The tenth circle of hell
In March or April of 1300, as he wanders through the underworld, Dante finds himself in a dark woods. Losing his way, he encounters monsters from classical mythology. As he stumbles further into the underworld, he faces leopards, wolves and a lion and is driven back into a dark place into which the sun does not enter. Dante meets his guide, Virgil, the Latin poet who will lead him out. Dante hesitates. Virgil explains that he was sent by Beatrice, the symbol of divine love, Santa Lucia, the symbol of Grace, and Rachel, the symbol of contemplative life to guide him through the underworld.
Dante then passes through the gates of hell which bears the inscription “abandon hope, ye who enter here.” Dante and Virgil hear the anguished screams of the uncommitted, the opportunists — those who were out only for themselves — and the cowards. These miscreants wander around naked in pursuit of their own ever-changing self-interest.
Dante wrote this epic poem to describe the punishment for sins, immorality and transgressions of the people and politicians of 14th Century Florence. While no one would suggest that COVID-19 is a result of moral turpitude, what doctors and nurses encounter daily, is no less traumatic.
Entering the ICU corridor, one is confronted with an imposing series of long, shiny, aluminum vent pipes that appear more suited to a factory than a hospital. They are intended to carry aerosolized viral particles to the outside, where they will be diluted and neutralized by the sun’s rays. The pipes are immediately discordant and jarring, although, after a while, one become oblivious to them.
The doors of the individual units are closed, and signs are hung on them that provide warning to the unbidden. Slowly opening the door, the nurse or physician enters a surreal world of gray, blue and beige, soothing colors that do little to dispel the gloom. Gone is the incessant chatter of nurses, respiratory techs, doctors who formerly would be going about the business of recuperating patients in various stages of illness. The silence is oppressive, because unlike previous ICU cases, where the vast majority of patients would survive, few current occupants will recover.
On one side stand the closed doors of the patient cubicles. Holes have been cut into the doors, through which pass various tubes connecting the patient to IV pumps and other paraphernalia, allowing adjustments without entering the patient rooms. This minimizes staff contact with patients and lowers their potential for contracting the virus. On a wall, seen only by staff, is a white board posting the names of the patients. “Room 1” on top and “Room 8” on the bottom. Next to the patients’ names are symbols. “V” stands for ventilator. “T” stands for tracheostomy. A red dot means “DNR,” do not resuscitate. The family or the patient has made the decision that if their heart stops, they will not receive cardiac massage and the often futile measures ICU doctors use to preserve life.
Nurses, respiratory techs and doctors move about clothed in protective blue, green or yellow plastic gowns covering their surgical scrubs. Their hair is protected with disposable caps, their mouths with salmon colored N-95 masks. Some wear an outer, more colorful mask over the N-95s because they complain it makes them look like a duck. Covering their face is a thick, rigid, clear plastic welder’s mask. Their ensemble creates a dystopian look of spacemen walking around a forbidden planet or deep-sea divers entering a wreck.
A visitor (if they were allowed entrance) would see a scrum of similarly garbed individuals in a patient’s room, working in unison, tending the patient. They turn the patient on his side and gently clean his body, rearrange tubes, and suck whatever secretions have accumulated in his airway. This ritual is repeated daily until the patient’s oxygen saturations improve and the lungs recover — or they don’t.
Looking through the glass in an adjoining room, a patient’s unmoving head and upper torso are seen, chest rising and falling with the mechanical rhythm of the ventilators. Other patients have an enhanced type of nasal tube that delivers higher flows of precious oxygen. Their breathing is more spasmodic: They must work harder to supply their bodies with that essential ingredient necessary to maintain cellular activity. When the oxygen levels fall too low, a larger tube is placed in their windpipe, and a machine takes over. Once this occurs, their chance for survival is around 10%. And even if they do survive, they likely will experience profound medical and emotional scars.
What is different from our experience a year ago is the color of the patients’ hair. It was gray; now, it is brown. Many men sport beards and upper torsos that look formidable and robust. Except for the tubes protruding from their nose, mouths or necks, they all look like they could pull out their IV, pack up their belongings and walk out of the hospital. It is unlikely that they will.
This past week, a nurse in the ICU cried softly. The day before, as her patient’s condition worsened, his family came in. They knew that they were probably saying goodbye. The patient was alert and responsive enough to know what was happening, and to have bonded with the nurse. When she came in at 7 a.m. the following morning, she learned that he had expired. She deserves respect for her humanity, for continuing to regard him as a human being. The only way many of us survive is by depersonalizing our charges. They are not humans; they are “cases.” To her credit and pain, she had not. Magnifying the loss was the patient’s widow and three young children. He was in his late 30s.
The scene was replayed the following day. This time a pregnant mother with severe COVID symptoms was flown in. Over the course of several days, her condition deteriorated. To try to preserve her life and that of her unborn child, a hysterectomy was performed. The child survived, but the mother did not.
She left behind several small children at home as well as her newborn child, who will never enjoy her mother’s hugs or kisses. The emotional effect on her caregivers exceeds my ability to describe.
What these cases have in common is the fact that neither of these patients were vaccinated. Nor are over 99% of the other cases in the ICU.
The real tragedy is that most of these patients die alone, absent their family.
America has overcome 9/11, depressions, recessions, wars and other severe adversities. We will doubtlessly overcome this pandemic. Life will again one day become normal. But we need to lower the number of casualties. We have the ability. We stopped smoking. We use seat belts. We have the means to do so. Creation of the vaccine in less than a year is a miracle in itself!
For those who work in these hospitals, there is only so much pain and suffering that our psyches can endure. We have given everything we have, selflessly, for over a year and a half. While there is no Virgil to lead us out of hell, there are vaccines. There are masks. There is simple distancing. To those who deny the reality of the pandemic and its morbid consequences, I ask: Please help us. Use those measures to keep yourself and others healthy.