Thread by @arghavan_salles

“I haven’t seen a patient leave here to go anywhere except the morgue.” This is what one of the advanced practice providers in the ICU told me. She’s been here 3 weeks.

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(photo I took of a sign on the street in Brooklyn)

In a “normal” ICU, there is a lot of movement—new patients getting admitted, other patients being sent to less acute units as they recover from illness. And yes, there would be occasional deaths.

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But of course nothing is normal now. Patients are still admitted to the ICU daily. And some do leave, but almost all of the ones who leave are doing so because they’ve died rather than getting better.

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When I called the admitting office to let them know of another patient passing, my interlocutor said, “Please don’t tell me it’s another death.”

It’s not just the doctors and nurses who are witnessing the toll of this virus and traumatized by it.

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There is a pervasive feeling of helplessness. We try to delay intubation for a young, relatively healthy person. But after days of BiPAP, he is getting tired and needs ventilator support. We’re all wondering if we just lost him.

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There are patients we just cannot ventilate. We play with their settings—change the volume of the breaths, change the number of breaths a minute. Can we do any of that without making the pressure on their lungs so high that they sustain irreversible damage? Not always.

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The tools we are working with seem insufficient. For the sickest patients, there are no ventilator settings that seem to work, there are no medications that seem to help.

I am not used to this.

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Four of us spent an hour at a patient’s bedside last night, continuously pushing different medications into his body to keep his blood pressure up so that he didn’t code. And we were successful, at least for the night.

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In normal times, that might have given me hope. But these are not normal times. We fight and we fight and we fight, but it feels like maybe we’ve brought a knife to a gun fight, and it will be hard to win.

Please stay home. That's our only real weapon.

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