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The first thing you learn is how fast people seem to fall apart. They come in short of breath, requiring a little bit of oxygen, and then take a turn for the worse very quickly. Not all of them do this, and that's another thing: COVID-19 is difficult to predict. We don’t know which patients will decompensate. But when they decompensate, they do it very quickly.
We still don’t know why certain patients are able to fight off coronavirus. Some get mildly ill, some get very ill, and some require hospitalization and intubation.
At first, I didn’t think too much about the risk to myself. When you’re a doctor, you’re always at some risk of contracting a disease. But that changed after I was exposed to a COVID-19-positive patient without personal protective equipment for a considerable period of time. I questioned whether I was reckless in examining the patient, who did not exhibit any symptoms, and worried about my ability to infect my family and other patients. I felt guilty and foolish for putting myself and my family in such a position. It was not a good day. But I’m not the only one who’s felt this way. One of my colleagues had even written a living will — just in case.
I’m going to take away many stories from this experience. But for now, I’ll share two. I treated an asthmatic lady whose boyfriend had been exposed to a COVID-19 patient. She came into my hospital, on the general floor. At first, she wasn’t that sick — she was comfortable — but then she began to feel much worse. I was called into the ICU at two in the morning to see her. She was in distress and rapidly declining. I decided to intubate her.
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I’d seen on social media how other physicians helped their patients use FaceTime to speak to their loved ones. We were so uncertain about the trajectory of the disease, and patients on ventilators had such poor outcomes, that people often didn't get a chance to say goodbye before they died.
This woman had a cellphone that she gripped in her hand. I encouraged her to call her daughter, even though she was short of breath. I stepped out of the room to give them privacy, but I know that she said things to her daughter that she’d always wanted to.
Thankfully, the story has a happy ending: Even though we put the lady on a ventilator, she recovered and is now doing well. I felt so grateful that I could give her the time to talk to her daughter because I knew what direction she was going in. I wish I could give more patients the ability to do that.
The second story is more tragic. I met a woman in her 40s who had lost her father to COVID-19 in my hospital’s ICU. Two weeks after he died, her mother was there on a ventilator and not doing well. We’d implemented some strict visiting rules, but it was confusing because they were changing on a day-to-day basis. Rules sometimes lag behind data. It took us a while to realize that rules prohibiting visitation were very restrictive and inconsiderate of the human soul.
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The woman on the ventilator wasn’t doing well. I realized that I couldn’t predict what would happen to her in the next couple of hours — much less whether she’d survive the day. Despite the rules, I felt very strongly that the woman’s daughter, who had already lost her father, should at least be called and given the option to visit. We were able to make this happen. And, a half-hour after she arrived, this woman saw her mother die.
Even though it was a poor outcome, it would have been a lot worse if we had just followed the “no visitors allowed” rule. We’re glad that we were able to bring her daughter to her bedside. These human stories, ultimately, are what I’ll take from this experience of treating the coronavirus.
