On March 26th, 2020, I posted the first installment of the COVID Diaries, written by a critical care doctor who was on call in the Intensive Care Unit the weekend that the first desperately sick COVID-19 patients began to show up at her hospital. As the tidal wave of patients was pummeling her, I suggested she write about her experiences. At the time, we agreed that her posts would be published anonymously since she was talking honestly about very sick people who were currently in the hospital and their families might read what she wrote. Last month, she and I met in person at a medical meeting for the first time since 2019. The part you can’t make up is that we both got COVID at that meeting — along with a lot of other people. Here’s a slightly blurry photo of the two of us -– me with my dear friend and colleague, Dr. Sandra Wainwright standing on the left. She’s a hero to me and I am happy at last for her to finally get the recognition she deserves as the author of Covid Diaries.

–Caroline

About two and half years ago, COVID was the greatest threat facing us in healthcare. While the world shut down in fear and an abundance of caution, we healthcare workers prepared for the battle of our lives with little information (a lot of which was bad), and with waffling guidance from the Centers for Disease Control (CDC) and the World Health Organization (WHO). I still remember one of the first patients I cared for – a small Guatemalan man. It struck me as strange that a virus from China infected a man from Guatemala living in Connecticut. We all found out just how small the world has become.

Masks and what kind, eye protection, droplet vs aerosol spread — no one really knew anything. Thankfully, human physiology is pretty consistent. There are only 5 reasons for hypoxemia. However, COVID impacted 4 out of the 5 mechanisms of hypoxia (the exception being that Connecticut is not at altitude!). Those first weeks of COVID were like the Wild West. We were desperate to do anything within our power to help our patients and it was very hard to lose so many patients, many of them young. In some ways the situation was freeing – doctors and nurses were just let loose to practice medicine to the best of their ability without the sea anchor of the usual hospital bureaucracy. However, although decades of experience had showed us that in the face of extreme hypoxemia, early intubation led to better outcomes, we found out the hard way that intubation didn’t work like that with COVID. We learned that ventilators were better saved as a last resort for COVID patients. No one would have guessed that would be true.

During the first wave healthcare workers were lauded as heroes, but by the third wave many patients viewed us as the enemy. Google became the authority on medicine and 2 years into the pandemic, angry families began demanding or refusing interventions based on the result of a Google search. Nurses, respiratory therapists and doctors were all burned out, making it harder to deal with all these conflicts. We’d had no rest or vacations for more than two years and were dealing with doubting, hostile patients and angry families. Months of quarantine had left people with poor coping skills and pent up anger. It helped me to remember a quote I saw on a medical library wall which said in essence, “Never become offended by an affront delivered by a sick patient.” Sick people are sick, we forgive them for their actions — they don’t mean it. We were all doing the best we could.

The virus eventually became a political and personal weapon. Even late in the pandemic, it was common to intubate patients who with their last breath, denied that COVID was a real virus. The political divide worsened first over the lock down and then over the vaccine debate. Drugs that have been considered safe for decades (like hydroxychloroquine and ivermectin) were now deemed unsafe even to try. The news cycle ran continuous 24-hour COVID stories. Everyone had a different lens on the situation, and most people had an agenda. Vaccines were touted as the answer, so investing in better therapeutics fell by the wayside. Despite all those things, the fact is that frontline workers do not have the luxury of engaging in debates. I kept my head down and just continued to do the best I could for my patients. You never know where life will take you. I had originally wanted to be an ophthalmologist, but ended up in internal medicine and then critical care. I was handed a hyperbaric wound care job because no-one else wanted it. The job chose me. You couldn’t predict that 13 years after finishing my fellowship training I would be combining these two unlikely fields and treating the sickest patients I’d ever seen in a hyperbaric chamber. We used HBOT to keep some very sick patients from being intubated.

The past 2 years have been an educational crash course in pandemics and politics. It’s also been a personal journey that has taught me what I’m capable of, what I’m not capable of, and shown me what rock bottom looks like. For me and my critical care colleagues, the emotional toll of the pandemic was severe. We tried to encourage each other when we could by phone and text. My heart went out to a colleague who had it worse than I did. She practices near a Marine base. There was a young special forces Marine who’d deployed multiple times into war zones and returned, but then got COVID and she couldn’t save him. She and I both wept when she told me “I couldn’t save Captain America.” All those, “I couldn’t save…” experiences led to deep moral injury among the ICU physicians and staff. Despite all our skill and technology, despite how hard we tried and how much we poured ourselves into those patients, we were shown over and over how inadequate we were. The experience shaved years off of all of our careers, and cost some clinicians their lives. Loss after loss emptied us of our well of compassion.

During the worst times, my best outlet was posting my thoughts on Caroline Fife’s blog. I would pour out the detritus of the day onto the page -– often in the middle of the night, and she would edit it so I wouldn’t have any regrets later. I kept it anonymous because I don’t like attention, because I was struggling with my own frustration and anger, and because media relations is an entire division in most healthcare systems. What has happened since that first post in late March of 2020? I was recognized for my work in my hospital system and rewarded with really great educational offerings and committee positions. I also stopped doing critical care. Ironically, as I write this update, I’m recovering from COVID myself — probably Omicron BA-2, which I got at a medical conference along with Caroline and a lot of other people.

Although the country is the weakest and the most broken I’ve ever seen it, there’s an undercurrent of optimism and I feel hopeful. But as I think back, I wonder how anyone gets through terrible trials if they didn’t believe in God. Where do they get their resilience? Where is their plumb line in a chaotic world? Where do their loved ones go when they die? I could not have made it through without a belief in God, but by the winter of ’22, I took a sabbatical because I needed to heal. I needed rest. I thought I needed to go to some remote place to find God. But, instead, God came to me. I was at church, feeling drained and numb, and I saw Jesus kneel at my feet and pour out amphora after amphora of water before me. In essence He was telling me, like He did the woman at the well, “I know what you’ve been through, and if you drink from living water you will never thirst again.” Thank you for all the encouragement you gave me via the blog. I hope all who read this will find comfort and that their reservoir of faith and hope will be refilled like mine was.

–Sandra

Caroline Fife, M.D.

Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos