IN one day, we lost three patients in the intensive care unit due to complications related to severe Covid-19 pneumonia.
The patients who died were 45,53 and 73 years old. All three had been on life support for more than four weeks and had developed multiple complications, including other infections with resistant bacteria, bleeding, acute kidney failure and shock. All three patients were on maximum ventilator support, and there were no more ways to give them more oxygen.
St Anthony Hospital is a “safety net” facility on Chicago’s Southwest Side that serves low-income and vulnerable populations. As with many hospitals across the United States, the number of deaths related to Covid-19 at St Anthony is accelerating, as more patients who were admitted a few weeks ago with respiratory failure and placed on mechanical ventilators are reaching the end of the road.
This virus is relentless. It attacks the body in different ways, and kills using different strategies. It is a smart and cunning virus. We have not seen anything like it in our lifetime.
One of the most demanding tasks in the intensive care unit is to call families and share with them the progression of the disease affecting their loved ones. We answer their questions, make sure they understand the gravity of the situation and tell them that cardiopulmonary resuscitation (CPR) will not help to bring life to the patient when their heart stops beating.
The conversation is often a rollercoaster of emotions. They are not physically present to see their loved ones. They can FaceTime and see the pale faces of their family members connected to all kinds of tubes and catheters. But many times, these new ways of communication do not do justice to the gravity of the situation.
Some families accept the information. When there is no hope, they make the hard decision to not resuscitate their family member. Others want “everything to be done” until the heart stops beating. Some get angry or very emotional no matter what we say.
The 73-year-old patient had been on life support for 31 days. Her organs had been failing. Her family wanted “everything” to be done to keep her heart beating. An hour after the call, her heart stopped. We “coded” her. We pressed on her chest 100 times per minute knowing that CPR wouldn’t bring her to life, but we respected the family’s decision. We gave her injections of epinephrine to stimulate the heart and circulation, trying to jump-start her heart. We could not. We pronounced her dead and informed the grieving family. The young nurse attending to her was crying. She was tired and devastated, but she still had to take care of three other critically ill patients who needed nursing care.
Six more patients were waiting in the emergency room to be admitted to the ICU. All of them were suffering from severe Covid-19 and may end up on life support. Some will survive the virus, and some won’t.
We ran out of beds and are about to run out of ventilators. We are using old, portable ventilators that do not have the bells and whistles found in newer, more expensive machines. We have to; there are no other options.
The situation is overwhelming. Sometimes, I feel that I am in disaster-stricken Yemen or Syria, not in the United States.
In another bed, we have a father who is only 59 years old with multiple organ failure. His prognosis looks very grim. He is dying. His daughter, who is only 31 years old, was just intubated in ta different room. She has severe Covid-19 pneumonia and is not doing well. We called a nearby medical centre that has more advanced technology to see if they would help give the younger patient a higher chance of survival. They initially refused. They said that they had “reached their cap” (full capacity). We begged them to transfer the patient to their facility. She needed a higher level of care than we could provide.
Only a few medical centres in Chicago have the advanced technology, and almost all of them refuse to take patients due to the large number of Covid-19 patients they already have. I understand their logic, but it is not right or fair. Why should your area code determine whether you will have a better chance of living?
The nearby centre finally agreed, and we transferred the young patient. We cried in celebration. We prayed that she would live. Her family was very appreciative.
To build resilience, my global health team teaches local frontline healthcare workers about the principles of dealing with limited resources in war-torn countries such as Syria and Yemen, and fragile states such as Sierra Leone and Bangladesh. The austere environment is the rule not the exception in some of these regions. I never imagined that we would be using the same principles in my hospital in Chicago.
A century ago, the United States lost about 675,000 patients to the influenza pandemic. That was before the invention of antiviral medications and modern ICUs. We are expected to lose more patients during this pandemic.
We are failing. Everyone should share the blame, from former President Donald Trump to the Centers for Disease Control and Prevention, to those who have politicised mask-wearing, to those who continue to gather in house parties, to the bikers who gathered in the tens of thousands in South Dakota. We should reflect on that as a society and draw some lessons for the future.
With the start of vaccinations, we see the light at the end of a long tunnel. It is still too early to celebrate, though. It will take a lot of effort and convincing of the 40% of the population who are sceptical of the vaccine. That should be our priority. We need to vaccinate at least 70% of the population to stop the pandemic and get our normal life back. Until then we should not lower our guard.
We can either tolerate wearing a mask for the time being and take the vaccine when it is available, or we will have to live with the collective guilt of squandering another opportunity to win the battle against this virus. – Chicago Tribune/Tribune News Service
Dr Mohammed Zaher Sahloul is a pulmonary and critical care specialist and the president of MedGlobal, an American medical charity that builds resilience in disaster regions by reducing healthcare disparity. He is affiliated with St Anthony Hospital in Chicago. The writer’s opinions are entirely his own.
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