Eric Siegal, an intensive care doctor in Milwaukee, posted his thoughts on social media related to experiences of the continuing wave of COVID-19 infections. The post was released on September 19 and went viral pretty quickly with the public reaction to its insight, sincerity, and helplessness in watching the unvaccinated Milwaukee perish so needlessly.
After a brief summer respite, our 24-bed COVID ICU is full again. Unlike previous waves, which largely affected the elderly and infirm, most “delta” patients in intensive care are young and generally in good health. Almost all are not vaccinated. The vast majority of those who end up being intubated and mechanically ventilated die. The ‘lucky few’ who survive leave the intensive care unit with a tracheostomy, facing weeks or months of rehabilitation, hoping they will regain the ability to breathe independently, let alone return to some semblance of life. their previous life.
Our hospital has been at full capacity or overcapacity for weeks. Hospital patients are piling up in emergency rooms waiting for hospital beds, and emergency room wait times have become so long that dozens of patients are leaving without being seen. Almost every day, I refuse transfers from small hospitals because I don’t have open beds. We (like everyone else) are desperately short of qualified nurses, forcing our nursing leadership into an endless game of endowing musical chairs just to make the place work.
We move from room to room, titrating infusions, adjusting ventilators and dealing with complications, racing against the clock before the lungs collapse, potentially life-threatening secondary infections set in and more. other organs fail. Every day, we call distressed families with grim news, made worse because they cannot visit their sick and dying loved ones. Frequently, they have other (unvaccinated) family members who are also hospitalized, dying, or already dead from COVID-19. I find it hard to stay calm when a patient or family member comes up with silly conspiracy theories while demanding that I prescribe ivermectin … and God knows what other unproven “therapies” have been Google searched for .
Most working days in the COVID ICU feel like rearranging the lounge chairs on the Titanic. The only way to stay (relatively) sane in the face of overwhelming horror is to cultivate apathy. It is much less painful to break my patients down into lists of diagnoses and problems than it is to think of them as husbands, wives, sons, or parents who have people waiting for them to come home. I introduce myself, do my job, tick the boxes, try to lighten the mood with gallows humor… and try not to let myself be overwhelmed by futility before the end of the day.
Death and suffering are inherent in intensive care, and one doesn’t last in this job without developing thick skin and robust (albeit sometimes dysfunctional) coping mechanisms. But COVID is something new and different. The realization that this horror has no end because far too many Americans are too cowardly, self-centered, or ignorant to get vaccinated is infuriating. I am tired, frustrated, hurt and downright enraged with my fellow citizens who have failed miserably to keep their end of the bargain. It is increasingly difficult to keep this anger from spreading into my personal life. Almost everyone I work with faces similar issues.
I love being a intensivist and can’t think of a career that suits me better, but COVID chews me up and spits me out. I will continue to run because I have taken the oath and absolutely will not give up on my team when they need me most. But I can’t help but wonder how badly I will be damaged once the dust settles.