An Inpatient Palliative Medicine Physician’s Experiences on the Front Lines During Covid-19

This 3 part blog series explores the experiences and thoughts for the physician FIRE community on why I left FIRE to return to work due to Covid. (FIRE=Financial Independence Retire Early/Recreational Employment)

In the first blog, I wrote about the difficult decision to come out of early retirement as a Hospice and Palliative Care physician to work on the front lines during a global pandemic. This 2nd blog post details what that return felt like and what I found when I went back into the hospital.

(Before you proceed: please be aware that there may be afflicted links in this blog that, although costing you nothing extra, may bring a small commission in to help support the cost of this blog.)

Working in the time of Covid has been surreal.

Before returning to work, I only left the house for grocery runs. Our family stayed on our land for fear we’d not know if my front line physician husband had given us Covid, and we’d unknowingly spread it to others.

 

Saying it was jarring to return to work is a severe understatement. It was strange to leave the relative safety of home to intentionally venture into a place teeming with Covid patients. I went back to a shockingly different medical world from the one I’d left. So much had changed, and yet not enough—we were still short on PPE.

 

On my first day back, I walked from the enormous parking garage in the pre-dawn light.  It was odd to see the visitor parking lots half-empty. As I strode along, I breathed in the hot, humid Florida air and tried to exhale my fear. The gentle murmurings of quiet masses of other still-waking up hospital staff and the sound of their hurrying footfalls surrounded me. A slight hum of communal, resigned stress floated between us all.

 

Back then, it was so odd that most of us, outside and distanced like we were, were masked up. The CDC still hadn’t said whether Covid was airborne, but medical personnel had suspected it was from the start, by the way it spread so quickly through the world.

 

I wore a heavy-duty face shield and hair cap my husband wears on the front line. Since we figured out how to juggle shifts to play hot potato with the kids, I could borrow his headgear.  As I wasn’t headed to the ER wing, I stuck out. The face shield was meant to provide a lot of protection while still being comfortable enough to wear for a twelve-hour shift.

 

One lady I asked for directions said, “That’s some face shield. Do you work in the OR or something?”

 

I shook my head. My specialty’s ‘operation’ is communication. We discuss difficult news about life-limiting diseases. That’s a less harsh way to say that part of my job is to talk about death and the dying process with patients and their families. Only, despite my years of training and varied experiences in Hospice and Palliative care, this whole experience would be so different than what I was trained to do.

 

By day two, I joined the other non-OR doctors in doing what none of us had done since residency: wearing scrubs! All of us were going home, stripping in garages and dashing to bathrooms to shower before seeing our families. At that time, we thought the survival of Covid on surfaces was a lot longer than we now know it is.

 

It was strange to leave the shield of professional clothes behind, and wear easily washed scrubs instead. I felt like I was walking around in my pajamas.

 

During that first week, I got lost—a lot.

 

This new-to-me healthcare system was even more massive than the VA I used to work at. Sometimes, though brightly marked with signs declaring absolutely NO visitors allowed, I still ended up wandering through a Covid unit, looking in the wrong places for patients. Everyone there wore N95’s, and most wore face shields. When I didn’t have a patient there, I exited as quickly as I could.

 

Wandering around the ginormous campus, it hit me just how radically my work field had altered since I’d left it. While the familiar smells of antiseptic floating through the air-conditioned hallways were the same, the feel of the hospital wasn’t.

 

The institution’s heartbeat felt off. The hallways were quiet, lonely places, mostly devoid of visitors. Staff were subdued and tried to stay as far apart as possible in elevators but mostly took the stairs. The cafeteria was eerily empty (I prepped seven days’ worth of food just to be able to avoid going there). Everyone wore masks—some cloth, most surgical, a few N95’s. Some people wore face shields. Above their masks, nearly everybody had a resigned look of stress etched across their faces.

 

The usual bustling life of hospitals that normally contain the noisy cacophony of human suffering and endurance had gone down to a dull, lifeless hum, sputtering along on life support.

 

Fighting at the unease that left a permanent feeling of having an itch between my shoulders that I could never scratch, I went to the PPE center for fit testing. There, they dispensed a seven-day ration of light yellow N95’s to me, along with seven brown paper lunch bags.

