I’m an ICU doctor and this deadly COVID-19 frightens me
I’m an ICU doctor in Honolulu, and my wife is Hawaii’s deputy state epidemiologist. She handles public health, and I handle the clinical medicine. Needless to say, she hasn’t had a day off in the past six weeks. But now, coronavirus has come to the intensive care unit.
The shift from trying to contain the illness to treating those who have been infected, one at a time, is eye opening and heart rending. What do you do when there are vastly more sick patients than you can care for?
This pandemic is like nothing else any of us has ever experienced. At the personal level, I must limit my use of masks to just one – for the whole day.
When I am caring for COVID-19 patients, I change into hospital scrubs when I arrive at the hospital. Before I leave, I change out of those scrubs, shower and wipe down my glasses, phone, shoes, stethoscope and work bag with sanitizing wipes in the hope that I don’t inadvertently bring disease home and expose either my kids or my wife’s parents.
Every one of us working at the front lines is afraid to cough, for fear of becoming a pariah; and whenever we feel a little scratchy throat, or sneeze, we think, “Is this it? Have I finally gotten this? This angst keeps me (and many others) up at night.
We are afraid of the disease itself, both for ourselves and for our loved ones. I have cared for hundreds of patients with respiratory failure like we see with COVID-19. If patients are conscious, they may feel like they’re drowning, and we force them to breathe with the smallest amount of air possible. This nearly always means inducing a coma and sometimes using medication to chemically paralyze them.
It is an honor to care for critically ill patients, but it’s also terrifying. What if we make a mistake that costs someone their life or causes irreparable harm?
We are anxious as well about how we will cope with the wave of critically ill COVID-19 patients we anticipate.
Hospitals must ensure that they have adequate personal protective equipment to keep their staff safe; by most accounts, we have approximately two weeks’ worth of supplies. In addition, we could deplete the entire supply of ventilators in Hawaii, and more of them likely won’t arrive for several weeks.
If there are 10 patients at a given time who need a ventilator, and only five ventilators available, there must be a rational process for literally deciding who will live and who will die. I can assure you, no physician ever wants to be faced with this decision.
We have vast experience caring for patients with acute respiratory failure, but COVID-19 appears to have a number of unique features: It is more severe, it lasts longer, it is unpredictable, it may impact the heart and, most important,
there is no cure.
The virus continues to spread, and my wife is still working seven days a week. But now it’s my turn to be overwhelmed. I’m frightened, for my patients, my colleagues, my family and my own health, both mental and physical. Please do not relax your efforts to “flatten the curve.” They give us the best chance of having the capacity to care for each and every person who gets sick.