A lot has changed since the first wave of COVID-19 hit Massachusetts.
The state has seen the number of cases decrease and infection rates fall. He experienced a second wave. Hope came with the development and launch of vaccines that lives would be saved and that the end of the pandemic was within reach.
But the effects and traumas of that first wave – and all the suffering that followed – remain, lingering for doctors and nurses who worked on the front lines in the spaces of the intensive care units, where they cared for sick and dying patients for COVID -19.
Looking at the first days of the first wave, Dr. Lakshman Swamy told Boston.com that, a year later, it is still difficult to talk about what he and his colleagues have experienced working in these ICUs.
The pulmonary and intensive 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 his call, so there was tremendous motivation to face the crisis. .
“But I know that in the beginning I pushed myself too hard, just immersed in COVID without stopping,” said Swamy.
Not just reading the news. The doctor and many of his colleagues worked to read as much of the scientific literature as possible, listening to podcasts and absorbing all the latest information available about the virus.
“I remember one of my colleagues telling me that his home was like a COVID research unit, and then he went into the ICU and worked around the clock,” said Swamy.
It has become exhausting, he said. And it was paired with a deep sense of fear that the doctor said he had never experienced before.
It seemed that society was falling apart and everyone was afraid of getting sick.
“This is the end result,” said Swamy. “I still remember the looks of my colleagues when I came in and just looked at us and was terrified. This was [at the] start and people didn’t know when or what mask to use. We didn’t have masks – the shortage of PPE was very acute at that time. We were reusing things, we didn’t know how to get it. We didn’t know if we were at risk of catching it, if it was inevitable that we would catch it and take it home to our families. That was really scary. “
Fear was a big part of what made the first wave so difficult. And resolving that fear in the workplace created another feeling for those at the forefront of patient care: the hospital no longer felt like home.
“The intensive care unit felt like a second home to me,” said Swamy. “I have been there for six, seven years and I knew everyone there, we were very close to each other, like a second family. And suddenly we were afraid of each other. I remember being afraid of my colleagues. Afraid that I would give them the coronavirus and that they would pass it on to me, if we were in very close contact with each other. “
The learning curve of the virus would take some time.
Eventually, Swamy said, he and his colleagues found that they would be safe as long as they were using their equipment. But that lesson was not really learned until the end of the first wave.
“I remember what it was like when the cases started to go down, it was like, ‘Oh my God, we lived through this, we survived,'” said the doctor. “It obviously wasn’t that simple, but just the feeling that it was the moment when it really felt like, ‘Wow, I can count on this protection I have.’ And then things changed. “
Even after COVID-19 cases began to decline and the staff increase was withdrawn, the ICUs remained as full as ever, with people sick with non-coronavirus diseases.
“There was no extension,” said Swamy. “We were being hit harder and harder, even though it wasn’t COVID … So it was difficult for a while.”
Only in summer did the level look dramatically different, the doctor said. It seemed quieter and safer.
Health professionals felt better, as if they could catch their breath. It also allowed them to think about everything they had experienced and witnessed, and it gave them a chance to try to sue you.
Even so, until vaccines arrived in December, uncertainty remained. Being vaccinated was incredible and overwhelming, said Swamy. The vaccine made him feel safe, but it didn’t change what he was seeing at the hospital.
“It has been a great roller coaster of emotions,” he said.
And even with the changes brought about by lower case rates and the hope of vaccines, the trauma remains.
‘You walk through those rooms and there is a lot that you are bringing with you’
Before the pandemic, health workers who worked in ICUs were used to caring for very sick patients, and deaths in the units happened on a daily basis, said Swamy.
But what made the first wave – and the ones that followed – so different was the volume and the degree of suffering.
“The fundamental problem for me was, and I’m not criticizing that at the time, but we didn’t have families by the bed,” said Swamy. “So, people were really dying alone, it seemed like only we were there, covered with all of our PPE, without family members, without loved ones, and so it was iPads and FaceTime … It’s hard to build this wall from just being kind of numb when you’re holding the phone and people are shouting on the other end of the phone. “
The intensive care doctor said the pandemic put a “thin tip” on the reality that many people went through a lot of agony and trauma in ICUs when doctors were forced to use life support measures, unclear about what individuals or their families might not have wanted to. This fact needs to be addressed by families and society more broadly, talking earlier and more often about “what I want, what I don’t want” if they are admitted to an ICU, he said.
