COVID has been with us for two years. I have written my reflection during the pandemic, periodically, to vent, to share, to disseminate information. But I have felt at a loss for words in the last few months. I am exhausted, emotionally drained, and bereft.
Critical care docs are resilient. We train to serve the sickest patients. We are used to making decisions in split seconds. Lives depend on us, and we strive to cause no harm. There is no room for error or delay. We know how to compartmentalize out emotions, hold back our tears, as we give news of loss and death to loved ones.
COVID has changed our working landscape. I know how to care for sick patients. But I have had to witness death and suffering at such an unprecedented and relentless pace, that I am broken, I am beaten, I am sad. I have borne witness to the deaths of two or three or more, young and middle aged mostly men and some women every day, in the prime of their lives, parents, children, lovers, friends. I have spoken to them, and I have seen their confidence melt away in a matter of hours and days. They come in with the unified belief that they will recover and leave the hospital. They don’t understand the havoc a virus can wreck on their seemingly indestructible bodies. They are surprised that they are in the hospital in the first place, they thought they would leave the ER after basic treatment. But as their breaths get shallow, as their lungs hunger for oxygen, as blood clots occlude their vascular system, as their lungs collapse, their bravado ebbs away and their eyes gloss over with fatigue and hopelessness. I have learned to recognize this resignation. They give up. They see the end, before I can. We talk about the ventilator, and they acquiesce between gasps of air. I am glad for PPE in these moments because it disguises my despondency. The reassuring hum of my air purifying CAPR hides the catch in my voice as I struggle to hold back tears. I endeavor to give them time with family, usually Facetime or video call. They all say the same things … ‘we love you’, ‘please fight’, ‘you will make it’. Some people share details of finances. They try to whisper because they don’t want me to hear about their secret ‘stashes’. Yet they need me to repeat their words to loved ones since their gasps are hard to understand over phone or video. I usually just stand there and wait. Its time I don’t have, but these fifteen or twenty minutes are the last moments these patients will have with loved ones. Who am I to take this away from them? These moments are sad, they are sacred, they are tragic.
After intubation, most of these patients follow the same general course. Their kidneys fail, their lungs collapse if they have not already, their lungs get stiffer, and become refractory to ventilator adjustment or other therapy. They eventually die. Some take a few days and others, weeks. It’s all the same. I must call and inform spouses and parents and children that they are going or gone, its soul-crushing each time.
It is surreal that 2020 ended on such a positive note, with the development of not one but several vaccines that showed real efficacy against death and hospitalization. Then how did 2021 end up being so much worse in that regard? Delta predominated 2021 and deaths and hospitalizations surpassed 2020. The vaccines could have prevented all of this, the deaths, the hospitalizations, IF ONLY…..IF ONLY…..
As a person of science and logic, I was floored by the tsunami of misinformation. I felt that the healthcare system was tasked with two parallel pandemics: SARS-CoV-2, and the misinformation surrounding it. My conversations with patients were much the same with regards to vaccination. I estimate less than a dozen total deaths in the ICU among vaccinated individuals. Deaths disproportionately affected the unvaccinated. I asked my patients why they chose to not get vaccinated to protect themselves. Their reasons, varied from ‘not having time’, to distrust, to being a victim of conspiracy theories. When, they were receptive, I counseled them, and some were eager to get vaccinated as soon as they could. Unfortunately, most never left the hospital. Many patients were so caught up in misinformation that they stated, ‘I would rather die than get vaccinated’. A majority did, and I sit here writing this essay wondering ‘why? Was dying worth it?’ I can’t understand or agree with this sentiment. I live on, and come to work, day after day and try to do my part. I value life, my life and theirs.
Misinformation was like a cancer, spreading its roots into all aspects of society. My conversations with patient families in 2021 were also colored by this as I got repeated requests, then demands then threats to prescribe unapproved and harmful treatments in dying patients. The healthcare heroes of 2020 had become the targets of hate, derision, and violence in 2021. Our knowledge, experience and expertise were trumped by social media influencers who had ulterior financial or political motives. They have blood on their hands. How did it all go so wrong?
The year ended on a better personal note. My family had the privilege to get fully vaccinated and we made the decision to fly out of state for our first vacation in two years. We had missed the ocean, sun, family time. We relished our newfound freedom, albeit within a new-pandemic-normal framework. We embraced public health mitigation measures and made it back home safely, rejuvenated, and ready for 2022.
2022 brought with it a new enemy, with a catchy name: ‘Omicron’. We have all the tools we need at our disposal to mitigate the risk. I start the new year with hope in our goodness, humanity, and resilience.
First Published on KEVINMD