University of Michigan/
VA Ann Arbor Healthcare
Ann Arbor, MI
This is the first installment of a new series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
What sort of story do you want?
How about one about a wife, calling to hear about her husband who is in my ICU with COVID…
When she’s home with COVID herself?
As my colleague Ellen talks with her each day, it is clear that this woman becomes a little more short-of-breath each day. She’s told to follow up with her primary care doctor.
But she doesn’t have one.
Meanwhile, her toddler son has been diagnosed with COVID, too.
And she’s trying to figure out if she can risk going to the hospital for her own care, but who would stay with her son? And does she dare ask his son’s grandparents to come stay when she knows he is infected?
And would they, should they, come if she needed them?
How about an inspiring story?
I’m inspired by how hard my ICU and hospital colleagues — docs, nurses, respiratory therapists — are working and how rapidly we are adapting to new ways of providing care. I’m inspired by the sight of a janitor jogging from room to room to decontaminate them so we could bring a patient up who was crashing in the emergency department. I’m inspired by the logistics staff coming in on a Sunday afternoon and, in four hours, building a wall and re-ducting the HVAC to turn half an ICU into an infection containment unit
I’m inspired by just what great physicians some of my colleagues are. I’m inspired by the trainees working the night shift, night after night. I’m inspired by the engineers and political scientists who dropped everything to solve problems I needed solved in 48 hours.
I’m inspired by the nurses who had retired from the ICU, who had moved on to day-hours-only jobs, who are back, relearning skills at the bedside as fast as possible to take care of the sickest patients they have ever seen — all while maybe bringing a plague home to their husbands and kids.
I’m inspired by my wife, who makes the time to drive a homemade latte to me at the hospital each day, three or four hours into my shift, because hospital coffee.
How about story of rage, instead? (Oh, there is a lot of rage.)
At those who assume there is always an infinite supply of nurses who can always be asked to work harder. At those who didn’t prepare as Wuhan and then Milan exploded. At those who insist all copies of a draft letter explaining altered standards of care be “encrypted” rather than that we make sure, if it comes to that, we have good clean simple language that can explain what jargon like “altered standards of care” means for our patients.
How about exasperated?
Like at colleagues, so very proud of their service during the COVID-19 epidemic, who were unwilling to do inpatient consults? At the colleagues who asserted the PPE with which I live is not safe enough for them to do their jobs? Who would rather let a patient not get the care that patient needs than risk one-tenth of the exposure they expect the ICU team to just live with?
Or exasperated at the scientists convinced that their pet project, unproven, should be administered to every COVID patient? Who denigrate the years of carefully developed science and art of best supportive ICU care as “nothing,” as “futile” despite the lives it’s obviously saving? Who would rather we spend millions of dollars on unproven drugs than on the overtime of the nurses and respiratory therapists and janitors who are really actually saving lives right now?
Or would you like a story of me as a hero?
A tired hero, because everything is harder to get done in this crisis for both infection control reasons, and because there is so much emoting going on. Yet proud, because today I realized that a patient who had a pneumonia, and who was also weak from days of mismanagement at another hospital, nonetheless also had a new clot in his lungs and that was why he couldn’t breathe. Shall I tell you of the young patient for whom I went against guidelines to get him the procedure he needed that got him out of the hospital just days later? Or shall I boast of the other patients to whom I doggedly refused to do insane unorthodox things, despite plausible physiologic rationales, because damn it, fundamentals are what save lives?
How about sad story? (Oh, there is a lot of sadness.)
Sad, because this epidemic has re-revealed just how racially disparate our society is and how ill-equipped our non-system of healthcare is to ameliorate it?
Or sad, because this epidemic has also shown my own limitations of compassion and forgiveness? Because I hold petty grudges at my colleagues who, when stressed, were not their best selves, even though they fixed it?
Because I can’t get some of these patients free from the ventilator, no matter how hard I try?
Because I yelled at my son about not eating the last of the carrot cake, when I was focused on my clinical work and forgot – I forgot – that the very next day was the day he would hear where he got into college and so he had a good reason to be stressed, too?
Because I threw myself into the work of caring for these patients and organizing the response to the surge so much that I have not really understood what it has been like for my children to be marooned sheltering-in-place and my wife to not be at work and even though I feel bad about it I can’t figure out how to stop writing this and go talk to them and actually be able to listen without worrying that my pager will go off or why haven’t I heard about that new patient yet?
But all of these stories are about me. And being a good doctor, if it is anything, is making it not about me. It is making it about my patients and their families and my colleagues and my students. So I don’t know what story to tell, nor how to pick just one when they all happen at once.
It’s been 27 days since I helped stand up a COVID unit. I’m tired, really tired.
Dr. Theodore “Jack” Iwashyna practices, teaches, and researches intensive care medicine at the University of Michigan and the VA Ann Arbor Healthcare System. His research focuses on how patients and their families heal from severe infections (sepsis), respiratory failure, and cardiac arrest. He is obliged to remind readers that the views expressed here are his own are not necessarily those of the U.S. Government or the Department of Veterans Affairs.