There will be no sit-down rounds before seeing the COVID patients today. As I enter the Medical Intensive Care Unit (MICU), a COVID patient is crashing and needs to be intubated. The halls that had previously been filled with families visiting their loved ones and greeting the nurses and doctors are now crowded with the empty “COVID suits” that health-care workers must put on before they visit COVID patients. The ghostly silhouettes of these strange outfits remind us of what we are fighting. I quickly put on my gear: hospital-issued scrubs, a hazmat suit, two sets of gloves, an N95 mask, goggles, a face shield, and a cap. Equipment that used to be readily available is now rationed to me only upon request.
But this first patient needs to be intubated, so I switch to my powered air-purifying respiratory unit—a helmet connected to a machine that supplies purified air—hoping it will work today and not fog up on me. Someone looks me over to make sure I’m as protected as I can be before I go into the patient’s room.
Meds, bougie, endotracheal tube, C-Mac, oral airway, oxygen-saturation level on the monitor. The intubation is successful, but the dread persists: Will this COVID patient survive? There are moments when this all feels like pantomime. We do what we are supposed to do, walk the stage, say our lines. But the reality is that, even if we hit our marks, many of our patients will not survive. I have COVID fatigue.
I spend the next two hours stabilizing the patient, hoping that everything we do will give him a better chance of living till the next day. I prepare for more procedures with another sterile layer to protect the patient, a third set of gloves on top of the two I was already wearing. I squeeze my fingers to help with circulation before I start my procedures. Sweat runs down my back from the layers of PPE, the hazmat suit, and the warmth of the room. My goggles and PAPR keep fogging up as I try not to stick myself with the needle.
I work in the Medical Intensive Care Center at the University Medical Center in Lubbock, Texas. The death rate in this part of the state is among the highest in the nation. To date, Lubbock County, whose total population is just over 310,000, has had more than 42,900 cases of COVID-19 and more than 570 deaths. I have been caring for critically ill COVID-19 patients since last March.
Since I’m already gowned up, I continue doing my in-person rounds. The team waits outside the room to notify me of overnight changes, phone updates, or alarming labs before I enter a patient’s room. (I will go over each individual patient’s data again later this evening on my own, in the quiet of my office.) Every time I finish with a patient and exit his or her room, one of my staff sprays me down with an antiviral solution. I gently scold the nurse to wear her goggles before she sprays me down—the staff know my feelings about how important it is for them to protect themselves. Then I move on to the next room. I enter each room with a heavy heart. I have to be careful not to pull the IVs running across the room, the ventilator cord connected to the control panel outside, the hoses from the dialysis machine to the patient: it would spell disaster if any of these became disconnected. A game of MICU Twister, with high stakes. Finally, I make my way to the patient. Some patients are upright, some on their stomachs; almost all have an endotracheal tube coming out of their mouths. Most are sedated, some paralyzed. I touch, I examine, I talk to them. Can they hear me? I open the doors and shout questions at the nurses because they can’t hear me through my mask and the door of a negative-pressure room. Then I close the door again and continue assessing the patient.