Life and Death in Quarantine: Part 4

Here we are again, right back to eerily similar circumstances to a year ago when we were mobilizing all resources to manage a winter COVID surge that was so much more devastating than anyone had anticipated.  This past week as we expanded the walls of the COVID unit yet again, cramming two beds into private rooms, counting the crash carts and oxygen tanks and N95s, transferring nurses from the orthopedic unit and ICU to cover the steady flow of COVID admissions, and making plans for allocation of resources under New Mexico's crisis standards of care, the thought on everyone's mind was, "Again?!"  How can we possibly be doing this all over again?  I don’t even know what to say. I don’t think anyone in healthcare right now knows what to say.  We’ve done so many things right with scientific research, controlled studies, developing treatment protocols, practicing collaborative care, rolling out the vaccine (and boosters), securing PPE, slowly opening and encouraging ongoing masking, and we still find ourselves faced with unmanageable and devastating circumstances.  

The virus is more contagious than earlier variants, and it will most likely continue to become more transmissible with every mutation.  Even though the death rate may be lower, especially among vaccinated people, greater contagion means more hospitalizations and more deaths, and it's hitting us at a time when everyone is eager to take their masks off, see their friends again, and have their wedding or party that was canceled in 2020.  In the hospital, things are dire as we struggle to treat both vaccinated and unvaccinated individuals, both of whom present different challenges, while facing our own biases and internal ethical dilemmas, and also struggling to keep up with the caseloads of sick people who didn't have the resources they needed to manage their comorbidities last year, individuals whose mental health and addiction problems have skyrocketed during the a pandemic, patients who are finally having their surgery that was canceled last year, elderly folks who were highly functional until the isolation of the pandemic made them take a turn for the worst, and marginalized individuals who lack access to services and transportation, making them even sicker than before the pandemic.  As I watched the team unsuccessfully attempt to resuscitate a COVID patient in his 40s last week, and intubate a woman in her 50s this week, I just felt numb.  How are we still doing this, almost two years later?  

Another day in the life

However, it's not the same as last year.  It's not even close.  Because now everyone is overwhelmed, and burned out, and angry.  There's a collective sense of knowing that this was entirely preventable, with vaccines and masking and testing, and it makes it really challenging to deliver compassionate care day after day.  We make up our minds every day to not blame individuals.  Most of our underlying problems are systemic and structural, issues with access to information, health literacy, systems to encourage the right behaviors, modeling, public health infrastructure, politicians turning public health issues into political divisions, transportation gaps, inequalities in prisons and institutions, and the list goes on.  But it's hard to not blame the unvaccinated, specifically those with access to healthcare and transportation, who have the opportunity to get vaccinated and chose not to.  One year ago this week I got my first dose, and I remember how incredibly excited and proud I was, and how even more grateful and hopeful I felt when it became available to more and more of my friends and community.  Never in a million years did I think that people who choose NOT to get it.  The selfishness, the irrationality, the blatant disregard for community and humanity is just completely beyond my understanding.  How is it that humans have the tools to outsmart a virus but they choose not to?  It’s like a really dark and obscure dystopian story, so far fetched that it would be funny if it weren’t 100% true and happening right now.

I'm heartbroken for the young kids who lose a parent because the parent didn't think people in their 30s needed to be vaccinated.  I'm so angry at the grandchildren who gathered together in person on Thanksgiving without getting tested first, resulting in their elderly grandfather becoming seriously ill.  I watch helplessly as the 40-year-old who had a major heart attack from COVID is not going to get the cardiac management he needs because he has COVID.  I hold back tears as the 85-year-old man in the car accident who incidentally tested positive for COVID continuously asks for his wife, unaware that his wife already died of COVID in the room next door.  So many people die alone, or, if they're lucky, with their family watching over Zoom on an iPad.  Not to mention the hundreds of people who aren't getting the rehab services, mental health counseling, substance abuse recovery, or other care they desperately need because they tested positive and their discharge options are limited.  This is only going to get worse as Omicron takes its toll.  Cancer patients are going to have delayed care, highly important planned surgeries will be on hold once again, patients will be writhing in pain in the emergency department because their diagnosis will not be as urgent as a critically ill COVID patient, and people in car accidents or those who have a stroke will not receive acceptable quality of care because there just aren't enough resources to go around.

I still mourn every death of my patients.  I reflect on that person's life and on their legacy.  I acknowledge the tragedy that is the loss of each individual life.  But I also find myself putting up a barrier.  Distancing myself from it.  Being at the bedside of someone who is dying without being fully present, or going through the motions of assisting with post-mortem care without getting too attached to the human body.  I see signs of compassion fatigue trickling in, and I am defending myself against burnout by separating myself from what is happening.  I think it's a defense mechanism that everyone in healthcare adapts because we just don't have the capacity for endless empathy.  I know doctors who are moving to another country.  I know nurses who are changing careers for good.  I know countless healthcare workers, counselors, and teachers who are retiring early because they can’t do this for another year.  And I also hope that every death is not in vain, that another death from COVID will convince somebody to get vaccinated or to wear a mask, or will teach someone that no one is immune from the pandemic's impact. 

 

The ever-evolving wall of the unit, moving on up once again

I think we're all at a juncture at which we're growing more aware that COVID is here to stay for the foreseeable future, and we have to find a balance between keeping our families safe while still living our lives and doing the things that bring us fulfillment.  Attending concerts and dining in are accessible options, but we need to have vaccine mandates and adequate ventilation.  Travel is safe if everyone is fully vaccinated, takes a test before getting on a plane, and focuses on outdoor activities on vacation with social distancing.  Consider traveling to places with strict travel requirements.  Have your wedding or memorial service or party, but do it outside, and allow your unvaccinated guests to watch online remotely.  Celebrate Christmas together, but take a rapid test before you go, and wear a mask to hug your elderly relatives or small babies.  If you haven't gotten your booster, get it now.  Let your kids play together, but don't allow them to be indoors with unvaccinated adults.  There is a high quality of life that is accessible to us all if we can all agree that living in a community and interacting with other humans requires adopting a certain degree of order and sacrificing a small degree of personal freedom.  (Hint: it's not a new concept.)

Christmas-ready

There is a path forward, and it calls for a >90% vaccination rate, readily available test kits to administer before any gathering, and vigilant masking in all public places.  It's not about individual illnesses but about public health initiatives to stop the spread and save our communities.  We are equipped with the tools to get through the next few months, but we have to work together.  And most of all, we have to remind ourselves of what's important and let go of the things that no longer matter, and recognize that our kids aren't missing out on anything but are learning and discovering in new ways.  We will never return to "normal" again but we can have a beautiful and rewarding "new normalcy" if we work together.

Vaccinated and proud!