I could be the last person some of these patients see or the last voice they hear. Many people will never detach from the fan. This is the reality of this virus. I force myself to think about it for a few seconds each time I enter the intensive care unit to intubate.
It’s all my work now. Airway. Coronavirus respiratory tract. I work 14 hours a night and six nights a week. When patients aren’t getting enough oxygen, I put a tube in their airways so we can put them on a vent. It gives them time to fight the virus. It is also probably the most dangerous procedure a doctor can do when it comes to personal exposure. I get a few inches closer to the patient’s face. I lean toward the mouth, place my fingers on the gums, open the airways. All it takes is a cough. A gag. If something goes wrong, you can have a room full of viruses.
About this series
The Voice of the Pandemic is an oral history of covid-19 and those affected.
So there is a possibility that I will get sick. Maybe a probability. I do not know. I have my own underlying condition regarding this virus, but I try not to dwell on it.
Until a few weeks ago, I was the anesthesiologist that people saw when they had babies. I would do five to seven deliveries a day, mostly cesareans and epidurals. We are a large state hospital at the University of Illinois at Chicago, and we end up having a bunch of high-risk deliveries. You are trained to be the quietest person in the room. They teach us, “Don’t just rely on medication to calm a person. Use your voice, your eye contact, your whole attitude. We give people positive ideas and expectations. It sounds cheesy, but it works.
Our team had a meeting on March 16 to develop a staffing plan, once it was clear where it was going. Chicago is becoming a hot spot now. Our intensive care unit is almost full of coveted patients. The pediatric ICU has been cleaned to manage the overflow. The wave is just beginning, and we need to limit our exposure or we will run out of staff. Everyone agreed that we should devote one person to convection for intubation during the day and another at night, and I started to think: I’m 33 years old. I have no children at home. I don’t live with older parents. About an hour after the meeting, I emailed my supervisor. “I’m happy to do this. That should be me.
Now my pager goes off all night. Nine, midnight, 2 a.m. and then again at 3:30 p.m. Most of the time, I do several airways during a shift. Next week or the week after, they say it could be 10.
It is a common procedure. Intubations are routine for us, at least most of the time. You can be in and out of the airways in 10 or 15 seconds if all goes well. But when you’re dealing with a patient who isn’t getting enough oxygen – which is everyone at this point – every second becomes crucial. As soon as I get the page in my call room, I take my medicine backpack and my gym bag and run down the stairs. We don’t have time to wait for the elevator. I go on two floors to the ICU and get into my protective equipment outside the room: mask, face shield, hood, secondary hood, personal air filter, gown, two sets of disinfected gloves. I hit everything together because the dress got up a few times and exposed my wrists. There are so many opportunities to get infected. I’m monitoring my heart rate and it goes from 58 to 130 by the time I enter the ICU. I am stressed and rushed and hot inside the protective gear. I try not to show it.
I was shocked at times when I entered and saw the patients. Most of those I intubated are young people – 30, 40, 50 years old. These are people who entered the emergency room because they were coughing a day or two or sometimes hours ago. By the time I enter the room, they are in severe respiratory distress. Their oxygen level could be 70 or 80% instead of 100, which is alarming. They take 40 breaths per minute when they should take 12 or 14. They have no oxygen reserves. They are pale and exhausted. It puts them in a mental fog, and sometimes they can’t hear me when I introduce myself. Some are panicked and gasping. Others mumble or are inconsistent. Last week, a patient was crying and asking to use my phone to be able to call his family and say goodbye, but their oxygen levels were going down, and we didn’t have time, and I couldn’t risk bringing my phone and infecting it with the virus, and everything was impossible. I continued to apologize. I come -. I do not know. I have to find a way to keep it together to do this job. I sometimes tear myself apart, and if I do, it can cloud my face shield.
The first thing I do is pull up a stool and get down to their level in bed. Most of the time, the look in their eyes is fear. But sometimes, honestly, it’s a relief, like, “Thank goodness. I can’t do this anymore. They don’t have the energy to be hysterical.
