You grow an exoskeleton, because it's the only thing you can do to protect yourself.
Yesterday was the last day of my three-week MICU block. My first day was on December 15. I barely noticed Christmas and New Year's pass by, as if the holiday lights had simply flickered on and off. On Christmas Eve, I took a new admission that was intubated almost immediately when he arrived to the unit. We tell our COVID patients to lie prone, because it's one of the things that can help in ARDS to improve gas exchange. He was breathing so fast while lying on his belly, I remember thinking he was like an upside-down V or U bowing in and out. There are some patients I see and cannot help but imagine, if we all had a timer hovering over our heads in red glowing digits, how many days or even hours must be left ticking down.
In these times, I have seen this one story play out too many times. It does not matter if it is a 34 year old man with no prior medical history or an 81 year old abuela with a slew of chronic conditions. Most of the ones who take their chances with the ventilator will never speak to their loved ones again. It feels like watching a slow spiral moving closer and closer to a monstrous whirlpool. Sometimes, we can power the boat with enough force to evade its grasp. Other times, it feels futile and inevitable as the boat is dragged under the depths.
Medicine stands on the muscled legs of science, but its arms require the dexterity and touch of an artist. I ask a patient hanging by a thread on high flow NC if he would want to be intubated. He asks me if I think he will live through this. I have seen too many like him who did not make it. But I am not cruel enough to snuff out hope. I tell him it is too early to say. This man is convinced by his wife and daughter to be intubated, and to our delight, he is successfully extubated a week later. He is one of the few lucky ones.
I call the families each afternoon to give them daily updates. At what point do you tell these families that they should not expect their loved ones to make it out of the hospital alive? Early, to give them time to process and prepare for the worst? Later, to give them hope to cling to until the patient is about to careen over the edge? The shades of gray in between are innumerable.
Do you know what self-care involves these days? Muting and deleting people on social media. The girl who was on your high school tennis team who writes "Scam-demic" under an article about the stay-at-home orders in California. The cousin of a cousin who praises Amy Coney Barett's Supreme Court confirmation and writes of how Biden will ruin the country. I never thought I was capable of such constant simmering rage. I am angry nearly every day of my life.
You grow an exoskeleton, because if you dwell too much on what is happening, it will rip your psyche into pieces. A woman in her 40s who leaves behind a set of 11 year old twins. A family tragedy that began at the father's funeral, then leading to the death of his 30-year old son. A 91-year old woman with dementia whose family chose not to intubate and to let her go peacefully, mouth open in a dark O and gasping alone as her daughter wails on the other side of the glass.
