A small piece of lint is tickling my nose as I am desperately trying not to sneeze into the tight-fitting mask on my face. I know that I will not be able to adjust the mask as my gloves are sterile, and I am standing suspended over a patient’s body with my gloves patinaed with small drips of blood mixed with an antiseptic. The procedure is challenging as the patient is lying on their stomach, and the angles are all wrong. The distant hum of the negative pressure filter combined with the intense heat of multiple layers of protective equipment donned with care creates constant steam rising around me, making the sweat drops rivulet down my back, into my goggles, and yes, into my mask. I finally inhale and, not unexpectedly, choke on the piece of lint and proceed to double over with a coughing fit that is poorly timed on my part. The patient is still there, the procedure half done, and everyone in the room is stunned into silence by my uncontrollable coughing.
Stunned expressions can no longer be found in the medical intensive care unit. The surprise and innocent platter of day-to-day life in the “unit,” as we referred to it, has been replaced by mostly silence and heavy sighs and, yes, tears. The daily routine continues as patient care remains paramount in all our minds, but the bodies are heavy, and spirits are filled with dark weight that seems like an oil slick. One you cannot see through or breakthrough, although it looks thin and innocent on the surface.
The medical intensive care unit is where one least wants to be; however, it needs to be when things are dire and serious. Although the space is filled with light, coming from the large windows of each patient’s room, it permanently feels like working under dank, muddy water, the light dimmed, filtered through emotions of despair, constant grief, and occasional jubilation. Wins are still celebrated as life continues, but losses are many. So many that some cannot simply go on as it feels that all of this could have been avoided, just a dream, we wake up and the last two years never existed, evaporated in sweat and negative pressure, simply wicked away.
The glass door opens, separating the hallway and the inside of the room, and reality floods in. The patient is quiet on the respirator, a machine that blows oxygen into the lungs and sweeps carbon dioxide out, helping and complimenting the lung function that is severely impaired and ravaged by the virus. The machine is physically divided into two parts so the dials and controls can be acted upon from the hallway and tubing and hardware that attach to the patient inside the room—separated by glass doors without needing to walk into the room. My colleague from respiratory therapy sits quietly outside of the space in front of the dials of the respirator machine, making the smallest adjustments to allow better oxygen delivery for the patient who is desperately fighting for their life.
The fight is a lonely battle. Interrupted by hourly nursing care, heavy medications to sedate and remove the pain, countless sticks of blood, tests, images, trips to the CT scanners and procedures, all alone. Zoom meetings with loved ones, quietly looking into the battle or emotionally overcome crying on the other end of the screen, only mere minutes of the long twenty-four hours, day after day. Although a lonely fight, it is certainly well witnessed, enveloped, and supported by all the health care staff who witness this battle every day. We bear witness while outside the glass door, outside of the hospital doors, voices, shouts, and screams defy our knowledge of reality and tell us that it is not true. That we made it up. That no one is dying. As we bear witness.
The procedure is all done and successfully finished. The patient is stable for now, suspended in a medically induced coma to allow life to continue and hopefully persevere, so all can bear witness. After the fight, after they leave the intensive care unit and return to their lives after returning to their routines and daily chores, will they?
I systematically and carefully take off my sterile and protective equipment and open the glass door. A whoosh of air enters the negative pressure room as I exit. It feels fresh on my sweaty, grimy face, and I instinctively lick my lips, remembering that I have not drunk any water today or had to use the bathroom. It feels like hope on my face. I take a deep breath and step outside, finish cleaning up and look into the eyes of my colleagues standing outside of the doorway. The eyes are the only part that I can see, as everyone is masked and typically wears some form of protective equipment, but the eyes say it all. Gratitude is what I want to send to those eyes, for bearing witness, for being there, for doing what’s right, time, after time, after time … healing, to the best of our abilities, and opening doors.
Katarine Egressy is a pulmonary and critical care physician.
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