I had a father and son in my ICU, both very sick with Covid-19. The father was in his 70s. His son was in his 30s. The father was not as healthy as his son. The father survived and was discharged from the hospital. His son, however, died.
Before them, I had multiple members of one family in my ICU who were also sick with Covid-19. The outbreak started in the patriarch, a man in his 70s. He gave it to his wife. His sons — who cared for their parents— caught the virus and got sick themselves. They gave it to their families. It was such a tragedy.
The parents both died. Of the multiple children who got sick, some recovered after several days in the hospital. Others, however, got very, very sick, and had to be transferred to another hospital for a heart-lung machine (ECMO). They ultimately survived, but with significant disability. One is still on ECMO as I write this.
This is what has been so maddening about Covid-19. It is the same virus, but it causes vastly different diseases in every person it afflicts. Sure, some people have underlying conditions — like high blood pressure, heart disease, and (especially) diabetes — that can cause the disease to be worse in that specific person.
At the same time, as we took care of patient after patient after patient with Covid-19, what drove us crazy is that the same treatments would work for one person but not the next. For some patients, steroids worked. For others, they didn’t. For some patients, blood thinners worked. For others, they didn’t. For some patients, Remdesivir seemed to work. For many others, it didn’t make any difference.
Why is this so? Why does this disease act so differently in different people? We are used to diseases behaving relatively the same in different patients. With occasional variations, sepsis looks like sepsis. Pneumonia looks like pneumonia. Heart attacks look like heart attacks. Of course, some patients have very bad manifestations of these diseases.
With COVID, however, it is a brand new disease in every single person. It is so confounding — and maddening — and it is something we have never seen before in critical care.
It has also been very humbling.
It is very easy to become arrogant in medicine, especially critical care medicine. When someone comes to you trying to die from respiratory failure, you put them on a ventilator, and they live. If someone comes in in shock trying to die, you give them fluids and blood, and they live. When someone comes in trying to die from an infection, you give them antibiotics, and they live.
Of course, we are not successful 100% of the time. At the same time, when the treatments you provide are successful most of the time, it is easy to think that you are invincible, that nothing can stop you. COVID-19 has upended all of that. It has been a very humbling experience, and it definitely has kept me honest as a critical care physician.
When this is all over, I know that I will be a better physician. This pandemic has taught me many things, and I know that I will become better as a result. But that day — the day when it is “all over” — is a long way off.
I look at the spikes in COVID-19 cases in Texas, California, and Arizona — places where I have friends in the ICU taking care of COVID patients — and my heart aches for them. I know they are going through hell right now, trying so hard to care for super sick patients trying to die from this terrible, maddening, confounding, and humbling disease.
May the Lord keep their patients as well as keep them and their families safe from harm.
