"You’re basically right next to the nuclear reactor"

Each night I try to do rounds with the doctors in the ICU to check on the patients I’ve intubated. They’re not allowed to have family or visitors. I’m not a religious person, but I do like to stand there for a minute outside the room and think about them and what they’re going through. I try to think about something positive — a positive expectation. Mostly they’re unconscious on the vent, but each day for an hour or two they get what we call a sedation holiday, which means we bring down their medications so we can check on their baseline level of consciousness and see how they’re doing on their own. In other words, for a little while, they might wake up.

They can’t talk with the tube in, but I have seen a few patients before write messages on a piece of paper. “Vent?” Or: “Surgery?” Or: “How much longer?”

Usually, before this, patients would be on a vent for three to five days. Now we’re seeing 14 to 21. Most of these people have acute respiratory distress syndrome. There’s inflammation, scar tissue, and fluid building up in the lungs, so oxygen can’t diffuse easily. No matter how much oxygen you give them, it can’t get through. It’s never enough. Organs are very sensitive to low oxygen. First comes kidney failure, then liver failure, and then brain tissue becomes compromised. Immune systems stop working. There’s a look most people get, called mottling, where the skin turns red and patchy when you only have a few hours left. We have a few at that point. Some have been converted to “do not resuscitate.”