A patient w/septic shock & ARDS who needs ECMO & CVVH & pressors & max vent support already has an extremely low chance of survival.
Factor in a #COVID19 infection which has no known cure and can take weeks to show improvement. 1/X
Factor in a #COVID19 infection which has no known cure and can take weeks to show improvement. 1/X
Consider all the patients waiting for an ICU bed & a ventilator & maybe ECMO.
Know that ~half waiting are younger than your patient & may be healthier.
Appreciate the well-being of your staff is so important, & each CPR super-spreads #COVID19 maybe exposing all around. 2/X
Know that ~half waiting are younger than your patient & may be healthier.
Appreciate the well-being of your staff is so important, & each CPR super-spreads #COVID19 maybe exposing all around. 2/X
As ur older patient’s blood press starts to drop, & their heart slows, what do u do?
Do u do EVERYTHING: CPR, meds, all-hands-on-deck?
Do u do a “chemical code”—compressions wud spread #COVID19?
Do you call futility & focus efforts on the next inevitably critical patient? 3/X
Do u do EVERYTHING: CPR, meds, all-hands-on-deck?
Do u do a “chemical code”—compressions wud spread #COVID19?
Do you call futility & focus efforts on the next inevitably critical patient? 3/X
Do you call family & ask their wishes? Do you have time for this?
Who gets to decide who you “go to the ground” for?
Who is “worth” pushing for that tiny chance they might make it out alive?
When survivability nears zero, when do u stop using resources? 4/X
Who gets to decide who you “go to the ground” for?
Who is “worth” pushing for that tiny chance they might make it out alive?
When survivability nears zero, when do u stop using resources? 4/X
We aren’t gods. We definitely can’t save everybody. We can keep blood circulating for a long time while the body slowly melts. But why? For what? Is there any hope at this extreme?
These are tough questions #HealthCareHeros have to ask, and TBH, it crushes us in our souls. 5/X
These are tough questions #HealthCareHeros have to ask, and TBH, it crushes us in our souls. 5/X
We never want to give up a fight esp when we don’t know for sure it’s game over. We often believe we can save everyone if we just push hard enough.
The fancifulness of this thinking has been made so apparent by #COVID19.
We wish we had control, but we certainly do not. 6/X
The fancifulness of this thinking has been made so apparent by #COVID19.
We wish we had control, but we certainly do not. 6/X
Before this, we had some semblance of control. We knew what we knew and had a fair idea of the massive amount we didn’t know.
None of us knew what this would be like, & right now, none of us know how to stop it.
With no control, we apply what we think will work & we hope. 7/X
None of us knew what this would be like, & right now, none of us know how to stop it.
With no control, we apply what we think will work & we hope. 7/X
We lean on each other for strength, the strength we used to garner from that fantasy of control, of knowledge, of ego.
We sail on the winds of our slowly faltering hopes. And we stare at the massive wave of incoming patients & try to recall a memory of the horizon. 8/X
We sail on the winds of our slowly faltering hopes. And we stare at the massive wave of incoming patients & try to recall a memory of the horizon. 8/X
We look at that patient before us, tubes everywhere, heart barely beating, organs fueled by so many machines. We swallow hard, realizing humility in the face of this relentless virus, the unstoppable death. We steel ourselves, and we make choices that will haunt us forever. X
