The Aftermath of Wave One

For months I have been meaning to post more COVID diaries, but in some ways, the aftermath of the battle was harder than the battle. When we finally got past the first COVID wave, everyone focused on getting business back to normal. There was a backlog of patients who had delayed medical care and who desperately needed attention. Additionally, there was pressure to recover the revenue lost when normal healthcare operations were put on hold in order to focus on COVID.

In some ways, taking care of normal medical issues was a welcome change of pace from the COVID war zone, but downshifting from critical care to wound care was hard. Wound center patients had no idea about the death toll we’d seen. They were worried about their 2 cm wound. Like many colleagues, I found I had “compassion fatigue.” It affected patient care and also impacted how staff members spoke to each other. After some brutally honest comment, the apology would be, “Sorry, COVID made me like this.”

We didn’t really have the chance to deal with the emotional aftermath of COVID — we just dove into the frenzy of the post-COVID work backlog. There was a brief interlude in September-October during which COVID numbers were low. Many of us were weary and kind of depressed. The hospital tried to help by setting up “compassion circles” and having us find “buddies” to talk to, patterned after the military’s efforts to help veterans. It’s a nice idea and I’m sure it works if you have the time to for it, but we don’t. There’s too much work to do. I started breaking down daily. I would cry in between patient visits. Thank God for personal protective equipment. My nose swells up something fierce when I cry, but no one can see it now. At home I moved back into quarantine, partly to protect my family and partly because I needed the solitude in which to process whatever this is that I’m going through. One of our chaplains who had tried to lead our team through a self-care session saw me and asked how I was doing. I told him, “We are in the second COVID wave now, and I haven’t had time to think about how badly wave 1 affected me – we’re just plowing through.”

The Second COVID Wave

The second COVID wave feels different. Clinical medicine has a “feel” to it. A gut feel. I know these are only the observations of one person, but they are real. In Wave 1 we may have intubated too many too soon. In Wave 2 we’re avoiding intubation, perhaps too many, too late. The patients are sicker, and once they get intubated it’s bad. Really bad. We’re not seeing people come off of ventilators anymore; we’re not extubating as many as we did before. If they survive to get a tracheostomy, they’ve already seen dialysis, hemodynamic instability, shock, malnutrition, critical illness myopathy and pressure injuries. We have no idea what their mental status will be when they come out the other side.

I surveyed my critical care friends from around the state and the country, North Dakota, North Carolina, Maine. They all say the same thing. It feels like the virus has changed. Patients present with the same symptoms and X-ray findings but if they get really sick – like “ICU sick,” it is not good.

We’re seeing more hypoxic encephalopathy. During the day, you can talk to the patient, they will make sense, they respond appropriately, but at night – they pull the oxygen mask off and desaturate into the 60’s. They take off their clothes, they become disoriented, they want to go home and can’t understand why we won’t discharge them. I didn’t see this much encephalopathy in the first wave.

There seems to be a phenotype in that Hispanic and Italian/Greek (Mediterranean?) patients get really sick from COVID. Little old White ladies seem to do OK. We do not provide different care to patients based on their race or ethnicity. The fact is that some patients just do better than others and we don’t know why. Let’s check political correctness at the door here, I’m speaking strictly as a scientist reporting on what I see from a population health standpoint. If stating facts as they relate to ethnicity upsets you, you have bigger problems to deal with. Sorry, COVID made me say that.