One awfully sad thing I've seen in this pandemic is guilt. An older man with metastatic cancer has been isolating himself. However, his son, worried about him, convinces him to allow a visit. The son brings his children - the patient's grandchildren - because they haven't seen him for over six months. This is complicated by the fact that the man's metastatic cancer gives him a survival prognosis of less than a year. His children and grandchildren may not be able to see him before the pandemic is over.

Several days after the visit, the man develops high fevers, shortness of breath, and cough. His oncologist by televisit sends him to the emergency department and he is diagnosed with COVID. Over the ensuing week he rapidly worsens. When he was diagnosed with metastatic cancer, he had discussed what he would want at the end of his life. He did not want to die on a ventilator. Eventually, his oxygen worsened to the point that we could not sustain him. He said that he was ready to move on.

The death, while tragic, is a common occurrence in this pandemic. We did what we could for him medically, and when we reached the limit of what we could offer, we tried to give him a painless, dignity-affirming end of life. But I was most affected by my conversations with the son. They were by phone because unfortunately, he tested positive for COVID as well. And as you may imagine, his sense of guilt was overwhelming. I struggled with what to tell him. 

What is it like to grapple with the guilt of Oedipus? How do we make decisions when each branch could lead to regret? Can we afford not to visit family dying of cancer? Can we live with ourselves if we think we might have hastened their death? Could this be happening around the country, around the world? It's easy to brush off consequences of our actions if they are far away and unknown, but how devastating it is to realize they are so close to home.