Coming home today I had a lot to think about. I say this not to seek sympathy, but it’s been a month since I last had a day off. For me and many of my colleagues it’s become a new normal. Watching young people die has become all too familiar as well. Not normal, but …
I spend my commute home telling myself that this is horrible. These deaths are preventable. That vaccines save lives. That those who fight them are the minority. I need to reinforce these walls, because it seems that the outrage is fading. That the news is stale. We’ve adapted.
I write these things down, as to mark the sand, for I worry that I too will adapt and begin to accept this. Be it fatigue or bombardment, eventually one must drop their head and tuck in their shoulders as if to bear the weight of loss. This wave has been especially brutal.
Not only by the numbers but in its plateau. This wave has held us under the water until our limbs trash, our lungs burn and our vision fades. I do not relish the irony that many drowning in it chose not to swim.
Perhaps that is why my journey home takes me in ever expanding arcs. I know that I will never accept this reality, & to bolster my resolve just takes longer, and those kilometres are essential right now. I will continue to tell their stories. I will be there to mark their graves.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
One of the most challenging aspects of the 4th wave has been the alienation and estrangement of families. Once our allies for shared decision making, many are skeptical of the medical management of COVID if not in complete denial it exists. Trust is essential in building rapport.
It is further amplified by isolation from our restrictive visiting policies. I miss the day where I could sit in the room with a family and explain what was going on. More importantly I could see the interactions and understand the dynamics of its members.
Daily updates, conversations about the weather, their participation in medical rounds all gave them grounding and trust in what we were telling them. That is gone now, and though we update family by phone or zoom it is a veil between us.
I had only known her while she was on the ventilator. Her case handed over to me with exacting details, her care detailed by vital signs and problem lists. It was only when we pulled those tubes from her mouth that we really saw her face and understood her tears.
“You look like you really need a hug.”
Though I knew she was still dazed from the delivery from her mechanical womb her eyes focused & she held out her arms, the tears intensifying.
Despite the gown, mask goggles & gloves, or maybe because of them, I knelt down and embraced her.
We chatted that afternoon. Some of it made no sense. I knew that her mind was struggling through the fog of weeks of drug induced coma.
I learned about her life, & her family. I could see her regret. I could feel her remorse. All I wanted was to tell her it was going to be ok.
So, we’ve reached 34 deaths per day from COVID. It’s a shocking number that really gets swamped over by all the other numbers. I’m going to describe the usual dying process in the ICU from this disease. I’m wearing my clinical hat, be warned.
The trip through the ICU is serpentine. We admit patients now who not only have low oxygen levels, but are in distress. Prior to that internal medicine physicians have been providing ICU level care on the floors.
They treat potential coinfections, mange noncovid aspects of patient health and importantly try to turn the course of the disease with steroids and monoclonal antibody therapy. If the trajectory is set, they come to the unit to be placed on a ventilator.
“I know you’ve been avoiding me, I understand why. Your heart must jump into your throat when you see the hospital’s number come up on your phone.”
“Please tell me he’s getting better.”
“Your father’s heart is failing.”
“He promised to help me with my schoolwork.”
The tears are welling up in our eyes now, but I know how to block them.
“You have to do everything. He worked two jobs to keep me in school.”
He is shrinking now. Only anger bolsters his impossibly thin frame from collapsing. His fists are clenched.
I stumble for a second, seeing my son in the flash of his eyes. That connection swamps me with empathy. I can’t give into it, or I won’t be able to go through with what I need to tell him. So I brace myself. I break the connection by stepping back.
How to maintain your sanity in the 4th wave. A work in progress from an non expert.
First. Go outside. It’s fall. The leaves are changing. Find some trees. Don’t just look at them, take a deep breath. That earthy smell is an anchor. If you are lucky enough to find just the right light the petrichor and the autumnal palette will elevate your spirits instantly.
Next, find a good mycologist. If that fails find a trusted friend who owes you a favour to show you their secret spot to find morel mushrooms. It’s been a perfect year for mushrooms, and those who know will probably not tell you their secret, but it’s worth a try.
What keeps us away from the brink that is triage is the number of people who are dying in our ICUs. I have had to show them that though not yet dead they will never get better. I have extinguished their hope. I have had to console their children, and bear their partner’s rage.
This responsibility I bear without anger. It’s always been part of the profession, but we can all survive a little dose of poison. Right? It is the confessions that break me. The vignettes of banal failings that I identify with, that I could have easily been complicit in.