The situation has changed a lot since COVID-19 first appeared in Massachusetts.
The state has seen a drop in cases and a drop in infection rates. It experienced a second surge. It is hoped that with the development and launch of vaccines, lives will be saved and lives will be saved, and the end of the pandemic is imminent.
However, the impact and trauma of the first wave and all the suffering that followed are still there, left to the doctors and nurses working in the intensive care unit on the front line, where they take care of the patients who died of COVID-19.
Looking back at the early days of the first surge, Dr. Lakshman Swamy told Boston.com that one year later, it is still difficult to talk about his and his colleagues̵
The pulmonary and intensive care doctor of the Cambridge Health Alliance is also a lecturer at Harvard Medical School. He said this is when health care workers feel that they are responding to their calls and therefore have great motivation to respond to the crisis.
Swami said: “But I know that I tried too hard at the beginning, just immersed in the COVID.”
Not just reading the news. The doctor and many of his colleagues strive to read as much scientific literature as possible, listen to podcasts and absorb all the latest information about the virus.
Swami said: “I remember a colleague of mine told me that his home was like a COVID research room, and then he entered the ICU and worked, and that was non-stop.”
He said it became ubiquitous. This was combined with a deep sense of fear that the doctor said he had never experienced.
It feels like society is collapsing and everyone is afraid of getting sick.
“That’s the bottom line,” Swami said. “I still remember the look in my colleague’s eyes when I walked in. We just looked at each other and felt scared. This is [at the] At first, people didn’t know when to wear which mask. We did not have masks-the shortage of PPE was indeed very serious at that time. We are reusing things, and we don’t know how you can get it. We don’t know if we are at risk of getting it, or if it is inevitable to get it and take it home to our family. That’s really scary. “
Fear is a big part of what makes the first surge so difficult. The resolution of this fear in the workplace brings another feeling to those on the front line of patient care: the hospital is no longer like home.
Swami said: “The intensive care unit is like a second home to me.” “I have been there for six or seven years. I know everyone there. We are really close to each other, like The second family is the same. Suddenly, we are afraid of each other. I remember being scared by my colleagues. If we are too close to each other, I am afraid that I will give them the coronavirus, and they will give it to me.
The learning curve of the virus will take some time.
In the end, Swami said that he and his colleagues knew that as long as they were wearing equipment, they would be safe. However, this lesson was not really learned until the end of the first wave.
The doctor said: “I remember the feeling when the case started to decline. It was a bit like,’Oh, my God, we experienced this and we did it.” “Obviously, it’s not that simple, it just feels like it was at the time. It made me feel’Wow, I can rely on this kind of protection I have.’ Then things changed.”
Even once COVID-19 cases start to decline and emergency personnel are withdrawn, the ICU is still full of people as before, and patients with non-coronavirus diseases are born as a result.
Swami said: “There is no delay.” “Even if it’s not COVID, we are getting hit more and more… so it’s sad for a while.”
The doctor said that it wasn’t until the summer that this level changed drastically. It looks quieter and safer.
The medical staff feel better, as if they can breathe. This also enables them to think about everything they have experienced and witnessed, and gives them the opportunity to try to deal with it.
But despite this, until the vaccine arrives in December, uncertainty remains. Swami said that vaccinations are both unbelievable and unbelievable. The vaccine made him feel safe, but it did not change what he saw in the hospital.
He said: “It was a crazy roller coaster.”
Even if changes are brought about by the lower case rate and the hope of vaccines, the trauma is still there.
“You walk in those rooms, there are so many things to bring to you.”
Swami said that before the pandemic, health care workers working in the intensive care unit were used to caring for critically ill patients, and deaths occurred in the ward every day.
However, what makes the first wave and the subsequent volatility so great is the amount and degree of suffering.
Swami said: “For me, the fundamental problem is that I didn’t criticize it at the time, but we had no family at the bedside.” “So people are really going to die, it feels like it’s just us. Standing there, covered with all our personal protective equipment, no family, no relatives, then iPad and FaceTime… It is difficult to build this kind of wall. When you raise the phone, people are a little numb, it’s just A feeling of numbness.”
