“Come to triage right now, and wear your N95. A patient going straight to OR and she’s having fever and chills.”
I was summoned to the triage area of labor and delivery for a patient brought in from the ultrasound clinic and found to have absent fetal heart tones. One of my colleagues started an IV, and I ran to the OR to set up for emergency general anesthesia. The patient was wheeled in 30 seconds later, moved from the stretcher to the OR table, and understandably terrified.
“My name is Dr. Sheikh and I am part of the anesthesia team, I know you’re overwhelmed because we are coming at you from all sides, but we have to get your baby out immediately. I need you to take 6 really big deep breaths.” The obstetricians splashed antiseptic onto her abdomen and tossed the sterile drape at us.
“I’m scared,” she said with tears in her eyes. I fought the urge to tell her that I, too was scared. This was it; this was the COVID intubation we had received training for the week before: on how to properly don and doff PPE to minimize the risk of infection. But when the baby is dying inside its mother, who has an extra 5 minutes to put on a powered air-purifying respirator (PAPR)? I wondered if my N95 fit securely enough.
“I know you’re scared, but I promise we’ll take good care of you. You’re going to sleep now.”
We induced general anesthesia and gave the obstetricians the ‘Go’ to proceed with emergent Cesarean delivery. Less than one minute later, the baby was delivered and handed over to the neonatal team for resuscitation.
The nurse handed me the swab to collect a nasopharyngeal sample for her COVID test. I placed the swab deep into her nostril and held it there for 10 seconds. The sooner I send this, the faster the results will come back, I thought to myself. And she could be negative! I wouldn’t have to sweat in this gown, N95 mask + surgical mask, face shield, and double gloves. If she’s negative, we could focus on her and not our own worries of becoming infected.
“There’s a large abruption and we’re bleeding,” the OB resident said with noticeable alarm in her voice. We immediately obtained more IV access, initiated a massive transfusion protocol, and sent labs to assess her blood counts and coagulation profile. All the COVID protocols went out the window. We removed the plastic coverings on our equipment and medication carts to obtain what we needed, contamination be damned.
She continued to deteriorate despite our resuscitation efforts, and we soon learned that she was in disseminated intravascular coagulation (DIC), which made her susceptible to ongoing bleeding. After several hours of surgical hemostasis and blood product transfusion, the patient was finally hemodynamically stable. She would have to remain intubated and go to the ICU due to the large volume of blood products she received. My anesthesia colleagues had left the OR to tend to other patients on the labor floor. We continued to refresh the electronic medical record and call the laboratory to see if her result had come back so we could take off our PPE and conserve the limited supply. At that point, we received notice that the ICU did not have the means to take a potential COVID patient due to current staffing.
The nurse and I remained in the OR for several hours, with the patient anesthetized, waiting for the call back from the ICU. I administered diuretics, corrected her electrolyte abnormalities, and adjusted ventilator settings. It was extremely hot as we had turned up the temperature in the room to warm the patient as cold worsens coagulopathic bleeding. I felt as though I was her one-on-one ICU physician, providing her with post-operative care in the OR because we could not go anywhere. I became so preoccupied with keeping this woman alive that for a brief moment, I forgot that we were in a pandemic. I had absolutely no idea that it was just the beginning and that our work and our lives would be changed forever.
Several hours later, we were able to finally transport her to the ICU in stable condition. I started the decontamination protocol by washing my face, neck, arms, and all other exposed skin surfaces. N95 masks were in shortage, and our supply had been locked up, so I wondered when I would receive another mask. There was still light outside as I walked to the parking lot. I sat in my car for a few minutes before driving and felt completely numb. I went straight home, did not play music, and skipped dinner as I did not have an appetite. Instead, I took a long, hot shower and lay in bed. I cried myself to sleep that night and wondered how we were going to survive this.
It has been 1 year since the World Health Organization declared COVID-19 a pandemic. So much has happened in the last calendar year that it is difficult to put feelings into words. I wrote several iterations of my thoughts and left the drafts unpublished as no essay could grasp the profound trauma experienced by the physicians, nurses, respiratory therapists, pharmacists, and all other workers at the frontline of this pandemic. We continued to show up for our patients despite the very real risk of becoming infected with a lethal infectious disease, only to be gaslighted by politicians and conspiracy theorists who refused to believe our truth. It hurts deeply to reflect on it.
Despite everything we went through, I am tremendously grateful to be alive and healthy and to have received the Pfizer vaccine soon after it was approved. Since receiving the vaccine, I have continued to wear a mask, practice physical distancing, and wear appropriate PPE. I am less fearful of getting infected during COVID-19 intubations. However, we still see patients — including young, healthy pregnant women — with severe disease requiring prolonged ventilation and extracorporeal membrane oxygenation (ECMO); therefore I refuse to let down my guard. We have experienced unquantifiable loss as a nation, but I take comfort that our country now has leadership committed to using science to guide us out of this pandemic. There is a light at the end, but the tunnel has been extremely damaging.
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