So much has changed since the first COVID-19 boom in Massachusetts.
The state has seen cases drop and infection rates drop. It experienced a second boom. Hope came with the development and deployment of vaccines that lives would be saved, and that an end to the pandemic was within reach.
But the aftermath and trauma of the first wave – and all the suffering that followed – remain in front of doctors and nurses who worked on the front lines in the spaces of intensive care units, where they cared for patients who died of COVID. -19.
Dr Lakshman Swamy told Boston.com that a year later it is still difficult to talk about what he and his colleagues experienced in the ICUs.
The lung and critical care physician at Cambridge Health Alliance, who also serves as an instructor at Harvard Medical School, said it was a time when health professionals felt they were responding to their calling, and there was a tremendous motivation to face the crisis.
“But I know in the beginning I pushed myself way too hard, just immersed in COVID non-stop,” Swamy said.
Not just to read the news. The doctor and many of his colleagues worked to read as much scientific literature as possible, listen to podcasts, and absorb all the latest information about the virus.
“I remember one of my colleagues telling me that his house was like a COVID research unit, and then he would go into the ICU and work and it was just uninterrupted,” Swamy said.
It became all-consuming, he said. And it was linked to a deep sense of fear that the doctor said he had never experienced before.
It felt like society was crumbling, and everyone was afraid of getting sick.
“That’s the conclusion,” Swamy said. ‘I still remember the look in my colleagues’ eyes when I walked in and we just looked at each other and were startled. It was [at the] start and people do not know when or what mask to wear. We did not have masks – there was a shortage of PBT then. We reused things, we did not know how to get them. We did not know if we were in danger of getting it, or it would be inevitable to get it and bring it home to our families. It was really scary. ”
The fear was a big part of what made the first boom so difficult. And resolving the fear in the workplace created a different feeling for those at the forefront of patient care: The hospital no longer felt like a home.
“The guard unit felt like a second home to me,” Swamy said. ‘I was there six, seven years and I knew everyone there. We were very close to each other, like a second family. And suddenly we were scared of each other. I remember being scared of my colleagues. Afraid that I would give them coronavirus and that they would give it to me if we were in too close contact with each other. ”
The learning curve about the virus will take a while.
Eventually, Swamy said, he and his colleagues realized they would be safe as long as they wore their equipment. But the lesson was really only learned at the end of the first boom.
“I remember how it felt when things started to go down, it was like, ‘Oh my God, we got through this, we got it right,'” the doctor said. “It was clear that it was not that simple, but just the feeling that it was the time it really felt: ‘Wow, I can rely on this protection I have. And then things changed. ”
Even after the cases of COVID-19 began to decline and the increase in staff percentage was reversed, the ICUs remained just as full as ever, with people sick with non-coronavirus diseases.
“There was no delay,” Swamy said. “We just got louder and louder, even though it was not COVID … It was hard for a while.”
Only in the summer did the level feel dramatically different, the doctor said. It seemed quieter and safer.
Healthcare workers felt better as if they could catch their breath. It also enabled them to reflect on everything they experienced and saw, giving them the opportunity to try to process it.
But still, until the vaccines arrived in December, uncertainty remained. Getting vaccinated was incredible and overwhelming, Swamy said. The vaccine made him feel safe, but it did not change what he saw in the hospital.
“It was just a wild rollercoaster of emotion,” he said.
And even with the changes brought about by lower fall rates and the hope of vaccinations, the trauma remains.
‘You walk in those rooms and you bring a lot along’
Prior to the pandemic, healthcare providers in ICUs were used to caring for very sick patients, and deaths in the units occur daily, Swamy said.
But what made the first boom – and the subsequent one – so different was the extent and degree of suffering.
“The fundamental problem was for me and I was not criticizing it at that time, but we did not have families in bed yet,” Swamy said. ‘So people really die alone, it feels like we’re just standing there in all our privacy protections, no family members, no loved ones, and then it was iPads and FaceTime … It’s hard to build the wall to just to be a little numb when you stop the phone and people just chat on the other end. ‘
The critical care doctor said the pandemic puts a ‘fine edge’ on the fact that many people in ICUs went through a lot of pain and trauma when doctors were forced to use life-sustaining measures, without there being any clarity about what the individuals or their families could do. did not want. The fact needs to be addressed more widely by families and society, by talking to each other earlier and more often about ‘what would I want, what would I not want’ should they end up in an ICU, he said.
