I’ve gotten a lot of kind feedback from the last post. Thank you--it means a lot to have this experience validated. Know that all the messages, the 7pm clapping for essential workers, all of it, doesn't go unnoticed by those of us in the thick of it.
Since it seems some folks are reading this I wanted to not just be the most depressing human being on the planet. Yes there is still death and yes it is hard. But there is good and kindness I am seeing. And what we are doing as a society is having an impact. I wanted to talk about that now.
One of the most incredible things about the unit is how diverse the work force is. Because of the need at Elmhurst, nurses and doctors have come in from all around the country. Even the freaking Navy is working at Elmhurst! Many of the nurses, like me, were not ICU trained. But I am in awe about how fast they got used to the new role. Any of our successes--the lionshare of credit goes to them. The attendings that helped staff the unit--ED doctors, anesthesiologists, and intesivists are incredible. Despite the craziness we were in, they were still eager to teach us. I became much more skilled in putting in arterial and central lines, changing ventilator settings, prescribing pressors and sedation drips, and running ACLS codes because of their insight. The diversity of perspectives they brought constantly made me think critically and helped me grow as a physician, even in this short window of time.
The kindness and maturity I have seen from our residents is something I never doubted, but was so happy to see in action. As I've mentioned before, we tried to call families multiple times per day and even video chat with them to say prayers or goodbyes to our patients. Our team took this as an important mission. As emotionally taxing as it was to have difficult conversations with families, I never saw anyone shy away from it. Residents from every level of training took on the task with maturity and absolute kindness. Those I have worked with have earned my utmost respect.
We are in a crazy time now in the country--debates and protests are going on about "liberating" states from stay at home orders while hospitals are pleading to keep social distancing going. I know it's not a popular opinion, but I get it. Even as a front-line provider, I empathize with these people. People are losing jobs, families are having trouble finding ways to feed their kids. That shit is real. And in states and places that have not been hit like NYC or the tristate area, it is hard to see the benefit of these social distancing and stay-at-home orders. Reopening the country is a delicate balance. There is no clear cut answer. I can tell you, however, from the side of a health-care worker what the social distancing has meant to us and to patients. In short: it's working.
Because of what we as a society have been doing, the numbers of sick patients in the hospital are objectively decreasing. When these surge ICU's were created, we were past max capacity. Sick patients were piling up and often dying in the ED. They were getting care, but there were too many of them to give them the care that could potentially save their lives.
Social distancing + the influx of providers from out of state + the extra sites (USS Comfort, Javits Center) decreased the numbers of patients that were coming to the hospital. As the cases in the state began to decrease, and less were coming through the door, the hospital decompressed. Instead of playing catch up, taking over care for patients who may have been too far gone to help, we are now getting the chance to take care of patients earlier in their clinical course where maybe we can make a difference. Surge units that were once open to handle the overflow of patients are now closing down, freeing up providers to do other things. Because of that we now have entire services dedicated to "proning" ICU patients (flipping them on their stomach to help with lung ventilation--actually a complicated process in critically ill, unstable patients, with multiple lines), which has been shown to reduce mortality. Psychiatrists are starting to come in and do videochatting with families. Patients can more readily get dialysis if their kidneys fail (which unfortunately happens often in severe disease). We are getting more supplies--both for patients and for providers. PPE, a precious resource, is still rationed but can always be obtained. Ventilators are pretty much always available now (albeit we have about 20 different makes/models so we as providers have to consistently learn new ventilator systems--but at least the patients can breathe!).
Importantly, we are seeing the number of extubations of our sickest patients start to rise. There was a time where out of the hundreds of patients at Elmhurst intubated only a handful were successfully extubated. Our unit only had one. Now a bunch of individuals we cared for have begun to be extubated or on their way to doing so. Numbers of admissions to ICU's and intubations in general have also declined. When we asked our anesthesia colleagues the other day about how many they intubated in the prior 24 hours--we were happily shocked to hear ZERO. Similarly when we asked the admitting medicine doctors about who we had on board to come to our unit (as we had a free spot), they too reported, for the first time, NO ONE.
We are on the right track. Things are improving. But that doesn't mean it's time to "go back to normal" (whatever that is). For those families struggling, and aching to go back to work to support their family--there is nothing wrong with that desire. But it's not safe to go to these widespread protests, especially if you are sick, even if it is your right. Some of the smartest people in the world are advising government on how and when we should reintegrate society without entering this pandemic all over again--because that's our fear. Even as we decrease the numbers, this fight is not over. We have begun to win a battle, not the war. More people are going to get sick, more will die. However, if we keep this at a low level, our hospitals can manage it and we can save more lives. If we "re-open" too early, especially in NYC, we run the risk of a second peak of infections, maybe even worse than the first. A slow burn is better than a roaring flame. Yes, eventually we have to open the doors of our stores and restaurants. Our economy needs it for our country's long term survival. But people dying also hurts the economy. And people dying, when they don't have to, is morally wrong.
If we can keep doing what we are doing, then our hospitals can take it and our healthcare workers can take it. I'll be honest, mentally, physically, emotionally, I am burnt out. I don't know if I can handle another peak. I'm destroyed from my involvement with this one, and there are those who have been exponentially more involved than I--I cannot imagine the toll it has taken on them. So when you have that urge to go out and meet up with friends on a nice day--and I have that urge too, believe me--think about the people taking care of everyone else. We can't do this again. And if that doesn't do it, think of your family who isn't sick right now, and who may become so if we as a society do not do our part.
OK PSA over. Just know that yes this has been tough. But I have seen love and kindness. I have seen strength and maturity. I have seen selflessness. I have seen strangers cheering and doing their part. There is a lot of positivity amidst this mess. The world isn't over. We are pushing through. There is a light. Let's get there together.