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It was a Thursday. It 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. Her symptoms began about six days earlier. She was seen in the emergency department five days ago. Her SARS-CoV-2 (COVID-19) PCR nasal swab was positive, and she was started on the oral antibiotic azithromycin.
Within five days, her symptoms worsened to include shortness of breath, hypoxia (low oxygen), increased liver enzymes, decreased kidney function, increased inflammatory markers, decreased lymphocyte counts, and severe lung disease (pneumonia/acute respiratory distress syndrome).
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. But shortly after admission to the intensive care unit, she needed to be intubated and mechanically ventilated. Within the next 3 hours, there were two more patients with similar presentations. All 3 ICU patients required intubation and mechanical ventilation to keep them alive.
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:
Jasminka Vukanovic-Criley is Awards winning physician hospitalist, mentor, educator and can be reached on Twitter @criley_md.