Note: The author has received permission from the families involved to share the following anecdotes.
Focus on all the positives that you have done. That is your entire mission statement — even if people die, you help them.”
I stared at my friend’s text, read it over and over, even as my tears fell and the words blurred. As an intensive care physician at UCLA Health and medical director of our ICU end-of-life program, I’ve agonized over the fact that COVID-19 has made me feel like I cannot live up to my mission statement.
I received that text just a few weeks ago when we were at the height of the coronavirus pandemic in Los Angeles. Our quaternary care hospital has five adult ICUs, and still, we’ve had to convert a regular medicine ward into a different, makeshift ICU. We’ve expanded our usual two medical ICU teams to four teams, and we are rapidly burning through an elaborate backup system of critical care attending physicians.
The ICU feels like a battlefield, where we race from one disaster to the next to put out fires that keep raging. Yes, we’ve seen triumphs, but the sheer volume of COVID-19 patients has overwhelmed any cause to celebrate, and sadness is often all I can see. Families delivering heartbreaking goodbyes to their dying loved ones via iPads have become familiar, but that doesn’t mean they’re ever any less jarring to witness. The number of deaths in one day in January was the same as the number of fatalities we used to have in an entire week.
The sense of defeat has been palpable. There were many times when I felt a terrible need to cry but knew an emotional breakdown would take too much time and energy, and in this war, I had neither to spare.
But even as the next ICU day awaits me, stories from the past few weeks replay in my head.
I can’t stop thinking about the 40-something man who told me, “I can’t die like this. I just got engaged and have a 6-month-old baby.” I encouraged him to be positive, but that didn’t stop him from dying two weeks later after maximal aggressive care and a desperate attempt at cardiopulmonary resuscitation.
I will never forget trying to comfort the patient who learned that his wife and mother had both died of COVID-19 while he was hospitalized in our unit. When I had to put him on a ventilator a few days later, I cowardly asked my resident to call his children and tell them they should FaceTime with him while they still could. He didn’t survive, and his children lost their father, mother, and grandmother in a span of just a few weeks.
