April 13: NYC Letters from the ICU
By Andrew D. Thomas, MD
April 13, 2020
Thank you all for your kind words of support. It means a lot. It has been a couple of days of watching, a day on a unit with the stable and the well, a day in the books uncovering so many forgotten things (anion gap?). Then, suddenly, the bleary Critical Care fellow coming off nights is finished mumbling the sign-out. He stops talking and drags himself away. I have the Wall.
The patients are mostly going die, but not today. I gather my boys, I gather my troops. Already I love them if only for their fashion sense. The looks are dizzying. Is this supposed to be a Vogue shoot or a COVID ICU? I got some gunslingers in lone K-95’s practically daring the RNA, a base pair at a time to make a run at them. Others, more whimsically mix the deep cranberries of their scrubs with sky blue full head and neck gear that is trimmed in cloud white with their double masks, face shields and cystoscopy thigh booties looking like psychedelic sand people out of the first Star Wars. Blue jackets, yellow jackets no jackets, high school chem lab googles, welding shields, ski googles (donated by some Vermont resort I was told). We are a rag-tag rebel army, brothers in our common religion. The religion that we are not going to let these people die.
I make everyone put a big piece of tape with their first name on it upon their outermost garment. Then explain that I have come from Minnesota to lend a hand and tell them something Coach Spencer told me during a Little League practice when I was 11. Baseball is a game of inches. Well, so is ICU care. You win because you back up the throw to third, every single time and run out a ground ball, every single time. People survive in ICUs because their ET tubes get suctioned on the hour, every single time, heels are kept off mattress so they don’t ulcerate, every single time. Lines are flushed, sheets are changed, pumps declogged, oral hygiene carried out. We are playing a mortal game of inches and if we win, it will be one inch at time.
I ask one other thing, this just of the nurses. I tell them what they already know, that 70% of our patients on Core E are going to die here. That there are families outside this hospital, unable to visit, whose lives have been reduced to the phone calls they receive each day from the communication teams. These calls are all they have to connect them to their children, their husbands, their mothers. If they wish, I say, they can write down something personal about the care of their patients. Something like how young the patient looked after they got a shave, or the loveliness of their nail polish and how gentle they were as they received their care.
I tell them that, if that want to, they can give me these notes and then someday, if this patient should pass, I will get these notes back to them. Then, if they wish, when this is all over they can contact the family members and tell them how beautiful they were during these long last moments.
By the end of the day, every nurse has given me a note.