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This story is from the Anamnesis episode called Scar Tissue and starts at 3:28 in the podcast. It's from critical care and infectious disease physician Taison Bell, MD, an assistant professor of medicine at the University of Virginia in Charlottesville and medical director of the intensive care unit (ICU) at UVA Health.
I wanted to tell the story about Nellie, or as we called her, "Maw Maw." She was a woman who was admitted to our ICU in the earlier sort of days of COVID before we had access to vaccinations or really even effective therapies that we had confidence in.
And from the beginning, it was a stressful situation because we knew that she was the grandmother of one of our ICU nurses. And this is a time where we don't have visitors coming into the ICU because of the restrictions, so this was really the first time we had a family member who was close to one of their loved ones in the ICU. And of course, it's one of our own, the family of one of our own. So everyone was on edge, we're really stressed and we're seeing how sick these patients become, and ultimately what happens when they go on ventilators and things like that. So everyone's just on pins and needles.
She's admitted to our hospital, and I'm the attending who's on call, and she's on my service, and I go in to meet her. And she's on a high rate of oxygen. And at that point, even then we're worried that she might have to be intubated or have a breathing tube put down and, all this stress, we just go into the room.
"Mother Claus's" Kindness
One thing that I learned right off the bat about Nellie is that she's the kind of person who really takes care of everyone else around her at the expense of even her own health or well-being. She's -- her background -- she is a former restaurant owner in a town not too far from here, a neighborhood restaurant. She knew everyone in town, and the effect that she had was immediately present because she was getting so many well wishes from the community. She also dressed up as "Mother Claus" every December. So she was that kind of person.
And I remember going in and talking with her and asking her my standard questions: How's your breathing feel? Do you have any pain anywhere? Anything I can help you with?
And in the midst of all the concern that we had for her, she looked at me and asked me, "I'm doing okay, but, how are you doing? This must be really stressful taking care of all these patients."
It was really the first time that a patient had actually shown concern for me, even while she was on the brink of having to be intubated. Just an amazing amount of concern, and it just shows how warm her heart was.
As a healthcare worker, one of the things that we're used to is shouldering the burdens of our patients and their families. That's kind of what we do on a daily basis. And you always have that comparator that no matter how bad things are going for me, at least I'm not in the hospital, at least I'm not on a breathing machine or connected to this, at least I'm not in that sort of situation.
So, we're not used to being complainers when it comes to things like that, and that means sometimes we're not used to thinking about how are we actually doing emotionally? And when a patient who's struggling for their own life, turns that back on you and says, "How are you doing?" I actually had to take an honest moment and take stock. This woman obviously should not be thinking about me and, you know, anywhere past what I can do to try to help her. The fact that she still had concern, demanded that I actually consider it. And I was not okay. When I think about it.
My child wasn't in school, my grandparents were high risk, my own parents are high risk, and I'm worried about how they're going to do. I have friends who are sick with COVID. I remember I had a former fellow at the time who was sick with COVID. And I'm wondering if he should go to the hospital. It felt like a war zone. And having to pause and consider all of that was a lot to take in.
And so automatically, it centers just how abnormal all of this was. That in a normal circumstance, we'd have a family member at the bedside, we'd have multiple family members in a room, we'd be able to have this conversation. And her granddaughter is right there, but you know, her other family is concerned for her, as is the whole community.
Now at this point, we have FaceTime setup or video conferencing sort of software, where we can try to have families who can't visit the hospital still be able to talk face-to-face with their loved ones. So there's an iPad in the room and the family is able to call in, and the conversation was just heartbreaking once the family called in. She's checking on them, Nellie is checking on them, making sure they're doing okay, while they're asking her how she's feeling. And the way she's talking kind of lets you know that she probably knows what's to come that she probably is going to have a breathing tube put down and she's not sure if that'll be the end of it or not. A lot of folks unfortunately know when a breathing tube goes in that means that someone's severely ill and their life may be very different if they're even able to survive. And, true to form, she's checking on them and making sure that they're okay as well.
COVID's Slow Death
And so we were very concerned. It turns out she was able to go on with a high level of oxygen for a few days, but sure enough, over time, her breathing tired out, and she had to have a breathing tube put down. And that's when things really became stressful, because we all kind of know how critically ill she is. She's older in age, she has some chronic medical problems. These are the kind of patients who don't tend to do well.
The thing that doesn't often get discussed is that COVID-19 is often not a quick death. A lot of times it's very slow. And patients are on a breathing machine, you know, some other organ system may go down, and they end up on dialysis. But it's not like they're emergencies every day that we're responding to. A lot of this is patients deteriorating little by little over time. And then you get to a point where you just can't keep going on, and the patient passes away. And so we see this slow decline, but it's happening in the context of her granddaughter being there, trying to work shifts and spending time with her grandmother. And we're trying to walk that balance of trying to take good care of Nellie, trying to have family there that we wouldn't normally have -- but a special circumstance -- trying to take care of her as a granddaughter but also take care of her as our own team member, you know, one of our own. And so it presented these challenges that were just gut-wrenching every single day.
And this went on for a number of days until she finally passed away, peacefully. But in that emotionally violent sort of way, where you don't have your family members at the bedside, or the bulk of your family members.
And that story just really stuck with me because she was taken too early. And the community deserves to have her still around, you know, checking in on people and dressing up as Mrs. Claus and spreading holiday cheer. And if we had vaccines available, I have no doubt she would have been one of the people who would have gotten vaccinated, her granddaughter would have made sure of that, and I think she would still be alive today. And it emphasizes for me how much is taken away from us.
I Can't Do This Again
We really have to take care of ourselves as healthcare workers and look out for each other. And our tendency to ignore what we're going through or continuing to place it in the context of how bad it could be, because of what we see, we have to get better at looking out for ourselves. Now, I know from this experience that, years down the road, if something like this were to happen again and I'm still working in ICU, I'm not going to do this again. I can't take it. I think the memories of what we're going through now and having to go through it again in this sort of visceral way, that won't be worth it for me.
And so I hope that there's not another pandemic, or you know, one is going to happen at some point, but hopefully, all of us will be dead and passed on at that point. But if one were to happen relatively soon, at this sort of scale, I don't think I would even try. That's a new feeling for me. I think this is actually the first time I've said this. And maybe the first time that I've admitted it to myself that I kind of have my own limits. That I can't do this again.
Check out other stories from the Scar Tissue episode, including "When the Patient Becomes the Healer" and "It Is Not a Sin to Cry."
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