People are bustling around in the room, going from the computer to the counter to pick up supplies, to the patient or the IV pump to deliver meds. The ventilator is making the sounds of inhalation/exhalation, persistently pushing oxygen into the lungs & evacuating the CO2.
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1/
There is a heart monitor that keeps alarming—a persistent ding, ding, ding--until one of the bustlers temporarily silences it. There is a continuous dialysis machine running, & blood fills up the tubing. The IV pole is overwhelmed due to the number of meds that are needed.
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2/
The nurse brings in a second IV pole for additional meds. In the middle of all this activity is the patient. Everything we do in that room is to try to keep the patient alive. As the oxygen level goes low, the monitor alarms again.
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3/
We turn knobs & push buttons on the ventilator, our eyes staring at the monitor hoping the blue number (reflecting the blood oxygen level) will climb. The tech wheels in a machine to get an EKG and then wheels it right back out.
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4/
With the abnormal heart rate (too fast) and oxygen level (too low), there’s a battle between the alarm on the monitor and the hands of those who can silence the alarm. It seems like it’s always like this near the end. The alarms are shouting, “These numbers aren’t right!”
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5/
We remain mostly calm despite the alarms coaxing us toward panic. Occasionally, someone snaps, “Can someone please silence the alarm?!” We know the numbers aren’t right. We’re trying desperately to change them. We don’t need the reminder of our failure every 20 seconds.
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6/
Sometimes the meds, the turning of the dials, the pushing of the buttons works. But in my limited experience, those who have COVID usually don’t recover from this point. And some of those who need a ventilator are marching slowly, seemingly inexorably, toward this type of moment.
Hopefully that moment has been preceded by a conversation with the patient (ideally) or their family (at least) regarding what their wishes are.
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Because otherwise you find yourself with a family member on the phone in the middle of those heroic lifesaving measures, and you’re asking them how much longer we do this. Is this medical care, or torture, you wonder?
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9/
Maybe they’re crying, and maybe your eyes are welling up too. No one wants to be there. What are the chances of recovery, they want to know? (close to zero) Is their loved one able to talk? (no) Awake? (no) Are they feeling pain? (we don’t think so)
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10/
And they struggle because they don’t want to “give up,” but they don’t want to cause more pain, either. Eventually they eke out, between their sobs, that they want the patient to be comfortable, meaning we will turn off the machines.
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11/
There are more questions they never thought they would have to ask about how we proceed, how long the patient will be alive, what happens to the body?
You answer as best you can, saying you’re sorry this is happening; you wish things were different; you know this is hard.
12/
You answer as best you can, saying you’re sorry this is happening; you wish things were different; you know this is hard.
12/
No one wants this to be happening. And yet it does, every day.
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13/13
