I was there the night my hospital ran out of ventilators. In March of this year, Northern New Jersey was scrambling to cope with a surge of COVID-19 infections. And intensivists like me were being called upon to care for those who could no longer breathe independently as the virus ravaged their lungs with an onslaught of damaging inflammation. Our tools were limited as this was before we had convincing evidence about the benefits of medications like remdesivir and steroids. And I was there when the best weapon in our arsenal ran out. At 4 a.m., after placing an unprecedented fourth patient on a ventilator, the respiratory therapist told me, “That was the last ventilator in the hospital.” This was when terror really set in.
At 6 a.m., the overhead call of “rapid response” stirred me into action. I walked into the patient’s room and saw her, a patient I had cared for in the past. The infection had damaged her lungs so badly that she had to breathe four times as fast as a healthy individual. She needed a ventilator and I had none for her, just a paltry CPAP machine that I had little hope would generate enough pressure to effectively support her entire lung function.
I did not want to expose my team to potentially lethal viral droplets for the procedure of placing the breathing tube in her mouth. But I also did not want to remove her autonomy in making a terrible choice: Should we place her on a (substitute) ventilator with little hope of success or should we help her die peacefully with the help of a continuous infusion of pain-relieving medication?
In the end, I chose to preserve her humanity by allowing her to make her own choice. With empathy, but honesty, I went to her bedside and told her that her lungs were failing and there was little hope she would survive. As my eyes welled up with tears, I pleaded with her to let me help her die peacefully and without suffering. Despite hearing me out, she chose to give the breathing tube a try. I gave her a sedative, inserted a breathing tube into her mouth and throat, and hooked the tube up to the CPAP machine knowing in my heart that she would likely die shortly thereafter. The CPAP attempted to support her breathing, but it was like trying to inflate a car tire using a bicycle pump. She died in a few minutes. Her husband was in the neighboring unit on a ventilator also due to a severe COVID-19 infection. He died a few days after her. At least neither spouse had to endure the knowledge that their mate had succumbed to the infection.
My experience is not unique. I, and many healthcare workers across the country, have witnessed things we would have never imagined: healthy people in their 40s and 50s dying alone in the hospital because their spouses and young children were forbidden to visit them; coworkers dying because they were exposed to the virus before knowing how deadly it could be; crying in front of our young children as we attempt to explain why we are acting more aloof; wondering whether we will develop post-traumatic stress as we try and process the shock of all we have seen.
By June, the number of COVID-19 patients in my hospital had gone from more than 200 to only a handful, and it stayed that way into the fall. But now, a new surge has begun in my region. And I am taken aback when I see assertions that this virus has been overblown. Allegations of hoaxes, political motivations and over-diagnosing for financial gain promote a reflex of anger that I try to rein in. I’ve composed this firsthand account with the hope it will give others pause before doubting the seriousness of this pandemic and negating the sacrifice and hard work of so many.
I am not seeking to debate the true morbidity and mortality of this disease. This disease brought our healthcare system to the brink of collapse. My patient died because my modern hospital did not have basic lifesaving equipment on hand. No argument about mortality ratios will change that fact. Containment measures needed to be undertaken as a response to such a large threat and it appears we are facing that terrible choice again if we don’t follow the guidelines for preventing community spread.
I pray the efforts of so many healthcare workers will not have been for naught. As we face a new surge of infections, I implore the public to take this disease seriously. Lockdowns aside, masks and social distancing are, for most people and most situations, simple to implement. Let’s all, at the very least, commit to adhering to those straightforward mitigation measures.
David Michael Rosen, M.D., is a critical care physician practicing in the New York metropolitan area.