NEW JERSEY: Marianne Holler, DO is no stranger to sitting down with patients and families for difficult conversations. For eighteen years, Holler began her professional career as a social worker in a hospital setting. She then decided to go on to medical school. During the last two decades, Holler has concentrated her practice on hospice and palliative medicine. She considers compassionate care critical to every patient she encounters, recently that includes many with COVID-19.
Holler currently serves as the Chief Medical Officer of VNA Health Group's Hospice, Palliative Medicine and Advanced Care Institute. She is credited with starting the first Palliative Medicine Consult Service at Community Medical Center (CMC) in Toms River. Amid the pandemic, Holler finds herself more of a regular at CMC.
Like the nurse helping coronavirus patients in another Ocean County hospital, Holler feels a bit shaken. A great many of her patients are seniors who seemed fine before the virus. Their rapid decline defies anything Holler has witnessed before. Meanwhile, she puts her personal feelings aside. Holler’s primary role in the sudden onset of a deadly disease – is not an easy one.
The burden of intervention means stepping in and having heart to hearts with struggling patients. They are alone without family members by their sides. Holler is the one to tell them they are seemingly facing their last days and wants to make it as good as possible for them.
In some cases, these same individuals will become part of the daily hospital discharge numbers. Holler says that everyone shows incredible compassion, from the nurses, aids, maintenance workers and housekeeping staff. In the end, they are all strangers. Many see passing at home surrounded by loved ones as the better option.
“I only deal with death and dying,” shares Holler. “I can’t imagine how hard it is for other doctors who aren’t accustomed to advanced care conversations.”
When Holler reaches out to patient families, the process silently exasperates her. The limitations on in-person contact are yet another side-effect of COVID-19.
“I can’t always sit face to face with families,” Holler laments. “I am asking people to trust me over the phone or by video-chatting.”
The onslaught of many more sudden deaths serves as a vital reminder. According to Holler, people talk about everything in society, with one vital exception.
“Nobody wants to address what happens if things don’t go well,” says Holler. For the most part, people do not want burdensome and unwanted care.”
As Holler sees it, many times it is the children who stop the conversations when their parents initiate them. Unfortunately, the risk of mortality still exists even if the discussions never happen. Holler implores adult children to speak with their aging parents about how they would like to spend their last days.
When it comes down to treatment, some well-meaning families implore Holler to give their loved ones a particular medicine. When she tells them they are already receiving the medication, the callers ask about dosages and want them increased. Holler completely understands their desperation.
“There’s an important difference between medicine and poison,” shares Holler. “Knowledge about dosage separates the two.”
“Like most physicians, I become frustrated when people stray from science to what they’ve read on the internet,” Holler admits. “I am open to listening to what families and patients have learned in front of a computer monitor. However, it’s not the same as direct care or medical experience.”
Holler dismisses the rumors that doctors place patients on ventilators to financially benefit hospitals. She recalls the day she was consulted about putting an elderly man on a vent. The reality is that statistics suggests that many COVID patients placed on vents will not make it. She finds that she and other doctors are pushed to the difficult conversations. If anything, Holler feels medical professionals often resist prolonging the inevitable when it comes to mechanical breathing assistance.
Without question, the effects of the novel coronavirus continue to surprise even the most experienced physicians. Holler scoffs at the idea that doctors would put their medical licenses at risk to falsely report COVID-19 as a cause of death.
“We are learning that there is an inflammatory component to the virus,” explains Holler. “A person can die of one thing as a result of another. We are seeing COVID-19 causing heart attacks, strokes, and blood clots. A patient may die of a heart attack brought on by the virus.”
“Any infection can cause diabetics to have uncontrolled blood sugars,” she continues. “Pre-pandemic, a person with Parkinson's Disease might die from pneumonia. The two are related.”
Holler admits that COVID-19 has pressed her down to the point that she feels as though she in a vise. She thinks of the horror stories – the husband and wife, who came into the hospital, one day apart. Holler recalls their children as shell-shocked as though their parents died in a war. She mourns the loss of two fellow friends and physicians, one just 44.
Meanwhile, Holler puts her personal feelings aside when she is at the hospital. She knows she is dealing with life and death situations.
“The best thing physicians can do is realize when God has their hands on their right shoulder,” says Holler. “There comes a time when it is time to let go of the left shoulder.”