UNMC residents share stories, mental scars left by COVID-19

2021-12-15 00:23:36 By : Mr. Kevin Wang

Omaha, Nebraska (KMTV) — With the end of mask regulations and the ongoing shootout, the community continues to feel the impact of COVID. A resident at the University of Nebraska Medical Center (UNMC) recently shared his story of "moral harm", and he and others tried their best to save lives and trauma.

The following content is shared by AJ Spanel MD on UNMC's website:

80/45. . .78/42. . .75/40. The bright red numbers flashed on the monitor like a street lamp on a stormy night. Beads of sweat flowed down my face and gathered on the chin under my N95. I wiped off the condensation on the mask with the sleeve of my robe and saw the infusion tower opposite the room. Norepinephrine, epinephrine, vasopressin, phenylephrine are all used up. The alarm sounded like a police siren. My heartbeat matches the crazy rhythm of the telemetry monitor. When I tried to weave the ultrasound probe through the tangled wires and ductwork on the patient's chest, my isolation suit felt like a tights. In the end, I was able to guide the probe to a sufficient position to evaluate his heart function, which made me even more suspicious that in addition to severe COVID-19 pneumonia, he may now have a pulmonary embolism. In any case, he was too unstable to be confirmed by a CT scan. I looked back at his face. So lifeless and cold. The phantom of the man I confessed less than 48 hours ago.

The knocking on the glass and the deep voice pulled me back to reality. "The patient's wife is here." The nurse told me through the window of the isolation room. "She is in the lobby outside the unit."

"Can you ask the pharmacist to send out a shot of TPA?" I asked as I took off my protective suit, and retreated from his residence in frustration.

The short walk between the isolation ward and the waiting room seems to be eternal. My feet feel as heavy as a sandbag. I pushed open the double door of the isolation ward and found a middle-aged woman sitting on a chair nearby. Her eyes were bloodshot, her face burst into tears, and her knuckles were as white as the tissue she was holding.

These images are still so vivid in my mind, permanently etched like a scar. The stress of the few days in the spring of 2020, my first time working in UNMC's COVID-19 ICU, has exhausted my mind and body. During my three years as an internal medicine resident, I have provided consultation services on hospice care for countless patients and their families. I am satisfied with these discussions. I am well trained to handle them. But this time is different. This is the first time I have experienced a pandemic. In less than two days, I took care of a relatively healthy middle-aged man who developed from a mild cough and difficulty breathing to the door of death. It happened too fast. So fast, I haven't dealt with it myself. I feel powerless to stop it. How can I explain this to his wife? How can I prove the fact that neither she nor any of their adult children can visit him? How can I explain why they couldn't even talk to him before he was intubated?

The sudden scream of the pager was the first in a series of catastrophic events, marking the beginning of the end.

"His oxygen saturation is dropping and his breathing is very difficult," my patient's nurse warned me when I returned to the page. "His flow has reached its limit. I'm not sure how much time he needs before intubation. He can barely speak, but said he wants to talk to his wife first."

"I will page for the intubation call and try to call her. Can you start the tablet and run the video call so he can see her?" I asked, collecting my protective gear frantically, and then Climb down the hall to his room.

At that time, our hospital policy prohibited any visitor from visiting patients admitted to our COVID ward. This is understandably scary and frustrating for patients and their families. As providers, we feel unnatural and present a new challenge to provide relatives with phone updates about the status of their loved ones, usually multiple times a day. During the first few hours of his hospitalization, I had many conversations with my patients’ wives and children, and provided reassuring words on every anxious issue. But at this most important moment, I suddenly couldn't reach them.

"You have arrived at...'s mailbox." I will try his son again. There is no answer.

"Is the tablet ready?" When I put on the isolation gown, I asked through the window, soaking my gloves with alcohol, and then yanked the mask on the N95 into the room.

"It won't connect to the Internet," she replied while tapping the screen vigorously.

When I started to understand the final outcome of the situation, I panicked. If we don't let his wife call now, he might never talk to her again. The anesthesia team started preparing for intubation at the bedside. He is breathing heavily now. Drowning. Can't speak a word. Our eyes are locked. His arms lifted listlessly in my direction, as if to reach out. Try to grab something, anything, so as not to be washed into the sea.

I quickly picked up his cell phone from the counter and dialed his wife again. There is no answer. His body became weak and weak. His eyes closed. When the laryngoscope lifted his chin, his hand gently dropped back on the bed, allowing the tracheal tube to slide into place.

A few seconds later, the phone ringing in my hand broke the silence.

"Hello? What's the matter? I'm sorry I was outside for a minute."

