COVID Reflections
by Abhaya Trivedi, MD
I am a critical care physician, and as I think about the initial stages of the pandemic in Chicago, three main points come to my mind: the risk to healthcare workers in taking care of these patients, the sheer number of sick patients at any given time, and the challenges in taking care of critically ill patients without their families allowed in the hospital.
My hospital developed a surge schedule to accommodate the exponentially increasing COVID admissions starting in March, and I knew that my new schedule of alternating between a 5 day stretch of days and nights would prove challenging to my family. I am married to a neonatologist, and we share childcare duties for our 2 children. I started working nights March 30th because my husband was working a 3-week stretch in the neonatal intensive care unit and was on call the following weekend. Given the risk of spreading COVID-19 to our extended families, we could not ask them to come to our home to help us care for our children. Trying hard to cope with these challenges, I remembered the sexist questions asked by male faculty members during my fellowship interviews: “What does your husband do? Do you want to have children? Do you know it will be hard if both of you are intensivists?” Of course, my husband was not asked a single question about my career aspirations or his future children during his interviews. Though I believed I could handle parenting and working while I was interviewing for fellowship, I could not have imagined what was to come being a front-line worker during a pandemic with 2 children at home, a 3-year-old and a 5-month-old whom I was nursing. This time period was filled with physical and mental exhaustion, sadness, and guilt. I felt guilty about missing time with my kids and also for leaving the demands of parenting them to my husband as I worked most weekends. As I think about the inappropriate questions asked by male interviewers, I am outraged. I am a mother and a critical care physician, and I have the same abilities as men who have chosen my specialty.
After the initial stress of figuring out how we were going to manage my new schedule and childcare, I became quite concerned about contracting the virus. In the early stages, news reports surfaced of healthcare workers not only becoming ill with COVID, but also of young providers dying from the disease. In discussing this with one of my trainees, we learned that we were both worried about dying of COVID and leaving our children motherless. My response was to try to increase my life insurance policy, while she was writing letters to her daughter for her future birthdays. We started meticulously following personal protective equipment (PPE) guidelines, engaging in non-stop hand washing, changing clothes multiple times a day, and following painstaking routines for pumping breastmilk to protect ourselves and our children.
Faced with a daunting number of critically ill patients, the first couple of nights I worked in March were the most challenging. Rush was receiving the sickest patients from around the city. There were times when I felt helpless because I knew we couldn’t save everyone. Often while I was dealing with one emergent procedure, another patient was declining and close to death. Seeing the providers from all departments of our hospital working together gave me hope. Working as a team of intensivists, respiratory therapists, nurses, and other support staff helped us save lives. The losses were devastating so I tried to focus on the incredible recoveries we witnessed. Patients that I did not think would survive were not just recovering, but were walking out of the hospital.
While I am proud and humbled by the work we were able to do together, I am reminded of the challenges of witnessing patients die alone. Last year, my father developed severe Influenza and required mechanical ventilation in an ICU. I was able to spend hours by his side, talking to him every step of the way through his recovery. Looking back, I feel an immense sense of privilege that I could be with him, aware of all of those families that COVID has ravaged.
I called the sister of my first dying COVID patient when it became clear our team could not save him. I will never forget her wailing outside of his room about how she was losing her best friend, and that she would not be allowed inside due to risk of her getting the illness. I will never forget holding up an iPad to the face of a dying patient so that his daughter and other loved ones could say goodbye.
This pandemic is likely to last for many more months. PPE and universal masking have kept infection rates in the hospital among healthcare workers low which has eased my initial fears significantly. However, as others may start returning to “normal” life, my husband and I have avoided in-person contact with our extended family due to concerns about putting our parents at risk of illness. I will always think about the countless families that have been affected by COVID-19 and cannot bear to think of spreading the virus to anyone. I know that my family and the people I work with are prepared for another surge to come, but I hope that we will not be faced with those earlier months of the illness in Chicago again.
Abhaya Trivedi, MD is an Assistant Professor of Medicine and an Associate Program Director of the Pulmonary and Critical Care Training Program at Rush University Medical Center.