James' World 2

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Shortly after his sixty-seventh birthday, Ernesto Chavez retired from his job at a Los Angeles food warehouse. Sara, his wife of forty-five years, told me that he meticulously took his medications for high blood pressure and cholesterol, hoping to enjoy his time with his grandchildren. But one morning in January 2021, Ernesto burned with fever, his chest heaving as though he were once again lifting heavy boxes. At the hospital, he tested positive for COVID-19. His oxygen levels plummeted, and he was quickly intubated. Ten days later, his lungs were failing, his face was bloated from liters of intravenous fluid, and his hands and feet had begun to cool. As his chances of survival waned, I arranged to speak with his family about a subject inseparable from death itself: cardiopulmonary resuscitation, or CPR.

For decades, physicians have debated whether CPR should be offered to people who suffer from the final blows of incurable illness, be it heart failure, advanced cancer, or dementia. Although CPR has become synonymous with medical heroism, nearly eighty-five percent of those who receive it in a hospital die, their last moments marked by pain and chaos. The pandemic only deepened the risks: every chest compression spewed contagious particles into the air, and intubation, which often follows compressions, exposed doctors to virus-laden saliva. Hospitals in Michigan and Georgia reported that no COVID patient survived the procedure. An old question acquired new urgency: Why was CPR a default treatment, even for people as sick as Ernesto?

As a palliative-care physician, I help people with serious, often terminal, illness consider a path forward. During the pandemic, this involved weekly Zoom meetings with each family whose loved one was in the I.C.U. with COVID. We discussed how the virus could damage the lungs irreversibly, how we gauged a patient’s condition, and what we would do if, despite being on life support, that patient died.

On a gray afternoon, I logged on to Zoom to speak with Ernesto’s family. I would be joined by Sara, her daughter Nancy, and Neal, an internal-medicine resident covering the I.C.U. Before the meeting, I asked Neal whether he’d been taught how to have these conversations. “Nope,” he said. I asked him what he might say to Ernesto’s family. “Unfortunately, he still needs the ventilator for his lungs, and he’s not showing signs of improvement. We want you to know that he is very sick,” he said, his expression solemn. “Because he is so sick, his heart could stop. If that happened, would you want us to do CPR to revive him?” He used his hands to simulate chest compressions on a phantom body.

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Photograph by Ashlee Rezin Garcia / Chicago Sun-Times / AP

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