Just a few weeks ago, this doctor was an anesthesiologist who helped women in labor bring new life to the world as painlessly as possible. And today, he saves dozens of adult lives-he is assigned to ventilate the lungs of patients with coronavirus. He had volunteered for this dangerous job. Says-went because he has no children yet, and the parents are still taking care of themselves. A real hero.
I might have been the last person many of these patients saw, and my words might have been the last human voice they heard. Many of them will never recover from ventilation. This is the reality of this virus. I force myself to think about this for a few seconds every time I enter the “coronavirus” intensive care unit to do intubation — an external injection of oxygen applicable in severe cases.
This is all my work now. Airway. Coronavirus Airways. I work 14 hours-night shifts, and I have six such shifts a week. When patients don’t have enough oxygen, I put a tube in their Airways to vent them. The goal is to ” buy ” for their body the time during which this body can overcome the virus. This, washes be. The most dangerous procedure for a doctor in terms of how much the doctor’s body itself is at risk of infection. There are only a few centimeters between me and the patient’s face. I lean into his mouth, put my fingers on his gums, open the way for oxygen to enter. And in this situation, it is enough for the patient to cough or choke. And if something goes completely wrong, the room will be full of viruses.
So, there is a possibility that I will get sick. Or probability. I don’t even know what to call it. I have my own fundamental ideas about this virus, but I try not to focus on it, not to make it the main topic of reflection.
Just a few weeks ago, I was just an anesthesiologist. The only time people would see me was when it was time for them to have children. I had 5-7 deliveries a day. Mostly it was a cesarean section or some kind of complication. We are a large public hospital at the University of Illinois at Chicago. And we always have a lot of risky deliveries. Every one of us doctors is taught: you should be the calmest person in the room. We are taught: “Don’t rely only on medicines to calm a person. Use your voice, your soothing gaze when making eye-to-eye contact, and use your entire manner of communication.” We inspire people with positive thoughts and set them up to expect something positive. It sounds very strange, but it really helps.
Our team gathered on March 16 to develop a plan — who will work how. It was already clear what was going on. Chicago is now becoming a “hot spot” of coronavirus. And our intensive care unit is almost full of COVID-19 patients. The pediatric intensive care unit has been cleared of other patients just in case-to take in more patients if it hits us. The tide is just beginning to rise — we doctors need to be careful-otherwise we won’t have the manpower to care for all these patients. The General opinion was that we should allocate one person for intubation during the day, and another person for night intubation.
And then I thought: I am 33 years old, I have no children, I do not live with older relatives… So an hour after our meeting, I sent this message to the supervisor of our Department: “I will be happy to do this job. This place is for me.”
And now my pager is going crazy all night. Nine o’clock, midnight, 2 am, then again at half three in the morning. I usually do several vents per shift. And next week, I am warned, the number of such vents may jump to 10. Or it will definitely happen in another week. This is a routine procedure. Intubations have become routine for us, and we devote most of our time to them, at least that’s for sure. You can start and finish the ventilation procedure in 10-15 seconds if everything goes well. But when you are dealing with a patient who is not getting enough oxygen (and this is now 100 percent of patients) — here every second is crucial. As soon as I get a message on my pager, I grab my backpack with my medications and medications, as well as my purse with personal security items — and run up the stairs. No time to wait for the Elevator. I go up two floors to the intensive care unit. I put on my “armor” in front of the coveted door: a mask, a hat, an extra protective cap, my personal air filter, a protective robe, two pairs of sanitizer-treated gloves. I tape everything up now. One day the sleeves of my robe were pulled up and my wrists were exposed to the virus. Yes, there are many ways to get infected. I keep track of my heart rate, and I know that despite my habit, just before I enter the ICU, my heart rate increases from 58 to 130 beats per minute. Behind my medical armor is a tired man who is stressed and feels very hot. I try not to show it.
I often got a shock when I went in and saw patients. Most of the people I have to intubate are young people in their thirties, forties, or fifties. These people came to us after they started coughing 1-2 days ago. Sometimes-the first cough appeared only a few hours ago! But by the time I enter the room, they are all severe respiratory patients. Their oxygen level is usually 70-80 percent instead of 100. This is disturbing. These people take 40 breaths every minute, but they should take 12-14. They have no oxygen reserves. They are pale and tired. Fatigue puts them in a kind of psychological fog. And often they don’t hear me when I introduce myself. Some are panicking and choking with fear. Others mumble something that is already inadequate. Last week, one of the patients was crying and asked me to give him my mobile phone to say goodbye to his family. But I couldn’t do what he asked. My oxygen levels were dropping, so I couldn’t risk bringing my phone into the Department and infecting it with a virus. I kept apologizing, I… I don’t know. I can’t hurry, I need a strong will for this job. After all, if I pay, the glass “windshield” of my helmet will fog up, and I will not be able to work.
