ObGyn attending physician
Bellevue Hospital, New York, NY
This essay is part of our 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.
Despite what you may think, no one becomes an ObGyn because she loves babies. Babies are cute and all, but we do it because we like taking care of women. ObGyn patients are an unusual patient group in medicine — a relatively healthy population whose main health risk stems from their ability to become pregnant. But despite the relative danger of childbirth, even my high-risk pregnant patients can survive tremendous hits — I’ve seen a woman lose literally all her blood during a massive hemorrhage in childbirth, only to walk out of the hospital three days later. We get to deal with the devil known; the risks are calculable and the solutions are at hand. As a physician, I’ve always liked feeling confident that I can solve my patient’s disasters. I can stop that hemorrhage; I can replace her lost blood; I can save her. Even when my patients are intubated for gynecological surgery, I can confidently hold their hands and reassure them, secure in the knowledge that they’ll be awake in the recovery unit in just a few hours.
But all that is now “pre-COVID” times, as we say. There are no more elective surgeries, and hemorrhage may no longer be the scariest thing that happens to pregnant women at the hospital. And when my department chair told me I’d been “redeployed” to help in our ICU, the idea of managing the rising sea of Covid-19 patients was thoroughly daunting.
I’ve now spent the last four weeks in a crash ICU refresher course, scrambling to remember how to track kidney failure in my patients, how to monitor sedation side effects, how to manage nutrition in a person who can’t eat. I surreptitiously take notes from the brilliant critical care fellows during the day and watch “Vent Settings for the Non-Intensivist” YouTube videos by night. And I’ve watched our ICU struggle to take in a continuous influx of new cases, none of whom we seemed to be able to cure. In a sense, this is everything I’d leaned away from in choosing to become an ObGyn: chronically ill patients, now hit with a devastating threat that we don’t understand and don’t know how to fix. No one on my patient list is going to walk out of the hospital three days later; some unknown number will never walk out at all.
And the inability to be confident, to reassure, may be the hardest of all. Last week, our ICU team evaluated a young man admitted for several days with COVID, previously getting enough support from nasal oxygen but now struggling to breathe despite a high-pressure mask strapped to his face. It wasn’t enough – he was gasping too fast and getting too tired. He needed a ventilator. In the last few minutes, as the anesthesiologists prepared their paralyzing drugs and the tube that would push into his lungs, I helped him dial his wife on WhatsApp. He couldn’t talk — the pressure from the mask was too strong, and the effort too much — but he held his heart and pointed at her, and she simply repeated how much she loved him. Because what can you say to your family in your last few minutes before intubation? Before you fall asleep, and perhaps never wake up?
And I, the doctor, in my mask and gloves and face shield and gown, just held the phone and let them look at each other. Because what can I truthfully say to them both? I don’t know if you’ll ever wake up, either. I don’t know if we can solve this disaster in the timeframe you need. All I can say is that we are here, and we are trying as hard as we can. After years of knowing the solution, and fixing the problem, and saving the life, I can now only say that we will do everything we can.
Dr. Colleen Denny is the Medical Director of Ambulatory Women’s Health at Bellevue Hospital in Manhattan, and faculty at the NYU School of Medicine in the Department of Obstetrics and Gynecology.