Time to Feel: thoughts from the COVID front line

How’s it going in the hospital?

That’s probably the question I get asked the most from people who don’t work in the hospital. When I hear it, I think about what the subtext is. I think most people really want to ask, Is it as bad as they say on TV? or Is everyone just dying? But, maybe they want to know if our lunch menu in the physicians’ lounge has changed (it hasn’t: individually wrapped hamburgers/veggie burgers or ham and cheese sandwiches). Maybe they are worried about our personal protective equipment stock (still shaky, but seems to be stable). Maybe there is an underlying concern about my fellow healthcare workers getting sick (just handful, thank goodness). It’s just such a vague question, I’m not really sure how to answer it most days. I typically think they are interested in knowing if our numbers are dropping off (they aren’t) or picking up (just steady), and I say so. I comment on how we’re all just going “day by day.” I finish it off with a positive quip, so as not to leave a bitter taste in their mouths.

The truth: I don’t know how to feel, because I don’t have time to feel. Rather, I haven’t afforded myself the time to feel.

I hate wearing a mask all day, my left nostril plugs up due to a deviated septum. I am tired of eye protection, it fogs up most of the time and bleach stains create a Jackson Pollock effect on the plastic lenses. I don’t mind wearing scrubs, but I’m ticked off that people keep taking the hospital ones home, so I’ve had to buy my own and wash them daily. I know the nurses do this on the regular, but I haven’t had a real day off since March 15, 2020. I’ve rounded — either in person or virtually — every day since then. That’s a lot of pants to wash, and I just can’t keep up.

I can’t wear make-up anymore, which initially was terrifying but now is just freeing. Foundation gets on your N95, and then it can’t be sterilized by the Utraviolet machine. I’d rather show some crows feet and skin blotches than go without a mask. With all the stuff we have to wear, it’s a wonder we can recognize each other at all. The tops of my ears are rubbed raw from wearing a mask all day. Some kind souls have created nifty little strips with buttons to off-load those elastic straps, and they are a life saver.

I loathe not having an armamentarium of medications at my disposal. As an infectious diseases physician, I’m used to having my pick of antibiotics to work with. Now, it’s oxygen, an incentive spirometer (I.S.) to practice breathing deeply, and low dose steroids. We give some unstudied cocktails that we hope offer some chance to dampen the immune response to this tiny virus. Mostly I sit on my hands, remembering the wise words of a former attending: Don’t just do something, Stand there. Sometimes, we in ID need to be examples of patience — trust the body, give it time. We have to quell other well-meaning physicians to not pile more and more vitamins and theories on.

I’m excited to be a part of this fascinating time, and my life will most certainly be divided into doctoring BC and AC — Before and After COVID. It is interesting to revisit the clotting cascade and understand why these patients seem to develop blood clots in front of our eyes. I am amazed at how critical care has changed in the 14 years since I was last in charge of an intensive care unit (ICU). I’m honored to be a source of encouragement daily, as I congratulate a patient when he can successfully suck in and hit 2500 on the I.S. I’m blessed to stand in the line of staff that clap as a recovered COVID+ patient gets wheeled to the back door to meet family they haven’t seen in weeks.

I love that medicine has regained its team mentality. In training, you’re always surrounded by a team — interns and residents together, an attending there for guidance, medical students to teach. Then you graduate and it’s every doc for herself. Now, we talk daily about the latest article, we email protocols and share what a colleague on one of the coasts is doing. We banter back and forth about whether to decrease steroids or increase aspirin. It mostly feels like we are just moving the puzzle pieces around, not making much progress until magically — and it really is like magic — one day it just works. The patient just doesn’t need oxygen anymore. He gets up and walks to the bathroom without any shortness of breath. It’s then that we realize that we’re really just there to cheer him on every day, offering words of encouragement, until his body is ready.

We’ve seen some deaths. More than that, though, we’ve been amazed and surprised that more have recovered when we had all but lost hope. And I have been in awe of my fellow doctors, the nurses and aides, house keepers, food handlers, maintenance and security. I saw the ICU nurse cry when her patient that she kept vigil over was extubated and finally able to smile. The bravery of the phlebotomists and imaging techs, who plug away and go in room after room, because they have a skill that no one else has. I am proud every single day to be with that work family. I’m honored to answer their late-night texts about low grade fevers and concerns about loved ones. I’m humbled to order COVID tests on them and offer the appropriate emoji when the results are in. I’m fiercely protective of them when supplies run short, and we need to conserve.

And I mourn my dear friend who I lost on March 23, one of our first COVID-related deaths, and the one that still stings the most. I don’t dare give myself time to feel that one. Not yet. In my head, she’s at home, playing with her dogs and riding out this virus until she gets the all clear from her asthma doctor to return. Things will never return to normal for me, because my friend is gone. When the face masks aren’t needed, when schools are reopened, I’ll still have an empty chair next to me in the ICU every morning. But, until that day, I will choose to feel hope and joy and strength and peace, feelings that can carry all of us through to another day.