COVID fatigue on the front lines: A personal story
Perhaps no one is more anxious for the pandemic to end than doctors, nurses and other medical personnel
As the world marks the second anniversary of the first reported case of COVID-19 and the threat of a new, more transmissible variant, fatigue in the battle against the virus is all too understandable and common.
But, while politicians and some anti-vaccine advocates have declared that “Real America is done with COVID” or a hoax, the roughly 750,000 Americans who tested positive last week would beg to differ. (To put some perspective on that number, that’s about the same number of people as packed into NFL stadiums last weekend.)
Perhaps no one is more anxious for the pandemic to end — and more appreciative of our work to make that happen — than the doctors, nurses, and other medical personnel who have to deal with the consequences every day, one patient after another.
My brother, Craig, has been one of those people from nearly the beginning. He is a lung specialist, an epidemiologist, and a professor at the University of Minnesota’s medical school. He’s also a leader of one of the largest Intensive Care Unit (ICU) systems in the Upper Midwest, and one of the organizers of Minnesota’s program for — he won’t use the word, but I will — rationing beds in hospitals throughout the state.
Recently, Minnesota has had the highest number of new COVID cases, per capita, in the country, though Craig tells me that “Michigan now appears to be taking the lead.” My brother has always been astonishingly even-keeled, which he has to be, given that a third of his ICU patients don’t make it out alive. But, in recent conversations, I can sense his frustration with the situation.
“Outside of the hospital, you’d barely know there’s a crisis going on. Hardly anyone wears masks. The governor doesn’t have the political capital to order a shutdown or any sort of mandate.
But, inside, it’s as bad as it’s ever been.”
I’ve recently talked to him about the details of his work. Here are a few snippets of those talks, including descriptions of problems you don’t hear about much in the news, but which illustrate the need to keep plugging away.
The Grim Math of Hospital Bed Availability
Pandemic-speak phrases like “flatten the curve” are abstractions for most people. And, while it doesn’t take a genius to know that running out of hospital beds is bad, it’s not so easy to understand why COVID makes the problem so acute and dangerous. My brother laid out the math for me:
“Take a hospital that has 12 ICU beds.
Normally, three of those beds are taken up by people on ventilators. They’ll be there for 3–5 days and either die or get healthy enough to be moved out of the ICU, maybe eventually to a longer-term care facility. Another six or so are taken by people suffering from other illnesses like severe infections, bleeding or after major surgery. They, too, usually can be moved out in a few days or, if they worsen, they become one of those on a ventilator. That leaves three unused beds that are available for unpredictable surges that happen every few days.
The thing with COVID is that we can keep people with bad cases alive for a long time, but they’re not leaving if they’re on a ventilator. So, now, we’ve got COVID patients on ventilators for 2–3 weeks at a time and they’re stacking up. Instead of three beds taken up by ventilator patients, there are now nine. And, because people are still getting severe infections or other pneumonias, etc., there are still six people coming in every few days needing ICU care, but only three beds for them.
Every day, our hospital system has to say ‘no’ to many many transfer requests from hospitals within a radius of several hundred miles. And every other large hospital system is doing the same.”
The Uncounted Death Toll
“There was a patient who suffered a blood vessel rupture.
Surgery within two hours of the rupture usually is successful. He made it to the nearest Emergency Room in time. But, while the facility had a surgeon and operating room to do the procedure, it had no post-op ICU bed to care for him.
So, the hospital had to call around to other area hospitals. But, while he was being driven across town in an ambulance, he went into cardiac arrest. By the time he made it to us, it was too late.
That fatality won’t be counted in the official COVID death toll. Nor will the people who died at home of sepsis and the like because they were understandably afraid of coming to the Emergency Room for fear of catching COVID.”
The Missing Silver Lining
My brother’s research specialty is figuring out the best methods for helping patients recover from major lung problems, especially weaning them off of ventilators. (One of his recent papers was on the therapeutic value of letting patients hear self-selected music to enable them to get through the agony.)
Historically, one of the challenges for his research has been finding enough patients to participate. So, in the hope of finding a silver lining to the pandemic, I suggested to him that “now that there are so many patients on ventilators, it must be easier to do your research.”
He replied, “actually, it’s worse.
For my studies, you need to check in with patients at least three times a day. You need to get real close to them, a foot or less away, and make precise measurements about their breathing, pain levels, and so on.
There’s no way to do that safely with COVID patients, no matter how geared up you are in masks and gowns. It would be unethical to ask my research assistants to do that. So, since COVID patients are taking up most of the ICU beds, there are fewer non-COVID patients that we could enroll in our studies.”
The Strained Line of Communication
“One of the most important and difficult things doctors and nurses have to do is be a liaison between the patient — who, if they’re in our ICU, is often unconscious or in a lot of pain — and their understandably anxious relatives and friends.
Under normal circumstances, I’ll check in on each patient several times a day, talking to them (if they’re able) about how they’re doing and relaying their loved ones’ thoughts. And, in many cases, some of the visitors can come to the ICU, communicate directly with the patients, if nothing more than holding their hand or singing their favorite songs. And then I can talk directly to family members about important things.
With COVID patients, you never see the family — they’re not allowed in the hospital until more than 20 days after admission. And, with all of the PPE gear I have to wear, it’s harder for me to get nearly as good a sense of what the patients are feeling or want. That makes my talking to the relatives over the phone even more difficult; I simply don’t have as much to say. I can’t answer their questions as well. And that’s really stressful for everyone.
We have internet-connected iPads pointed at the patient’s bed. Families can view their loved one from their home computer and hear the monitors beeping and the alarms chiming. That’s hardly a therapeutic interaction.”
The Shrinking Will To Go On
I’ll add something my brother won’t talk about much.
Doctors and nurses are supposed to be prepared for unusual situations. During his years as a med school student, intern, and resident, Craig worked what was then the standard 100+ hours per week, including 30+ hour shifts, so that, when he was making the final call on life-and-death situations in harrowing situations, he’d have some idea of what to expect.
But my brother isn’t twenty-something anymore. Nor are most doctors and nurses; pre-pandemic, doctors’ average age was about 51, nurses averaged about 49.
And that now-long-ago training didn’t prepare them for two-plus years of crises, including the psychological whiplash caused by rising and falling waves with each new variant. It’s no surprise that few doctors these days talk about continuing to practice in their old age, like our grandfather, who was still going at the age of 88. And who can blame nurses for being a big part of the “Great Resignation”; about one-sixth of medical workers have quit their jobs since February 2020.
That trend spells disaster for the post-COVID world. With our country’s aging population, we’ll need more doctors, nurses, and technicians in the near future, not fewer. The best-laid plans to provide more and better health care to all Americans will be devastated by a shortage of people to provide those services. Either those services won’t be provided or we’ll have to spend much more than anticipated to train new providers and/or pay more to keep the current ones working.
So, consider that one more reason to do what it takes to declare a real victory against COVID for all Americans ASAP.
