What I’ve Learned Treating COVID-19: One Year Later
It has been one year since the World Health Organization declared that COVID-19 is a global pandemic. What a year it has been! So much has changed since then, and so much tragedy has occurred. Yet, out of this tragedy there has been good, and I pray and am hopeful that this good will far outshine the tragedy. And part of that good is how much I have learned and changed as a result of this global pandemic.
The Sickest Patients For Whom I’ve Ever Cared
As an intensivist, or critical care medicine specialist, I typically care for very sick patients. Those with COVID-19, however, have been the absolute sickest I have ever seen. They become frighteningly sick frighteningly quickly, and they stay frighteningly sick for a very long time. And — despite all the strides we have made in caring for these patients — many of them still end up dying. This experience will stay with me for a very long time.
COVID-19 Has Fostered A Lot Of Innovation
Given that this disease is brand new (“novel”) and we still don’t know everything we do and don’t know about it, caring for patients with COVID-19 has fostered a lot of innovation in healthcare. I rarely, if ever, thought of having patients with hypoxia, or low oxygen levels, sleep on their stomachs if they were not on a ventilator. I have done this routinely with COVID-19 patients.
Telehealth, a slowly growing segment of the healthcare sector before COVID, has absolutely exploded as a result of the pandemic. I myself helped care for COVID-19 ICU patients using telehealth all across the country during the pandemic. I continue to do so now, and I think Telehealth is here to stay for the long-term.
COVID-19 Has Further Emphasized The Critical Importance of Evidence-Based Medicine
Even though the sheer scale of the global pandemic has helped foster innovation, it has also completely solidified the critical importance of having good, solid evidence behind the treatments we administer to our patients. Before the pandemic, whenever a colleague would tell me, “What’s the evidence?” behind this or that treatment — such as vitamin C for septic shock — I would roll my eyes at them. After COVID, however, I am now a deeply devout believer in evidence-based medicine.
Take hydroxychloroquine for COVID-19, for example. Based on a very small, poorly conducted trial, everyone started using it to treat patients with COVID-19. It had very fervent believers. Once good trials were conducted, however, it turned out that it did not help and may have actually hurt patients. The same is true for other treatments as well.
This COVID-19 pandemic has taught me that good, solid evidence from well-conducted clinical studies is essential before widespread adoption of a particular treatment is recommended, no matter how “logical” that treatment may seem, including proning awake patients I mentioned above. Otherwise, we will have absolutely no idea if a treatment we are administering actually works or not, and we may be actually harming patients without even knowing it.
My Skills As An Intensivist Have Dramatically Improved
Caring for patients with COVID-19 has made me a much better intensivist. I have learned amazing things about the human body that I did not know before. For example, I have never seen patients with oxygen levels — previously thought to be not compatible with life — present to us with absolutely no symptoms of shortness of breath.
Before COVID, I had never seen patients with oxygen levels as low as 0 not suffer cardiac arrest. Taking care of COVID-19 patients has further strengthened my skills with mechanical ventilation, fluid management, pathophysiology, and the like. As a result, I am much better equipped to manage patients with all kinds of critical illnesses in the future.
I Will Never Take PPE For Granted Again
I am ashamed to admit that, before COVID-19, I took PPE, or “personal protective equipment,” for granted. I would grumble if I had to wear gowns and gloves and the like if I had to see a patient in contact isolation for a specific infection.
COVID-19 has taught me that this PPE is there to save my life. Yes, now I am vaccinated and protected — God willing — against COVID-19. But those vaccines only came on the scene after almost a year of this scourge.
Before vaccines, all we had were the gloves, masks, gowns, goggles, and other equipment to protect us from this strange, new disease that had the potential to kill us or, worse, kill our families if we brought it home to them. And, for the most part, that PPE worked very well to protect us from getting this disease. Forever more, PPE is my friend. In fact, I don’t think I will abandon wearing a mask at work for the rest of my career.
COVID Will Leave Lasting Effects On Clinicians Worldwide
As I said before, as an intensivist I am used to seeing very sick patients. I am used to seeing patients die. Never before, however, have I seen the scale of devastation like that wrought by COVID-19. Never before have I seen this amount of death from one single illness.
And many of those patients, tragically, had to die alone with no family at their side. This was devastating to watch over and over and over again. I couldn’t even imagine not being at my daughter’s bedside as she took her last breath. Yet, this happened to patients succumbing to COVID-19 over and over again.
Every one of us has had a moment when we couldn’t keep it in any longer and openly sobbed in the ICU or hospital. It happened to me relatively early on. I will never forget this experience for the rest of my life, not just for the rest of my career, and my heart will be forever scarred because of the experiences I have had caring for COVID patients.
Yet, I Still Care
Even though I will forever be affected by my experiences taking care of patients with COVID-19, there is a silver lining to my anguish. That silver lining is that I still care. I still have compassion, and the pandemic has not beaten it out of me completely. This is truly a wonderful thing.
Making Sure Patients Die On Their Own Terms
The experience of seeing so many patients with COVID-19 dying in the ICU has further emphasized the absolute importance of making sure our patients’ goals of care get discussed and followed in the ICU. None of us knows when we will die. None of us knows from what we will die.
Every single one of us, however, deserves to die on our own terms.
Every time I contemplate placing a patient on a ventilator — especially one with COVID — I ask the question of whether my patient wants to die on a machine, because that is what they may be facing with this disease. I work for the patient, and I don’t want to do anything beyond what is consistent with my patient’s values and wishes. Finding out what those values and wishes are is absolutely critical.
A lot has happened in the year since COVID-19 was declared a global pandemic. It seems that we are finally turning the corner against this horrible disease. A lot has changed, and we have all changed along with it. Hopefully, we have all changed for the better, and that change will help us do more good in the many years to come.