Hospitalist Shift
It was a Thursday evening: a day that was supposed to be one of those “regular” evening shifts. Then, at 6:15 p.m., my first page went off: “Bed 11, Mrs. R., Dr. H. needs to talk to you”. The page came from the COVID section of the emergency department.
I immediately called back. It saddened me when I learned that our patient was a young woman health care worker in her early 50s. She worked in a nursing home. She developed upper respiratory infection symptoms about six days earlier. She was seen in the emergency department five days prior. Consequently, her SARS-CoV-2 (COVID-19) PCR nasal swab was positive, and she was prescribed an oral antibiotic Azithromycin.
Afterwards, within five days, her symptoms became much worse. She developed shortness of breath, hypoxia (low oxygen level), increased liver enzymes, decreased kidney function, increased inflammatory markers, decreased lymphocyte counts, and severe lung disease (pneumonia/acute respiratory distress syndrome or ARDS).
Initially, her oxygen saturation was very low: down to 40 percent! After arriving in the hospital, her oxygen level improved with expert care in the emergency department. However, shortly after admission to the intensive care unit, she could not breathe on her own. As a result, her medical team had to intubate and mechanically ventilate her (i.e they had to put her on a breathing machine). Within the next 3 hours of my evening shift, there were two more patients with similar presentations. All 3 ICU patients required intubation and mechanical ventilation to keep them alive.
Reflection
These encounters made my evening shift much more emotional than usual. I am still not sure what it was exactly that evoked such strong feelings of sadness. Was it having a patient who was a health care worker? Was it the rapidity in which all three patients’ conditions deteriorated? Was it realizing that without timely, expert care, all three would die very quickly?
Or, was it hearing people wanting to relax the measures and not wear masks, without insight into how quickly things can go wrong and end up deadly?
Or, was it the cost of empathy, and just feeling the pains of my patients way too deeply?
Or, was it talking to the family members of patients and trying to answer their many questions: How will it be in the ICU? Will it be lonely? Can you please let us visit? Just one time? What can we expect? When will they recover?
Or, was it my inability to answer some of these questions? My lack of a crystal ball? Or, was it being already emotionally exhausted from managing everyday challenges of keeping life as normal as possible, with remote learning, running a household, and helping elderly in-laws with lots of medical, emotional, and personal needs?
Whatever the reason for my profound sadness, I was reminded of some important lessons I had learned over the many years in the health care field:
1. Medicine is a team effort, and every single member of the team counts.
2. Emergency room colleagues, hospitalists, intensivists, and other hospital specialists are on the very front lines of this awful pandemic. I am reminded daily to be grateful for their hard work, their dedication, and expertise in providing the best care to patients that they can.
3. Medicine is more than the work of the mind and hands; it is also the work of the heart. Patients are touched by all three.
4. But empathy and compassion can weigh heavily on physicians. Compassion wounds. When we feel connected to everything, we also feel responsible for everything. We must learn how to carry the universe and help others, without being crushed by it.
5. You do not have to be positive all the time. Sadness is one of the four main human emotions: the others being happiness, fear, and anger. For physicians and health care workers, sadness may feel like a shadow. A shadow that might pass quickly or might linger for a while. During COVID-19, sadness might linger longer.
6. Unexpressed emotions never die. They are buried alive and may come forth later in uglier ways.
7. Sadness is a valid and useful emotion. It is important to recognize it, acknowledge it, and talk about it.
8. When times are tough, dare to be tougher. The strongest people are not those who show strength in front of others, but those who win battles others know nothing about.
9. Allow yourself to be sad and find out what you need while working through it.
10. We all have lives and responsibilities outside our work. That responsibility might deplete our emotional reserve when we are at work.
11. We must be protective of our physical and mental health, including getting enough sleep, exercise, nutrition, and managing stress and events of life the best we can.
12. Emotional health is real. Mental health is real. Taking care of yourself is important. If you do not, nobody else will.
13. Our health is our true wealth. Most people learn to appreciate it only when they lose it. During this pandemic, many did.
This article was also published at KevinMD.com
Jasminka Vukanovic-Criley MD, FACP, FHM is a multiple award-winning physician, from cancer researcher, internal medicine physician, and Medical School Associate Clinical Professor to entrepreneur. She has mentored many undergraduate, graduate, and postgraduate students and faculty. She is the Principal Investigator on studies from the National Institutes of Health and the U.S. Department of Education creating research-driven #edtech games and digital media to improve health, civics, science education, and healthy habits. Dr Criley is also a founding Board member of Physician’s Weekly. She can be reached on X at @criley_md and at www.linkedin.com/in/jasminka-criley-md