The other day, I received my vaccine against COVID-19 – a novel mRNA vaccine that will without hyperbole likely someday prove to be one of the greatest achievements in human history. As I look at social media, I see a deluge of my colleagues posting selfies or photos of themselves receiving the vaccine. Many of them describe the relief, the liberation of burden, and the tears of joy they felt as they got injected with liquid hope. A few hours after my shot, I felt a noticeable muscle pain in my arm. But I can tell you, the pain felt good. I actually relished the pain. It represented the beginning of the end of this shit show.
Back in March, at the start of the surge, I can remember the first time I intubated a COVID patient. The donning and doffing of my personal protective equipment was done with simultaneous trepidation and exactitude as if I were defusing a dirty bomb.
As the outbreak escalated, true fear engulfed the hospital. One evening as I was arriving for an overnight shift in the ICU during the initial rise of COVID in Los Angeles, I passed a weary looking ER nurse in the parking lot about to start his shift. He had the look of fear in his eyes. I offered a perfunctory “How you doing?” He glanced at me and spoke with a crack in his voice. He told me he just heard today that two of his nursing school buddies had died from COVID infections in New York City. His friends didn’t have access to quality PPE and it was thought they got sick at work. “Crap- that sucks” was all I could think to say. I readjusted my N95 mask and approached the hospital temperature checkpoint with a reinforced feeling as if I was being sent off to war.
The reality is when a patient dies you feel bad, but when a colleague dies you feel scared. Over the course of the pandemic, something like 1700 healthcare workers have died from COVID. That’s what makes this whole pandemic different for frontline workers. We’ve never encountered anything like this before. Sure dealing with overwhelming death, human suffering, lack of resources, and a public that doesn’t seem to care really sucks. But what sucks even more is risking your life while doing all that.
What exacerbates healthcare workers predicament, even compared to most everyone else in society, is we are traditionally not good at choosing between our own health and the health of our patients. The natural instinct of a typical healthcare worker is to run to help their patient when they are in need.
One time I was summoned to the ICU to intubate two COVID patients back-to-back. The first intubation went smoothly, and since the second procedure wasn’t a dire emergency, I took a quick moment to go grab a drink of water. When I returned to the ICU, all of my protective equipment was gone- no one could find it. Someone had inadvertently taken it. I had nothing available to protect me for the second intubation.
I had a resident doctor with me and decided to use this as a teachable moment. I asked him, “If this lady suddenly needed an emergency intubation and she was about to code and we don’t have our PPE, what do you think we should do?” He said, “maybe you could just go in with a regular mask, or borrow an N95 mask, or even try to move quickly and hold your breath during the procedure.” I was impressed with his dedication to the patient. Then I confidently told him what I thought was the best answer- “Let her die.”
Anyone here who risks their own life for their patient’s life might be a hero, but is also stupid. Sounds harsh I know. At the beginning of the pandemic, many nurses, doctors, and others paid with their lives because they couldn’t quickly enough suppress their instinct to help others before themselves. Frankly many of them didn’t have access to the PPE or didn’t take the extra time needed to protect themselves and were effectively sacrificed. I still remember the lesson I learned from my lifeguard training at age 16: If a drowning victim panics and grabs onto you and starts to jump on top of you, pulling you underwater, you must push them off, and swim away. Only then can you try to save them from a distance. If they then drown, they drown. Don’t let them take you with them. You must choose yourself first.
The buried rage healthcare workers carry comes from now having to make that choice within the halls of the hospital.
The most difficult facet of the pandemic for healthcare workers has been balancing these choices. Each time I take care of a patient, either diagnosed with COVID or not, I am taking a risk with myself and indirectly with everyone I know. What risks are reasonable to take? What risks are too perilous ? This constant battle in our own minds has worn us all out and regretfully has affected how we sometimes perceive our patients.