 

On the outside of the bag, I was to write the day of the week and record the number of hours I wore the mask. After too many hours worn, I was to dispose of them and ask for replacements. It was odd to carry a lunch bag in a big outer pocket of my white coat, but I had to take my N95 off to climb stairs. Otherwise—I quickly found out—I’d pass out from breathlessness.

 

At first, I was terrified I’d catch Covid and bring it home to my family, so I wore my precious N95s whenever I was around patients. Which was a good thing since some of them were afraid they’d be turned away from the hospital if they had Covid, so they lied on their intake screenings.

 

Patients lie to doctors all the time, so we’re used to it. We have ways to figure out around lying though. Every patient got a Covid test on admission and usually again later on during their stay.

 

The huge problem with all this lying though, was that a huge part of my job is to sit with patients and their families for up to an hour and a half at a time, just talking. If you’re in a room that long with someone whose adult child just had Covid—and was living with them while contagious right before the patient came into the hospital—then you could have been exposed to Covid (yes, this happened to me).

 

Hence, why I made sure to also don my goggles while with patients and their families. My husband’s headgear turned out to be too heavy for me. It also made it hard for people to hear me. Again, talking is a huge part of my job. That headgear had to go.

The Very Real Horrors of Covid

 

Talk to anyone who’s worked the front lines, and we’ll most likely tell you the same thing: we’ve taken an emotional beating like we’ve never experienced before. By far, the worst part has been watching isolated Covid patients die without their family members allowed at their bedside.

 

Only one visitor was allowed per Covid-free patient. Two were granted permission to enter the ward if a Covid-free patient was dying. I talked with children, barely out of their teens, whose tears soaked their upper masks while a young parent lay dying beside them. The anguished eyes of those children haunt me. Yet those offspring were the ‘lucky’ ones because had their parent been Covid positive, the patient would have died without any family at bedside.  

 

It was shocking how, over a day, Covid patients could be improving and then suddenly worsen and have to be intubated. Covid made it so life—and death—could be separated by mere minutes.

 

“But they were just getting better!” was a refrain I heard wailed over the phone from too many patient’s family members. They sobbed while I confirmed what the other specialists had already said: their loved one’s organs were shutting down, and they were dying from Covid.

 

Christmas time 2020 was personally the worst for me as a physician. One day, half of my patients were dying from Covid. It got to the point when I was happy when someone called me with a non-Covid consult because it meant more hope for an immediate chance of survival.

 

Walking by a Covid resuscitation attempt in an ICU was like watching something from a space mission on Mars or a movie about Ebola. Staff wore oblong helmets, respirators running down their back, gowned in hazmat-type suits from head to toe.

 

It was odd to not hear the hiss of the respirators coming from through the open door. Even the orders called out inside the room were muted by the thick sheet of plastic taped over the entrance to keep Covid inside. Medicines were kept outside in the crash cart and passed through slits in the make-shift protective doors.

 

Our specialty’s frustration was palpable. Having to sometimes change from having long, difficult conversations at the bedside to—in a small select few cases—speaking to a Covid patient via cell phone. Their fingers wrapped tightly around their phones, knuckles pale, while I looked at them through the ICU glass. It was soul-crushing. And if the Covid patient was already intubated, we were forced to speak to their next of kin on the phone, instead of face to face. It was beyond difficult for all involved.

 

Family members sobbed to me over their phones. Anguish came through the line with every word they managed to utter between gasps for breath.

 

“I Zoomed with him last night, and he could barely catch a breath. He told me he was going to die. He knew it and gave me instructions on what to do about the finances.”

 

Sometimes, after conversations like that, I’d hang up and sit back, eyes closed. I tried not to think of the young kids, soon to be orphaned by Covid. Some of them were mere infants, being cared for by extended family that was already emotionally strapped to the breaking point.  

 

A few times, I had to find Kleenex before I could move on to calling the next Covid patient’s family member.

 

I thought I was prepared to handle how soul-crushing this pandemic would be. In reality, nothing could have prepared me for this past year and a half.

