Dear SIO Friends:
As I write to you, I am happy to report I have just completed a seven-day rotation at the COVID-19 inpatient service at my hospital in New York City! Overall, it was a positive experience, despite the occasional sad and scary moments. I left the service feeling uplifted and fulfilled. I am glad to have been on the front line of the war against this life-changing virus, making my contribution.
The most important lesson I have learned through this unique experience is things are not as bad as I thought they would be. I started the service with eleven patients; all were COVID-19 positive with cancer. Most of them had received chemotherapy within the previous two weeks, and some had low white cell counts and other co-morbidities. I thought most of them might deteriorate rapidly, and found with amazement that nine patients remained stable and got better over the next seven days. Among them, seven went home and two remained in the hospital with minimal COVID-19 symptoms, but waiting for placement. Two elderly end stage cancer patients ultimately passed away peacefully, with their family members able to visit the bedside one by one. I am glad our hospital was able to make the exception for our dying COVID-19 positive patients by allowing their family members to pay tribute as the end approached. As such, it makes this process much more humane and tolerable.
We admitted eight new patients over the week. Six were quite stable on the floor and would be going home soon. One patient quickly went to the ICU the same day of admission, but miraculously did not require intubation, improved significantly over two days, came back to the regular floor, and was discharged home three days later. Another patient with metastatic cancer, who had received chemotherapy about ten days prior, came in with COVID-19-induced respiratory failure. Initially he was classified “Do Not Resuscitate/Do Not Intubate” after extensive discussion with the family about his poor prognosis and essentially zero chance of coming off the ventilator. The family members then reversed his code status back to full code (requiring chest compression and intubation) when he was actively dying.
The whole process was very painful for everyone, especially the family members. My observation is that COVID-19 significantly shortened the time remaining for some of our end stage cancer patients, and often the family members were not ready for the inevitable end, not having had time to fully process their impending loss. We must be supportive in these cases, and should call in psychosocial support for the family when available.
Even though my service is over, there are a few moments that keep resurfacing in my mind.
Heartwarming moment: One of the infectious disease (ID) attendings not only saw patients and gave advice on COVID-19 management, but also helped us with code status discussion (Discussing Resuscitation Preferences), which is completely above and beyond her duty. One of our patients was not a native English speaker, but this ID attending happened to speak the patient’s language. She helped us clarify the patient’s code status while spending lots of time in the room with the patient, not worrying about her own risk of being infected at all. When I thanked her for doing this, she responded, “No problem. He reminded me of my dad.”
Nerve wracking moment: On my second day in the COVID-19 service, during our afternoon call, the resident told me the new intern was sent home early because of shortness of breath. The intern had just come off the ICU rotation in a busy COVID-19 hospital two days before. While listening, my mind was racing, recalling every moment I was standing close to her, touching her phone while talking to our patients. Over the next few hours while her COVID-19 test was pending, I tried to recall what I did after my close contact with her over the previous two days, almost reliving every moment, preparing for the worst, and considering what to do if she tested positive. Finally, her COVID-19 test result was negative. I was so relieved.
Heartbreaking moment: “Why don’t you monitor his heart rate? His oxygen level?” the patient’s daughter came out of the room, asking us with teary eyes.
My reply: “Because he is actively dying. He has too many underlying conditions and now severe respiratory distress.”
“But he is a fighter. It just takes a few days, then he will get better. He will overcome this.”
Again: “He is actively dying. We are trying to make him comfortable. Look, he is very comfortable.”
“He will get better, he will get better.” She started crying, I got teary too, for her, and for the helpless situation.
Before I knew it, the rotation was over and I am back to normal life. No more wearing scrubs, rushing to the hospital; no more wearing double-layered face masks that would leave a mark on my nose and face; no more FaceTiming with the patient right outside the room; no more going back and forth to the laundry room four times per day; no more wondering every time anyone around me sneezed, coughed, or complained of sore throat, D'id I catch it? Did I spread it to my family?' I am glad I worked on the front line and helped some COVID-19 patients. I am no longer living in fear that most of my cancer patients will die if they catch COVID-19, as I have seen that truly, most of them got better with time and treatment. I will continue to be cautious, though, as some of them could get very sick and die quickly.
The best moments usually came at 7pm everyday, when my daughter would join her friends on our building’s terrace, cheering for the health care providers. She would always add a sentence at the end, “I am cheering for my mom! She took care of COVID-19 patients!”
Stay safe and well. Let us stay connected during this isolating pandemic.
Ting Bao, MD, DABMA, MS