“We put families in a terrible position in this country, where your elderly loved one is sick and you never had this conversation with them about what they would or would not want,” said Swamy. “It’s not about who should get what … it’s about who really wants what. And it is so common that we have a family communicating with us, where a person is saying, ‘That person would never have wanted this.’ But that conversation was not maintained. And not only is that human being suffering in that ICU bed, but the family is suffering and they are under incredible pressure trying to figure out what to do. And that is not fair. This is not fair to anyone involved in this. “
Now for doctors and nurses, it is now more difficult to be in the ICU than before. There are triggers all over the space, reminders of what has been experienced in the rooms by patients and health professionals, he said.
“There is really a spot in the ICU … that even now when I take care of someone who does not have COVID and has something that improves relatively quickly, you go into those rooms and have a lot that you are bringing with you,” said Swamy. “Because I remember when I was in that room resuscitating someone … I remember seeing the same person in that bed for weeks on end, seriously ill, having one problem after another and then dying. This is not something that you can easily forget or ignore. “
Before the pandemic, it was not uncommon to have such intense and persistent memories of dramatic moments of caring for patients in one or two rooms.
But now, the challenge is greater because the wave of suffering that has occurred has been experienced in almost every room. Each now carries many memories of the first wave, said Swamy.
And the echoes continue as new patients with COVID-19 continue to arrive at the hospital.
“Now, it’s like this extra question, ‘Oh my God, we could have vaccinated that person. Why was this person not vaccinated? Why was this elderly black man not vaccinated? What’s going on here? We could have stopped it, ‘”said Swamy.
‘We need to get really aggressive support for frontline workers’
The doctor said that there are still a series of measures to be taken to alleviate the trauma experienced during COVID-19 in ICUs. One of the most important for him is taking families back to bed, allowing them to see their loved ones in critical condition.
This will help not only families, but also doctors and nurses.
“It makes a big difference to have family members in contact with them so that we can humanize their experience,” said Swamy.
But Swamy said he remains concerned that the mental health impacts of health workers during the pandemic will result in individuals in direct clinical care positions finding ways to do less of that work. Burnout among physicians was already a phenomenon, prompting physicians to decide to reduce the length of clinical care, he said.
“To be honest, this is what I’m doing,” said Swamy. “I did this after last year and now I work part time in the ICU and part time in the administrative function. I’ve always been interested in that, so I think I’m kind of an exception there. But I have to admit, part of it is just, it is not the same thing to work in the ICU … So I worry that the pattern is that people get out, get out of bed, get out of the ICU ”.
It is not a good solution to the problem, he said, as it will likely make people with more experience leave for another job or retire early.
Instead, more needs to be done to find ways to support healthcare providers and improve their own work and deal with the “slow burn” that was already happening.
“Before, I think a big part of that was the need to fix the systems that we work on,” said Swamy. “This is still true. But beyond that, I think we really need to get aggressive support for frontline workers. Before the pandemic, I didn’t have a therapist, I told people that everyone should have a therapist – I was one of the people who said these things. I never had one. And it really took this crisis for me to discover it for myself. And it’s a huge, huge help. “
There is still a lot of stigma surrounding access to mental health care and barriers to obtaining therapy remain, which urgently need to be resolved, he said. Support is lacking and needs to be there for everyone.
“Everyone has suffered a lot from this – it’s not just the doctor,” said Swamy. “Everyone has been through a lot, and I think we really need to find ways to recognize that and support each other.”
Meanwhile, doctors and nurses working in the ICU still expect to see more outbreaks of COVID-19.
The difference now, said Swamy, is that they know what it will be like and are better equipped to handle it.
As for himself, the doctor said he is trying not to be pessimistic, given the pace with which vaccines are being administered – doses that a year ago he never imagined would be as effective as they are in preventing the disease.
But it can never be fast enough.
“It’s hard to balance, however, when you see sick people who could have been vaccinated and it didn’t, and you’re seeing the same thing as before,” said Swamy. “The patients looked the same as in March last year. They come with bad COVID. We are concerned about that. “
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