hospitalized and the mother who had died as the more contagious, virulent variants caused entire families to fall ill. “the amount of trauma that was downloaded onto them is actually not comprehensible,” mahtani says. being by their side as they began to process how their lives had changed was crucial for their care, she says.
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