Critical Care Physician
University of Michigan Hospital
Ann Arbor, MI

- - -

This is part of our 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.

- - -

I still love my job. I still feel privileged to care for people and their loved ones during their darkest times. But it feels different in the hospital.

We are all used to lack of sleep, and oftentimes that complete exhaustion is visible in our eyes, even with a mask on. I am used to that look. Right now I am seeing something different, and much more painful. It is a look I never expected to see on so many of our faces, a common sense of helplessness.

When the surge first hit Michigan, I was the first intensive care physician to work in our isolation unit, which would soon fill to 50 critically ill patients, crammed two-by-two into rooms designed for one person. Like all of my colleagues, I was scared, but in many ways I felt prepared. This is the purpose of our years of training. It was clear that this pandemic would be ours to handle, and we were running at full throttle, powered by adrenaline and donated coffee.

I vividly remember the energy buzzing inside and outside the hospital. Chalk on the sidewalk greeted all of us those first few weeks, reminding us we were appreciated. That first week a security guard I had never met left me with a permanent memory and a sense of pride I have not felt before. He was screening hundreds of people each hour without an N95 or a face shield to protect himself, and he was dealing with irritated people unable to access their normal doors or visit their family members. He saw my identification badge and said, “Thank you for being here.” Taken totally off guard, I froze and looked him in the eyes. “Thank YOU for being here,” I responded. We shared a moment of understanding and a nod, acknowledging that we were both here because we wanted to help, but that we were scared. I have never been thanked just for showing up to do a job I love, but that “thank you” was one of the most meaningful experiences of my professional life.

As we worked to manage the unmanageable surge, we experienced a prolonged sympathetic surge of our own. While the sympathetic “fight-or-flight” response is generally followed by a parasympathetic response, this was not how our experience played out. There was no time to decompress or feel our heart rates slowing down to return to homeostasis. The virus and all that came with it was not slowing down. So we did not slow down, not because we did not want to, but because it was not an option. The patients kept coming, and we all understood that this was not sustainable, but there was no backup plan or relief valve. In my experience, especially in the intensive care unit, when we are unsure of what to do, we cope by falling into our comfort zone and doing what we know how to do. We knew how to manage hemodynamics and ventilators. We knew how to place endotracheal tubes, central lines, chest tubes. We did not know how to process so much loss. So we put our heads down and worked, in part because if we looked ahead we would have been paralyzed with fear and uncertainty. We would have had to deal with an impossible reality.

We have been able to slow down and begin the parasympathetic response. We saw our numbers drop, and we closed the doors to the temporary COVID ICU. We had two weeks with no new COVID ICU admissions, and I hoped that I would start to see the usual smiles on the faces of my team. However, as the numbers have decreased in our area, they have risen dramatically throughout the country, and we are now being forced to face a reality for which none of us is ready. The smiles have not returned. The admissions are starting to come in again, and we have all seen our neighbors start to relax and stop wearing masks. We have driven by crowded graduation parties and packed stores. We have watched the maskless videos from bars and beaches. We have witnessed Texas and Florida start to experience what we experienced, knowing that it did not need to happen. And as the numbers start to rise here, the true toll that this has taken on our teams is becoming even more visible.

Recently, my children asked me whether I would help run the COVID ICU if it opens back up. I said that I probably would because I would like to help people, but I reminded them that I hated being away from them, quarantining, and going so many weeks without hugging and kissing my wife and both of them. My seven-year-old son asked me if I remembered “those four days and nights when I did not come home,” and his older sister immediately recognized the guilty tears forming in my eyes and chimed in “we know you have to help people; we miss you but we know what you are doing is really important.” She is wise beyond her years, and she is protective of our family. She has also seen me cry recently, and she knows I have been dealing with people “who sometimes die.” She does not know the details of how many patients and loved ones I have seen suffer because of this virus. I selfishly hope she never does.

We have not rested or recharged as we need to do. We are a resilient group, but this cannot last. The environmental service workers continue to throw themselves into harm’s way and enter the rooms that nobody else enters. The technicians, nurses, respiratory therapists, physical therapists, and countless others continue to care for these patients, because it is what they know how to do. But they are not smiling like they used to. The security guards continue to selflessly screen all of us as we enter the doors, but they no longer thank us for being here. And nobody is thanking them.