COVID-19 has upended the medical community. Nowhere more so than in the intensive care unit. Life as an intensivist with two young children and a working spouse is never dull. I liken it to tight-rope walking with a pole for balance. I wake up every morning and balance the clinical responsibilities, teaching, reviewing journals, learning, school assignments, lunches, after school activities, bedtimes, repeat, repeat, repeat. The balance remains just about perfect, until one thing tips it and causes chaos. That thing can be as small as conjunctivitis. Or it can be a global pandemic. The latter has provided unprecedented challenges to parenting. After long, exhausting ICU days, I usually play catch-up with my post-call days—catch-up on emails, documentation, non-clinical duties, housework, errands, time with my kids. During COVID, these have become intense reading days. I am desperately combing through papers, anecdotal reports, anything that might help us do better for these patients. One afternoon, I had a higher-than-usual amount of reading given the current pandemic. “Umm, Mama? Can I have a snack?” “Yes, of course. I’ll just make you one.” Leave the laptop and commence snack-making, finish snack-making, return to laptop, try again to read Gattinoni’s paper regarding lung compliance in COVID pneumonia. “Indeed, the primary characteristics we are observing (confirmed by colleagues in other hospitals), is the dissoci-“ “Umm, Mama?” “Yes?” “Can you play with me? Alice won’t play with me.” “Not right now, Lucy. I need to do some reading. Play with your sister, and then I’ll come play with you in half an hour.” Cue sad face and dejected walk away. Return to the laptop. “Indeed, the primary characteristics we are observing (confirmed by colleagues in other hospitals), is the dissociation between their relatively well-preserved lung mechanics- “ “Umm, Mama?” This time, the eight year old needs something. “What is it now?” “I have a Zoom meeting with my class. Can you set it up? We are already 10 minutes late. Daddy is talking on a work meeting.” Shoot. Lost track of time with snack making. Locate the second laptop, begin to figure out where Zoom invitation is for the eight year old. Join the meeting; wave apologetically to her teacher. Check on three year old, thankfully happily playing by herself. Finally, some peace. “Indeed, the primary characteristics we are observing (confirmed by colleagues in other hospitals), is the dissociation between their relatively well-preserved lung mechanics and the severity of hypoxemia. As shown in our first 16 patients (Figure 1), th-“ “Umm, Mama?” I can feel the anger rising. I turn to face my three year old, ready to yell, to send her away. But her sweet face stares at me, and she has tears in her eyes. “Mama, my fairy’s wing broke. Can you fix it? Maybe after your work?” I feel my whole being soften. The innocence of my child strikes me. The world is literally upended around her, with every single facet different; but to her, the fairy’s wing is everything. I reassure her with a big hug and a promise to locate the superglue for her poor fairy. Honestly, the hug and reassurance was everything to me that day. It was a realization of how little control I have over the situation at hand. The constant interruptions. The responsibility of educating two children at home, while trying to work long, hard hours in the ICU. The stress my husband feels trying to “work from home” while I am at the hospital, holding meetings through the constant interruptions that he navigates with far more grace than I could. The ICU full of high acuity patients that had since spilled over into two additional surge ICUs. The stress of PPE with the realization that slipping up with PPE may mean infection. The adrenaline rush following every intubation: was I thorough enough in my doffing to avoid contamination? The nightly decontamination ritual, praying desperately that I don’t bring the virus home to my family. The mounting piles of housework and laundry and endless mess that comes from four people sharing a space and rarely leaving. The desperate combing through of literature trying to find ways to beat this virus, to offer hope to my poor patients. The Zoom meetings, all different permutations of healthcare professionals trying to bring some semblance of order to the entropy in front of us. The phone calls, texts, emails from colleagues around the world, asking for advice, for help, for solidarity in this time of great uncertainty of clinical knowledge. The nightmares, recurring, of not getting to the intubation fast enough. The often heard sound of ventilator alarms now intermittently creeping into my consciousness at home. And then, the broken fairy wing. Perhaps I needed to fix the fairy wing more than I realized. I stopped what I was doing. I put away my laptop. We carried the poor fairy to the counter and located the superglue. A minute later, and she was well on her way to recovery, and the tears had dried. We left the fairy to continue her healing and went to play. Gattinoni would have to wait. This phase of life is difficult for all of us. My realization has been that, as a mother and ICU physician, I will not be my most productive. I will not be my healthiest. I will be more apprehensive and anxious than normal. Sleep will be less than I usually get. All of our family will appear less well-groomed. My children will not learn as well at home with a working father and an intensivist mother as they do in their classrooms with their talented teachers. However, I can provide excellent-quality, evidence-based treatment to critically ill COVID-19 patients. I can prioritize the information overload to filter key studies and be confident in leaving much news and social media unread. I can show kindness and empathy to my coworkers. I can do my best to comfort patient family members by phone and video call. I can help with homework assignments and school work when I am able, and my children’s teachers understand our limitations. I can value rest and well-being on my days off. Most importantly, I can have the grace to embrace small moments and fix fairy wings with the ones most dear to me. I wish this grace for us all as we carry on in unprecedented times. Mary Jarzebowski is an anesthesiologist. Source
