WEDNESDAY, APRIL 22
I’ve been really shaken by the emergency intubations this week. The patients have been terrified. By the time I’m called, they are gasping for air. Because no visitors are allowed, they are alone. These encounters are emergencies and can be chaotic. We are all wearing PPE, so they can’t see our faces. I try to be kind and reassuring. I ask if they have any questions. But so often, as a result of the patient’s respiratory distress and the oxygen mask over their face, I can’t make out what they are trying to say. I have to say, “I’m sorry, I can’t really understand. We are going to put you to sleep now and put in a breathing tube.” I push medications to sedate and paralyze them, and then put a tube through their vocal cords. Looking down at them as they go to sleep, I’m the last person they see. And for the ones who don’t survive, I will have been the only one to hear—or rather, not hear—their last words.
The main resources we lack are respiratory therapists and ICU nurses. Our department has organized a huge operation in which doctors explicitly fill the roles of nurses and respiratory therapists outside of our regular physician shifts. This week, I’m working two overnight shifts as a respiratory therapist. The chair of my department is walking from room to room suctioning breathing tubes. Senior physicians are brushing patients’ teeth.
In the ICU, patients become voiceless and personless. We take care of their bodies for weeks: examining them, adjusting their ventilators, titrating their sedation, and carefully considering their medical management. But in the absence of family contact, we have no idea who they truly are. Last week, when we were rounding in the OR-ICU, I noticed my intern perusing a colorful website rather than the medical record. A note from a family-liaison doctor had pointed him to a support site for one of our patients. We saw for the first time that this patient was a teacher. The website had hundreds of comments from students and parents: “We are thinking of you every day!” and “We are praying that you make it through this!” There were dozens of photos of a middle-aged man with his students—in the classroom, at school sporting events, wearing different silly costumes. He had a huge, toothy grin. My intern stared at the website, stunned. It took my breath away. My attending physician said, “I can’t look at this. Please close it.” We get through our day in the OR-ICU by compartmentalizing—by ignoring the fact that our patients are people who are deeply suffering. When reality cuts through our fantasy, the job can be unbearable.