It was another week working in the ICU and, even though it was August, it felt more like the previous April. We had a rise in the number of COVID-19 cases and were suffocating a bit trying to breathe through our surgical masks and N95 combos. It was a typical busy COVID Thursday morning, the bustle of doctors, nurses, and the rest of the ICU staff creates a buzz of activity. I was rounding with the team of residents, nurses, and respiratory therapists and we were nearly finished. Our last patient was a newly transferred, very anxious lady with COVID-19 who had rising oxygen requirements. We sorted out her medical problems and treatment plan and were relieved to be done with rounds. She was in room 16.
A few hours later we got a call about a woman in another part of the hospital who was deteriorating rapidly. In spite of being on 100% oxygen given through a high flow nasal cannula she still had very low oxygen levels. She was pale, sweaty, and breathing unnervingly fast. She was rushed into room 17.
I put her on CPAP. This is a machine that provides a continuous flow of air pressure to open up the lungs and maximize the ability for oxygen to get into the blood. This is the last hope to avoid being put on a ventilator. Unfortunately, even with this high level of support, she had an oxygen level of only 90% and was breathing rapidly and appeared fatigued.
I suited up in my gloves, gown, and PAPR device and entered her room loud with the noise of her negative pressure fan. She did not look good. She was pale, tired appearing, and short of breath. She was struggling to come to a detente with the mask which bothered her greatly. I knelt down and got as close to her as I could so she could hear me over the constant whirr of the negative pressure fans, the CPAP machine, and my PAPR air filter. She had a look of foreboding in her eyes but as of that moment she was holding on. “You’re very sick from the COVID,” I told her, “but we’re going to do everything we can to get you through this”. In the back of my head I was not optimistic. It turned out to be the last conversation she ever had.
I went home after she stabilized but got a call at 1am from the resident saying she had taken a turn for the worse and would need to be put on life support. She was intubated but her oxygen never again returned to normal. We used paralyzing agents, put her on her stomach, and did everything one can do with a ventilator, all to no avail. Eventually her heart stopped and, after CPR for several minutes, she died.
It was a tough night.
I collapsed on the bumpy mattress in the resident’s call room at 4:30 only to get up 2 hours later to start the new day’s ICU rounds. After dragging my tired body through rounds on our ten COVIDs and seven other patients we finally finished. As I was about to get lunch, one of the nurses came to me and said, “Bed 16 just got a call from her brother to tell her that her sister died from COVID-19 last night.” This poor lady, anxious, sick, and alone in her isolation room now had to also learn that she lost her sister. That fact is a common one in the era of COVID that we all have sadly grown accustomed to. What shook me to the core was the fact that the lady who died in room 17 the night before was her sister.
She had deteriorated so fast that we didn’t have time to connect the dots. The two patients had different last names and weren’t listed as next of kin in the electronic record.
She had deteriorated so fast that we didn’t have time to connect the dots.
There was more. We found out that her sister-in-law was in room one, her husband was on the 3rd floor, and her son was just admitted to the hospital, all with COVID-19.
We were told that younger family members had gone to a party. They had “had enough” of the restrictions and didn’t think anything bad would happen.
There are many nonbelievers, skeptics, and cynics. These conversations are very difficult for me after having seen so many people devastated from COVID-19 and its extensive fallout. I know there are many out there who have been in arguments with them and find themselves not knowing what to say. While, in many (or even most) cases, the individuals asking these questions are not interested in what you have to say sometimes it’s nice to have an answer for yourself even if it will not convince someone else.
- Why are we so panicked, the virus kills such a small number of people?
- You’re overreacting, there have been no cases in our area in several months and nobody is wearing masks anymore.
- Masks don’t even work!
- It’s all a conspiracy.
My response to all these questions is usually the same. I tell people that I hope they are right. I sincerely hope that all the medical experts are wrong and that the naysayers and deniers are correct. I hope that this is all being overblown.
With that said, while I will hope and pray that they are right, I don’t think we should bet the lives of others on hope and prayer. We all know that the masks are uncomfortable and how terrible it is that we are not able to socialize like we once did but it is clear that these interventions slow the spread and save lives. We just need to stick with it a little longer until the vaccine comes.
We can then discuss how to answer the anti-vaxxers. Better yet, someone else can make that blog because I don’t think I’ll have anything left after this is all over.