The novel coronavirus pandemic (COVID-19) has drastically increased the number of critically ill and dying patients presenting for hospitalized management of dyspnea, acute respiratory failure and other serious complications. The emergence and spread of SARS-CoV-2 has created unprecedented demands on all avenues of inpatient hospitalist medicine. One of the many services in high demand includes palliative care, with increased need for complex end of life planning.
In my home city of Washington, D.C., citizens have taken the changes brought on by COVID-19 very seriously; social distancing, masking and frequent hand hygiene are now routine. These days, I am startled when I see the bottom half of someone’s face out in public. Our homes have become our sanctuaries. In the hospital, however, much of our work continues unabated. Orders are written, notes are signed, lab work is drawn, imaging is performed. Housestaff are on the front lines with nurses, respiratory therapists and patient care technicians taking care of the sickest patients day-in, day-out.
Earlier in February of this year, before COVID-19’s onslaught in London, UK, I was covering service on a respiratory ward when a young medical student made herself known to the physician’s office. “Could I borrow your stethoscope? I’m here to practice my respiratory examinations.”
For the first time in history, a pandemic has shut down the entire globe. COVID-19 has affected our lives in many ways, including significantly impacting health care services. Many people, sensing an unseen danger looming in the air, have become increasingly afraid to visit their primary care physicians, and we are now discovering the catastrophic consequences of this delay.
This elderly yet jolly gentleman answers our unending questions about his physical health, but it is his question to us that makes me pause. Do I have time for a poem? This busy clinic day, I stop reflecting on why his heart stopped beating and instead what motivates his heart to beat in the first place.
No one had told her how difficult the fight after COVID would be. Of course, few in her community had lived to tell the tale. And then again, precious few people had expected her to survive at the ripe old age of 86.
In medical school, I was taught to sit at eye level when speaking to patients, ask how they would prefer to be addressed, and ask open-ended questions to allow them to express themselves. I learned to interject with “That must be really difficult for you,” or “I can only imagine how that makes you feel,” as a way to show empathy and foster better connection with patients.
I was appointed to do the morning shift in the COVID ward of our respected hospital. The unit is a negative pressure area and, to us doctors, it is comforting as we embark on the Icarus flight.
As I enter rooms filled with aerosolized forms of the coronavirus, realizing that I am at high risk of catching this highly contagious disease, I set aside my fears to hold the hands of patients — strangers and friends, all alike. I love what I do.
When I first met Rita, she didn’t make things easy. She fired a barrage of questions at me, punctuating her litany with the dreaded blow to every resident’s ego — “Are you a student?” — before slouching back on her bed, sweat glistening on her gray-streaked temples as though she had run a marathon.
As I check in on my patients each morning, I wonder if some will unexpectedly decompensate and die over the coming weeks. I think about myself and my co-residents who are in the hospital all day swabbing patients for COVID-19 without adequate personal protective equipment. Many of my co-residents are on home isolation as a result of this exposure, waiting for their test results and praying that our government will step up and fund more mask production, or civilians will return the N95s they’ve hoarded, or the set of a TV medical drama will donate their props to us.
Earlier last week, one patient had been referred in from their family physician, and the onsite senior resident, Adam, had been the doctor to assess them. Symptoms were vague — generally unwell, off food, bit of a cough, possible headache. Viral swabs were taken, because pretty much anyone that had lately walked through the hospital door with even a suspicion of sepsis now had samples sent off.