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Point of View: A first-hand account from an Alberta ICU during Christmas

Dr. Chowdhury is the associate chair, quality and safety and an assistant professor in the Department of Critical Care Medicine, Faculty of Medicine and Dentistry. He is an intensive care physician and ear, nose and throat surgeon at the Royal Alexandra Hospital adult intensive care unit. 

Other doctors and nurses think that we are specialists in resuscitation and life support. 

At the end of the day, that is certainly true. As intensive-care doctors and nurses, we can push the body to extremes in an effort to help someone survive that cannot be accomplished anywhere else. 

We are the last line of defence between life and what lies beyond. The more I do this job, however, the more I feel that we are experts in the human condition.  

We are first-hand witnesses to the triumphs of survival beyond all odds, and messengers of the worst news many people will ever get in their lifetimes.  

COVID-19 in the ICU has been a daily education in the human condition for me. 

This Christmas week on the unit, during Alberta’s second wave, has been a crash course.

Hope, despair, fear, anger, triumph and every emotion I imagine shuffles through our halls and in-patient rooms, making this Christmas like no other.

dr raiyan chowdhury says he is seeing serious edmonton covid 19 cases in surprising age groups
Dr. Raiyan Chowdhury says he is seeing serious Edmonton COVID-19 cases in surprising age groups. (Raiyan Chowdhury)

‘The story of his night’

Walking on to the unit just before 7 a.m., I found my colleague who had covered the night before looking a little dishevelled.

The board listing the patients and their diagnosis summarized the story of his night.

Some said hypoxic respiratory failure. Others said pneumonia. Others said COVID-19.

One simply read, shortness of breath.

It’s funny how many ways we’ve come to label this illness.

The patient stickers on the board, highlighted by the charge nurse in different colours, look like a piece of modern art.

The stickers spill over the boundaries of the board as we run out of room, showing how the illness is metastasizing in the hospital like a cancer.

The irony of my medical analogy amuses me a little, until it hits me what this means and what the next few weeks will bring.

Like drowning in air

When patients arrive in the unit with COVID-19 often they are awake and able to speak, albeit in short phrases in between gasps for breath.

It is as if they have been running a marathon for their lives, and every breath might be their last.

Watching a person die of COVID-19 is like watching a person drown in air.

That’s when we get involved. That is probably the most heart-wrenching time for us.

Before we put the patient to sleep and on life support, that is when the patient makes her final call to loved ones.

Through gasps, I hear, “If I don’t wake up from this, always remember, I love you.”

We’ve admitted rich and poor with COVID-19. White, Indigenous, Black, brown, and every other colour and background of Canadian.  

Regardless of their background, the conversation always seems to end with some version of that. 

It reminds me how much we are all the same, despite our superficial differences.

I’ve been doing this job now for five years and have seen my share of grief and despair.

We consider ourselves to be very resilient and strong people. You cannot do this job if you aren’t.  

Despite that, my eyes always flood a little hearing these conversations.

‘What seems like an eternity’

What makes COVID-19 so different is that I can see my parents, my siblings or friends, in every patient I’ve brought through. 

The days are hectic. We typically have two intensive-care doctors to take care of our regular unit of 24 patients.

On a regular pre-pandemic day, half our unit would be ventilated patients.

We are now approaching 40 patients, and most of them have COVID-19.

Once they come in, they tend to stay for what seems like an eternity.

We now have four intensive-care physicians present. We have three nurse practitioners working continuously.

Help has been recruited from outside. Nurses and anesthesiologists have been redeployed from other units. Some have volunteered to give up their holidays with their families to help us.

Words like redeployed, called up, and contingencies make me feel like we are running a combat mission more than a hospital.

What progress is made is slow.

Rather than Christmas movies and the usual cheer, we spend our nights reading the latest medical papers to see if anything new has been learned or tried with success.

The words are a jumble in my head by the end of the night.

Hope matters

I’ve come to the conclusion that positivity and hope probably matters as much as anything else.

Maybe because I can actually control that. So, when the respiratory therapist tells me enthusiastically that the oxygen on the patient in Bed 19 is down by 10, or that there were no issues ventilating the young woman in Bed 23, we celebrate those wins.

It makes the list of worsening issues that follows a little easier to handle.

Some patients die from illness. That’s a normal part of critical care.

The part that is not normal, that is absolutely heart-wrenching, is calling families to tell them their loved ones are dying, but we must limit who can come to say goodbye.

There are no special considerations for those loved ones who themselves might be positive, having been in the same household.

I hate these conversations.

As if telling them I couldn’t save their loved ones wasn’t enough. There’s a specialty cruelty in this.

How will we recall this tragedy?

People tend to remember historic events by recalling where they were when they first heard.

But how will we recall a tragedy that seems to be a never-ending slow train wreck?

At the Alex, I think many of us will remember the pandemic through “proning rounds” and the COVID-19 “cabana.” 

Proning is the daily labour-intensive ritual of going from COVID-19 bed to COVID-19 bed, turning people face down because such positioning may help with ventilation when oxygen levels are low.

Proning is a reminder of how unforgiving this illness is.

The virus doesn’t allow victims to face it head on but rather with eyes toward the floor.

I’m not sure who named our overflow area in the post-anesthesia care unit “the cabana,” but I instantly see where they got the name.

The rows of unseparated beds with drapes acting as barriers give it a distinct look. It’s full of our sickest COVID-19 patients and it’s a sight from this Christmas we won’t forget anytime soon.

I know Christmas and the holidays for all Canadians is going to be hard this year.

It’s especially sad in our unit.

Most Canadians know that while this year will be lonely, they will see their loved ones in person again and life will eventually return to normal.

That’s not the case for our COVID-19 patients and their loved ones.

For some in our unit, this will be their last Christmas together. I try to remember that as I power through one of the most difficult working weeks of my life.  

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