Have I become a cracked shell?
I know I haven’t written for a while, but I’m going to try to rectify that, and be more regular about it. Many of you will know that along with many other anaesthetists in the UK I’ve spent the last few months as a full time intensive care doctor. When I moved “up” (to the ninth floor in our hospital from the fourth) things were really ramping up, with many admissions each day. I remember my first weekend was extremely busy, new admissions of terribly sick patients not much older than I am, all requiring us to take over their breathing and ventilation imminently to avoid them dying in front of us.
During that weekend I went down to the covid ward to bring a patient to intensive care. The patient was sick, struggling for breath, coughing, and his oxygen level was very low. We stood back while he said goodbye to his family on a video call, and then when he was ready, we started working. The other three patients in the bay were very, very quiet - presumably thinking they could be next in line. We drew the curtains, and then as the anaesthetic drugs made him unconscious and paralysed his muscles, we took over his ventilation. His oxygen levels dropped precariously and I’m sure everyone in that bay could feel our anxiety as we struggled to improve his condition, he improved a little and we rushed him through the CT scanner and up to the ICU, in one of the more hair raising transfers of my career.
This scenario is common, and every anaesthetist reading this will recognise it, and an anonymous writer explained it very well in this article in the Guardian at the end of January.
“I don’t know how you guys do it…you have it every day…” was one of the responses when I shared the article. To answer that, I’m not sure either, but I’ve been thinking about it recently and will try to answer it.
I was discussing how we carry on with one of my more experienced trainees and a highly experienced ICU nurse, and much to our surprise we realised we are actually ok. Yes we feel for our patients, we know they’re in an awful situation, we feel the emotional intensity of some of the situations we end up in, like the one above, but we aren’t going home crying, we’re still able to have a happy family life, still enjoy all the normal things, and feel the same boredom that the rest of the UK is feeling at not being able to go to the pub during lockdown.
Maybe it’s because our hearts have become an empty, cracked shell with no flicker of emotion in it? During our conversation we did joke about it, but I really don’t think that is true. We do feel empathy, but I think our experience has given us tools to deal with it. During our career in healthcare in general - but particularly in anaesthesia and intensive care – human tragedies are a daily part of our work. My hospital is one of the regional trauma centres and we regularly see people who just happened to be in the wrong place at the wrong time, suffered an accident and suddenly become disabled or have their life taken away from them. We talk to their grieving families, and feel their emotions at this shock. We sometimes cry with them. I think with time we become better at processing our emotions, become able to take pride in handling difficult conversations well, and gain a lot of satisfaction from our jobs. (I wrote about this previously in “refilling the tank”).
I suppose the covid-19 surge is no different, except we’ve had to expand what we do and draft in a lot of staff with very little experience of intensive care into the service to allow us to look after all these patients. The staff we’ve “redeployed” have been amazing. They’ve come from areas very very different from intensive care, and have stepped way out of their comfort zones to learn a new skill very quickly. They have been working long hours at the bedside in sweaty PPE looking after extremely sick individuals, speaking to their grief stricken families, proning and de-proning. Many come from very elective services where they wouldn’t have been exposed to such seriously ill people, and I worry they may not yet have developed the mental ability to process what they’ve seen. I have to say, though, so far they’ve shown incredible resilience and I pay tribute to them, their willingness to step up, and their enthusiasm on the ward. We wouldn’t have been able to do this without them.
At the time of writing, many of our patients are getting better, weaning off the ventilator, and we’re hearing them speak for the first time. Some patients who we never thought would survive are walking around the unit, or going for a trip to the canal side with the physiotherapists to feel the warmth of the early spring sunshine on their skin. Hearing our patients’ voices for the first time makes everything we’ve been through over the last few months worth it.
I hope we never, ever have to go through a surge like this again.