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My first on-call on the Corona ICU

A surreal experience, it made me a little anxious and a little proud -- until a quick phone call turned things around, and not for the better
Illustrative. A patient is seen through the glass of the door inside the intensive care unit at the CHRU hospital in Tours, northwestern France, on March 31, 2020. (GUILLAUME SOUVANT / AFP)
Illustrative. A patient is seen through the glass of the door inside the intensive care unit at the CHRU hospital in Tours, northwestern France, on March 31, 2020. (GUILLAUME SOUVANT / AFP)

It’s 01:30 a.m. during my first on-call on the Corona ICU.

I know this might sound almost silly, but I’m feeling a bunch of emotions I’m not used to during my work, including a little fear.

Doctors are used to being around health risks, but it is thankfully pretty unusual for us to feel personally endangered. Yes, all ICUs contain patients with various “super-bugs,” but I tell myself, probably with justification, that my young healthy immune system can fight those off.

Here, you spend a long time getting dressed, and checking and double checking that you did it right. Then getting a friend to recheck. Then you go through an airlock system, and end up in this strange other-worldly place, with nurses and doctors dressed like space-men, and perfectly ordinary looking people walking around, looking fine. It’s like some surreal alien movie.

Finally, after walking through this, you get to the very center and the ICU. There are the four sickest patients, who you will take care of. I won’t go into details because of confidentiality, but they are really sick. They are on the border of death, and you are constantly aware that the things that did this to them is invisible, and all around you, and that it is the reason you are dressed as you are.

You become aware of your breath. Little jets of breath come out of the top of your mask and fog your glasses, which makes you worry that the N95 mask isn’t fitting tight.

You turn round and your gown catches on a bottle of alcohol gel. For a moment you worry it tore, but it didn’t (the truth is, it wasn’t even close, and we have multiple layers).

You are constantly squinting through a visor which is sometimes not 100% clear, reminding you of the spacesuit-like gear you are wearing, and the unusual environment you are in.

Finally after a maximum of only a few hours like this, you get to go out. The nurses are doing 12 hours straight there, hardly managing to take a break at all. No chance to drink water, or go to the toilet, or just escape for a bit. I kept suggesting that they need to leave for a rest, but they say they have too much to do. Finally, they manage to send one of them out for a short rest.

To get out, you go through this elaborate ritual to remove layer after layer, carefully trying not to get infected, and again, knowing that if you screw up, unlike in other aspects of this job you’ve been doing for years, you risk harm to yourself and your family, not just your patients.

This whole surreal experience is making me a little bit anxious. Although as I write this, I’m also feeling a little pride in what we’re doing here.

Goodnight all

* * *

This is a bit of a post-call post-script:

It’s been a bit of a roller-coaster ride.

After the catharsis of writing at 01:30, and the supportive comments of some night-owl friends on social media, I had started to find the whole experience pretty exhilarating. Excited to feel like we’re fighting on the front-lines, as people say.

Then at 3 a.m., that feeling crashed. I had a patient who had arrived very sick earlier from the ER and who I had managed to stabilize. Still sick, but very likely to make it through the night, and a fair chance to recover, I thought.

I was woken from my short sleep (the only 1.5 hours I got last night) by a call from the nurse, who had just taken a blood gas from him that looked pretty terrible. While he was on the phone, the nurse said “Oh! The patient is becoming bradycardic.” I immediately hung up and sprinted down from the old building, past the security guard, turning into the Corona Ward air-lock. The nurses in the Covid Control Room helped dress me fast, and as I pushed through the air lock the cardiac arrest alarm sounded.

We worked to resuscitate him for maybe 45-60 minutes, but without success and my patient died. One of the first ICU corona patients in my hospital (or so I was told later by a nurse).

That was bad enough, but then I had to call the wife to inform her. Everything I was ever taught about dealing with these situations went out the window: I couldn’t invite her in, sit her down, talk to her face-to-face, with a kind nurse to give us support. She wasn’t even allowed to come to the floor the unit was on, and would not be allowed to see her husband, and she didn’t even know anything was terribly wrong with him.

In the end, I explained very briefly how sick he had been on arriving, and that unfortunately he had deteriorated and died.

She got me to say it again because she couldn’t believe her ears, and then said, with complete justification, “This is how you choose to tell me?!”

All I could do was apologize. I sat and spoke more with her and did everything I could to help her and my patient’s brother, but she was 100% right. This was a terrible way to pass on such terrible news to someone.

I am still trying to work out a better way to do it. I tried to talk to a friendly internist, and my boss. Everyone agrees it sucks, but no practical advice yet.

So now going to sleep a bit before driving home, somewhat deflated.

About the Author
Aaron Krom is a resident in Anaesthesia and Intensive Care at Hadassah Ein Karem.
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