“We put families in a terrible position in this country where your elderly are sick and you have never had that conversation with them about what they would like or not,” Swamy said. ‘It’s not about who should get what … it’s about who actually wants it. And so often we have a family that communicates with us where one person says, ‘This person would never have wanted it.’ But that conversation was not conducted. And not only is the person suffering on the ICU bed, but the family is suffering and they are unfortunately trying to figure out what to do. And that’s not fair. This is not fair to anyone involved. ”
It is now more difficult for doctors and nurses to be in the ICU than before. There are triggers throughout the room, memories of what was experienced by patients and health professionals in the rooms, he said.
‘There really is this stain on the ICU … that even now, when I care for someone who does not have COVID at all and has something that gets better relatively quickly, I walk into those rooms and there is a lot you bring to in, ” Swamy said. ‘Because I remember when I was in that room resuscitating someone … I remembered seeing the same person in that bed for weeks on end, being critically ill, having one problem after another and eventually dying . This is not something you can easily forget or ignore. ”
Before the pandemic, it was not uncommon for there to be such memories of dramatic moments of caring for patients in one or two rooms.
But now the challenge is greater because the wave of suffering has been experienced in almost every room. Everyone now carries so many memories of the first boom, Swamy said.
And echoes continue as new patients sick with COVID-19 continue to arrive in the hospital.
“Well, it’s like this extra question: ‘Oh my God, we could have vaccinated this person. Why was this person not vaccinated? Why was this elderly black man not vaccinated? Whats going on here? We could have stopped it, ” Swamy said.
‘We need to get really aggressive support for the frontline workers’
The doctor said a number of further steps need to be taken to mitigate the trauma experienced during COVID-19 in ICUs. One of the most important things for him is to allow families to go to bed again so that they can see their critics.
Doing so will not only help families but also doctors and nurses.
“It makes a world of difference to have family members connect with them so we can humanize their experience,” Swamy said.
But Swamy said he remains concerned that the consequences for the mental health of health workers during the pandemic will lead to individuals in immediate clinical care positions finding ways to do less of the work. Burnout among doctors was already a phenomenon, which led to doctors deciding to reduce the clinical care time, he said.
“In fact, that’s what I do,” Swamy said. “This is what I did after last year and now I work part-time in the ICU and part-time in an administrative role. It was something I was always interested in, so I think I’m a small exception there. But I have to admit that part of it is just, it’s not the same to work in the ICU … That’s why I’m worried that the standard is for people to leave, leave the bed and leave the ICU. ‘
This is not a good solution to the problem as the people with the most experience are likely to leave for other jobs or retire early.
Instead, more needs to be done to find ways to support healthcare providers and improve the work itself and address the “slow burn” that has already occurred.
“Before, I think a lot of it had to repair the systems we work in,” Swamy said. “It’s still true. But beyond that, I think we need to get really aggressive support from the frontline workers. Before the pandemic, I did not have a therapist, I told people that everyone should have a therapist – I was one of the people who said those things. I never had one. And it really took me a while to find this crisis for myself. And that’s a huge, huge help. ”
There is still so much stigma surrounding access to mental health care and there are still barriers to treatment that need to be addressed urgently, he said. The support is lacking and it should be there for everyone.
“Everyone has suffered a lot through this – it’s not just the clinician,” Swamy said. “Everyone has really gone through a lot, and I think we really need to find ways to acknowledge that and support each other.”
Meanwhile, doctors and nurses working in ICUs are expecting more and more increases in COVID-19.
The difference now, Swamy said, is that they know what it will look like and are better equipped to handle it.
The doctor told himself that he was trying not to be pessimistic, given the rate at which vaccines were being given – doses he had never suggested a year ago would be as effective as preventing the disease.
But it can never be fast enough.
“However, it’s hard to balance when you see people who are sick who could have been vaccinated and it didn’t happen, and you see the same thing as before,” Swamy said. ‘The patients looked the same as in March last year. They come in with bad COVID. We’re worried about that. ”
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