From One Dying Breath to the Next
I could not forget Thanksgiving 2020 if I tried.
I had a COVID patient who was dying, and his family had to say goodbye through a screen The man had his eyes closed. He was breathing heavily and shallowly, seemingly unaware of what was happening around him. As his family spoke, I placed my hand on him. He seemed to smile. He passed away.
I realized then that my role as a respiratory therapist had changed. I could no longer be the nameless, faceless and sometimes unseen presence in the room. I could no longer maintain that level of distance or unfamiliarity that sometimes helped me get through the day. The patients did not have a close human connection anymore, so that task was now mine. I had to be that connection, and the consequences were that I would now have to feel each loss as if it were my own family slipping away.
My role as a respiratory therapist was very different before COVID. I could do my job and distance myself enough to be able to handle decisions to end patients’ suffering by removing the life support. Usually, the patient’s family would be sitting in the room holding their loved one’s hand. They would begin to say their goodbyes, remembering the good times and memories. Then I would knock on the door, walk over to the bed, remove the tube from the patient’s throat, and walk away apologetically. Then I would move on to the next patient, purposefully detached to survive the day.
But now, after fighting a constantly changing virus, I think there are many things hospitals can do to be better prepared for a future with COVID. There must be a better focus on minimum supply levels to ensure availability for disasters. There must be mass casualty drills that ensure the preparedness of personnel to deal with more patients than supplies. I also think hospitals need to have a level of transparency with the public they are not used to. When I would run from room to room to grab ventilators after people had died, I realized the general public saw the empty rooms and assumed we weren’t completely full and completely overwhelmed.
The past two and a half years with COVID have been so like my years as a combat medic, there have been days that felt like I never left the Army. And those lessons are worth sharing.
I was a freshman in college in Puerto Rico, walking through the lobby between classes, when on September 11, I watched the Twin Towers fall and 3,000 lives end in almost an instant. I was studying to be a history teacher, but I realized that history was being written every day, and if I acted now, I could help put more good things into the pages of history than bad. I became an Army combat medic in 2003, knowing that I would take a life if it was necessary to save my patient or protect my country, but could still save as many lives as possible.
I went to Iraq in 2004. I learned very quickly that there were things no one could teach you about life and loss—you had to experience them. I was a medic with an aid bag that weighed almost 80 pounds. No matter how many casualties, I had to make sure that what was in that bag would last, and I often had to improvise to make it happen. A medic must use the least number of supplies to save as many people as possible. I had no idea how important the lessons of 2004 would become in 2020.
I came back from combat in December of 2005 with a mind full of loss and nightmares and a combat badge “for engaging and being engaged by the enemy.” I found it surreal that something that would follow me perhaps for the rest of my life could be summed up into one sentence.
In 2010, I started having sudden respiratory issues. I was diagnosed with asthma, and the Army medically retired me. I became an EMT in San Antonio, and feeling that it wasn’t enough, I decided that the respiratory condition that sidelined me could be the very thing that brought me back into the fight. I became a respiratory therapist. I tried to put the war behind me, but as we all now know, an enemy more dangerous than any we encounter in combat was coming.
As SARS-CoV-2 began to make its way around the world, health organizations, hospitals and the media tried to keep us informed. I listened to the news, read study after study and realized quickly that we may have some trouble ahead. It was not the description of the virus that was worrisome. What was worrisome was how different the information was depending on where you decided to get informed. An opinion that was more pleasing to hear was preferred to an ugly truth: we had a virus that was new, that could kill, and that we had to face head-on.
For respiratory therapists, exposure was a guarantee. I was terrified. I was very aware that I was at high risk of severe illness and death because of my history of asthma and sleep apnea. However, I still volunteered when my hospital asked for volunteers to staff a new COVID unit for the hospital.
My routine consisted of wearing an N-95 mask, two pairs of gloves, a gown and shoe covers for 12-hour shifts. I would shower at work, go home and shower again. I had a bucket with a lid by the door. When I got home, I would put all my clothes into a bucket and place the clothes into the washer. I would disinfect my gear with a UV light box, and do it all over again. I hoped we would get enough people informed, distanced and protected in time to avoid overwhelming the hospital until we had a vaccine. This was unfortunately not the case, and we would battle a full hospital for almost a year.
Today, we have more and more variants and more and more skepticism. If we can keep people from becoming infected, the virus gets fewer chances to change. If the virus spreads, it will eventually change to defeat natural immunity as well as vaccine-mediated immunity.
I believe a lack of public understanding is why our job has changed, perhaps forever. We can no longer expect or assume that people will try not to expose themselves to a virus. We must act as thought the virus will have an unlimited supply of opportunities to change over and over. We must now expect variants, expect an increase in severity, hospitalization and death, and stock hospitals with equipment and personnel that will ensure we can handle large numbers of contagious patients over an extended period of time.
We must also accept that scenario I thought I would never see again, where supplies are less than the number of casualties, and we must triage according to who has the greatest chance of survival. Is this happening now? Thank goodness, no. COVID is still around though, and people are still giving it chances.
Today we are not overwhelmed with patients. We are not short on supplies to the extent we were before. The vaccine seems to be doing the job we hoped it would do. There is, however, an uneasy feeling that still creeps into our minds whenever we see the rooms in the ICU fill up with “Airborne Precautions” symbols on the door. Is today the next one? Are we ready?
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
I could not forget Thanksgiving 2020 if I tried. I had a COVID patient who was dying, and his family had to say goodbye through a screen The man had his eyes closed. He was breathing heavily and shallowly, seemingly unaware of what was happening around him. As his family spoke, I placed my hand…
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