The day everything changed for the hospital was when we closed the ICU to make it a COVID unit. We were now in the middle of the reality that had engulfed the world. The number of patients with COVID-19 was going up, and we were hoping we wouldn’t see a repeat of Seattle or New York in Erie. It wasn’t long before our 14-bed ICU became full of patients with COVID-19.

The ICU can often be a sad place to work. We talk about death and disability all the time, and I frequently think of my own mortality. Even so, we do have what we call in the ICU “wins.” These “wins” are patients who were very sick and survived only because of good critical care. With COVID, the wins were elusive. We’d high-five when we’d get a patient off the ventilator. I’ve high-fived only a couple of times in the past year. The patients that go on the ventilator would end up on it for weeks, often with significant complications on the other side of it. And yet, some persisted. I had to change my frame of mind and tell myself that I would not see recovery quickly, that it would take weeks for most patients to get off the ventilator, and months more for rehabilitation. 

The pandemic has been demoralizing. Usually, we would have one or two patients a month with acute respiratory distress syndrome, the final common pathway for many severe respiratory illnesses. During the peak of the pandemic, our entire ICU was full of these patients. There were days when I felt helpless. I wanted to dive in and prevent this wildfire of inflammatory response from filling up the lungs with fluid. This process that eventually left behind scarred, stubborn balloons that wouldn’t want to expand. My colleagues and I would try every trick in the book; sometimes, the patients would make steady steps towards recovery, and a lot of times, there would be a range of complications that would drag the improvement down. A sick game of snakes and ladders. We’d think we were making progress – the ventilator settings would decrease, we would be able to lighten sedation without the patient waking up in a frenzy, and the blood pressure would have stabilized. Then, there would be a fever. The game piece sliding down the merciless snake, going several steps backward. And we’d start again. Treat the patient with antibiotics for a few days, move up those ladders, then find ourselves in another unexpected complication, another unwelcome snake.

What I remember most from my time during the peak of the pandemic is not so much the medical conundrums, but my patients who were awake, talking on maximum oxygen, on the precipice of needing the ventilator. While I could speak to them about their odds of survival with some imperfect statistic, I could not take away the fear. I reminded myself this could be me; this could be my father. Many would forego ventilators, take control of the little time they had, meet their families over Facetime, and then drift away on clouds of painless sleep induced by fentanyl. Many would commit to the long course, many would die trying to survive, and some would actually survive, often injured and weak, but alive, with hope.

I realized a long time ago that the fact that I could breathe without feeling short of breath, that I could stand up, walk, kiss, and dance, was all a privilege. That one day, I will cease to be able to do those things. It is possible that someday, I will be that relative in the throes of grief holding a cold hand, speaking to my dying lover, hoping he is listening. And someday, I will be that person in and out of consciousness, my hands held (if I’m lucky), my body pierced with needles, my lungs dense with fluid, hoping that I simply sleep it off and never wake up.

How did I cope with so much death and defeat? Though I acknowledged my feelings at the time, had hours-long conversations with my partners, wrote poems and essays, the COVID-19 pandemic catalyzed the process that the ICU itself had started a long time ago. The process of chipping away at something unnamable inside me, making me live my future pain in my mind, often making me see a distant loss in present love. How did I cope with so much death and defeat? I don’t know if I ever did.

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