COVID-19 GEAR

The last two days have been brutal. The tents closed. Some of the other city hospitals started accepting patient transfers several days ago, so we’ve been transferring some people elsewhere and haven’t had to overflow the oxygen-only patients to the tents. Unfortunately, we can only transfer the patients who are stable enough to be moved, so offloading some of our patients to other hospitals is only so helpful. The raw number of patients in the department has improved a bit, but the sickest patients are still in our department and we’ve had many deteriorate over the past few days. I’ve lost track of the number of patients we’ve placed on ventilators, and many who have been on ventilators for a few days are deteriorating and dying despite escalating support. Yesterday we had 1,000 total COVID-confirmed deaths in the United States. We don’t test people post-mortem unless they have an autopsy, so I’m sure those numbers under-represent the total deaths by a significant margin. We’ve had at least three patients tonight arrive via EMS and simply be declared dead on arrival; they weren’t tested and likely won’t count toward the official COVID-19 count, even though odds were good they had it.

I’ve had to both order and place restraints on many patients because some are becoming confused and agitated. Sustained low oxygen levels, even when they aren’t low enough to be deadly, have a negative effect on brain function. I suspect many are also becoming combative due to a phenomenon called “ICU delirium.” Patients are in a chaotic, noisy, brightly lit, constantly stimulating environment for days on end, with no clear indicator of day or night, how much time has gone by since the last event that happened, and no rest period. I remember seeing similar problems when I worked in the ICU years ago, and the chaos here is on another level compared to the semi-predictable, rhythmic noise of that ICU.

I feel like I’m in a haze in this environment, too. I’ve done so many things that under any other circumstances would be very remarkable and memorable, but the intensity in this area is so high and things are happening so quickly that all of the crises start to blend together. I barely remember doing anything last night, and I’ve had to reread my own journals to recall what happened just a few days ago. I’m duller when I wake up, too. Normal tasks that I remember spontaneously are being forgotten, and I have to stop and think about what I’m doing multiple times when I’m responding to an email. I normally never proofread my emails or even these journals, but I’ve had to lately because I’m just not cognitively functioning at 100%.