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Journal from a Critical Care PA on the Frontline

By Marianna Langlois, PA

photo courtesy of author

I decided to keep a journal of her experiences with this pandemic; in my 32 years of practice, I have never seen something like this. I have given so much thought to what makes the corona virus different (not from the physiologic perspective, but from my personal one). I love what I do. I love critical care and the patients we treat. I love the adrenaline rush of having to work quickly along with the team to care for a severely injured patient, someone with a subarachnoid hemorrhage from an aneurysm or a septic patient that is close to dying. To clarify, I do not like seeing people critically ill; but if they are, I like knowing what to do to save lives.

So what is different this time? For me, the difference is the human connection. By the time these patients come to the ICU, many are intubated and on a ventilator having come from the ED, or they are sent to us close to the point of needing intubation. Patients arrive alone, without family who (during normal circumstances) are usually waiting in the Family room to speak with us. But we are on lockdown: no visitors are allowed in the ED or ICU. So, I get sign-out from the ED doctor or have gotten a brief history from the patient themself before they are no longer able to talk. Perhaps we are able to get collateral information from the electronic medical record.

We call family over the phone to try to get medical information or to ask if they want their mother, father, child intubated or not. Who is the health care proxy? Is there an Advanced Directive? Who will give the consent for procedures? There is no personal connection. It is a quick, to the point conversation. I tell them I will take good care of so and so and I'm done. I have to move on. I am so used to getting to know a patient either by talking to them or to their family. I love learning about the patients I care for, beyond just their medical history. I am used to hand-holding and hugs...

For patients who will die in the unit of this disease, there is no one but us to witness. We have our phones or other devices that we use to allow family to Facetime or call their loved one, but to me, it will never replace the physical presence of having family or a loved one be present when a patient passes. I have often stayed in a room as a patient dies, just so they do not have to be alone.

I have to say, the true heroes in this fight are the nurses, who work tirelessly caring for these people at the bedside.The next few weeks will be difficult for us all. We need to continue to socially distance ourselves to flatten the curve. We need to watch out for each other and appreciate what each of us contributes to this new lifestyle, from the postal workers and delivery people, supermarket workers, our police, fire and EMS personnel. For me, the folks who come and clean the patient rooms are on the front line! For my son Nick, who had just started his part time job at the Home Depot and now spends evenings helping disinfect the store so shoppers can stay safe: you are essential! We will get through this! Wishing everyone who reads this love and good health!

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