This has been the most difficult day of my medical career. It's my first day at Saint Barnabas Medical Center working in the ICU. Saint Barnabas is a suburban hospital very different from the urban, indigent patient population of Beth Israel. The shiny exterior is not representative of whats happening inside. It is filled with COVID-19 patients in ICU's.
I start my day pulling into the physician's parking lot. As I enter the hospital, I pass by a refrigerated trailer, housing poor souls that have passed away from COVID-19.
I have no idea how many patients are in the trailer, but its disturbing to walk by as you enter the hospital to take care of patients. I was assigned to the PACU ICU. This is an ICU that formerly would have been the recovery room that patients would have come to after a routine surgery. It has now been transformed into an open ward ICU. All the patients in this ICU are victims of the COVID virus and are being mechanically ventilated. It is only one of the many ICU's in the hospital containing ventilated COVID patients. In this hospital alone I think there are about 90 patients on ventilators with COVID currently. I know that might not seem like a lot given the numbers we all hear on the news, but this is a ridiculous amount of critically ill patients for a 650 bed community hospital.
The PACU ICU has 18 patients. I have been assigned four patients. I think, sure I can handle four patients. I had arrived about 30 minutes before we rounded on patients and I scramble to get the information necessary. Well, in that thirty minutes, I realize that I should have arrived two hours earlier. Each patient has been in the ICU for over a week, a couple patients over two weeks and they are on complicated regiments. Drug and ventilator managements unlike what most of us typically deal with. Instability of blood pressure, inability to oxygenate, multiple organ system failure, novel drug treatments that recommendations are changing daily. I try in that thirty minutes to get all recent labs, ventilatory settings and any glaring issues that I identify. During rounds I try to keep up, writing thoughts on patients but I know I'm unprepared. Everybody seems to understand, telling me, "I know its a lot, don't worry about it we all felt that way our first day". I have not felt that overwhelmed, or unprepared... EVER. I spend the next ten hours trying to get to know all the patients. I read over every patient's clinical course from their admission until today. I try to get a sense of whats been done, what's currently being done and what can be improved on. It's different for every patient. Every lab needs to be looked at, all chest X-rays visualized, every note read by consulting doctors, Renal, because many of these patients are losing kidney function, Infectious disease because along with the infection of the virus many of these patients have secondary bacterial infections that need to be treated with antibiotics, hemotalogic doctors because these patients often have clotting disorders. Of course I've seen all these problems as a doctor, but not it these numbers and strange combinations. In addition, many studies are being done that require specialized tests and protocols. Many of you have heard about the idea of using blood products of recovered COVID patients to treat currently sick patients in the hope that the convelescent blood products will have antibodies that will help the sick. We are now starting that in conjunction with a university research project. I hope it will help, because at this point not much is. But I'll be better tomorrow. That's all for now. Stay safe.
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