A teardrop slid down my cheek and mixed with the sweat bead under my mask.

Less than a day later, I found myself sitting outside the double doors, separating this woman from her husband instead of a hundred feet away from him. As I stammered through the lump in my throat, she wiped the tears from her cheeks with one of her white knuckles, trying to find words to describe his possible fate.

"We are doing everything we can, but despite all the medications and treatments we have taken, it seems that the virus is taking over his body. He may now have a large blood clot in his lungs. His blood pressure keeps dropping and he is very sick. I worry that he may not have much time."

"This can't be true. There must be other things you can do. Will the drugs help? You gave him everything they always said should work? Our kids are driving in from outside the city, and they will be there tomorrow here."

"I'm not sure if he has the strength to survive until tomorrow. If his heart stops beating, I'm not sure he can survive CPR," I told her in a gloomy tone.

"You have to save him. You need to do anything. We can't live without him. This can't be true. I only spoke to him yesterday. He was okay a few days ago." When she started to lose hope, what she said Go crazy.

I tried to comfort her with all the remaining strength, but after walking away, I felt as if I had done nothing for her. I pushed open the door of the isolation ward, only to hear her grief intensified. The entire unit could hear her crying. I feel very defeated. My first real experience of COVID-19 coincides with everything I see on TV every night.

A few minutes later, my shift was over, and it was time to hand over to our night shift. My departure made me feel uncomfortable suddenly and wrongly. At the climax of the fighting we have endured in the past two days, I have a feeling that I am abandoning this man and his family. When I got home, many conversations during the day reverberated in my mind and kept me awake all night. When I returned to the hospital the next morning, my fear was confirmed. He passed away less than an hour after I left. His children cannot see him. When he passed by, his wife could only hold his hand for a few minutes. Although I have done everything possible in medicine to prevent this result, I feel responsible.

That morning, I did not have a moment of comfort, and was soon overwhelmed by the ruthless chaos that lasted for weeks in the ICU. I am at the bedside of more than a dozen patients who have passed COVID-19. I have had many similar conversations outside those double doors. I told many husbands, wives and children that they are not allowed to be with relatives who are fighting for their lives. Every time I interacted, I started to be fogged up, and I started to feel numb. I started to behave differently at home. I am nervous and easily irritated. My friends and family started asking me if I was okay. I just waved to these questions and said that my days in the hospital were very stressful. I did not provide any details. I didn't expect anyone to understand. Under my appearance, I know I am not good. My world is slowly declining.

A few months later, I finally found some probation in the outpatient rotation, but I was still in a downturn. I'm getting better, but I haven't resumed being myself. Disasters continue throughout the year. I'm not sure that 2020 will get worse, but I can't shake the feeling that another tragedy is coming.

Then my mother told me of her cough.

"Please go get tested," I begged her. "Oh, nothing," she would say, "it might just be allergies. They always get worse at this time of the year." She didn't know that many patients I cared for used this exact phrase to describe their The onset of symptoms was just a few weeks before the virus took their lives. When the worst situation appeared in my mind, fear quietly enveloped me. Since she has been cancer-free for five years and no longer undergoing chemotherapy, I began to rationalize that she would be better even if she tested positive. She is healthy and strong. But then again, so do many of my patients. Eventually she was wiped and tested negative. I was relieved that this is not COVID.

But her cough did not get better.

It started to get worse. Almost. As she became more and more short of breath, days turned into weeks. In each of our video calls, she would stop in a sentence to cough with her sleeve and take a few deep breaths before continuing. This is definitely not an allergy. Will she have a false negative test? My fear is back.

Then one dull autumn afternoon, my phone rang in the middle of the clinic. Usually, I mute such calls and go out to reply later. But when she called at this time, I knew something must be wrong. A few months ago, when I could not reach the patient’s family, I remembered those important moments. I will answer right away. I encountered a suffocating silence. When she spoke, her voice was trembling and soft. When a series of images from my time in the ICU flooded my mind, I was prepared for the worst. In fact, she is on her way to the hospital. The hospital where I work. Her symptoms are getting worse.

But this is not COVID. It is fluid.

A lot of fluid, according to what the radiologist who performed the CT scan told her. Pleural effusion. Large enough to collapse her entire right lung. She was taken directly to the hospital to urinate. She wanted to know what caused the liquid. She was scared. In my physician's opinion, I know exactly what caused the fluid. I was terrified.

