I've taken a few days off from this blog. I hit a wall. Returning after work to my hotel, too tired to write and just going immediately to bed after a shower. Today is now Mother's Day and also my last day in New Jersey. Later this afternoon I will get on a plane and return to Reno. And so, this will be my last post. In this post I'll try to catch you up with what's been going on in the ICU the past couple days and will also try and sum up my overall experience.
We have not had a death in our ICU in five days. You would think this would unload some of the stress. This is not true for me. What is particularly exhausting, is the very slow improvement, followed by a setback and then again trying to optimize care and push for improvement. This goes on over and over again-----with every patient. Of course, if I find this exhausting, I can only imagine what it is like for these patient's families. I speak to these families often twice a shift. I dread calling to tell a family about another set back. I can hear the disappointment in their voices. I know they are trying to remain strong and hopeful. I am too.
I finally found a surgeon willing to do a tracheostomy on one of my patients. A tracheostomy is a procedure that involves surgically making a hole in a patient's neck in order to place a tube through the neck into the trachea. This allows us to remove the breathing tube from the patients mouth. This patient has been intubated and on the ventilator for over a month. During the course of her disease, she had been in kidney failure and on dialysis. She was dialyzed for ten days but gradually her kidneys improved and has now been off dialysis for over two weeks. She is the only COVID patient I've seen regain kidney function after being on dialysis. Her lungs appear to be improving and her blood pressure and heart rate are stable, however she remains somewhat confused. She's unable to follow simple commands and so it would be too risky to remove her breathing tube. There is a lot of debate regarding when to perform tracheostomies on patients with COVID. We don't know how much additional risk there is for a COVID patient when undergoing a surgery. Additionally, performing surgery on patients with the virus, can expose everyone in the operating room to COVID. However this patient has now tested negative after being on the trial drug, Remdesivir. She is scheduled to get a tracheostomy on Monday. There are several reasons I feel its important for her to get a tracheostomy. First, she will be more comfortable. Having an endotracheal tube and being on a ventilator is uncomfortable. Removing the endotracheal tube also reduces her risk of a bacterial pneumonia and will allow her to get physical and occupational therapy. Her family has come to depend on my advice. I have given them my cell phone number and they will update me after the procedure and her ongoing progress. After today, I have no role in their mothers care, however, they know I'm always available to take a phone call.
Of the remaining patients in the ICU I am only cautiously optimistic three others will survive. I hope I'm wrong. It was difficult to tell these families yesterday that it was my last day and that I would be flying home today. Each family thanked me for taking care of their patient but more importantly were grateful for the discussions I had with them and the times I Facetimed with them by the bedside. It's difficult to leave these patients and families that I have gotten to know so well. I will keep in touch with the doctors taking over and follow the patients progress from afar.
My time in New Jersey has been difficult. I've seen overwhelming courage by healthcare workers and families, overwhelming sadness and grief, overwhelming compassion and gratitude. I do not regret coming. I am also glad I wrote this blog. I appreciate every person that read this and hope it provided some insight into this healthcare crisis in New Jersey. The kind comments people left me often helped me through the day. Thank You!
That's all for now.
ADDENDUM
So I boarded my United Airlines flight 698, from Newark to Denver. I was seated in a middle seat towards the back of the plane. I thought, ok I guess I have the whole row. I watched as other passengers filed in, wearing various forms of masks. Some simple surgical masks, some homemade masks, one woman who seemed to be using her scarf as a mask, sometimes having it fall away from her face. As I watched these people find their seats, I noticed it seemed whole rows were filled, shoulder to shoulder, wedged in like sardines as is air travel in normal times. I thought, you've got to be kidding me are they now filling flights? When I traveled to New Jersey a month ago there were less than twenty people on my flight. So then, a person indicated they had the window seat in my row and about the same time a man behind me coughed. That's when I said, "NOPE", and called for the steward. I asked him, "Is this a full flight?" He said, "There are four empty seats". I told him, "I want off this flight". I didn't spend a month, wearing three layers of protective gear, to sit shoulder to shoulder with unscreened passengers and a man behind me coughing on a plane. NOPE! So after everyone boarded, I walked back up the aisle to disembark the plane. As I was walking up the aisle, the stewardess made an announcement. I kid you not, this is what she said, maybe in response to the coughing man. "We are happy to have you onboard with us today, if you feel like you are going to sneeze or cough, we encourage you to sneeze or cough into the emesis bag that is provided in the seat pocket in front of you. BECAUSE AT UNITED YOUR HEALTH AND SAFETY IS OUR FIRST CONCERN". I just started laughing. I made my way to the United counter and complained about the full flight and told them I didn't care what time I would fly out, I wanted the least populated flight. The person at the counter seemed irritated by this request. I asked him if he saw the irony of the sign posted behind him given I had just been on a full flight in a middle seat. He turned to look at the sign.
He seemed unimpressed or maybe didn't get it, I'm not sure. They found a flight tomorrow morning leaving at 6am that is a third full. I'll be on that flight, hopefully unless it fills up, in which case I might drive. That's all for now.
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