I’m sorry to say that the courageous author of “COVID Diaries” is back working in the ICU, preparing for another wave of critically sick COVID patients. In my own suburban hospital, there are 75 COVID patients hospitalized right now, 72 of whom are unvaccinated (meaning, 96% of patients hospitalized with COVID at my institution are unvaccinated). The 3 vaccinated patients in the hospital are doing great and will be discharged. The unvaccinated patients are not doing great. Three of the unvaccinated patients are on extracorporeal membrane oxygenation (ECMO) – meaning their lungs are so bad, a machine is oxygenating their blood outside their body. Last week, the husband of a friend of mine died from the Delta variant. Last year he contracted COVID pneumonia and recovered. He chose not to get vaccinated and this year died of the Delta variant.

Some people I love have decided not to get vaccinated, in part because they are afraid of side effects and in part because they don’t want to be told what to do. I too have an independent spirit – but I still wear my seatbelt, have car insurance, and pay my taxes. I don’t rebel against things just because I have to do them. Like taxes, death is also inevitable – but I’d rather not die of Covid. The risks of the vaccine are minor compared to the risks of a COVID infection– and given how contagious the delta variant is – I am pretty sure my unvaccinated friends are going to get COVID , and spin the wheel of fortune on their lives. In a world of evil, all we can do is pick the lesser of the evils.

COVID Diary: COVID and the Freedom to Choose

Here we go again. My email “in” box is full of requests from other hospitals for temporary critical care physician staff members. It may be an indication of how bad things are getting out there. I personally have only had a handful of “scary sick” patients. I can’t decide if this is just a bad weekend or if it’s all starting over again. One patient is an African American man in his 50s who was fully vaccinated for COVID two months ago, but he came in with an oxygen saturation around 40% and I couldn’t get his saturation up. He tested positive for COVID. He got a central line, was put on vasopressors and was intubated. We turned him prone (face down, as I’ve described before) in order to improve oxygenation. When we turned him over, a lot of grey dishwater-looking fluid poured out of his lungs through the endotracheal tube and into the circuit of the ventilator. I’ve never seen grey fluid just pour out of anyone’s lungs before, nor has the respiratory therapist with 35 years of experience. Ultimately he coded and died. He had a few risk factors, like high blood pressure and being overweight.

Another patient is a Hispanic lady in her 60’s with a lot of medical problems. She’s obese, has underlying heart disease and obstructive sleep apnea. She was fully vaccinated a month ago, but came in with an oxygen saturation of 68%. She didn’t even live long enough to get to the ICU. She coded and died in the Emergency Department. Her COVID test was negative but given how low her oxygen saturation was, I don’t know whether to believe the negative test. Before COVID, an oxygen saturation of 85% would freak us out and we almost never saw oxygen saturations below 80%. With COVID, oxygen saturations below 70% are routine. I saw the look on the ER doctors faces after they intubated her and she still died right in front of them. It’s so demoralizing.

In the beginning, when the public was scared, for a few weeks people appreciated the risks we took to care for pandemic sufferers. It was nice to be appreciated. There were even rumors that frontline workers would get raises or bonuses as a thank you for risking our lives. Instead we got pay cuts. Yes, for my dedication, I got a pay cut as a thank you from my hospital.

At my institution, the healthcare workers who are vaccinated resent the anti-vaxxers, since unvaccinated people represent the majority of those hospitalized with COVID and the majority of those who die. We are already burned out and the prospect of another wave – due in part to people who won’t get vaccinated – makes the rest of us feel resentful. It’s fair to say that even though not all healthcare workers are pro-vaccine, most of us got the vaccine anyway. Despite the risks of the vaccine, it’s still a lot safer than getting COVID. My view is that you can get a small portion of the RNA to the spike protein and thus train your immune system to fight real COVID, or you can get 100% of the COVID viral RNA. You can either get a sore arm and fever from the shot (which go away), or long term problems which may not go away, like brain fog, from contracting the virus. My last patient who got transferred for ECMO [extracorporeal membrane oxygenation], (only 37 year old), is still alive. He got extubated after 123 days but his chest CT looks like the worst pulmonary fibrosis patient you’ve ever seen. I had to show this images to the residents, to underline the fact that a fast death from COVID can be merciful. With all we can do to keep patients alive, survival may not be pretty. And that’s why it doesn’t feel like we have much choice but to get vaccinated.

At the very least, I’d like to go back to being a wound care doctor. I love treating something I can touch and actually get better. I have a good rapport with my patients. I affectionately call them “Trouble with a capital T,” or “handsome” or “beautiful.” I love nothing more than telling a man to just sit there and look handsome and stop worrying about his venous ulcer, I’ll heal the leg. On a “bad” day in the wound center, only about 3 out of 20 patients do badly. It’s not because I’m that good of a wound doctor, it’s because wounds generally WANT to heal. But with COVID, no matter what you do, no matter how good you are, they just keep going downhill.

Every doctor I know is burned out. We have taken blow after blow. Our families have suffered. We’ve lost co-workers to COVID while others got burned out and left. My critical care colleagues tell me that this pace isn’t sustainable. If we have to handle an upsurge in sick COVID patients on top of everything else – I don’t think we can do it. I’d like to be like that couple on YouTube who quit their jobs and live on a catamaran off the grid. But I’m so specially trained in medicine, it’s all I know how to do. Medicine is all I ever really wanted to do. But I wonder whether there will be a mass exodus from medicine? And I wonder whether the snowflake generation will have the grit to provide healthcare when my generation is too exhausted to go on? Will they step up or become Tik Tok famous and quit?

I’m sorry you have to read this, but I have to write it for my sanity. My fuse is short, I can fake empathy and professionalism, but inside I want to slap stupid people. I want to slap the lucky people who get to work from home, who don’t have to put on scrubs and masks and hot, sweaty gear only to fail at saving lives. But don’t worry, I won’t actually slap anyone because I’m too exhausted to raise my hand. I want to scorch the earth with a flame thrower but don’t worry about that either– I’m to tired to pick up anything heavy. Three weeks ago I had a dream that I was at the hospital being harassed from all angles and I finally said, “You know what??? I QUIT!” It was scary and incredibly satisfying. Should we mandate vaccination? I will have to care for the unvaccinated people when they get desperately sick and yet I, too believe in personal freedom. And that means I have the freedom to quit.