If you ask ICU team members around the country, one of the most heart-breaking things they witness with COVID-19 patients is the phone call a decompensating patient makes to their loved ones prior to being placed on the ventilator. While some patients arrive at the hospital in such dire condition that they must be immediately put on a ventilator, others arrive and slowly decline over days to weeks. COVID-19 often offers us an almost cruel window of time, again often days, in which we know a patient is declining but do everything in our power to stave off the inevitable.
When it is apparent we can wait no longer, we still often
have time. Time to allow patients to call or video chat with their families.
Each of us has held the phone or tablet for more patients than we care to
count. Allowing them to tell their families how much they love them. Hearing
their families provide words of hope or prayer. We reassure the family that
their loved one will be made comfortable with sedation. We hold out as long as
we can, not wanting to end the phone call, or deflate the hopefulness. Because
we know. We know that so many patients who go onto a ventilator due to COVID-19
lung disease will not survive. We know that this will be the last time they
talk to family. We know that hours, days, and even weeks will go into caring
for these patients to no avail, and countless updates will be given to their
loved ones.
We are tired. Our hearts are heavy. The ICU is not the
battleground on which we will win this fight- that will happen with vaccine and social distancing and masking- but we have to keep fighting. Even as
we fear variants that render vaccination less effective, and beds that will
soon reach capacity. Many of us couldn’t imagine doing anything else, but none
of us could have imagined what this would mean. What it would feel like to make
that last phone call over and over again, to see more loss in 18 months than we
have seen in decades-long careers. We will not win on the ICU battleground, but
we have no choice but to fight.
Sincerely,
A tired and heartbroken ICU nurse practitioner