 

Dealing with the Anti-Mask and Anti-Vaccers

 

Meanwhile, some of our friends and families intimated to us that Covid was a hoax dreamed up by the left-wing media and the vaccines are ‘the Mark of the Beast.’ Some days I wanted to type back IN ALL CAPS at them because of how frustrated I was with them.

 

Instead, I avoided social media, unfollowed, and ignored certain people. Marginalizing relationships with the far-right people in our lives has become a mental survival tactic. Gradually, I learned to let go of those people and their opinions. They hadn’t seen the death and destruction wrought by Covid first hand.

 

How can they know how truly horrible Covid is when they’re being exposed to well developed brain-washing techniques by the news programs they ingest?

 

Covid-deniers haven’t held the hand of a teen whose death certificate was authored by Covid. I have. That case was absolutely gut-wrenching for everyone involved.

 

The moral injury health care workers have sustained this past year and a half has been tremendous. It’s been difficult for us to find strength in sharing a common trauma when half our population doesn’t even believe Covid is a real threat.

Adaptation and Resilience in the time of Covid

 

 

During shifts, something that helped me tremendously was the Insight Timer app Physician on Fire’s wife told me about. There’s a two-minute meditation I use to reset and center myself.

I learned about stopping to recenter myself from High Performance Habits (a book every professional should read). This ‘start over’ helped calm my jagged nerves of adjusting to this strange, new work-life.

 

Gradually, my heart rate stopped racing every time I walked into the hospital. I grew accustomed to wearing a mask for twelve-hour shifts (and gulping water whenever I was alone). I gave up on dental hygiene while working, though. I was no longer comfortable brushing my teeth in the communal bathrooms. Sometimes I forgot to wear my N95 around patients, and those times, my pulse started to race again. But it all turned out okay because I didn’t get COVID-19 until after I was vaccinated.

 

It was bizarre to stay so physically distant in a world where a pat on the shoulder helps convey empathy for the grief at staring into the face of dreams not met. As we say in the Hospice and Palliative medicine world, unfinished business is the fabric of life.

 

I was surrounded by that cloth when patient’s family members screamed and swore at me over the phone. They took their frustration out on me for the hospital policy of not being allowed in to see their family member, dying too prematurely, from Covid. And their guilt all of us shared at wishing we could do more—be more—for the patients.

 

I got it. I could empathize with why they raged. Some of the patients I consulted on were dying from Covid at young ages. Others were uncomfortably close to my age, with kids in the same grades as mine. It was like staring in the mirror of mortality.

 

Why them, instead of me?

 

As a physician, certain cases will haunt you for the rest of your life. This past year and a half, I’ve had three such cases. Complicated cases, ones that strained our brains, and we willingly stayed in the hospital for way past duty hours. All of the patients were my age or far younger. Those patient’s faces revisit me in my nightmares, where there’s a tightness in my chest, and I wander across a lost landscape of medical futility.

 

Survivor’s guilt has never felt as great for us physicians as it has been since March of 2020. Those of us who made it through physically unscathed are forever grateful. And when vaccines arrived, our Covid anxiety decreased tremendously.

 

A Year and a half into a Global Pandemic

 

And now, we’re well beyond the one-year mark of those fateful days in March 2020. Looking back, I’ve somehow managed to survive one of the most challenging periods of my life. My husband and I have been through tough times before, but never such intense roughness that dragged on for such a long time with so much psychological pressure.

 

It’s been a long, terrible period of isolation, staying away from people least we unwittingly kill them by carrying a disease we’re learning more about daily.

 

Nowadays, it no longer feels like every nerve ending I have is constantly firing. Once again, I can stand tall, shoulders relaxed.

 

What are you most looking forward to doing once we have herd immunity? What’s been the most difficult part of this pandemic for you?

 

(The last blog in this three-part series will detail why I decided to continue working in the hospital even after we return to our new normal—whatever that looks like. If you want to be notified when that releases, please subscribe below. And if you found this blog interesting, please use one of the buttons beneath to share it. Thank you.)

 

(And as I stated at the end of my last blog post: All troll comments will be deleted.)