Last Week on the Front Line

Hi everyone,

The first wave of COVID is receding. Yesterday morning, we had 52 COVID patients left in the hospital, down from 450. Thirty remain in the ICU. My days as a COVID intensivist are ending for now. Some closing thoughts:

1. Patients remain ill: Some have been hospitalized since March. The battle continues.
2. Recovery is hard: Many patients have trachs and feeding tubes after being sick so long. Most are weaning from the ventilator, recovering muscle strength, and waking up, but they have miles to go.
3. Survivors are heroes. Some are featured on local TV, but the news reports barely hint at their odysseys. The flips to prone position. Wars waged with delirium. Temperatures of 107 and plummeting blood pressures. Decisions to switch ventilator modes or give steroids a try. Only the ICU teams know the full story.
4. Scrub lesson #1: Back pockets are too shallow for wallets. They slip out, not once but repeatedly, if you don’t learn your lesson. When your resident finds it lying on the floor, you’ll be grateful and embarrassed. Don’t bring wallets to the ICU. There’s nothing to buy.
5. Scrub lesson #2: Front pockets are deep. If you put your head phones in there, you’ll lose them. After searching everywhere, you’ll realize you had them all along, once you reach in far enough.
6. Scrub lesson #3: You have 7 pockets, 11 if you count your fleece. There’s room for everything you need: Peet’s coffee pods, an iPhone and iPad Mini, keys, a battery recharger and cable, pens, a patient list, reading glasses, and headphones. Just don’t bring your wallet.
7. God bless America: There are no red states and blue states in the MICU. The unit is filled with traveling nurses and therapists from Texas, Alabama, Mississippi, Tennessee, the Carolinas, and Missouri. Yale is good, but we have no monopoly on talent. We’re saving lives together.
8. It’s becoming routine: You get used to wearing a mask all day. You put on your N95, face shield and gown to see patients. You remove them carefully and wash your hands when you’re done. You round. You teach. You eat lunch. You laugh. You shower when you get home. It’s almost normal.
9. But not quite: It will never be routine. No families visiting. Devastated lungs. Lives shattered. I’ve never seen so many sick patients at once.
10. The world moves on: Outside the MICU, we’re fighting for social justice. We’re teaching remotely. The new interns have started orientation. COVID lingers, but it’s not the whole story.

The first wave of COVID is receding and, if we’re lucky, this will be the only one. We don’t know if and when COVID will return, so we have to stay vigilant. But if it does come back, we know this: we’re up to the task.

Enjoy your Sunday, everyone, I’m heading back to the ICU,

Mark