You see, when you show up to hospital with COVID, if we are honest, in some ways we kind of hate you. You’re the drowning victim that is trying to push us under the water. We hate that someone has entered our lives that could, if things went bad, make our kids lose their parent. Even the idea of that immediately withers our empathy. As we do our best to help you, we also harbor a simmering rage toward your disease that we don’t know what do with.
When I newly round in the ICU, I unconsciously scan for the patient that might quietly satisfy my subconscious hope for schadenfreude. Where is that COVID denier who went to a party with no mask and is now suffering the consequences? I imagine saying, “See we told you, but you didn’t listen and hear you go…hope you make it.” Morbid I know, but without even knowing I look for a target on to which I can release my buried rage. But inevitably, as I look around the ICU, it is not filled with patients that satisfy my revenge fantasies. I see the poor Mexican immigrant who got infected at his factory job that had inadequate PPE. Then I see his wife and father-in-law who live with him and followed him to the ICU two days after he arrived. I see the nursing home resident who has long been close to death, that quietly seems to have been discarded, suffering at the end of a long life, alone. And I see the young man who has no idea how he contracted COVID, but is morbidly obese staring at the wall with constant fear. It is hard to direct rage toward these folks. So my rage remains buried.
Two days before I was scheduled to get my vaccine, I got a phone call from the ICU I was covering, that I needed to intubate an 85 year old guy with COVID. My first feeling after hanging up the phone was anger. Anger at the old guy with COVID for needing an intubation- an old guy who would probably die. Anger for making me take a risk right before I would get my vaccine. What if during this last intubation I somehow contracted COVID and then passed it on to my family and friends? As I entered the room and really saw him, I instantly knew he was not going survive this illness. These were his last moments on earth without sedation. He was drowning in his own breath. He had multiple failing organs. I am glad to say, my anger immediately evaporated. I no longer saw a COVID patient who was putting me at risk, but a man, who had a whole life story to tell, a life that was abruptly coming to end. I touched him on the shoulder as I looked into his eyes, pushed the medicine to make him sleep so I could place a tube in his throat and said “I am going to let you rest now.” He died the next morning.
For the last year, just about everyone in healthcare has had these conflicted feelings–a constant seesaw of anger and resentment mixed with true sympathy and love. It is a weird feeling to fear the person you want to help.
But if we are honest, we as healthcare workers understand how hard it can be to maintain these precautions. ICU workers go directly from treating COVID patients to break rooms. Inside we eat snacks without masks, joke and laugh- everything we say not to do. I’ve gone to those breakrooms. And those breakrooms have led to outbreaks. We fail- again and again.
I think, as humans, during this pandemic we have always been destined to fail at socially distancing and wearing masks. It seems doable, but over time it is really hard. We may be super careful at the supermarket around strangers, but are less so at work or with our family. Remember these are the people we love, not the people who hurt us. But the highest risk for contracting COVID is probably in your own home from your own family and friends. But who cannot understand the husband who may not want to wear a mask and socially distance from his wife who just returned from a high risk activity? Potential death versus facing the wrath of treating your wife like a pariah? Those are no doubt equivalent bad choices.
It isn’t really people’s failure to always wear masks nor consistently socially distance that has fostered my pandemic rage. My anger is charged by stories of those who call COVID a hoax, or refuse to experience even the most simple of inconveniences, such a wearing a mask in public spaces. It’s not failure but rather open indifference that has fueled the brewing often silent resentment of healthcare workers.
The vaccine presents an opportunity to exorcise that buried rage. That is why we take selfies of us getting a shot. It is the start of our emancipation from the bonds of this plague. As we mitigate our own fear, we can finally let go of this resentment, this rage, and return to the empathetic caregivers we all once were.
As the hospitals fill up and death explodes around us all during this holiday surge, I can say that it is starting to feel different than it did March. And although the next few months are going to be terrible, draining, and probably bruise my soul, I feel like I have been injected with optimism. My rage is gone. Bring on the second shot.