Medicine is typically an intimate interaction with its one-on-one conversations and physical exams behind closed doors. Covid-19 is changing that as doctors and other clinicians are learning to care for patients while social distancing via telehealth. I was surprised to learn that this distanced care extends to intensive care units.
As a first-year doctor specializing in psychiatry, I was redeployed in the beginning of March to work in the newly created ICUs in my New York City hospital. Before Covid-19 emerged, first-year doctors were expected to perform the initial exam on each of their patients every morning, which would later be repeated by more senior doctors. To preserve personal protective equipment and limit exposure to the virus that causes Covid-19, the process has been streamlined. It’s now my job to gather from a distance information like ventilator settings, drip rates, and vital signs while more experienced clinicians examine our patients.
Even when I do enter patients’ rooms, all of them are intubated and unconscious, unable to interact. I have taken care of unconscious patients before, but never only unconscious patients. I have not had a conversation with a patient since mid-March.
That is just one novel feature of being a doctor in the time of Covid-19. We are all trekking through a forest of firsts. It’s the first time these rooms have been used as an ICU — two months ago they were just regular hospital rooms. A sticky note taped to the door with “ICU” handwritten in block letters attests to the change. It’s the first time many of our patients have ever been hospitalized. It’s the first time nurses are using baby monitors to watch over ICU patients rather than being by their bedsides. For me, it’s my first time working in an ICU.
The nature of the work — following up labs, monitoring vital signs, placing orders, calling consultant physicians — is familiar. What is different is the distance: My patients are behind closed doors in rooms I enter only when they need me.
Still, the intimacy of the relationship shines in unexpected ways. I immediately recognize the voice of this patient’s family on the phone and know the precise volume of urine that patient has made over the past 24 hours. It’s meaningful work. But I can’t tell you the color of my patients’ eyes or what languages they speak. When this is all over, I’m not sure I would recognize any of them walking down the street.
In the quiet moments, I think of two people close to me who are also unusually far away: my pregnant wife, Alison, and the baby she is carrying. She is our first, due at the end of May, meaning that the first five months of pregnancy were BCE: before Covid era.
On BCE weekend walks through Riverside Park, Alison and I sketched the details of transitioning into parenthood. We filed away which strollers could navigate bumpy sidewalks and chuckled about our dog adjusting to life as second fiddle. A website told us that at seven weeks a developing baby was the size of a blueberry. The name Blueberry stuck, even as she’s progressed to avocado, papaya, and now pumpkin.
At the start of Pol Pot’s deadly regime in Cambodia, the despot declared 1975 as “Year Zero” in the country. It’s now clear that Blueberry will be born under the reign of a tyrant, a virus that forces children off playgrounds, teachers out of classrooms, and far too many people into early graves. In this Year Zero, all plans made BCE are extraneous.
That Blueberry would be born in the hospital where I work and come home to our apartment was once as manifest as the growing bump in my wife’s belly. Then we found ourselves packing a rental car so Alison, entering her third trimester, could move to her parents’ home in New England for the foreseeable future.
This decision, though steeped in privilege, was difficult. How could separating our family unit make us safer? That’s not how humans evolved. But vindication came a few days later when I was unusually tired after my bike ride home from the hospital. That night I spiked a fever, then spent the next 10 days shuffling between bed and couch, intermittently short of breath, but glad that Alison and Blueberry were safely quarantining three states away, with no symptoms. (My hospital didn’t have enough swab tests at the time, but an antibody test weeks later was positive for Covid-19.)
I’m now recovered and back at work. Statistics, though cursory, show that more than half of patients with Covid-19 who are intubated will die from the illness, despite all of our efforts.
Caring for patients in their final days is among the most human acts that clinicians can perform. In normal times, we could try to buy enough time for family and friends to hurry to the hospital to say goodbye. I could take a patient’s hand, skin to skin, and try to comfort him or her by saying something like, “This is a safe place. We are here for you.”
Not today. Nurses provide the most direct comfort to dying patients. Their poise and compassion is unmatched. Even so, most intubated patients will die apart from their loved ones, surrounded by figures wearing masks, gowns, and face shields.
Given the odds, it is hard to know what is reasonable to hope for. In the end, I want my patients to be comforted, even unconsciously, by how hard we are trying. My day is not done until I have had an unhurried conversation with each patient’s family on the phone. And when there is no hope of survival, I offer to hold the iPad while the family says goodbye via FaceTime.
Similarly, I hope that Blueberry knows — or will someday understand — how present I am for her even though she is hundreds of miles away. Photos of my wife prove that time is moving forward as Blueberry asserts herself further in the world each day. Sometimes I imagine Alison turning in just the right direction to align Blueberry between Manhattan and herself, like we are three points on a line.
On the phone, Alison and I repeat to ourselves, almost like a mantra, that if we can come out on the other side of this alive and with a healthy baby, then we can shoulder the rest. Blueberry is our proof there is a future — the calendar for after Year Zero waiting to be unwrapped. Right now, that means a lot.
Christopher Magoon is a psychiatry resident at Columbia University Medical Center in New York City.