ICU doctor humbled by his COVID patients’ hope to “simply to stay alive”
Dr. Luke White, Beacon Medical Group critical care and pulmonary specialist, shares his perspective of working on the front line of the pandemic.
Dr. Luke White of Beacon Medical Group.
“Keep it up!”
“Are you eating OK? Can I get you anything?”
“It’s great to see you sitting in a chair!”
The things I say to my patients in the ICU with COVID can sound like platitudes, even to me as I’m saying them.
These are the especially unlucky among us; they’ve suffered disease bad enough to need more than what a regular hospital room can provide them. They sit in an ICU bed separated from everyone they love, connected to every sort of oxygen device we have, waiting.
By the time I’ve seen them, they’ve usually gotten every medication we have that might help to fight the virus. None work well. We will likely discover that some don’t work at all. The oxygen cures nothing, but it buys time as we hope each one heals in the same mysterious way they got sick when others did not. It takes a long time, if it happens at all.
And so we are left with offering the smallest of things — encouraging words, off-menu Pepsi, chats about grandbabies on the way and the world outside that they are cut off from.
I’m always humbled by my patients’ hope, even as they breathe like marathoners, day after night after day, simply to stay alive. They are always hoping. When I come into see them they’re often looking out the window, which faces a wall.
Sometimes the crash comes fast; a patient I was laughing with half an hour ago is suddenly unresponsive and their heart has stopped. Sometimes it’s slow, and I’m kneeling by the bed in my mask, explaining as best I can through the hurricanes of oxygen and filtration swirling around us that we are out of options, and now have to put a breathing tube in and go on a ventilator.
Fast or slow, the moment moves the same. A sedative, sometimes a paralytic, and then a pause while waiting for the medication to work. I hold a mask over their face. I push the air in and out, watching the rise and fall of their chest, feeling the pressure of lungs damaged by COVID, not as the beep of a vent, but as an actual force as the air is pushed back through the bag into my left hand.
In this minute or two I often think about the polio epidemic in the 1950s. When vents weren’t available, medical students were recruited to hand-ventilate sick children for hours at a time. The children, paralyzed from the virus, would look into a mirror and blink to let the students know if they needed more or less air. At night, the lights would shut off to save power and the students would squeeze the oxygen bag in the dark. They would sometimes find, when the sun came up, that their patient had died sometime in the night.
I’m grateful for our modern machines. I’m also grateful for these few minutes, when I’m connected so closely to my patient, each breath an alliance.
At home, I sometimes pull up charts while my children play, hoping to see encouraging new blood gases or some improvement in vent pressures. Usually there’s nothing new. When bad things happen, they happen fast. Good things happen slowly, if at all.
When I’m not working nights, we all say prayers together. My three year old son usually talks about mac and cheese, which is OK. We pray for the people in the hospital suffering from what my children call The Virus. We pray for their families. We pray for ourselves, our own family, our friends, those we haven’t met.
It’s hard to know what prayer does, maybe harder still in times of tragedy, even as my family has been spared for another day, in the morning I’ll see someone new who hasn’t been. There might be a cause, but there’s no reason why.
Still, we will keep praying at night, and in the morning we will keep fighting in the hospital, and after work we will keep trying to live in way that protects and shelters others. It’s all we can do. It’s all we’ve ever done in medicine, and sooner or later it will work and things will be better.
