For Hospice Physician, Patient Care Means Walking 'The Path With Them'

Jun 26, 2020
Originally published on June 26, 2020 7:06 am

The coronavirus pandemic has forced Dr. Joseph Kras, an anesthesiologist training in hospice and palliative care, to face some tough choices.

His 18-year-old daughter, Sophie, has lupus, which makes her high-risk should she contract COVID-19. Kras has to be very careful when he goes home, and he makes sure to keep his distance from his daughter and disinfects common surfaces to keep her safe.

At the beginning of the pandemic, Sophie was upset her dad kept working.

"Whenever you talked about your duty as a physician, my mind would just turn that around as, 'What about your duty as a father? You could save them, but you could end up killing me,'" Sophie tells her dad during a StoryCorps conversation.

For Kras, it's a matter of balance. He says he would of course feel guilty if she got sick, but "if I don't do it, who is going to? Is everybody gonna step back and not do it? Would I want other physicians to turn their back on you if you were sick? Absolutely not."

As a physician treating end-of-life patients, Kras is committed to both being honest with his patients and making clear he is willing to "walk the path with them, whatever that path may be."

He remembers one COVID-19 patient who, as she was deciding to go on a ventilator, was prohibited from seeing her long-term partner because of hospice lockdown rules. In that moment, he was moved by the idea he might be the last person she would ever talk to.

"There was just the sense of aloneness that was over the room," he says. "And me trying to be present — because sometimes that's the most and the least that you can do for your patients. But sometimes, you know, that's not enough."

If you're a good doctor, he tells his daughter, "a lot of your patients take a little chunk out of you every now and then."

Sophie says that she now realizes how tough her dad's job is. "Even though I don't really tell you, I really admire that you go out there and confront these contagious diseases and people who are dying, and people who are angry and sad," she says.

There are things you can't change, and you just do your best, he tells her. "But, I gotta say, one of the things I miss most is giving you a hug," he says. "And when this is all over, it's one of the things I wanna do."

Audio produced for Morning Edition by Camila Kerwin.

StoryCorps is a national nonprofit that gives people the chance to interview friends and loved ones about their lives. These conversations are archived at the American Folklife Center at the Library of Congress, allowing participants to leave a legacy for future generations. Learn more, including how to interview someone in your life, at StoryCorps.org.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

(SOUNDBITE OF MUSIC)

RACHEL MARTIN, HOST:

Time now for StoryCorps. Dr. Joseph Kras works in hospice care in St. Louis. He treats a lot of COVID-19 patients and has to be very careful when he goes home. His 18-year-old daughter Sophie has a condition that makes her vulnerable to the virus. They spoke recently about the tough choices the pandemic demands.

JOSEPH KRAS: At the beginning of the coronavirus pandemic, you got really, really mad at me that I kept going into work to hospice and palliative care.

SOPHIE KRAS: I was mad at you because I felt like you were choosing your work over your family and me. Whenever you talked about your duty as a physician, my mind would just turn that around as, what about your duty as a father? You could save them, but you could end up killing me.

J KRAS: If I should infect somebody in my own family and they should die or get very sick, of course, I'd be guilty forever about that. How do you balance other duties that you have in your life, including, of course, to your own family? And so here's the thing - if I don't do it, who is going to? Is everybody going to step back and not do it? Would I want other physicians to turn their back on you if you were sick? Absolutely not.

S KRAS: So I've always wondered - how do you talk to patients who are dying but, yet, they want to live?

J KRAS: You know, they are owed honesty above all else, and so I give them that. But people need to know that you're going to walk the path with them, wherever that path may be. I had this one patient - her longstanding partner was not allowed to come into the hospital, and she was getting near the end of life. And the last time that this person was going to be talking before she decided to go on the ventilator was to us and not to her partner. And there was just the sense of aloneness that was over the room and me trying to be present because sometimes that's the most and the least that you can do for your patients. But sometimes, you know, that's not enough. I think if you're a good doctor, a lot of your patients take a little chunk out of you every now and then.

S KRAS: If I think about it harder, which I've had a lot of time to do since school stopped, I realize that being a physician is hard. And even though I don't really tell you, I really admire that you go out there and confront these contagious diseases and people who are dying and people who are angry and sad.

J KRAS: There's things sometimes you can't change, and you just do your best. But I got to say one of the things I miss most is giving you a hug. And when this is all over, it's one of the things I want to do.

(SOUNDBITE OF MUSIC)

MARTIN: Dr. Joseph Kras and his daughter Sophie. Their conversation was recorded with StoryCorps Connect, which allows loved ones to interview each other remotely. Their conversation will be archived at the Library of Congress. Transcript provided by NPR, Copyright NPR.