Life and Death in Quarantine: Part 3

Here we are in month ten of the pandemic, now in the midst of a second or third wave that is so much worse than the first.  After getting through the initial surge of the virus, then adhering to masking and social distancing and staying home all summer and fall, I naively thought that we had succeeded in flattening the curve locally, so this new surge took me and many other healthcare providers by surprise.  I watched our COVID unit expand by four more rooms, then another four, then another 12, until it took over an entire wing of the hospital.  Then I watched private rooms become double rooms as we went over capacity.  I watched our ICU fill up with patients from other states, from pueblos and reservations in Arizona and New Mexico, and from towns 200-300 miles away because all of the hospitals in closer proximity were already full.  I watched multiple code blues happening simultaneously, wondering where we would get another crash cart if another code broke out.  I watched a physician declare someone dead, and wondered how many more times this week he would have to say those words, and whether he was grieving or feeling numb and detached by this point.  

I've worked with many patients who were discharged from the unit and thought to be on the road to recovery, only to be readmitted in a deteriorating condition.  I've helped patients set up Zoom calls with their families as they are isolated in the hospital for days or weeks, wondering if the family members grasp the severity of the situation when all they see is a face on a computer screen.  I have way too many patients stuck in the hospital longer than they should be because there are no nursing homes available to take them, or no safe place to quarantine, or no family members available to help out because they are all sick with the virus as well.  I have patients who can't go home because they don't have electricity and the generator overheated, or they don't have a working bathroom and they can't walk far enough to make it to the outhouse, or they warm their house with a wood-burning stove that isn't conducive to supplemental oxygen.  I've had patients younger than me succumb to COVID-19, and patients in their 90s recover, and I ponder all the things we still do not know about the virus.  I witness first-hand the wide disparities that exist in terms of access to resources and availability of healthcare to people who need it most.  And I lost count long ago of how many patients I've had this year who were in the hospital as a direct result of substance abuse, addiction, or mental illness.  

Back in the spring, I was part of conversations and policy development around determining who would receive care and triaging of patients in a crisis situation, but I never thought until this month that we would ever have to put these plans into action.  I never imaged that in the United States we would be faced with having to choose.  We are in the richest country in the world, and we are in a situation in which we do not have the resources to care for all the people who are sick.  Hospitals are beyond capacity.  Patients are being turned away to die at home.  Some rural areas have a greater rise in cases than New York did in the spring.

Earlier in the year there was this weird disconnect as the majority of Americans didn't personally know anyone affected, or if they did, they saw that person recover quickly, leading some people to believe that the virus was "not that bad."  Furthermore, because of the wide range of symptom presentations and disease severity in different populations, many people only have a mild presentation and do not require hospitalization.  This leads people to be noncompliant with recommendations and to believe that the benefits of resuming their normal lives outweigh the risks.  Our President didn't help with this.  Now, months later, I think more and more of us have a personal friend, colleague, or family member who is sick, so it's becoming more real for people, but the majority of people still don't have someone close to them who has died.  Most Americans only see the mild presentation, the people recovering at home, and not the critically ill individuals in the hospital.  Most sick people will recover from COVID-19 (although with long-term effects that are still largely unknown).  This is in contrast to previous pandemics in which entire populations were wiped out in a short period of time.  We are so fortunate that this pandemic is different from others in the past, but does this make people think they are invincible?

I hear people talking about statistics like "death rates" and "survival rates," which is further contributing to this tremendous gaslighting.  Statistics are irrelevant when it comes to human life, to human dignity, to human relationships and loss.  Statistics are harmful in the absence of personal stories.  We are often blind to the reality of situations that aren't directly in front of us.  One million deaths is a small percentage of the entire population, but 1 millions deaths is catastrophic to our civilization.  We don't talk about statics pertaining to other tragedies.  We don't say that or only __% of the population died in 9/11, in Afghanistan, in Hurricane Katrina, in a school shooting.  No, we mourn the terrible tragedy that is the loss of human life, especially when there are steps we can all take to mitigate the situation and bring down the death toll.

Outside of work, I worry about the increasing numbers of the virus in my community.  Every decision to leave the house or encounter another person runs a risk, and it's a daunting task to constantly have to decide what risks are worthwhile to the wellbeing of my family, and what risks just aren't worth it.  We are all looking for a quick and easy equation: do these things to stay healthy, avoid these things and you're safe from the virus.  We want to attribute sickness to a specific set of behaviors or actions, to blame the sick person and reassure ourselves that we won't make the same mistake, but we also know it's not that simple, and the ambiguity and unknown is the most anxiety-provoking aspect.  

The negligence of the federal government has created a situation in which individual behaviors and choices are guiding the direction of the pandemic, and it's an impossible situation for everyone.  Ordinary people are faced with the task of saving lives by masking and social distancing, and the balancing of individual freedom with public health is creating a worsening divide in our nation.  It doesn't help that misinformation is being widely disseminated, so many people don't know how to react.  It's completely unforgivable, in my book, that national leaders have failed to provide guidelines or oversight or to apply any of the scientific knowledge we now have into practice.  

I'm fortunate to live somewhere in which masking is the norm, and has been for months.  We've had a mask mandate, travel restrictions, and stay at home orders since the spring.  But there is definitely a sense of mask fatigue, and I am shocked to see pictures and videos from around the country of people going to crowded bars and restaurants, people gathering indoors without masks, people holding large weddings or social gatherings, and I am completely taken aback.  This is just a huge contrast to what I see and do every day, and I struggle to understand people's perspectives and priorities.

Hospitals throughout the region are beyond capacity, providers are burned out, mental illness is on the rise, and patients are being made to feel like a number rather than a human when we no longer have the time or the capacity for connection.  Everyone is fighting their own battles as COVID presses on unrelentingly month after month.

But I think in all of the chaos and the unknown, we are developing resiliency.  We are working together to rebuild our communities and to help other people, even when we think we have nothing left to give.  We're finding humor in the day to day moments and acknowledging this collective feeling that we're all in this together.  We're thinking about the stories we will tell our grandkids someday when they read about this in their history books.  And we hope that our family members will be lucky enough to survive and tell their stories too.

There are a lot of memorable moments working with patients in the COVID unit.  I've met individuals from all over the state and even from neighboring states.  I took care of two sisters who were sharing a room (two beds and two Bipap machines crammed into a single room) and held the hand of the big sister while the medical team attended to an emergency situation with her younger sister in the next bed.  I brought pumpkin pie to an especially sweet and childlike man on Thanksgiving Day.  I took a patient outside for the first time in weeks.  I watched many people take their first steps after being bedbound.  I've heard the stories that make each person unique.  None of my patients are just a number or a diagnosis. 

One final thought that helps me get through the day is the training in GRACE that I did with Roshi Joan Halifx, a program I attended and wrote about last year that helps healthcare providers to cultivate compassion through mindfulness.  GRACE entails gathering attention, recalling intention, attuning to self and others, considering what will serve, engaging and ending.  GRACE is my self care and it's how I can be present with suffering without getting burned out.  My colleagues and I ask each other, "Are you GRACE-ing today?"  

Image from the Santa Fe New Mexican, 11/25/2020

And finally a shout-out to the leaders at my organization who are saving this community day after day in the Frost 19