“As you know, his condition has been worsening dramatically over the past week. He is unable to breathe without the non-rebreather since last night. Today may be a good time for a goodbye visit.” I told the family of my COVID-19 positive patient who was DNR/DNI (Do not resuscitate/do not intubate). In my second year of residency in obstetrics and gynecology, I thought that the days of caring for a male patient were well behind me, let alone a male patient dying of a respiratory illness. With New York becoming the pandemic’s epicenter, I found myself eagerly volunteering for redeployment to the floors to help our internal medicine colleagues fight against the disease. During my rotation, I had treated mostly male patients; some required intubation, some required comfort measures, and a few were discharged. I soon realized that a big portion of my responsibility was having a conversation with patients and/or their families about intervention versus end-of-life care. In fact, for me, this was the most challenging aspect. My first two years as an OB/GYN resident had been mainly focused on managing obstetrical patients, but the transition from delivering life to facilitating its end had to be quick. I found myself invested in making sure that my patient’s wife paid him a goodbye visit, a fairly new rule that I had to effectively exploit at a time when most hospital visitations were not permitted yet. I also realized how deeply I can empathize with patients and their families, yet feel emotionally detached from the situation; an innate skill I am grateful to have and plan to utilize as I pursue gynecological oncology later in my career. After my redeployment came to an end as the virus spread started to slow down, I couldn’t but wonder who actually are the heroes in this fight? Are we really heroes for doing what we love, except now in a setting of a pandemic? Are we heroes because we save lives, except light is shed on it now only because there’s a pandemic? Yes, working in health care may be the ultimate form of heroism, but we’re heroes for choosing to go into the field in the first place. Some of the under-heroized are sanitary workers, delivery people, cab drivers, small business owners, etc. However, in this fight, the biggest heroes are the patients; what a scary experience it must have been for them! I can’t begin to fathom their thoughts and emotions as they struggled to breathe, got intubated, were on sedatives for weeks at a time, then woke up with utter disorientation. I am especially in awe of the pregnant woman who brought herself to the hospital with shortness of breath in an attempt to protect herself and her baby and woke up weeks later unsure of what spiraled. As I followed up with one of our patients in that situation, it was heartbreaking to hear that she was struggling with PTSD and panic attacks. It can be quite overwhelming to deal with postpartum emotions due to the hormonal changes after delivery, and how challenging the experience must have been for COVID-19 survivors in the context of such trauma. Perhaps, once we have a solid grasp of the medical management of COVID-19, light must be shed on the reality of the emotional consequences of the virus. I believe that every single person living in New York during these times has learned a thing or two about themselves and the world around them. I have learned that kindness is attractive and compassion can go a long way not only in my career but also in life in general. Even when we are unable to offer sympathy, we can always practice empathy. There is no better time to offer support to those around us. As a health care provider, I cannot wait to take on all the skills that I gathered during my COVID experience and utilize them in building the most durable relationships with my patients. Judy Hayek is an obstetrics-gynecology resident. Source
