What We Owe Them
A Tribute to the Victims of COVID-19
bY Dr.Eileen Harrigan
My name is Eileen and I'm a doctor in the neurology department of a Manhattan hospital. Recently, though, I'm mostly a covid doctor. Last month, I was "redeployed" to our Emergency Department. I'll try to not be hyperbolic, but those shifts honestly felt like a nightmare. Even on a good day the stress level in the ER is usually high but that part of the hospital in early April was really unlike anything I'd ever seen. Patient after patient kept coming in gasping for breath, scared and alone. They lined the hallways, on oxygen, sick and crying out for help. We did "oxygen rounds" every few hours where we walked around checking oxygen tanks. Each time, we found patients with empty tanks and critically low oxygen. It was impossible to know how long their oxygen had been in the 70s, or how much longer they could sustain that level. Each time, I swore it wouldn’t happen again, but it did. I guess it was nobody's fault, but it was also everybody’s fault. We just couldn’t keep up.
When a patient comes in, you first learn their story-- you hear their age, medical history and a summary of their current condition from the EMTs. One patient really stuck with me. A man in his 80s, diabetes, high blood pressure, asthma, obesity...called 911 for difficulty breathing. He's on maximum oxygen support and still with oxygen levels in the low 80s. A constellation of facts that amounts to only bad news. In cases like his, it's pretty obvious that whether we put him on a ventilator or not, he probably wouldn’t make it out of the hospital.
"Would you want to live on a ventilator even if you knew you would never come off?....If your heart stopped would you want chest compressions or would you want to be made comfortable?"
He was gasping for breath but still mentally clear. My supervisor and I approached him for a "goals of care" conversation--a discussion about how aggressively we should treat him. A checklist of questions that can sometimes seem so rote takes on new weight with each patient. "My name is Dr. Harrigan and I'm here to help you. We think you have the coronavirus that's been in the news. Your oxygen levels are very low right now and we're really worried about you. We can give you a breathing tube, but only if you want it. Is that something you've ever thought about before?" We talked about what that process entails. "Would you want to live on a ventilator even if you knew you would never come off?....If your heart stopped would you want chest compressions or would you want to be made comfortable?" His eyes were big with fear. He was still gasping for breath, asking for water. I never realized how thirsty patients feel when they're on so much oxygen. He was quiet for a few minutes but then looked me in the eye, "no tube." He didn't want a ventilator and he didn't want CPR. I asked if he understood this means he would most likely die in the next day or two. He knew. I asked if he wanted me to call anyone. He uttered a name, his daughter's.
A 5 AM call I hope I never get. "Hi my name is Dr. Harrigan and I'm calling from the hospital. I'm sorry to wake you but unfortunately I have some bad news...." She asked to talk to her dad. I stood there as they spoke on speaker. I held the phone to my patient's ear, trying to drown out the hiss of the oxygen, the humming and beeping of the department. They exchanged "I love yous" for what felt like hours. There was a lot of silence. They would never say goodbye in person. I'm a little embarrassed to say I cried with them.
A few minutes later, the next patient rolled in and needed our help. Dry your eyes, learn a new patient story. Give them oxygen, hope they get better. It's a tiring but predictable exercise.
A lot of people are calling what we're doing a "war." We're described in military terms--as troops on the frontline of the battle against COVID-19. In some sense it feels like an apt metaphor. We're surrounded by unimaginable pain, facing a trauma I never could have prepared for. An overwhelming burden of death and suffering surrounds us. Ultimately, though, our purpose is to care for the sick. We have trained to treat illness, but we’ve also trained to provide comfort. It’s our job to adjust the ventilator settings and change medication doses, but it's also fully our job to provide our patients with a softness that makes them feel cared for. I don't know which of these two things is more important.
It's been hard recently to practice medicine the way I want to. Every minute in a COVID patient's room confers more risk to me & there's a lot to lose. We stand squarely inside the conflict of providing compassionate care and making it out of the room without an exposure. We see this fear play out in visitation policies. No families or guests are allowed in the hospital, period. Patients spend some of the scariest days of their lives alone. Families spend some of the most painful days worrying in the dark, waiting for the singular daily update from their doctors. If they're lucky we'll have time to videochat with them and the patient. Some families just want to see their loved one, even if they're unresponsive in the ICU. Some families tell stories or sing, hoping to penetrate the haze of sedatives. So many families say goodbye over a shaky connection, their doctor holding the phone, intruding on their most private, sacred moments. I can't help but cry while I stand there, listening to prayers in a language I don't understand. It feels like an invasion. The pain never needs translating.
Processing this whole experience has been really hard. I’ve tried to keep myself busy for the most part, and control my intake of the news, because I’m sure we all know that sometimes it’s just too much. I started learning ukulele and weaving on a loom--something creative to keep me distracted. I play an audiobook or podcast in the background; I've been listening to a lot of comedy. I try to workout and cook when that feels good to me, which it usually does. But eventually I also have had to set aside time to just reflect and feel it all. Sometimes honestly, I just sit on the couch and feel sad. But I think that's a necessary part of me just processing it all. There's just no way around the heaviness.
I've had a lot of friends asking what they can do to help & I think it's actually very simple. We need to stay home! And we need to be generous to one another. In a lot of ways these are one and the same. This whole situation has shown me how vulnerable we all are, and how desperately we need to protect each other right now. I’ve been really disappointed to see protests in favor of reopening, and it’s been really tough to go out and see people ignoring social distancing guidelines, not wearing masks, etc. I know it’s all getting really hard. I miss my friends and family, miss doing regular things. I’m scared about the economy and all the downstream effects. But we’re just not ready yet. We still have so many vulnerable people to protect and so, so much to lose. We’ve already lost thousands of patients to this disease. I don’t know how many lives our hospital staff has lost to COVID at this point, but I know it is too many. I know that the count includes a brilliant and talented Emergency Medicine doctor, who surrendered her life in suicide in the wake of the trauma. Tragic and preventable deaths, may they all rest in power. We owe them all more.