Note: The author has received permission from the families involved to share the following anecdotes.
“Focus on all the positive that you have done. That is your entire mission statement — even if people die, you help them.”
I stared at my friend’s text, read it over and over, even as my tears fell and the words blurred. As an intensive care physician at UCLA Health and medical director of our ICU end-of-life program, I’ve agonized over the fact that COVID-19 has made me feel like I cannot live up to my own mission statement.
I received that text just a few weeks ago when we were at the height of the coronavirus pandemic in Los Angeles. Our quaternary care hospital has five adult ICUs and still, we’ve had to convert a regular medicine ward into an additional, makeshift ICU. We’ve expanded our usual two medical ICU teams to four teams, and we are rapidly burning through an elaborate backup system of critical care attending physicians.
The ICU feels like a battlefield, where we race from one disaster to the next to put out fires that just keep raging. Yes, we’ve seen triumphs, but the sheer volume of COVID-19 patients has overwhelmed any cause to celebrate and sadness is often all I can see.
Families delivering heartbreaking goodbyes to their dying loved ones via iPads have become familiar, but that doesn’t mean they’re ever any less jarring to witness. The number of deaths in one day in January was the same as the number of deaths we used to have in an entire week.
The sense of defeat has been palpable. There were many times when I felt a terrible need to cry but knew an emotional breakdown would take too much time and energy, and in this war, I have neither to spare.
But even as the next ICU day awaits me, stories from the past few weeks replay in my head.
I can’t stop thinking about the 40-something man who told me, “I can’t die like this. I just got engaged and have a 6-month-old baby.” I encouraged him to be positive, but that didn’t stop him from dying two weeks later after maximal aggressive care and a desperate attempt at cardiopulmonary resuscitation.
I will never forget trying to comfort the patient who learned that his wife and mother had both died of COVID-19 while he was hospitalized in our unit. When I had to put him on a ventilator a few days later, I cowardly asked my resident to call his children and tell them they should FaceTime with him while they still could. He didn’t survive, and his children lost their father, mother and grandmother in a span of just a few weeks.
I will never forget facilitating a phone call between a husband and wife who had been together since their teenage years. As I was setting up for his intubation, the wife said on speakerphone to her husband, “You don’t know this, but I just blew you a kiss,” and his last words to her were, “The kiss actually knocked my socks off. I love you.” After he died, she told me that the crematory was so backed up that it would take weeks before they got to him. She sobbed and said, “I asked them to put a blanket on him. I am worried that he will be so cold.”
I will never forget admitting a father and daughter at the same time for COVID-19 respiratory failure. When I learned that their family of five adults lived in a one-bedroom apartment, I was embarrassed to have asked about social distancing. I requested that they be placed in adjoining rooms, and in full personal protective equipment, I pushed the two ICU beds together so that the daughter could see her dying father one last time.
I will never forget a lung transplant patient’s final words as I was about to put a breathing tube down his windpipe: “I have faith in you guys.” His lung transplant had occurred less than a year ago, and regardless of how much faith he had in the medical field, he was denied the life he had fought so hard for.
“These stories, and so many more, have given me an appreciation not just for life but for the enormity of human suffering that comes with it. Death is not an unfamiliar occurrence in the ICU, but COVID deaths feel different — sometimes unnecessary and often profoundly unfair.”
These stories, and so many more, have given me an appreciation not just for life but for the enormity of human suffering that comes with it. Death is not an unfamiliar occurrence in the ICU, but COVID deaths feel different — sometimes unnecessary and often profoundly unfair. They say this virus does not discriminate, but I can assure you that is not true. It adversely affects the most vulnerable — those who can’t work from home, who can’t socially distance or who have chronic medical conditions.
Bearing witness to the triumphs and defeats of our ICU has taken its toll on all of the health care workers here. A patient’s recovery is our success, but a family’s loss is also our loss. I know I’m not alone when I say that these moments and experiences often enter my dreams or cause unrelenting insomnia. I know I’m not alone when I admit that I’ve had to double the dose of my antidepressant. I know I’m not alone when I say that a peaceful walk on a beautiful sunny day is often accompanied by a confusing myriad of emotions: relief that I’m away from the constant beeping of IV pumps and life support machines, envy that there are happy carefree people going about their lives, and guilt that I am not at a bedside putting out the flames that are engulfing our ICU.
There is no doubt that what we have witnessed and continue to witness will shape this entire generation of health care workers and how we practice for years to come. I can only hope that one day we will be able to look back and see these stories not as painful open wounds, but as well-healed battle scars.
Ask any one of my ICU colleagues and they will share their own heartbreaking stories ― stories that they will also never forget. And even more tragically, these stories will play out over and over again across this country if Americans don’t change their behaviors. My colleagues and I have fought many battles and will continue to do so, but this is not a war that health care workers can win alone. I know everyone in this country wants to get back to some sort of “normal.” I desperately want to believe in my own mission statement again.
We can’t go back and undo all the mistakes that we’ve made as a country or as individuals — mistakes that have contributed to the deaths of almost half a million Americans. As pandemic fatigue and desensitization to death spread, it is more important than ever for the nation to affirm and present a united, nonpartisan public health message.
Americans need to stop ignoring the realities of COVID-19 and take it seriously enough to protect not just themselves but the people around them. Wear a mask. Socially distance. Wash your hands. Be vigilant and kind. Take the vaccine when given the opportunity. Only then will we stop dying at unprecedented rates and start on the road back to recovery. Only then will health care workers be able to sleep through the night, take walks without guilt and go to work without bracing for another traumatizing day. Only then will our stories and their endings finally begin to change.
Thanh Neville, M.D., M.S.H.S., is an ICU physician and researcher at UCLA Health. She is also the medical director of UCLA Health’s 3 Wishes Program, an end-of-life initiative in which clinicians elicit and implement final wishes for dying patients and their families. For more from her, follow her on Twitter.