I put an oxygen mask on the patient and give him 100% oxygen for a few minutes. You want to charge them because they will not be able to breathe on their own. Then I give medicine to put them to sleep. We are trained to touch the lashes a bit to make sure they are down. Then I give a muscle relaxant and take a look in the airways for the vocal cords. With this virus, I see significant swelling of the upper airways, swelling of the tongue, a lot of secretion. When I start to put the tube on, it gives the virus the chance to release itself into the air. The patient’s airway is wide open at this point – no mask or anything. People can cough when the tube enters the trachea, a deep, powerful cough. My mask and hood can get covered in liquid. These are usually tiny droplets. The aerosol virus can float. You are basically right next to the nuclear reactor. I’m confident and quick, because if you miss it the first time, you have to do it again, and then you bring out a ton of virus.
Once I’m done, I will sometimes go back to the call room and do squats or lunges. I try to keep my lungs strong. It’s hard not to think about it because I’ve had severe asthma since I was a kid.
I use an inhaler twice a day. I am very in tune with my breathing, and each time I get sick, the first symptom is that I start to breathe. My whole family used to say to me, “Why are you volunteering for this?” What are you doing? My father and brother got a bunch of tools and built a Plexiglas intubation box based on a Taiwanese model. It rests above the patient’s face, like a shield to reduce your exposure. I haven’t been able to use it yet, but they are worried. They are trying to protect me.
Last week, I called to tell them about my end-of-life wishes. Then I sent them an email, just in case. I said, “If I’m going to be intubated, that’s fine. But if I suffer from liver and kidney failure, and if I have a cognitive impairment at that time, and if you can say that my body is failing and that I will not become again what I am … “Well . It was a difficult conversation. But I know how this virus can disappear.
Every night I try to go around with the ICU doctors to check on the patients I intubated. They are not allowed to have family or visitors. I’m not a religious person, but I like to sit outside for a minute and think about them and what they are going through. I’m trying to think of something positive – a positive expectation. Most of the time, they are oblivious to the vent, but every day for an hour or two, they receive what we call a sedation vacation, which means that we lower their medication so that we can check their level of consciousness basic and see how they do it by themselves. In other words, for a little while they might wake up.
They cannot speak with the tube, but I saw a few patients before I wrote messages on a piece of paper. “Wind? “Or:” Surgery? Or: “How much longer? “
Usually, before that, patients were ventilated for three to five days. We now see 14 to 21. Most of these people suffer from acute respiratory distress syndrome. There is inflammation, scar tissue, and a build-up of fluid in the lungs, so oxygen cannot diffuse easily. No matter how much oxygen you give them, it can’t get through. It’s never enough. Organs are very sensitive to low oxygen levels. First come kidney failure, then liver failure, then brain tissue is compromised. The immune systems stop working. There is a look that most people have, called mottling, where the skin becomes red and uneven when there are only a few hours left. We have a few at this point. Some have been converted to “do not rise again”.
Between intubations, I’m going to sit in my call room and watch the monitors. I can see all the vital signs of the patients and see how they are doing. We have had some success. A young patient came out of the vent earlier this week and has just been sent home. The staff at this hospital are incredible. Even so, it usually goes the other way. I’m looking at the monitor right now, and there is a patient who is not going to stay overnight. Three others tip over to the edge.
It’s a feeling of helplessness, watching someone die. The oxygen level goes down, the heart rate goes down, the blood pressure goes down. These patients die on the ventilator, and sometimes when they remove the body, the tube is still in the airways.
Learn more about Voices from the Pandemic
More coverage against coronaviruses
Coronavirus Newsletter: Subscribe to our Coronavirus Updates newsletter to follow the epidemic. All related stories in the newsletter are available for free.
How to Help: Your Community
FAQ: what you need to know about coronavirus