Just Another COVID Post

Our ICU has been putting together a series of photos of us to put together into a book called “The Faces of the Pandemic.” A request went out to tell some personal stories about our experiences in the pandemic. Some story prompts were personal – “How has the pandemic changed the way you view your role as a healthcare provider?” and “What is one of the greatest challenges you are facing during the pandemic?” while others triggered a vast trove of memories of long-duration PPE and daily anxiety.

One particularly poignant prompt for me was “What was it like walking into a COVID-19 patient’s room for the first time?” Of course I remember it, the anxiety about it had been building for weeks, even months, as we heard of New York, then Detroit and Seattle’s struggles with inadequate PPE and resultant health care losses. My colleagues and I came up with treatment algorithms and discussed which “experimental” therapies we would want for ourselves. Intrinsic to the discussion was the morbid curiosity: which of us would die or get severely ill during COVID?

The first time I was in a COVID patient’s room I was actually on another ICU team and was asked to do an emergency in-room anesthetic for a severe COVID patient in the middle of the night. All the other anesthesiologists were busy staffing the ORs and no one could help quickly; I’d have to do the anesthetic alone, and it had to be now. I remember I had to climb under tubing and cords to get where I could do the anesthetic, to resuscitate the patient and keep them safe, due to surgical equipment, the true emergent nature of what was happening, and the tight room.  I remember vividly when the lines, tubes and wires dragged over the back of my head, neck and back. I thought to myself – “This is how it happens. This is how you are going to get COVID.”

Thankfully, with immense effort, speed and skill, the nurses, surgeon and I were able to get the patient through the procedure safely. I ran off after to change scrubs, shower in a dirty call suite and cover my body in rubbing alcohol. I was so terrified I’d bring it home to my little girls. I felt anxious every time I cleared my throat for the next week – was that the early sign that I got COVID? I barely told my family about it.

That’s when I first realized the constant anxiety of being in those rooms and the sacrifice the in-room nurses were making. As a physician, I’m able to go in-and-out of rooms in a controlled way, and in limited experiences, over 99% of the time. I do an exam when needed, I limit what I touch, and I get out. The nurses are not offered the same protected, guarded and controlled exposures. They go for every alarm – every time the vent disconnects from the patient moving and the air is filled with high-flow COVID ventilator breaths they have to run in, speedily getting PPE on and heading into a high-risk room. And they do this all day, every day. Very little I do compares to that.

I still think about this patient. I was so impacted by the loneliness our patients must feel being so isolated in those rooms (especially early pandemic), the terrifying nature of the measures we took to try to save her life, and the daily anxiety the nurses experience in and out of PPE with varied levels of urgency.

It wasn’t much after this that I was, in fact, on a COVID-ICU service. I had a younger adult who we needed to intubate, not much older than me but a single parent with children at home. Utterly terrifying for them and their family. Terrifying for us, since we knew we may not be able to save them. But selfishly, I was intensely afraid to go to talk to them since they were breathing so hard, clearly contagious, and not yet intubated. I knew the air in the room was filled with virus. I knew no PPE would prevent small particles from being on my shins, or my shoes, or anywhere else.

I think most people become physicians because we have a “Savior Complex.” Whether that’s for outpatient physicians, helping them deal with chronic health conditions and making clever diagnoses, the surgeon who offers healing by way of a scalpel, or for the high-acuity emergency or critical care physician – all of us have a unique take on how we want to fix, help or save someone. My identity has partially been tied up in this idea that with enough study, practice and bedside skill, I can keep people safe and even save them sometimes.

COVID has made this hard. The patient asked me if they would die. I had no idea, but I knew it was a distinct possibility, even a likelihood. Yet I still had to tell them that I would do everything it took to keep them as safe as possible; to keep them alive for their kids. The patient was wide-awake, lucid and scared. They tried to joke, to make light of the situation, to maintain hope. Reassurance felt disingenuous. Of course I would do everything, but sadly, I knew that no matter how clever I could be or how hard I would work, it may not be enough.

I had difficulty sleeping thinking I might be the last person to have heard them talk. The last actual conversation they had. Did I do it right? Was I honest enough? Did I balance hope and realism, or did they want more of one or the other?

It continues to haunt me. I never looked at the chart again after I went off-service; I couldn’t bear the idea that they didn’t make it and the kids would be alone without them.

I hope I did it right.