Eric Siegal, a critical care physician in Milwaukee, published his thoughts on social media related to experiences from the ongoing surge of COVID-19 infections. The post was made on September 19, and rather quickly went viral from the public reaction to his insight, sincerity, and helplessness in watching the unvaccinated of Milwaukee perish so needlessly.
After a brief summer respite, our 24-bed COVID ICU is once again full. Unlike previous waves, which largely affected the elderly and infirm, most “delta” ICU patients are young and generally healthy. Nearly all of them are unvaccinated. The vast majority of those who end up intubated and mechanically ventilated die. The “lucky” few who survive leave the ICU with a tracheostomy, facing weeks or months of rehabilitation, hoping that they’ll recover the ability to breathe independently, let alone return to some semblance of their former lives.
Our hospital has been at or over capacity for weeks. Inpatients pile up in the ER waiting for hospital beds, and ER waiting times have gotten so long that scores of patients leave without being seen. Nearly every day, I refuse transfers from smaller hospitals because I have no open beds. We (like everyone else) are desperately short of qualified nurses, forcing our nursing leadership into a never-ending game of staffing musical chairs just to keep the place running.
We move from room to room, titrating infusions, adjusting ventilators and dealing with complications, racing against time before lungs collapse, life-threatening secondary infections set in and other organs fail. Every day, we call anguished families with grim news, made all the worse because they cannot visit their sick and dying loved ones. Frequently, they have other (unvaccinated) family members who are also hospitalized, dying or already dead from COVID-19. I struggle to stay cool when a patient or family member spouts idiotic conspiracy theories while demanding that I prescribe ivermectin… and God knows what other unproven “therapies” that they Googled.
Most workdays in the COVID ICU feel like rearranging the deck chairs on the Titanic. The only way that I stay (relatively) sane in the face of overwhelming awfulness is through cultivated apathy. Far less gut wrenching to break down my patients into lists of diagnoses and problems than to think of them as husbands, wives, sons or parents who have people waiting for them to come home. I show up, do my job, check the boxes, try to lighten the mood with some gallows humor… and try not to let the futility crush me before the day is out.
Death and suffering are inherent to critical care, and one doesn’t last in this job without developing thick skin and robust (if occasionally dysfunctional) coping mechanisms. But COVID is something new and different. The realization that this horror has no end because far too many Americans are too cowardly, self-absorbed, or ignorant to get vaccinated is maddening. I am tired, frustrated, wounded and frankly enraged at my fellow citizens who have abjectly failed to meet their end of the bargain. I find it increasingly difficult to keep this anger from spilling over into my personal life. Nearly everyone I work with struggles with similar issues.
I love being an intensivist, and I cannot think of a career that better suits me, but COVID is chewing me up and spitting me out. I’ll keep showing up because I took an oath and I absolutely will not abandon my team when they need me the most. But I cannot help but wonder how badly damaged I will be after the dust settles.