Across the globe, there is hardly a physician or healthcare worker who has not encountered a patient with COVID-19. However, there are those who were on the frontlines when it started and will still be the frontline workers taking care of the declining curve. These are the emergency medicine and critical care physicians. Just as our ways of living have transformed, so have the standard operations of the process of treating our patients. A day in the lives of these physicians will remain just as busy and emotionally charged as it was during the peak of the pandemic.
One such critical care physician and friend, Dr. Amina Saqib shared her experiences of treating critically ill COVID-19 patients. Patients that she has been treating include those who appear to be well, some who require high amounts of oxygen therapy; and others who are brought to the intensive care unit already and placed on a ventilator. Some died within hours. Amina's words were haunting:
"There is no one size fits all. No organ system is spared. We could be pushing blood thinners in one patient for right heart failure and a suspect for clotting in the lungs, while transfusing blood products in another to counter bleeding. Superimposed infections are rampant, kidney failure is profound and unrelenting. You name a complication and it’s there."
Amina described that taking care of critically ill patients has become very labor intensive. "Someone said to me that in a few months when the new trainees come, they will walk into this world of 'Personal Protective Equipment' and would consider it a norm while we are still reeling from the effects of donning and doffing like an astronaut or a scientist from a level 4 clearance microbiology lab. The mere physical strain of repeatedly wearing the PPE is enormous but the fear of contracting the infection is paramount,’ she told me.
When it comes to our patients, we cannot even begin to comprehend the fear, the anxiety, the uncertainty, and the loneliness they feel. There are many who walked into the hospital, waved goodbye to their loved ones hoping for a short stay and returning home, but never went back home and never felt the touch of a loved one again. None of my patients have seen me smile, and they do not know how anyone taking care of them looks like.
I worked on the oncology COVID-19 unit. I had never thought there could be anything worse than a diagnosis of cancer. But this was different. The cancer was sidelined in the face of the immediate threat. Cancer patients are immunocompromised and are a particularly vulnerable group. Given COVID-19 is a new disease, learning and managing its implications in different patient groups had to take place simultaneously. It was most heartbreaking to see patients who had been successfully battling with their cancer die of COVID-19. It was incomprehensible and unacceptable. ‘Why?’ The thoughts were not allowed to linger for long, because the room would be occupied by a new patient within minutes.
I never thought I would be holding my patient’s hand to comfort her daughter on FaceTime and telling her that I am here for her loved one. Or promising a husband that he would be allowed to see his wife if it was determined that she would no longer survive. These circumstances sound inhuman. But they did not appear so given the extraordinary circumstacnes. The situation has been worse for patients in the ICU.
Amina also told me that the most distressing part of this pandemic has been its social aspect. "Patients suffer from complete isolation while they battle the disease. As critical care physicians, we are trained to emotionally detach ourselves from our patients and difficult conversations with the patient’s families are part of our everyday routine. However, nothing had prepared me for the emotional burden that came with the conversations that I had to have with the loved ones of COVID-19 patients."
She added, "How do you tell a sister that is beseeching you to save her 38-year-old pregnant sister who was perfectly healthy prior to falling a prey to COVID-19 that there is nothing more you can do to help her or her baby? How do you deal with a wife whose perfectly healthy 35 year old husband and a father of two young kids is fading away and there is not much you can do to keep him going, not even offer them a chance to hold their hand while they are dying. Despite our best efforts, we couldn’t save a lot of them. Every loss felt like a personal failure. I woke up many a times at night with a sinking feeling of helplessness and frustration."
The sense of failure is deep and recurring. At the end of the day you are exhausted, but that is when you start asking yourself, ‘Did I do enough?’ ‘Was I able to console the sister who was crying on the phone?’ ‘Was I patient with the son who had unreasonable demands because of the shock and distress he was in? As Amina stated, “the emotional and physical strain is enormous, it’s like a weight sitting on your chest or a like a claw that’s gnawing at your insides. You think that when you walk out of the hospital you can leave it all behind but you are badly mistaken. It’s like a shadow that you cannot shake off. It sneaks into your life and imperceptibly takes over every conversation and interaction.”
The distress comes from the fact that we care. We want to do anything possible to make our patients recover. What is different now is that as physicians we are equally vulnerable to acquiring the disease. Many physicians away from home, including myself, did not tell their families until much later that we were managing COVID-19 patients. For those living with their families, the dread of bringing the virus home has been their biggest fear. Amina states that she has woken up in a pool of sweat from nightmares about what would happen if her son or husband contracted the disease and she was the one responsible for bringing it to them.
Even though the pandemic has been brutal in many ways, we have no choice but to move forward with the many lessons it has taught us. Most importantly, it has taught us how precious every moment of life is. And what makes it precious is the happiness and well-being of people around us. No one can be happy in isolation. We are all connected with the thread of kindness, and if we see it getting broken somewhere, it is our fundamental duty to do everything in our capacity to make things better. The pandemic has also taught us that we are capable of utmost kindness in the toughest of times. That all we need to do is think beyond ourselves and the world around us will fall in place.
COVID-19 has taught us that if you protect yourself, you won’t harm yourself or others. It has reminded us that any good you do will come back to you in one form or the other. You just have to be willing to embrace it with open arms.