Here’s a guest blog from a friend and colleague who practices Undersea and Hyperbaric Medicine and is also a Critical Care physician. I believe that she should remain anonymous for now. However, I was inspired by the emails and texts she has sent me and thought you would be, too. She’s sending me messages off the cuff – they are “raw” and not edited by her. However, I think that is best. She uses a lot of abbreviations and when I thought it was useful, I explained them in brackets. One day at the right time, I will tell you who she is and we can all thank her properly for her courage and commitment. Here are her COVID-19 Diaries – uncensored.
The Big Little Things
I am reflecting on the illness of these patients and feeling like I’ve failed them somehow. It’s little-but-not-little things – like seeing a creatinine creep from 1.15 to 1.6 with a rise in potassium – hints of impending renal failure which we are seeing in conjunction with pulmonary injury. It is watching a tidal volume decrease from 460 to 380 – hints that the lungs are getting stiffer. Little things multiplied by 12 critically ill patients. It’s the constant phone calls – to tell wives their husbands won’t survive or tell primary care docs that their patient/friend is succumbing to septic shock and there’s not much we can do about it. It’s making the two-physician decision that CPR isn’t indicated for this patient. It’s the daily grind of, “order a cisatricurium drip!” and getting a call from Pharmacy, “Doctor, we don’t have cisatricurium anymore.” “OK, FINE – then give me Versed.” “Doc, we don’t have that either.” “Ok, tell me what you DO have!” Guessing my way through the bottom of the pharmacy supply closet is wearing my patience thin. It’s that a novice nurse was paralyzing the crap out of my least sick patient. So many little-but-not-little things.
There was one bright spot. The first COVID-19 patient that I intubated – and the first one for whom we used prone positioning – was extubated two days ago and is doing better. She has a little boy at home praying Mommy will live. Her nurse, who had only one week to fast track her ICU training, watched as my wound nurse Facetimed her son. The patient smiled purposefully for the first time in 24 days. Both nurses wept. I had gone home already, but received a text update from them about this rare moment of joy. What a blessing. We are all trying to be the best we can be. To be thoughtful, careful, anticipatory and humane in this dark place.
I come home and go into quarantine in the basement. It is isolating, but it is also my cocoon. I need time away from my nearest and dearest to process, to grieve, to self-flagellate that I “let” my patient’s renal function worsen. That I didn’t see that my patient was becoming hypotensive because the crappy ventilator he was on didn’t have an auto-peep function to alert us that he was breath stacking. Yes we have enough ventilators, no we don’t have enough good ventilators to help us do our jobs better. It sometimes takes two intensivists studying a ventilator and the patient, two nurses and a respiratory therapist covering 30 patients to figure out why one of them cannot breathe. One of the reasons I love critical care medicine is that I can control so many things about the patient. Except with this disease, I don’t have control. It’s another lesson in humility.
Out of the Frying Pan and Onto the Floor
I am rotating off the ICU, and normally I would not take over another service right away. However, I made the decision yesterday that I’ll take on the Pulmonary consult service. We are short of physicians so I’m taking back to back rotations – we are all doing that – not just me. The floors are actually where the doctors are getting exposed the most – not the ICU. We will put my older male, slightly overweight colleague in the ICU where it’s safer. I’m younger with a smaller BMI, so I will take the more lethal medical floors – something our hospitalists have been doing all along. At least 6 doctors I know of have gotten sick with coronavirus after a week on the floors. One of them is back again after only 14 days off, because we don’t have enough physician staff. He’s an ironman triathlete. He describes the fatigue of making just one more phone call to pharmacy to reconcile discharge medications – sends him over the edge. He also got anosmia. He was bleaching kitchen counters during his quarantine and didn’t smell a thing! Fortunately the sense of smell is returning, though anosmia is good for weight loss.
I got an email from our hospital system yesterday. The email stated that, since they noticed I’m a pulmonary critical care doctor, they wanted to inform me that there is a need for pulmonary critical care docs to help other hospitals in our system which are understaffed. By instinct, I started an email reply with a helpful, “Yes, I am pulmonary/cc and thank you for your email…” and then stopped myself. Instead, I replied that I’m currently covering both units at our hospital which are at 200% capacity while we’re at 50% physician staffing levels due to COVID-19 related illness (and cowardice). I told her I was glad to know they’re trying to find some locums relief – so when would I be hearing back from her about said relief for US? I’m holding my breath inside the N95 mask I have been wearing for 2 solid weeks, because I know she’ll reply soon about some extra doctors for our hospital…
I imagine this is a taste of what our fathers who fought our wars must have gone through. They probably felt like I do right now, that there are no good days – there are bad days and less bad days.