As I got ready to head back home after an already exhausting ICU shift, a nurse called out: “Hey, the patient in Room 18 with coronavirus might need to be intubated.” I went to evaluate the patient and saw a young man breathing rapidly, trying to catch his breath. He was on maximum high-flow oxygen, but his oxygen saturation was dropping. I called my attending physician, and we quickly donned our PPE and prepared for intubation. A few months prior, I had read all the protocols for PPE, so by then, it had almost become a habit; there was never a mistake, never a doubt in the protocol. I began to explain the procedure to the patient as he mumbled, “Please help me, doctor. I can’t breathe.” After the intubation, I called his wife to update her, and I heard her voice trembling on the phone. While I tried to reassure her, I realized that, in reality, the patient’s fight with COVID-19 had just begun.
Over the last nine months, this scenario has repeated itself countless times in hospitals all over the world. We continue to fight the deadliest pandemic of our time without any definitive therapy. Although hospitals are reporting fewer COVID-19 patients than before, I know it is only a matter of time before we see a new surge of cases. In the thick of it, we serve selflessly and persevere to do everything we can for our patients. It was only after several months of such work that I was able to absorb the profound magnitude of this pandemic and the sense of impending doom it gave me, as if I was a surfer in a vast ocean suddenly aware of a massive wave just beginning to crest behind me. How do I know how deep it will be? Can I survive the current and the undertow? When I think about the magnitude of this event, I feel like all of the emergencies and eventualities that I have prepared for are trivial in comparison.
As doctors, we pride ourselves in our knowledge, skills, and professionalism. We are not afraid of difficulties or fatigue, because we know what we do is far bigger than us. The courage shown by health care workers from all across the U.S. in fighting the pandemic is comparable to the firefighters who sacrificed their lives during the 9/11 attack. The medical community has faced many pandemics over the last century, including the plague, Spanish flu, and Ebola, to name a few. These pandemics of the past are affirmations that, time and again, life returns back to normal after fighting deadly diseases. However, despite witnessing the severity of the COVID-19 pandemic in China and Italy, our government’s response to the virus has been nothing short of astonishing. Well into the pandemic, we did not have adequate testing available, there was a significant delay in the reporting of results, and hospitals suffered from shortages of PPE. The lack of these simple measures not only cost our country an enormous amount of money, but more importantly, cost us many lives.
Losing a patient is difficult. We are not immune to death or the effect of death on one's mind and soul. As we move on with our lives, the fear of catching the infection always lingers in the back of our minds. This constant fear, and the overwhelming guilt of potentially exposing our near and dear ones to the infection, can take a toll on our mental health. We are so busy taking care of others that we can lose sight of our own health and miss our own symptoms when they initially arise.
In my case, however, COVID-19 presented swiftly like an unexpected whirlwind. I had a high-grade fever and chills, the dreaded typical presentation of COVID-19. With a sinking feeling in my gut, I hoped for flu, but the physician in me was aware enough to know that I had now become the patient. The medical professional in me began a mental calculation regarding my severity of disease, risk factors, and likely outcomes, as well as the protocol that needed to be followed for observation, treatment, and protecting others; but the 27-year-old woman in me was petrified. The initial days were tough. My body was fighting a war, a war I had witnessed many others fight over the past few months. Every day, I struggled to eat, to breathe. As my symptoms progressed, dysgeusia and anosmia were added to my list of difficulties. Suddenly, I was on the other side of the bed. It was then that I realized that the constant fear of spreading the infection, the fear of reinfection, and other disease-related sequelae were having an effect on my mind. One of the least-addressed issues of this pandemic has been its effect on the mental health of health care workers. The CDC has reported over 200,000 positive COVID-19 cases and at least 800 deaths amongst health care professionals. Many of us have lost a colleague, a coworker, or a friend to this horrible disease. Time and again, we have been shocked by the medical trajectories of our COVID-19 patients, losing some of our youngest and healthiest.
As our world continues to open up and people attempt to return to normalcy, we must reckon with whether this is the new normal. What started as the dreaded Spanish flu now stays amongst us as seasonal influenza. Is it going to be the same for COVID-19? As we prepare for the next “wave” of the novel coronavirus amidst a flu season, health care workers are overworked, underpaid, and trying to overcome the vast amount of disinformation and anti-scientist conspiracy theories, some coming from the highest levels of our government. We wish we could just pause and take in a breath of fresh air. Our initial lack of information about this disease and our response to it has actually highlighted what a gift it is to have knowledge, science, and insight on our side. We will need to learn to live with this disease, and young children and newborns will never know a life without it. Even more, this pandemic has taught us how to appreciate our loved ones and the value of community and service. With so much fear and anxiety surrounding us, we have had to relearn the importance of love, friendship, and kindness.
So, today, let's make a phone call to our loved ones, let's make sure we tell our colleagues in the hospital that they are doing an amazing job, and let’s take a step back to appreciate the effort we have all been making in fighting this disease. This is the time when we, as health care workers, are making a significant difference in peoples’ lives, and isn’t that why many of us chose to be in this profession in the first place? Often, when I find myself cornered and defeated, I find solace in the words of the poet Robert Frost:
‘The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.’
What lessons have you learned in dealing with the COVID-19 pandemic? Share your experiences in the comment section below.
Mansi Chaturvedi is a second-year internal medicine resident at Medstar Washington Hospital Center/Georgetown University Hospital. She is interested in doing pulmonary and critical care fellowship in the future.