Daily Archives: April 28, 2020

The Cost of Service: Doctors, Nurses, First Responders, and other Medical Personnel During the novel Coronavirus 19 Pandemic


Friends of Padre Steve’s World,

I’ve served in ERs and ICUs during pandemics, but none as bad as this one. Likewise, I have seen far too many people die, I lost count somewhere after 700, but can still remember many of the dead, their families, and those who tried to save them like it happened yesterday. Many of the cases I dealt with were violent deaths, others from people who were in the words of ICU doctors and nurses, medical disaster areas because they had so many things wrong with them that you could treat one disease or organ, but have more organ failures. In the Medical ICU this is called multiple system organ failure. I have been with people who died with loving families and friends with them, others who died alone, and still others, especially dying AIDS patients die and being condemned to hell by family members who then used the opportunity to separate the patient from his lover and best friends.

I have also seen those who survived their illnesses or injuries, but never fully recovered after long periods on ventilators to keep them breathing and huge concoctions of drugs and procedures to give them a chance to survive.

As a part of the treatment team I was often the go between from the physicians to the patients family members, providing ministry, even as I shuttled information between them with the goal of trying to help the patient survive. Sometimes all treatments were futile and I would help prepare the patients or the families for the end. Even as I write this the memories, images, and even sounds of these encounters of life between life and death.

Even without the scourge of a pandemic, ERs and ICUs in inner city medical and trauma centers, tend to resemble combat zones. Surges of critical patients flooding ERs followed by brief lulls, that are then followed by more surges. In between surges housekeeping crews clean the blood, fluids, gauze, wrappings from needles, intubation kits, chest tubes, masks and gloves, as doctors transcribe their notes, nurses and techs restock the rooms, and others either prep and transport the patient to the operating room, appropriate ICU, or ward. If the patient didn’t survive, following time for the family or friends to say goodbyes, the staff preserves the body, leaving in it the intubation tube, chest tube, catheters, and any other invasive treatments, place it in a body bag, and transport to the morgue. If the person was known to be infected by HIV or H1N1, or the SARS, MERS, or Ebola outbreaks when I was working in a hospital, more protective measures are taken.

 

Unlike television where miraculously people are pulled from the jaws of death, it doesn’t always happen, especially if the patient is being coded when they arrive in the ER aboard an ambulance, or their heart and breathing stops requiring the ER team to begin the Code, which unlike on television is a rather violent attempt to save the patient’s life. Cardiac compressions begin, the patient is incubated, lines of saline IV fluids are placed and set to maximum flow to keep the blood pressure up, if need cardiac stimulants such as atrophiere are administered, sometimes directly into the heart.  If the injury is due to trauma, or perhaps an Abdominal Aortic Aneurysm, the patient’s chest may need to be cracked. If this happens happens in the ER it is a truly ghastly sight, as the instrument used to separate the ribs looks like the bones of some dinosaur, and unless the trauma surgeons, surgery resident, or ER physician manages to repair the damage and get the heart started the patient dies. Only about one in a hundred survive the procedure under those conditions.

In the  ICUs of various types, Medical, Cardiac, Trauma/Surgery, Cardio-Thoracic, Neurosurgery, Burn, Pediatric, and Neo-Natal there can be chaos as well, but in normal times it is more controlled than in the ER, but despite the best efforts not everyone who gets to the ICU gets out. No matter how caring the staff, the ICU is a clinical and cold setting. In every room or bay there are ventilators, monitors, specialized beds, pneumatic heated blankets sometimes known as Bear Huggers”, crash carts. Available in a fully equipped ICU are dialysis machines, portable X-Rays, and even CAT Scans, under the direction of the ICU attending physician, physician specialists of various types, residents, and physicians. Most of the nurses are Critical Care RNs or have have attained the status of Nurse Practitioners. The techs that work in the ICUs are the best. Likewise there are Clinical Social Workers, Discharge Planners, Unit Clerks, and often Chaplains, like me.

 

In my last full time fully equipped ICU I took the time to learn about what our physicians, techs, and nurses did. I asked questions about how to read cardiac monitors, understand the importance of blood oxygen levels, know when a patient was going into an abnormal heart rhythm, or who was dropping their blood pressure, or de-sating. I still have a copy of the ICU book. One of our ICU attending physicians asked why I didn’t go to medical school, and I had to admit that because of my wretched high school advanced mathematics experience was that it would probably take me at least three years to catch up on the math, algebra, and calculus needed just to get into medical school, and that after the poverty of seminary that Judy would never consent to it. He understood.

All that being said I treasure my time with those physicians, nurses, techs, and EMT and Paramedic first responders, many of whom are now in the front lines fighting COVID-19. When I read about what is happening in ERs and ICUs in major urban areas, when I see the horrors of what these men and women are experiencing my heart goes out to them. They are being confronted in real life with what one could only imagine in the most terrifying Science Fiction, or Horror story. Take a combat zone and add a pandemic which not only infects and kills those brought to hospital, but those risking their lives to treat them. As of two weeks ago some 9,000 health care workers have been infected and about 30 have died as a result of COVID-19. That doesn’t count those who have committed suicide because of the impossible conditions they work under and the impossible choices that they have to make, of who lives and who dies, and which of their staff has to go back into the battle even if they are unready. The cases of PTSD, Moral Injury, and other psychological conditions that will afflict these heroes will rise to exponential level. Others will commit suicide, and even more will abandon the medial profession because the spiritual and psychological toll is simply too high. These are not weak people, but people whose humanity is being assaulted by their inability to save those committed to their care, and fear that they will make a mistake that will get them, their patients, friends, or families killed because they didn’t have the correct PPE or got infected during an intubation, or during CPR.

Sadly, while for the moment the first wave seems to have crested. But without adequate testing, tracking of cases, and eventually effective treatments, and a vaccine, COVID-19 will keep coming back. Each time it does it will harvest those foolish enough to tempt fate, or God, whatever works for them, and put others in harms way. Personally, I don’t want to see those I know fighting for the lives of others die because of the arrogance and stupidity of others who think that getting a haircut, their nails done, going to a fitness center, or going to a dine in restaurant or movie trumps the right to life of others. Anyone who thinks that their right to do what they want for enjoyment which endangers the lives of others is nothing more than a sociopath, incapable of empathy. Sadly, evil, is the lack of empathy.

As for me, I know all too well the consequences to others when people decide that their need for fun and to do what they want to do when they want to do it trumps the right to life of others, including those who are putting their lives on the line every day to fight a pand

Until tomorrow,

Peace,

Padre Steve+

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