A physician’s first night at the MICU in New York City

Tonight will be my first night shift in the medical ICU (MICU) since COVID began ravaging New York City. I was on the hospital floors as an internal medicine resident during the early period of the COVID-19 pandemic. Since then, my clinic block was canceled, and I was placed on sick call, though I didn’t get called into any additional shifts. I felt uneasy in the days leading up to my return to the MICU, and the hours before it were filled with angst as I made my final preparations.

6 hours to go before my shift:

I try to nap, so I don’t tire out of sleep deprivation overnight but feel too anxious.

3 hours left before going in:

I convince myself to do a quick home workout before taking a shower. I then do something I’ve been dreading for days; I shave my beard, which has existed in one form or another for over a decade. It’s hard to recognize the face now staring back at me in the mirror.

2 hours left:

Dinner time before the 12-hour shift.

1 hour left:

The depth of emotions really starts to settle in. I don’t want to move, I can’t bring myself to get off the couch, and I certainly don’t want to go into the hospital and fight what feels like a losing battle with death. This risk I’m about to place upon myself feels surreal. Every single bed in the MICU is filled with COVID positive patients struggling for their lives. I know the limitations we have with adequate protective equipment because of severe shortages, and I know the current policy of reusing masks and gowns just makes it that much easier to spread viral particles to my body. It is not outlandish to envision myself in an ICU bed as a result.

30 minutes left before the shift:

I hug my wife extra tight for what must have been a minute but felt like mere seconds. I wonder how risky it will be to hug her after tonight. I change my clothes at the door into the pair of green hospital scrubs, carefully placing one arm and leg into the scrubs at a time and avoid touching anything else. This will be my new routine before leaving, with a more diligent routine re-entering.

Time to go.

My heart is pounding, and it is difficult to take full breaths. I can’t describe the sensation in my chest, I’ve never experienced this before. I know I’m scared, but is this also anxiety? My body feels heavy, and it takes a focused effort to walk to the doorway. Even putting on my shoes is now a challenge. I put on my hospital badge around my neck, which now feels like metal weighing me down. I enter the elevator in my building to leave; it’s is just me and my racing heart. There is not a sound except my quick, shallow breaths. I cross the street to the hospital and enter what now feels like a foreign space.

I hurry to a different part of the hospital where an N95 mask was set aside for me, putting it on for the first time and wondering if the fit is appropriate. “This better work,” I think to myself. I get to the MICU, where my co-intern is ready to sign out the current patients so I can take over for the night.

“This is a 54-year-old patient, no past medical history, COVID positive with acute respiratory distress syndrome.”

“Next is a 38 year old, no past medical history, COVID positive COVID positive with acute respiratory distress syndrome.”

“29 year old, no past medical history, COVID positive here with acute respiratory distress syndrome.”

“73 year old, history of hypertension, COVID positive here with acute respiratory distress syndrome.”

The only thing that breaks this monotony is the rapid response called overhead for another part of the hospital, within just a few short minutes of my shift beginning. It may just be a matter of time before this happens to one of the patients in front of me. I finish my sign out as I watch the rise and fall of my N95 with each breath.

I make a quick round to visualize the patients from behind the glass wall enclosing them in solitude. The entire unit is sedated, nearly all of them intubated. I rejoin my senior resident currently fielding phone call after phone call from worried family requesting information about their loved ones, answering every question with a soft and comforting voice that provides me some relief. I cannot imagine the fear they experience knowing someone dear to them is on the brink of death secluded from the rest of the world.

There is a young patient who is on a breathing machine though his body is still struggling to get enough oxygen despite this. We are nearing the end of medical options that can help him improve. We decide to prone him, but before doing so, I try some osteopathic manipulative therapy a doctor friend showed me from a clinical trial. There are no more medicines to try, so I decide to try whatever I can offer with my hands. My desire to preserve life as a doctor is somehow overcoming my fear. I see the beads of sweat running down his face, almost as though each bead is timing the duration of my therapy. Other doctors and nursing staff join me to help flip him over safely.  As we finish I notice the TV on in the corner with CNN playing, Anderson Cooper is talking about how today was the deadliest day from COVID in the country to date with over 500 deaths. I return my gaze back at the 29-year-old in front of me; he is my exact age.

I cannot recall the total number of rapid response codes called overhead that night. There were too many to count.

Nasir Malim is an internal medicine resident and can be reached on Instagram @thedoctornas.

Image credit: Shutterstock.com

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