The Look… COVID-19
One of the most devastating aspects of COVID-19 is the look. It’s the look you see in a patient’s eyes when they suffer acute respiratory failure. It’s a look that only we see at the bedside, and that the public does not see, and a look that I believe if people could see it, they would realize that this pandemic is all too real, and they would join us in doing whatever they can to fight this virus.
On a recent night on call in the ICU, we admitted the husband of one of our patients already in the COVID ward of the ICU. He had been sheltering in place since his wife was admitted, but time and the virus caught up with him, and he was brought to the Emergency Department via ambulance. When he arrived on 15 liter non-rebreather (a face mask equipped with a bag reservoir and valves so that the patient always gets oxygen in with their next breath rather than the air they just exhaled) he was in visible distress: using accessory muscles, breathing fast, with his chest retracting with each breath. He soon felt some relief on heated high flow nasal cannula, at 100% oxygen flowing at 60 liters per minute, and was given dexamethasone IV, Remdesivir, and was transferred to the ICU. When he arrived on the Unit around 10PM, he appeared to be comfortable. He was watching TV, and breathing at a reasonable rate. When I went to talk to him, however, I found myself receiving 1–2 word answers, not because he was too short of breath to speak, but because of the fear I could see in his eyes as he sat back in bed on high flow oxygen. This was that look. That look a patient gets when they don’t know if they’ll get better, and when they really fear (especially having seen others decline from COVID-19) they will get worse.
It was the same look I saw in the eyes of Mr. L back in April when I was in New York City. Mr. L was a very robust-appearing yet kind and gentle man, the patriarch of his family, who had been admitted to the hospital the day prior. He had been in a shared hospital room in which one of his roommates (who also had COVID-19) had gone into respiratory arrest and had to be resuscitated with CPR. He watched the whole event occur right before his eyes, and then was transferred to another unit where again, he witnessed another patient surrounded by a code team, require intubation (a breathing tube to be placed into their windpipe) and be placed on a ventilator. After these two events, Mr. L was transferred to our step down unit for better delivery of oxygen. When I met him, I saw that look, the look of not knowing what was to come. The look that comes from seeing people look relatively okay, and then suddenly go into respiratory failure right before your eyes. As doctors we’ve seen people decline like that with this disease and it is horrible, but I imagined even more how horrifying it is to a non-critical care physician or nurse, who is not used to seeing people so critically ill. He also gave me short phrased answers about how he came to the hospital and so forth. We took care of his orders, and when I had a moment I went back to him to ask him, softly, “I heard you witnessed two people in the last 24 hours go into respiratory failure and need to be resuscitated. I can only imagine how hard that was to see… Sometimes talking about it can help.” He told me that he was worried that the same would happen to him, and as he looked away from my gaze, told me he would not forget what he had seen for as long as he lives. At the end of my time in New York, Mr. L was still doing okay, still on high flow nasal cannula oxygen, but holding his own.
The same cannot be said for the kind man who came into the ICU on my more recent shift. Later that evening we put him on BiPAP, as he was on positive airway pressure therapy at home for sleep apnea, so we hoped we might buy him just a little time for the steroids and anti-viral therapy to help, as well as time to receive convalescent plasma. We put him in prone positioning around 3AM, and saw his oxygen levels rise to 92%, and thought maybe, just maybe we bought him time. He lasted that way for about 14 more hours, but his disease progressed, requiring that he be intubated and placed on the ventilator, and the next day ECMO (which is lung bypass, a machine that oxygenated the blood and returns it to the body when the lungs cannot do this work even on a ventilator) to treat his respiratory failure.
It is this look in people’s eyes that you see when they realize how tenuous their breathing is, how tenuous life is, that one cannot forget. And once you experience that look, you cannot help but do everything possible to help them and also do what you can to fight this pandemic.
Will you help us in this fight to help our family, friends and neighbors? Please do not give up or give in to the misinformation. Please do not minimize the pandemic. It is very real, and only by coming together can we defeat it. What does that mean? Practice social distancing, avoid crowds, wash your hands, and wear your mask when you can’t stay socially distanced. Please help us help our fellow human beings.