Intensive care doctors say that this epidemic has an “advantage” in reality, because when doctors are forced to use life-sustaining measures, and people or their family members may be unclear, many people experience a lot in the intensive care unit. Pain and trauma. Nothing wanted. He said that this fact needs to be resolved by the family and society as a whole. The method is to talk about “if I want what I want” as soon as possible and more frequently, and if they fall into the intensive care unit, they will have a dialogue with each other, he said .
Swami said: “In this country, your family is in a terrible situation. The old man you love is sick. You have never had a conversation with them about what they want or don’t want.” “It doesn’t matter. Who deserves what… It’s about who really wants what. We often have a family communicating with us, and a person says: “This person will never want this. “But that conversation didn’t. Not only does this make people suffer in the ICU bed, but the whole family is also suffering. They are trying to figure out what to do with incredible pressure. That’s unfair. It’s not fair to anyone involved. It’s all unfair.”
At the same time, it is more difficult for doctors and nurses to enter the intensive care unit now than before. He said that there are triggers throughout the space, reminiscent of what patients and medical staff experience in the room.
“There are indeed stains on the ICU… Even now, when I am taking care of a person who has no COVID at all and is in a relatively better condition, you walk into these rooms and there are many things to bring you. Swami said. “Because of me I remember resuscitating someone in that room… I remember sleeping with the same person in the bed for several weeks, critically ill, and died one problem after another, and then died. This is not something you can easily forget or ignore. “
Before the pandemic, it is not uncommon for memorable moments of caring for patients in one or two rooms to leave such deep memories.
But now, the challenge has become even greater, because almost every room has experienced a wave of pain. Swami said that everyone now has so many memories from their first experience.
As patients newly infected with COVID-19 continue to arrive at the hospital, echoes continue.
“Now, this is like an extra question,’Oh, my God, we could vaccinate this person. Why is this person not vaccinated? Why is this old black man not vaccinated? What happened here? We could have been Stop this,” Swami said.
“We need to really actively get the support of front-line workers”
The doctor said that many measures still need to be taken to alleviate the trauma suffered during COVID-19 in the ICU. For him, the most important thing is to get his family back to the hospital bed again and let them see their critically ill relatives.
This is not only helpful for the family, but also for the doctors and nurses.
Swami said: “It’s really different to let the family stay in touch with them so that we can humanize their experience.”
But Swami said he is still concerned that the impact on the mental health of healthcare professionals during the pandemic will cause people in direct clinical care positions to find ways to reduce their workload. He said that burnout among doctors is already a phenomenon that has led doctors to decide to reduce clinical care time.
“To be honest, this is what I’m doing,” Swamy said. “This is what I did after last year. Now I work part-time in ICU and hold a management position. This is something I have always been interested in, so I think I am a bit exception. But I have to admit that working in ICU is not It’s exactly the same…so I worry that the default is for people to leave, leave the bedside, and leave the ICU.”
He said that this is not a good way to solve the problem, because it may cause the most experienced people to leave to do other work or retire early.
Instead, more work must be done to find ways to support healthcare providers, improve the work itself and address the “slow burning” that has already occurred.
“Before, I thought that a large part of it needed to repair the system we used,” Swamy said. “That’s still true. But other than that, I think we need to really actively get support from frontline workers. Before the pandemic, I didn’t have a therapist. I told people that everyone should have a therapist-I’m the one who said One of those words. I have never had one. I really need this crisis to find a crisis that suits me. This is a huge and huge help.”
He said that there is still a lot of stigma in access to mental health services, and there are still obstacles to treatment, which need to be addressed urgently. Lack of support, so everyone needs it.
Swami said: “Everyone has suffered a lot because of this, not just the clinician.” “Everyone has gone through a lot of things, and I think we must really find a way to recognize this and support each other.”
At the same time, doctors and nurses working in the intensive care unit still want to see more COVID-19 surges.
Swami said the difference now is that they know what it will look like and are better able to deal with it.
For himself, the doctor said, given the speed of vaccine administration, he has been trying not to feel pessimistic. A year ago, he never thought that this vaccine would be as effective as preventing this disease.
But it can never be fast enough.
Swami said: “But when you see that a sick person can be vaccinated but there is no vaccine, it is difficult to balance. What you see is the same as before.” “The patient’s appearance is the same as last March. The same. They carry bad COVID. We are worried about this.”
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