Dr. Chris O’Connor is the president and founder of Think Research, a Toronto-based clinical content and health technology company that helps streamline and standardize care. He is also a practising physician at Trillium Health Partners. Here, he recounts his latest shift in the ICU.
Before last week, it had been more than a year since I treated a patient who needed to be turned onto their stomach to try and help them recover from severe damage to their lungs caused by acute respiratory distress syndrome.
Last week, it happened five times.
This is the new normal, for however long it may last.
The technique is not new. Placing a patient on a ventilator in the “prone” or stomach-down position is a technique that’s been used for decades to help improve blood and air flow through the lungs. It helps to better match the blood flow in the lungs to where the ventilator is pushing the oxygen-rich mixture of gases the patient needs. It’s shown some promise in some of the most ill COVID-19 patients — that’s why it’s become so commonplace in the ICU these days.
In the new normal, we aren’t seeing the same variety of patients we usually do in the ICU. The effect is dramatic. We are not really sure why — the cancellation of elective surgeries and patients choosing to stay home because afraid to come to the hospital, would not seem to apply to the sickest of patients we see in the ICU. And so, door after closed door in the unit separates one COVID patient from another.
We are not overwhelmed. Not yet. But the tone of the ICU has changed.
In the new normal, the ICU is quieter. There are no families keeping watch at the bedside. These days, it’s the staff, typically the nurses, who will visit with a tablet and try to keep their patients connected to worried loved ones.
The biggest surprise for me was how exhausting the week was. I’ve talked to colleagues about the feeling of exhaustion. It’s unlike anything I’ve felt before. The endless meticulous attention to infection control, donning and doffing of gear, over and over. Endless changes to ICU organization and keeping up with the daily, even hourly, changes in knowledge about how to treat patients. It was like practising in a lead radiation suit — everything felt slower and harder. Rounding on patients took hours longer than it used to.
I thought maybe it was me getting old. And then I worried. I checked myself for any other signs that I may have contracted the virus. Fever? Cough? No, I had no obvious symptoms of COVID-19. I was not so secretly relieved when a colleague, decades my junior and very fit, said he has the same crippling feeling of fatigue.
Working in the ICU, I have always been moved by what my patients are facing but I’ve often felt somewhat untouchable — that disease was something that affected them, not me. It was a necessary fiction, perhaps, to get through my day. But COVID-19 has levelled the playing field. I can no longer pretend that is the case. We are all human, we have no immunity, and we are so, so vulnerable.
We have always worked as a team in my unit but the current situation has deepened that sense. We now take the time to talk with each other even more than we did before. I speak with radiation techs, the people who are taking those lung x-rays we depend on, who are closely exposed to patients with the virus dozens of times a day and who continue to work despite the risk.
In the ICU, we see the sickest of people and our goal is to keep them alive. So, we intubate and ventilate, we sedate or even paralyze patients and we do these things to give them the best possible chance to recover. Typically, when a patient is admitted to ICU, they stay a while — there are rarely quick fixes.
But the sickest of patients can and do recover and that’s a large measure of why we’re here.
In the new normal, our work has been brought into the spotlight in an unprecedented way. For most people, it will be understood through the lens of the outstanding journalists in our country who have dedicated themselves to covering the stories of patients and the healthcare professionals who are caring for them. For many, it will be lived because they, or a loved one, becomes ill with this disease and experiences the impact firsthand.
For all, I’m certain this pandemic will leave a lasting impression of what my colleagues are capable of — what we are trained to be able to do.
And when we eventually go back to the old normal, or some version of it, let’s all promise to carry that with us.