Doctor describes unforgettable conversations, emotional last goodbyes of COVID patients in ICU
Dr. Luke White, a Beacon Medical Group critical care and pulmonary specialist who works in the Memorial and Elkhart General critical care and intensive care units, describes the emotional challenges physicians face during the pandemic.
Part of my work as an intensivist is performing the brain death exam, which we do when we suspect that the brain has been irreversibly damaged and all activity has stopped. Often, I do this after a patient is shot in the head.
It happens a lot in South Bend.
It’s a simple but thorough exam, and we can’t afford to make mistakes. It is as much a ritual as anything in medicine without variation, improvisation or hope.
I don’t enjoy it. There’s no chance of fixing anyone, and it’s often performed on the young. I especially dislike what we call the caloric reflex. Normally if you squirt cold water into someone’s ears their eyes will move in a predictable pattern. This won’t happen if your brain has died. So we test this as part of the exam.
What it specifically involves is taking a glass of ice water, filling a syringe, and squirting it into the patient’s ear while holding their eyes open to watch for movement. Sometimes I can’t easily do this because there’s too much brain tissue dislodged by the water.
Another, newer ritual in my job is talking with patients when they need to be intubated for worsening COVID. Like the brain death exam, the pattern is predictable. Patients talk to their families on my battered speakerphone as best they can between gasps because I’ve told both patient and family that this may be the last time they speak. They say their goodbyes, then I intubate them.
Sometimes they survive.
Usually – after a battle of months, or weeks, or sometimes only minutes — they don’t. I never forget those conversations.
The best treatment for bullets and viruses that ravage the bodies of the innocent is to keep them out in the first place. When people cross the threshold of the ICU and become patients, the damage has been done.
The best cure will always be not being injured in the first place.
I understand those who fear our rights are being eroded. And I understand the argument that exposure to illness and death has biased us as healthcare providers.
To which I can only reply: Yes. Listen to enough sobbing spouses and children beg their dying family not to die and you may feel differently about vaccination. Throw enough human brain that used to be a delicate lattice of memories, speech, and emotion away into the red biohazard bin and your opinions may change.
There is no freedom in death.