I rushed out of the clinic and rushed towards the hospital in the torrential rain that had already started. Trying to identify each street light, I used the sleeve of my shirt to remove condensation from the windshield. My efforts were of no avail, tears filled my eyes. A storm of emotions swept across me. The first is panic and despair. Soon after, guilt and shame followed. I began to understand that my fear of this deadly virus prevented me from seeing the truth: my mother’s cancer had returned.

I drove into the parking lot of the hospital and started walking along the lobby to the ward where she was hospitalized. I finally reached a set of locked double doors. Suddenly, a harsh reality appeared: I was not allowed to see her. To my shock, I forgot our visitor policy. I was standing there, now on the other side of those doors, when my mother received this devastating news, my knuckles were white and red, and my eyes were bloodshot.

The epidemic finally broke me. I collapsed on a nearby bench and buried my face in my hands. In the silence of the empty hall, I was at the climax of my struggle with this miserable year. I imagined the many husbands, wives and children I tried to comfort me not far from where I was sitting. I understand their sadness. When facing the pain of being separated from my relatives in trouble, I also felt the same pain that I wanted to heal. These emotions cannot be comforted.

It's been more than a year now. We are still fighting this virus, but since the chaos of early 2020, we have made significant progress. When we came to the other side of this storm, we were slowly lowering our vigilance (and our masks). We had begun to take a breath and reflect on the wreckage left after COVID-19. In order to understand its impact, we must remind ourselves of everything we endure as health care providers. Many of the adversities we face are not new to our field, although all adversities have been magnified to the extent that future generations of this industry may never fully understand. These struggles may leave us many scars.

We have experienced the pain of loss. Loss of patients. Lose friends. Lost family members. The pandemic has taken lives with unprecedented uncertainty and an overwhelming frequency. Usually, we have little time to mourn these deaths before we are forced to turn our attention to another terminally ill victim. Healing is part of the spirit that drives us all to the field of health care, and although there is sometimes no cure, it will always leave traces.

We have worked for a long time under unprecedented pressure. Every day we take N95 and the finest precautions we can devise to enter the lair of deadly viruses; however, nothing can quell our own fear of being infected. The levels of sleep deprivation and burnout vary, and we have no reinforcements because we are staffed in the isolation ward and at the same time take care of those who are hospitalized for other diseases. We struggle with the inevitable narrow vision, and when we decipher COVID from non-COVID, we often try to identify other disguised diseases.

It may be more difficult for us to express the moral harm we have suffered. When quarantining our patients, we acted to delay the spread of the virus and our obligation to protect our community to the best of our ability. Controlling the pandemic requires isolation. But what followed was an inevitable sense of shame, because we witnessed a new kind of pain. We mourned with our husbands, wives, parents and children while trying to find a reassuring word, usually through the screen of a tablet computer, sometimes outside the two-door roadblock. Many of us even experienced this firsthand with our loved ones.

When we face these unique challenges, the difficulties outside the hospital seem to intensify. Financial difficulties plague our society. Political turmoil and ethnic turmoil make us feel sad, anxious and angry. Some of us have lost loved ones due to other diseases. Others learned that our cancer had returned. More importantly, we suffered all this while being confined at home and keeping a distance from society. We are more alienated than ever. We go home from get off work every day, which is a hotbed of mental illness.

There is another side to our story that has yet to be told. The attack on our hearts is not over yet. In recent years, we have become increasingly aware that mental health disorders affect medical professionals with alarming frequency, and this dilemma will only be exacerbated by the pandemic.

I have no mental health disorder myself. I have never struggled with drug abuse. I can't say that I ever thought about suicide. I can't imagine experiencing the past year under these conditions. Undeniably, I don't even want to share my own experience because I am worried that if there is no history of these diseases, they may not be relevant. Nevertheless, I have been on the path of depression more than once or twice. If I say that I don't show up at work and feel numb, and sometimes even through movements, then I'm lying. I have been guilty, at a loss, and exhausted, more than I am willing to admit.

Bottom line? I have struggled to ask for help.

This is not easy. I want to look confident and not staged, "like everyone else." Get involved and continue to work. In order to hide the part that I feel weak. In hindsight, I realized that this attitude was the main reason for my downward spiral. It might get me into serious trouble. If I didn't discuss my experiences and emotions, I'm sure I would continue along a very dark path. I now appreciate a basic truth that I have always known to be true: there is no weakness in asking for help. It doesn't matter if it's abnormal.

Finally, I contacted a psychologist through our hospital’s PiNS (providers requiring support) program. Our conversation sparked a series of other discussions with my friends, family and colleagues, who generally normalized my reaction. Although I still bear the same burdens, I now deal with and understand them better. I started to heal because I opened my heart. I will never know what this saves me from.

So please talk to someone. We are all in the same boat.

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