Dedication And Donuts: The Extraordinary And The Everyday In The COVID-19 ICU
Life in the intensive care unit always blends the extraordinary with the everyday. That is true now more than ever. While everyone else is fleeing from COVID-19, my ICU teammates and I come in to confront that pestilence every workday.
Exceptional, yes, but also ordinary. That’s just our job.
In the extraordinary aspects, we are following the example of our colleague, Dr. Aaron Baggish. When Aaron, medical director of the Boston Marathon, heard the bombs go off on April 15, 2013, he left his usual post at the finish line to do the opposite of virtually everyone else: He ran toward the explosion.
This spring, our new emergency is COVID-19. For us at Massachusetts General Hospital, it began with one patient admitted overnight to our 18-bed medical ICU, a blip in the daily work. Only a few weeks later, we have 12 ICUs packed with COVID-19 patients and several more filling up. We see no signs of slackening. Our home and work schedules lie in tatters.
This emergency will be a marathon.
For me, this prolonged crisis is personified by another local hero, an icon of the everyday: Fred the Baker. We New Englanders grew up with those unforgettable Dunkin' Donut commercials featuring the droopy-eyed, slope-shouldered Fred. Every ad opened with him rolling out of bed in the dark and cold at 3 a.m., muttering, “Time to make the donuts.” Shuffling to his truck, opening the store, Fred kept chanting his monotone mantra. People depended on him, and he would get there.
Fred’s early a.m. anthem resonated for those of us up and at it before sunrise. “Time to make the donuts” helped you heave yourself out of bed. Whether your work was medicine or making donuts, you heeded that call to duty. People depended on you, every day. Stirring donut mix might seem mundane compared to shepherding patients through a harrowing illness, but neither can happen until you first put your feet on the frigid floor in the predawn.
COVID-19 is at least my fifth epidemic, preceded by AIDS, SARS, H1N1 influenza, and Ebola. AIDS and SARS arrived surreptitiously, while we watched H1N1, Ebola and now COVID-19 first announce themselves elsewhere and surge toward us. But each crisis, while differing in specifics, has felt the same for our ICU team in this disparate blending of the extraordinary and the everyday.
Once again, now, we find ourselves awash in patients afflicted by a virus with no known antidote, because it is our job to run toward the coughing. We chose this vocation, knowing that in trying to save another's life, we might be risking our own. But we also show up because of our training and our teammates. We can’t let our people down.
We have trained side by side over the past decade, or two, or three. Our respiratory therapist was there with us a decade ago during H1N1, running heart-lung machines for two patients at once, through an improvised door cut between adjacent rooms.
This week, he stands elbow to face mask with the anesthesiologist who is intubating a patient with respiratory failure, setting up the ventilator. Sure, the CDC calls it a high-risk procedure for spreading COVID-19, but they don’t flinch. Every day, in extraordinary times.
Our pharmacist is here to help us decide on medications like once-humdrum hydroxychloroquine and the experimental remdesivir, just as during H1N1 she guided us amidst experimental anti-virals and routine antibiotics. The residents, too young to recall even Ebola professionally, have spent the past several years learning the latest and the traditional in medicine; COVID-19 is the latest chapter, being written as we go. They are watching the veterans, and we must prove ourselves worthy of their emulation.
Our nurses range in experience from veterans of the AIDS era to those serving in their first pandemic; already, all are adept at the new normal, spending their days gowned head to toe behind double glass doors.
And as always, our intrepid housekeeper commutes here every morning from her neighborhood in Chelsea, a hotspot of COVID-19, to clean the rooms and keep a reassuring stock of personal protective equipment at every door.
“Hey, doc!” one patient not yet on a ventilator — my first ICU patient with COVID-19 who was able to talk — greeted me. It was a refreshingly human interaction, briefly. Then, as I leaned over to listen to her heart – “cough cough hahhhkk.” Whap. Her cough shook my faceshield, spritzing swarms of virus inches from my eyes, nostrils, and open mouth.
Back at the staff desk, I asked, “Does she ever cover her cough?” Her nurse, shrugged, “Nope.”
Neither of us said, “What if I had only grabbed goggles?” Or “What if the mask’s rubber band had failed?” (The first day, three in a row had snapped). All in a day’s work. So far, no fallen comrades in our unit. Even so, we all know the numbers from the 2002 SARS outbreak, when 20% of people infected were health care workers, and from COVID-19 in Europe, where thousands of health-care workers have been infected in the line of duty.
Our team at home also worries, wordlessly, about our safety at work and our bringing home viral vestiges of our trade. Many of us are banished in the name of love to basements, hotels or even boats until our work in this new plague is over.
Our team includes my longtime patients cheering us on from home, too. In my empty office five floors below the ICU, patients have been messaging or calling. Most voice no anxiety for themselves. Those with the most to fear from COVID-19 are the quickest to say, “We’re worried about you. Take care.” Or “Thank you for what you do.” Humbling and gratifying, their inspirations help us get out of bed and head toward trouble.
Victor Frankl wrote that three things give meaning to our lives: work, love and courage in difficult times. In these difficult times, we in medicine ride the storm tides together, from work, to home and back again, until this tempest finally ebbs, as they always do.
Tomorrow morning, our alarms will go off again before dawn. As my teammates and I drive toward the coughing, we’ll channel Aaron Baggish for the extraordinary and Fred the Baker for the everyday.
Walter J. O’Donnell, M.D., is a pulmonary and critical care physician at Massachusetts General Hospital and Harvard Medical School in Boston. The views expressed here are those of the author. He tweets at @epictetusMD.