The first time I walked into a COVID-19 ICU, it was the repurposed post surgical unit at Vassar Brothers Hospital. I was wearing a brand new PAPR with a fresh N95 mask, double gloves, double gowns, and boot coverings. It was the beginning of the pandemic, and I was frankly excited to be there, on the front lines doing my part.
As I walked through two sets of doors to enter the isolation unit, a new sensation came over me. There was something different about this unit. I’ve taken care of a lot of sick patients before and never experienced anything like that first walk into a COVID-19 unit. It’s hard to describe exactly.
Holy shit. This is real.
Although the room was filled with the usual beeping and talking like any ICU, I couldn’t hear much since any noises were drowned out by the buzzing of filtered air in my ears - like a white noise machine from hell. In front of me is a group of hospital beds separated by curtains, each one of the patients sedated with breathing tubes in their mouths. Nurses were scattered about, tending to the patients, giving medications, and entering data into the medical record.
And the patients were just so sick.
After no more than 30 seconds of taking in the scene, the work started, and it felt almost like a normal ICU day. But I’ll never forget that initial sensation, an overwhelming combination of intensity, anticipation, dread, and fear.
Working in a COVID-19 ICU overwhelms other stuff
Every time I’ve rotated through an intensive care unit, the job takes over my whole life.
First, it’s the hours. As a resident, I remember a 27 hour shift every third day with an 8 hour shift the day in between. As a fellow, my ICU day would go from 7am-7pm. In the COVID unit, I would get in at 7am to hear about the events from the night before, work until about 7:30 at night, and then sign my patients out to the night coverage by 8pm. ICU work and the travel to and from the hospital encompasses essentially all of your waking hours.
Next, it’s the complexity of the patients and how much you’re responsible for. I’d spend so much time looking at each patient and their chart - their labs, their testing - that the numbers and units get embedded in my brain. I know each patient’s ventilator settings by heart. I can picture in my mind’s eye what happened with their white blood cell count for the past week. I would look at their urine catheter bag so many times that I’d forget I hadn’t peed in 8 hours.
It’s also the emotional intensity. More so than the medical decisions, the phone calls with patients’ families would define each day for me. Even though I was always exhausted, I would leave each shift wired - it’s impossible to walk out of the hospital and immediately turn your mind off. When I was done each day, I spent the trip home rehashing the days events, conversations, and decisions. As soon as I got home, I would undress outside and then immediately hop in the shower, still unable to turn down the volume or pace of my thoughts.
I’d shovel down some dinner with my wife, incessantly chatting about the day’s events. And then I’d try to get some rest, but would lie in bed feeling completely drained but not at all sleepy. I’d often either dream about COVID or wake up in the middle of the night thinking about it.
Then the morning comes, and it’s up again to start another day. Each morning, I would wake up with a mild headache and ask myself the same question, “Am I just tired or is this COVID?”
And then it’s over
All ICU stretches abruptly come to an end. Anticlimactic doesn’t do the feeling justice. The shift ends, you walk out, and then you don’t come back the next day.
The next day is always an out of body experience. To some extent it’s mental and physical exhaustion, but really it’s the way the being in that unit has been how you define your existence and sense of purpose, at least transiently.
Once it’s over - when you can go back to your regular life - things feel distant at first. Like the volume of everything else has been turned down. It’s not so much missing the feeling of intensity, but its absence is noticeable, and it’s hard to get back to normal. Working in the ICU means you’re away from your family, disengaged with your friends, unavailable to your other patients, and generally ignoring your own well being.
But with the abandonment of everything else that’s important to you comes a clarified sense of purpose. It’s almost like a higher calling. I don’t know how else to describe it.
When that clarity goes away instantly, it can feel like a part of you is lost.
If you haven’t worked in an ICU before, this probably comes across as somewhat insane - either I’ve been brainwashed or I have Stockholm syndrome.
But that feeling of loss doesn’t last forever. It goes away gradually until you don’t even remember that you had it. After a few days, things feel normal again. And then I’m somehow able to convince myself that I’m ready for another round of days in the ICU.