Epi (On) Demos (People)

November 17, 2021

This excerpt from Chromatic: Ten Meditations on Crisis in Art and Letters is written by 2020 Wall Scholar, Steve Reynolds, critical care physician and Clinical Assistant Professor in the Department of Medicine, UBC. Illustrations are by Jess Stanley.  Order your copy today!

Winter 2021

I am gone

Physically. Emotionally. For the times

I arrive,

I am worn and rageful in equal measure. Every email contains a hidden slight, every slight is

An act of war.

In my silence, I writhe in discontent. Groping to find

My way back.

Spring 2021

I’ve always thought that the 7 p.m. displays of appreciation — the joyful cheering and the pans, the signs and the notes of thanks — were really more for someone else. 

After all, it’s the nurses who are in the rooms with the ICU patients constantly, the respiratory therapists who tirelessly change the mechanical ventilators and suction secretions. I know deep down in my soul that what really makes patients with COVID — and most ICU patients — better is good care by people who know what they are doing. More than just knowing it, they apply it in everything they do. They take care of all the small things, and those small things add up to saving lives. That’s why I’m proud to work where I do, because I see this every day in the folks around me.

So, it’s always seemed to me that the nurses and respiratory therapists are more apt targets for the outpourings of appreciation. Hour after hour, they are the ones who show the quiet courage necessary to support people through the direst of times.

Today was different. Today I would spend hours with COVID-positive patients, moving a camera through their lungs while cleaning out secretions and taking samples. Not a glamorous part of my job but necessary to help the lungs open up and to optimize their function in the sickest of patients.

Much of what we do is to minimize stirring up the virus, to keep it quiescent in the lungs as much possible. Prevention is far better than protection. Today I knew I couldn’t do that. I was kicking the hornet’s nest today.

Before I started, I asked everyone to leave the room. No need to expose others for the luxury of having more hands around. They could come in if needed. In each conversation I could see their calculations as they thought through the next hour or two. They would be there if I needed them.

As I started the first bronchoscopy, with all of the necessary tools laid out in an array, I had a quiet moment of realization. There was no doubt that the virus was on the other side of my mask. I marvelled again that something so silent could upend everything we knew. It was there. Waiting for me to mess up. Thick in a cloud.

I’m experienced at using personal protective equipment. I knew that even if I got COVID, it was likely to be a cold or at worst a flu-like illness. The numbers said I would be fine. Large numbers make sense in terms of the science. I would very likely be part of the vast majority that only have minor symptoms. That doesn’t reconcile with the emotional impact of the stories out of New York and Lombardy, of colleagues who have sickened or died from the disease.

This was where mistakes were often made. These last few moments where all of my efforts at self-protection could come undone.

Panic tickled at the edge of my awareness.

Calm, settle, focus. No getting around it. This needed to be done.

I decided to push through all the procedures I had lined up. I skipped breaks in an effort to conserve personal protective equipment and avoid doffing my equipment. By the end of hour five, I was tired and frustrated. The inside of my mask smelled foul, like the assault when first entering a barn but with no reprieve. I was sweating through my three layers and had resorted to muttering to myself.

I finished. I paused and resettled my focus to remove my outer protective layer cautiously. This was where mistakes were often made. These last few moments where all of my efforts at self-protection could come undone. I felt battered but had to summon the deliberate concentration to pay attention to each small step. After I was done, I felt like flopping into my car and driving home to see my family. I had to gather the energy to shower before I left, and I lost myself under the hot water.

As I walked to my car I reflected on my actions — if I had been cavalier; if I could have avoided the procedures. No, it needed to be done. I knew that finding an excuse to avoid it was tempting. What I did today was part of the constant attention to detail at the core of good ICU care.

I was unlocking my car as the parade of ambulance and police cars began their 7 p.m. ritual. The sharp sound of sirens mixed with the clapping and cheering. The metallic sound of pots in the distance from multiple balconies. I paused and teared up.