The first thing I do is pull out the stool so that my face is on a level with the patients in bed. Most of the time, the main expression in their eyes is fear. But sometimes there is an expression of relief: “Thank God. I can’t do it anymore — and I’m leaving.” These people no longer had the energy to become hysterical.”
I put an oxygen mask on the patient and give him one hundred percent oxygen for a few minutes. I want to pump them with oxygen to the limit because they can’t breathe on their own. Then I give them medicine to make them sleep. We were taught how to touch the eyelids-lightly so that they just closed their eyes. Then I give them a muscle relaxant and look at their Airways-assess the position of their vocal cords. With this virus, I observe frequent bloating, swelling: swollen upper respiratory tract, swollen tongue, strong secretion.
When I insert the tube, it allows the virus to escape into the air at this point, the patient’s airway as it were opens — without any masks or filters. People sometimes cough when the tube moves to their trachea — and it’s a deep, heavy cough. My mask and cap may be covered in drops of their cough. It can fly around and air virus. It’s like sitting next to a nuclear reactor. I try to act confidently and quickly. Because if the first attempt at ventilation fails, you will have to do it again, and then a whole ton more virus will be released into the air.
When I’m done with the ventilation, I go back to the residents ‘ room. I try to take care of my lungs so that they remain “strong”. Although it’s actually easier for me not to think about it: I’ve been asthmatic since childhood. I use an inhaler twice a day. My life is synchronized with my breathing so that whenever I feel bad, I get shortness of breath. When I got into this business, my whole family stood on its hind legs: “Why are you climbing, and even voluntarily? What are you doing?» But then my dad and my brother put together tools and made a plexiglass intubation box — they copied it from a Taiwanese model. It turns out that when I do intubation, it is just above the patient’s face, thus reducing my vulnerability. I haven’t been able to use it yet. But I know my relatives are worried about me. And they’re trying to protect me.
I called them last week to tell them what my wishes were in case my life came to an end. Then I sent them an email just in case.
It said so: “If I have to do intubation, I agree in advance. But if my liver and kidneys fail, and if my mind goes haywire… Also, if my body just refuses me and there’s no hope of getting back to the way I was…” Well, it was a heavy letter. But I know what this virus does to people.
Every night I try to go on rounds with the doctors to check on the patients I have intubated. You can’t take any relatives or visitors with you. I’m not really a religious person, but I like to stand outside the ward sometimes and think about them-my relatives. And what they have to go through. I try to think about the positive side, such as expectations of a bright future. My patients are usually unconscious during ventilation. But once a day, for an hour or two, they have contact with us in a clear mind — this is when we bring them medicine to check their level of consciousness and ability to care for themselves. Translated into human language, they temporarily Wake up from their last dream.
When the tube is inserted, they can’t talk, but I’ve seen several patients write me questions on scraps of paper. Usually: “Ventilation or surgery?» And more: “How long will I last?»
Usually, before such thoughts, patients spend 3-5 days on ventilation. And now it comes to the deadline of 14-21 days. Most of these patients have acute respiratory distress syndrome. They have inflammation, soft tissue cuts, and fluid accumulates in their lungs, making it difficult for the body to process and absorb oxygen. How much oxygen do not give them, it does not pass. It is always missing. And our organs always react very badly to oxygen starvation. As a result, first, there is kidney failure, then liver failure. Well, in the end, the cortex is affected.
The immune system stops working. Many people have something wrong with their appearance — we call such people “speckled”. With this turn of events, the skin of a person becomes red and is divided into peculiar “sections”. This means that such a person has not days left to live — hours. We have several such clients. Some have already been transferred to the category “no more resuscitation”.
In between intubations, I usually sit in my resident’s office and monitor the monitors. I can see all the data on the live status of my patients there, check if they are all right. We have made some progress. A young patient got rid of the need for ventilation last week — and now, he has already been allowed to recover home. The medical staff at our hospital is amazing. But, alas, as a rule, everything does not go according to the scenario with a good ending. I’m looking at the monitor right now — and I’m afraid there’s one patient who won’t make it through the night. And the other three are getting closer to the edge…
It’s a terrible feeling-someone is dying and you can’t do anything about it. The oxygen level drops, the heart works worse and the blood pressure decreases. These patients often die during ventilation. It even happens like this: the body is carried away, the person is no longer there, and the tube still pushes the life-giving air out of itself.