COVID-19 ICU Care

New Orleans, Critical Care Unit, April 2020

Sat, Apr 18, 6:07 AM (4 days ago) I feel a little bit like a man chasing a crawfish, as I struggle to find the right words to share about this experience. Perhaps I should just plunge in, risking a little bit of injury in my attempt to navigate the muddy swirl that are my thoughts. A feeling in my chest had been building for weeks. Having been at the ICU bedside for too many deaths to count, I knew what kind of suffering was being endured by patients, families, and healthcare workers alike to deal with the decimation that COVID-19 was causing in many areas. One day I found myself chatting with my friend Jill in Cleveland, who had been working on the ICU with their 16 ventilated COVID patients. She had just found out she was pregnant, and was torn between her desire to reduce her pregnancy risk versus doing her job. It turned out that was the last straw for me. I emailed Barb and Michelle that day to volunteer for any critical care needs that might arise, including out of state. I am still qualified and capable of caring for these patients, and if it means that I can reduce the risk for someone like my friend Jill, then it should happen. I’ve also seen the incredible life-or-death difference qualified nurses will make with these types of patients, and I couldn’t shake the feeling that I needed to be there. So I went. New Orleans was obviously shut down, and the ICU seemed like a madhouse with all the IV pumps outside the rooms with extension tubing creating a pathway on the floor to the patients’ beds. The previous two weeks, the ICU census had been five times its normal; unfortunately, they were ill prepared to know how to manage these very sick patients, and the first few weeks they had a 70-90% mortality rate for COVID patients who were intubated, ranging from a 25 year old to over 90 years old. Very little contact with family members occurred, as visitors were not allowed. Clustering of care was to the extreme, and almost every patient in the ICU was there for COVID. Many of the nurses were out. That first night, I worked with a 31-year old who had been extremely ill at home for fourteen days; he said he just sat in his little isolation room by himself, questioning whether this would be his end. He felt like he was dying, like he couldn’t breathe, but with the local hospitals completely overwhelmed he had no wish to go in. Across the street, all COVID patients in the ICU were blanket DNRs no matter their ages, and nurses entered the room twice per shift due to a lack of PPE. Three of the patients in my hallway died within the first few hours of my arrival. More died the next day, and the day after that, and the day after that. I took care of one to two patients at a time, on night shift; I told them that I had one purpose for being there, and it was to make them get better. After the rush of deaths, things started to improve. The residents were better at managing the patients. Traveling nurses from all over the country were brought there to help, most of them very experienced ICU nurses. The local staff were allowed to go home to rest, and those of us stepping in essentially winged it for the couple of weeks we were there. I experienced some consternation at the thought I could die like some of these souls. I planned everything out; if I started showing symptoms, I was immediately renting a car and driving to Utah where I could stage myself close to a hospital system I knew was prepared to effectively deal with COVID patients. Soon, however, those fears subsided. My patients improved little by little until extubation and transfer to the floor. Meals were donated by local restaurants to nurses across the city, so there was always plenty to eat even on night shift. I spent an evening jogging around the city, eventually ending up at the shuttered WWII National Museum. Outside, a memorial for the 88,000 airmen lost in the skies of WWII stands, representing a briefing of young pilots before a dangerous raid. Behind the pilots, the spirits of pilots already passed on stood and gave subtle guidance and comfort. I stood there at sunset, overcome with a feeling of gratitude for the bravery and goodness of mankind in times of distress. I stood at attention, bringing a slow salute to my brow in a moment of dedicated silence for the courage that so many have shown. These are the times that we muster up that piece within ourselves that craves meaning in the world around us; soon, we realize that we create that meaning ourselves, by reaching out and showing that we will make a difference for each other. So let’s make this the most meaningful time we have. ReplyReply allForward