I Lost a Patient to COVID-19…and then Openly Sobbed
He was 43-years-old, and his loss caused all my emotions to flow out
He was very sick with COVID-19. His oxygen levels were dangerously low, and he needed a lot of support with pressure and oxygen to make sure his levels remained normal. The team and I was watching him very closely, because any sign of distress would mean he would need to go on a ventilator. So far, he was holding his own.
By the next day, however, things became a little worse. While he was still talking to me and able to interact with us — albeit in a tight-fitting mask — there were subtle signs of distress, and I did not want him to struggle more, which can cause lung damage in and of itself. And so, I decided to intubate and place him on a ventilator. I got all dressed up in my PPE, said a prayer, and then entered his room.
The set up for the intubation was routine, and once everything was ready, I said another prayer and proceeded with intubation. The procedure went very smoothly. That was not the problem. It was afterwards that something went wrong.
I was absolutely sure the tube went into the lungs. Despite this, his lungs were not moving properly on the machine. His oxygen levels were still low. We then took him off the ventilator and breathed for him manually. His oxygen levels finally came up, and I was relieved. Then, suddenly, his heart rate slowed down and then stopped altogether.
We called a “CODE BLUE,” which means cardiac arrest has occurred and we need help. I immediately got on his chest myself and did CPR. We gave multiple drugs to jump start his heart. It worked, thank God, and his heart came back, and he even opened his eyes. I was so relieved.
There were a number of procedures I was planning to perform to help him get treatment, and as I was setting up for them, his oxygen decreased again. I started working with the ventilator, trying to do what I could to help bring them up. Then, his heart stopped again. We called another “CODE BLUE.”
We did CPR, we gave multiple drugs, we worked and worked and worked and worked on him. We did everything possible to try to bring him back. We were not successful. He died despite all that we did.
As the CODE BLUE was proceeding, I was getting the sinking feeling that he was not going to survive. I was praying for him silently. You could see the anguish on my face. I was trying to keep it together, because there were a lot of other very sick patients in the ICU that needed my care.
My heart sank again knowing I had to call his wife and tell her the horrific news. She was devastated. “I don’t understand,” she said. “They told me he was doing OK yesterday.”
“He was doing OK yesterday,” I replied. “Sometimes, these things happen and we don’t understand why.” I couldn’t say sorry enough times.
Right at that moment, I got the news that the hospital was about to discharge a patient who had suffered cardiac arrest and survived despite all the odds working against her. I helped take care of her, and I needed that moment of positivity after such a terrible incident. As I was walking out of the ICU, I saw one of the nurses who was helping us in the code.
“Thank you for all your help,” I said, barely able to say the words, tears welling up in my eyes.
“Are you OK?” she asked.
“Yeah, I’m OK,” I replied.
But, I was not OK. Then, all of the sudden, as the ICU doors opened and I walked out to a large crowd of people waiting for the survivor to leave, I lost it and openly and loudly sobbed. I couldn’t stand, overcome with the emotion and anguish and distress of what had just happened.
As leader of my team, I have worked my hardest to be strong for everyone else. Sometimes, however, I get tired of being strong.
Multiple people came over to comfort me, and I was able to stop crying. I got to see our patient — blowing kisses to the dozens of staff, including me, clapping and cheering for her — leave the hospital alive and well. I got multiple texts of support from friends and colleagues. The following morning, on my computer in the ICU, someone had put the sign pictured above. The support I received was truly wonderful, and it helped ease the pain of that day.
This patient was not the first patient I had lost in the ICU. He was not the first patient I had lost to COVID-19. This time, however, it was different. His loss hit me particularly hard, and I couldn’t stop the emotions from flowing out of me.
I won’t lie: I was a bit embarrassed at my sobbing. As the leader of my team, I have always tried my hardest to be strong, to help comfort other members of my team through the distress of this scourge. I would lend them an ear, listening to they talk about how they are feeling. I have tried my hardest to be the support of everyone else.
Yet, you know what, sometimes it gets tiring to be strong all the time. And, after this particular patient’s unexpected and devastating loss, I could no longer be strong, and the sobbing flowed.
For sure, it was good to get the emotions out. At the same time, my sobbing also left me relieved because it showed me that my heart — after seeing so much death, so much pain, so much anguish — has not become dead and hardened. I was relieved that I had not become jaded and emotionless. If I ever lose compassion for my patients, it will be an injury I could not bear as a critical care physician.
Even though my emotions were still very raw — and my eyes still wet — I had to keep going. Another patient suffered cardiac arrest almost immediately after our first patient died, and we had to spring back into action to help save his life (he ended up dying later that night). And the ED called me with another COVID patient who had dangerously low oxygen and needed to come to the ICU.
The fight against COVID-19 is not abating at all, and there does not seem to be any end in sight. Since that terrible day, we have lost more patients. We have had to intubate other patients who could no longer go without a ventilator (and those intubations went smoothly, thank God).
I still firmly believe that providing a “good death” is extremely important as an ICU doctor, especially during COVID-19. At the same time, there are some deaths that are very hard to bear. And, unfortunately, COVID-19 keeps providing those very hard deaths. This pandemic will have lasting effects on me and many of my colleagues — doctors and nurses alike — for many years to come. I pray that I will be all the better because of it.