‘I know that Christmas and holidays for all Canadians will be difficult this year’.
Drs. Chowdhury is the associate chair, quality and safety and assistant professor in the Department of Essential Medicine, Faculty of Medicine and Dentistry. He is a physician in critical condition and a specialist in ear, nose and throat surgery at Royal Alexandra Hospital.
Some doctors and nurses think that we are specialists in improving the quality of life.
At the end of the day, that’s really true. As doctors and nurses who are seriously ill, we can force the body to overreact in an effort to help a person live an unfulfilled life elsewhere.
We are the last people to defend ourselves between life and beyond. The more I do this work, however, the more I feel that we are experts in the human condition.
We are eyewitnesses of the triumph of survival over all obstacles, and the worst missionaries that most people will ever experience in their lifetime.
COVID-19 in the ICU has been a daily lesson about the human condition to me.
This Christmas week in this unit, during the second wave in Alberta, was a crash.
Hope, despair, fear, anger, victory and all the other thoughts I have are entering our halls and patient rooms, making this Christmas unlike any other.
‘The story of his night’
Moving on to the wing just before 7am, I found a colleague who had been covering him the previous night looking confused.
The board that lists patients and their diagnoses summarizes the story of his night.
Some say that excessive respiratory failure. Some say pneumonia. Some say COVID-19.
One simply reads, exhaustion.
It’s funny how many ways we have helped write this disease.
The patient’s stickers on the board, highlighted by a charging nurse in a variety of colors, resemble a piece of modern art.
Stickers spill over the boundaries of the board as we run out of space, which shows how the disease spreads to the hospital like cancer.
The paradox of my medical analogy makes me laugh a little, until it touches on what this means and what the next few weeks will bring.
Like a sinking in the air
When patients arrive at this unit with COVID-19 they are usually awake and able to talk, even in short sentences between shortness of breath.
It was as if they were running the race for their lives, and every breath would be their end.
Watching someone die from COVID-19 is like watching someone drown in the air.
That’s where we come in. That is probably the saddest time for us.
Before the patient sleeps and supports health, it is when the patient makes his or her last call to the loved ones.
With a sigh, I feel, “If I don’t wake up to this, always remember, I love you.”
We have acknowledged the rich and the poor with COVID-19. White, native, black, brown, and every other Canadian color and origin.
No matter what their background, the conversation always seems to end with some sort of discussion.
It reminds me of how much we all have in common, even though there are differences between us.
I have been doing this work for five years now and have seen my share of grief and despair.
We consider ourselves strong and resilient people. You cannot perform this function without it.
Other than that, my eyes are always full to hear a little of these conversations.
What makes COVID-19 so different is that I see my parents, siblings or friends, in every patient I’ve been through.
The days are hectic. We usually have two primary care physicians to care for our standard 24-patient unit.
On a typical pre-epidemic day, half of our unit could be airborne patients.
We are now approaching 40 patients, most of whom have COVID-19.
Once inside, they often stay in what seems to be an eternity.
We now have four emergency medical doctors present. We have three full-time nurses.
Assistance is outsourced. Nurses and anesthesiologists were also removed from other areas. Others have volunteered their time and energy to help out with family and friends.
Words like redistribution, summonses, and possible scenarios would make me feel like we were carrying out a war effort over the hospital.
Progress is slow.
Instead of Christmas movies and ordinary fun, we spend our nights reading the latest medical papers to see if there is anything new to read or to try successfully.
The words are confusing in my head at the end of the night.
Hope is essential
I have come to the conclusion that hope and hope may be as important as anything else.
Probably because I can control that. So, when the respirator enthusiastically told me that the oxygen in a patient in Bed 19 had dropped by 10, or that there had been no problems putting a girl in bed 23, we celebrated that victory.
It makes a list of the most difficult problems that follow to handle it easily.
Some patients die of disease. That is a normal part of critical care.
The strangest, most touching part, calls on families to tell them that their loved ones are dying, but we should limit who can come to say goodbye.
There is no special consideration for loved ones who may also have a hope, since they were in the same house.
I hate these conversations.
It was as if telling them that I could not save their loved ones was not enough. There is a special cruelty in this.
How will we remember this tragedy?
People often remember the events of history by remembering where they were when they first heard.
But how will we remember the seemingly endless catastrophe?
At Alex’s, I think most of us will remember the epidemic through the “sounding rounds” and the COVID-19 “cabana.”
Naming is a practice that forces workers every day from a COVID-19 bed to a COVID-19 bed, turning people upside down because such a stand can help with ventilation when oxygen levels are low.
The pronunciation is a reminder of how unforgiving this illness is.
The virus does not allow victims to face them directly but with their eyes down.
I’m not sure who named our overflowing area at the post-anesthesia care center “cabana,” but I quickly see where they got the name.
The rows of separate beds with drapes that act as barriers give it a different look. It is packed with our critically ill COVID-19 patients and the vision from this Christmas will never be forgotten anytime soon.
I know that Christmas and holidays for all Canadians are going to be tough this year.
It is especially painful for our unit.
Most Canadians know that although this year will be a lonely one, they will see their loved ones again and life will eventually return to normal.
Not so with our COVID-19 patients and their loved ones.
For others in our league, this will be their last Christmas together. I try to remember that as I am strong in one of the hardest working churches in my life.