We sit silently on this precipice—my family, my friends, my colleagues. Time spins. Momentum is building. It is a tidal wave slowly moving towards us. We are fixed in its path of raging destruction. It is our enemy, not each other. Each tick on the clock, an ICU bed filling across the West—an exponential net positive, admissions to discharges—true or celestial. Yet, still the world turns, blissful unawareness in our chasms, pulled-up by our sought-out joys, combating boredom, or pulled-down by more tangible and pressing catastrophes. We continue to quietly work, beckoning resilience to rise within us, around us—disregarding the stacking politics that feel offensive and oddly opposed rather than supportive of the people upon which the weight of the world rests right now—the health care workers. There is a perpetual buzz of this is no big deal. Some friends unaware, still gathering on vacations. Each of us rationalizes various activities, logically contemplating perceived safety versus desire. Others are seemingly in blatant disregard of their fellow humans’ health in the name of “civil liberties,” skewed by misguided or misinformed, sometimes unintelligent leaders. All are driven by fear, control, loss, desperation for something normal, or survivable. I cannot blame anyone; we are all just trying to find a way through. I can only live my days working alongside ethical leaders and dedicated health care workers within the walls of a hospital that has already mourned over 100 COVID deaths and celebrated more than 500 discharges. We are a network of unified warriors: nurses, doctors, nursing assistants, respiratory therapists, environmental services, in this hospital and across the world, upholding great strength and morality in this once in a lifetime battle. “Fear-mongering,” they say; this is our reality. We would be irresponsible not to share it. I peer into an indescribable future at a loss for words, familiar with what may come in this second wave—bracing for the rage and sadness that will grow within me and around me—digging deep for tools to find my way through—to not sink my own ship or those around me. The looming reality is foreboding and feels nothing short of “unsurvivable,” I tell my friend as we run down a mountain, golden sunlight cast over the peak behind us, crunching fall leaves under our feet. The recent suffocating tragedy of the spring is already fading. There is hope in this sense of resilience alone. They say it will be different; the public believes it will. It seems to be less severe, we think. Doctors apparently now have tools, a greater understanding of the disease. Do we, I wonder? We started using steroids early, anticoagulation, delaying intubation, continuous pulse oximetry, community education, a COVID 2 Home team. Maybe Remdesivir is helping? Perhaps there is some fine-tuning, less fear for our own lives and those of our family… Beyond this, I feel like we.have.nothing miraculous to offer in this rapidly filling ICU; we sit silently with hope alone. “I’m sorry this happened,” I whisper as I put in an arterial line somehow now warm and cozy in my layers of PPE. At a socially distanced family meeting, a patient’s brother was upset, angry in fact, because I do not work every day of the month, and he so desperately wanted the same doctor every day for his dying brother (not of COVID). I found myself saying out loud as much for him as it was for me: “Doctors are humans too. I am only human.” I remind myself today, I am only a single human walking this road—inward, I look—examining my own implicit biases and tendencies, seeking to offer equity in this tumultuous present, envisioning a better future, making but a tiny difference today. I think back to May, our first “peak” when the codes seemed perpetual and lucid people sat slowly dying before our eyes with an eerie, vivid awareness incomparable to anything I’ve ever seen. Our own health care workers occupied our ICU, one texting his friend and colleague, “I feel like it’s time for me to be intubated,” acutely aware of his declining condition. And a deeply moving display of love: the phlebotomist’s coworkers and friends standing in the parking lot, masked faces and signs of encouragement as she peered out the window from the 4th floor—the blue New Mexico sky wide and open behind their silhouettes. They were specks of hope waving on the gray pavement that day. With our visitor policy safely strict, we were her only company as she sat in that still room, high-flow echoing, our voices cutting through at times. They snuck her some pie. It is both an honor and a burden to be here for these moments. I gave her daughter hope, I regret. This is COVID, I learned—wildly unpredictable. It was the greatest love story: the couple who lay together for days fighting then welcoming the heavenly beckoners. The wife passed, and hours later, her seemingly stable husband followed her. There have been many more ends unfolding within these walls–other ill family members scattered across New Mexico. Among scrupulous PPE practices and many more, COVID has brought new habits. I offer words of reassurance before intubation to my clear thinking, sometimes praying patients. “We got you” or “We are here with you.” My words feel inadequate. Wide, clear eyes peer up at me, entrusting, expectant, begging. The soothing whirr of my PAPR hums; we share a moment in time. At home, I scream at my husband for leaving the front door open, sure our youngest child will drown in our pond. Death is chasing me down, silent and sneaky. It is all around me—coming for me. We transitioned into a “new normalcy” over the summer, and in came all those who waited and all those who drank—drowning their own sorrows of loss. It is coming again, only bigger. Suffering. We all are in different ways right now, but we must unify and create hope, and we will emerge stronger. Vulnerable populations will continue to die; our beds will continue to disproportionately fill with Navajos, the elderly and infirm with their deaths preceded by a stifling loneliness of isolation in SNFs, and the homeless, our societal failures magnified. It is an alarming reality if chosen to be viewed. We must look with a steady and strong gaze and let our leaders see this too: These lives matter. Let the impetus to change be the light pulling us forward through this darkness. Erin Philpott is an internal medicine physician. This article reflects the views of the author and not of her organization. Source
