Open Letter from a NYC COVID19 ICU Physician Volunteer

I wanted to update everyone on my trip to New York to work in a surge intensive care unit (ICU) for COVID19 patients. First of all, I’m sorry it’s taken me a while to write this; life was moving fast and it took some time to reflect on the experience. I still have a little bit of writer’s block.

Thank you to everyone who encouraged me. I was overwhelmed, blown away, and humbled by all the messages. I had physician colleagues and friends reach out to offer housing, cars, food, moral support, and anything else I could possibly need in NYC. I even had a goodie bag waiting for me when I arrived at my hotel!

My first few days were hard. My set-up for organizing my personal protective equipment (PPE) and scrubs seemed cumbersome, and I felt like I kept messing up my “sterile technique” (as a surgeon this was very frustrating). I never fully unpacked, which was really out of character for me. The first day, work was disorganized and felt like a big noisy traffic jam. I just ran around doing procedures in an ICU where patients seemed to be near coding constantly. There was nowhere out of the way to stand or sit, so I felt like I was dodging traffic all day. Instinctively, I tried to learn the equipment and system quickly, and found a wonderful NP who had been there for a few days to show me the ropes. I tried to learn about the logistics and the realities of their environment in order to be effective. This was a situation unlike any we have experienced in our modern, developed healthcare system. Because of the chaos and sheer magnitude of the problems, I sincerely wondered if I would get to do anything worthwhile.

The “Morgue trucks” parked near my hospital entrance.

The next day they moved me and a team of other travelers to a new makeshift unit. It was a blank slate. Really blank. We had to scrounge for every wire, sensor, IV pole, and even beds. Somehow, we rigged up a fully functional, high quality ICU within a couple of days, and our clientele ranged from 6-8 patients (8 was a really tight fit). My colleagues were amazing, and everyone was 100% on their best game. We had some amazing saves; one patient coded on arrival and got 5 minutes of chest compressions before starting his long journey out of the abyss to extubation nearly 3 weeks later.

One of our amazing nurses running the quality checklist faithfully, which they did every day for every patient.

We spent 12 hours a shift covered in layers of PPE, ate snacks and meals together, talked about home, made jokes, solved problems…it was peak foxhole camaraderie experience. We even filmed a TikTok, one of many firsts for me.

Our amazing dietician who went to great lengths to set up a coffee station near our hot-zone ICU, even donating her own Keurig!

The equipment was intimidatingly retro and clunky. Every patient was supported by a transport LTV vent that I quickly had to learn how to use. Proning without a special bed, updating families over the phone through interpreters, trying to keep ET tubes clear without aerosalizing maneuvers–everything was new, different, and challenging. Little fires everywhere.

LTV vents hung from the ceiling like big bats, but faithfully kept our patients alive, sometimes for weeks on end.

The patients were shockingly ill. Every day a new challenge came up. Nearly everyone was maxed on vent settings with respiratory acidosis that bordered on “incompatible with life.” I read another ICU doctor’s essay on how the “game of inches” is won there, and it rang in my head when I felt like I wasn’t gaining any ground. We played the game of inches. We had checklists and followed every letter, responded to every actionable piece of data. In a few cases, we slowly won that game. Inch by inch.

“Loaner” says it all. This is what we called a “Christmas tree,” and most patients needed this many infusions.

We called families multiple times per day. I was prayed for in 4 different languages that I can recall. These phone calls were often a source of unexpected emotions. One time, I answered the phone in complete business-as-usual mode, started to update the family, and shared that their Dad was staying strong for the moment, despite our worry that he would pass away overnight. Their response was tears of joy and fervent encouragement, gratitude to our team for not giving up. Tears suddenly stung my eyes and a lump in my throat made responding physically impossible. I managed to squeak out, “It’s our privilege.” I pulled it together quickly, but my own emotional wobbliness surprised me.

In the evenings, I would schlep home in my Lyft and do my decontamination routine and shower. Then, I ritualistically face-timed my husband and kids. To be honest, this felt like a chore that I didn’t have much energy to perform. I didn’t feel like talking about my day at all, and the girls were too small to pay attention. So the conversation only lasted about 10 minutes before I would say goodnight and turn on Netflix. Then I took a melatonin and watched TV til I fell asleep, because I felt really lonely even thought I didn’t want to talk to anyone. I did this pretty much every night.

The two weeks went by slowly at first. Midway through my second week, I worried about who would take over for me. I received amazing news that another ICU physician volunteer was coming from LA, and I started plotting to go home the day after she arrived. Once I oriented her to the unit, I was confident that she didn’t need another cook in the kitchen, and I booked a Delta flight out for the next day. I left all my remaining PPE, disinfected absolutely everything, and headed back to the South. I got a COVID19 test on my way out of the hospital.

It wasn’t until this point in the journey that I considered not being able to return straight home. I talked over the risks of it with my husband, and we shared concerns over the safety of traveling home from New York. My COVID test returned negative, so that was a relief. I decided to self-isolate at my mom’s house in Nashville. We were very strict about physical distancing, but it was so nice to be with someone who loved me and took care of me. I rested, exercised, ate, and reflected for a few days. I got another COVD test that was also negative, and then headed home-home.

My kids fell into my arms and were so sweet. They stalked my every move like little shadows. I enjoyed a few days of quiet while I waited for yet another COVID test to be resulted negative so I could go back to work at my hospital.

I’ve had a fair amount of interest by folks at home in my trip. Several people have asked me for advice in how to use PPE, and decontamination routines as their work-places reopen. And from some very surprising people, I’ve heard comments like, “I had no idea you were a badass! Way to go girl!” These always catch me off-guard and make me laugh.

However, anytime someone wants to congratulate me on my trip, I immediately think of our colleagues permanently in the trenches in NYC and other COVID hotspots. It’s easy when there is an escape plan, but I just can’t imagine living in that situation for months on end (although this may be our situation everywhere soon). So, to all our frontline workers in NYC, please reach out. Let us know how we can help. Tell me your struggles, let me try to lift you up with exclamations that you’re a freakin’ badass, even if only a tiny jagged splinter of your brain lights up in belief and recognition of that fact. I know I did my best for you, but down to my core, I wish it were much, much more.

https://www.instagram.com/mjhiblenart/

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