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COVID-19 Experience: CountBackwardsfrom10
By David Convissar, MD.
Walking into an ICU in general, especially one with a lot of patients can be a bit overwhelming to most. Here you go, 20 patients, all very sick... fix 'em.
But there is always something about each patient that makes them different from the next. There is always something to make them unique. You walk into their room and sometimes they’re awake and talking to you. You can see what they look like and hear the sound of their voice. Other times, you get to know them, they have interesting stories, rare pathologies, there is something that in an ICU of 20 patients, makes each of them stand out.
It's something many don't think about when managing the critically ill. Why? because it helps keep your thoughts organized. It keeps your management in line with each patient, you know what's going on with each of them at any given moment because their treatment is a story unique to them. “Oh yes, he’s the 80-year-old with pneumonia on Vanc and Cefepime”, or “ She's the 26-year-old who passed out and now has an AICD for heart block”.
Each person has the things that make them, them. Believe it or not, it's those qualities that make managing so many patients at once doable while at the same time personalizes it to the physician. It's more than just a disease, or a patient, it's a 55-year-old woman with a teenager at home who fell and hit her head or a 30-year-old who was in a car accident whose girlfriend was in the passenger seat.
COVID took all of that away.
It made everything different by making everything the same. Every patient was the same. Every treatment plan was the same. Every X-ray, every ABG, every lab was the same.
There were no more differentiating factors, nothing that made anyone different from anyone else, nothing that made anyone stand out. There were no more stories, just one... X year old Y, who presented to the emergency room short of breath, found to have bilateral fluffy pulmonary infiltrates on chest X-ray and oxygen saturation of 70% on 100% non-rebreather, admitted to the ICU for hypoxic respiratory failure.
Everyone intubated. Everyone proned. Everyone on the same treatment cocktail.
I realized very quickly how important those details about patients were. I realized how distant and cold medicine is without the person. It was just bed after bed of the same thing, I found it difficult to keep track of who was who. Who was supposed to be proned, who was supposed to be supined? Who needed their vent adjusted, who was improving, who was getting worse. Who was being considered for ECMO, who may be soon to die?
We kept our entering the room as limited as possible, I didn't even know what most of these poor people looked like, let alone what other issues they had. Everyone blended together, and for a moment it also felt like medicine for me had been dehumanized. I was treating a sea of COVID and not people. And not because I didn't care, and not because I was callous, but because we were overrun and overwhelmed and it was all the same thing. Not only was this experience a unique one, but one that gave me perspective. It gave me the opportunity to look at my patients now, the people I take care of, with a new respect for THEM, and who THEY are, and not just their diagnosis.
Of course, I had always been aware, spoken to many, but I think I took it for granted, and this changed everything. I also think now what I would do differently if there were to be a second wave, how I would improve my management so as to keep humanity in my work.
The scariest part is, facing a situation like this, I'm not sure what I could do differently.
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