Life Lessons: What Doctors Learned from Death and Death in the Covid Ward | Life and Style

WDr. Luis Seyja stared at the patient and said softly. His voice, muffled with two masks and a face shield, fought audibly above the noise of the hospital room. There was a monitor beep, an alarm ringing, and a negative pressure machine hum.

“We are playing this for you,” Dr. Seija told the patient, a Latina woman in her 60s. “So you can dance away from the night.” He took her hand in his hand, and he soon realized how soft her skin felt.

The patient’s daughter woke up and lay in the hospital bed next door. The daughter, like her mother, tested positive for the coronavirus. She started playing her mother’s favorite song, Marc Anthony’s Vivir Mi Vida, on Android. This means Live My Life. The swaying sound filled the room, almost blocking the sound of the old woman’s last gasping breath. Dr. Seja removed the woman’s oxygen concentrator. His team determined that she was no longer likely to recover. A few minutes later she died.

Looking back on the months Dr. Seija treated a Covid-19 patient at Mount Sinai Hospital last spring New York, These are the moments of stacking: painful loss in the deepest part of his body, sadness that remains like a melody that he cannot get out of his head. Recently, he has counted the number of notable patients he has taken care of since he started his resident last year. That number is 185, and he estimates that at least 60% of them have died.

I first contacted Dr. Seija in the fall of 2020, interviewing dozens of front-line doctors about the fatigue that resulted from the long and heavy period of the early Covid-19 surge in New York City. was doing. Now that a new variant is in circulation in the United States, we tell his story again. Currently, it’s far from the peak level of more than 5,000 Covid cases every day in New York, With the 7-day average of infectious diseases soaring 70% and the number of cases starting to increase again, I felt it was important to capture those early grief.

Dr Seija was part of a Covid-19 class medical intern., In short, a New York hospital scrambled to capture the hustle and bustle of Covid’s patients and the city. Packed the corpse in the freezer of the warehouse, He was his first year as a trainee. His first few months as a doctor were spent repeating the same conversation over and over – helping the patient understand when he could die and how it wanted to happen. It was.

When a patient first arrives at the hospital, the doctor needs to help determine when to abandon life-sustaining measures if the patient is unable to recover meaningfully... Do you want chest compressions when your heart stops? If their lungs fail, do they want to put a tube in their throat?

Known as “goal of care” conversations, these conversations are challenging in any situation. No one wants to confront their own death to investigate their survival potential through the lens of logistics. If patients are unable to make their own decisions, the choice is left to their health care agent or decision maker, usually a partner, child, or parent. At that point, the debate can be even more tense. The family instinct often says, “She is a fighter. We do whatever we can to save her life.” The doctor must explain that a complete recovery may not be possible. Chest compressions can break the patient’s ribs. If the patient is on a ventilator, the patient may never come off.

The pandemic has brought new wrinkles to these conversations. It was difficult to fully understand how poor the luck of a loved one was, as the family participated in the zoom rather than directly. Doctors had to learn all the usual ways to approach these emotional moments. Instead of slow replacement, the patient’s bedside time had to be limited to minimize exposure to the virus. They couldn’t use much physical touch to comfort the patient, and the mask made it difficult to read facial expressions.

In some cases, the patient suddenly deteriorated and did not have time for a complete conversation to consider medical options.

Dr. Seja ran into this particular dilemma one afternoon when he was assigned to a new patient whose shortness of breath continued to worsen. The patient had the highest amount of external oxygen, but his blood oxygen level was still in the 1970s. The medical team realized that there was no way for men to survive the transfer to the intensive care unit.

Dr. Seja had to call the patient’s wife, introduce herself, and tell her that it was time to say goodbye. Her husband was under sternum compression nearby and could die soon. He listened when his message encountered a sobbing soul.

He became a doctor to learn how to heal, but the first few months of the internship taught him what to say when healing was impossible. And that lesson became more and more resonating when it was Dr. Seja, who was on the other side of the doctor’s call.

ADr. Seija’s mother, an immigrant, was always aware that American hospitals were horrifying. There was a white man in a lab coat, documents to fill out, and an invoice to pay. Still, for some reason, she managed to raise a son who became a doctor and a daughter who became an ICU nurse. But that may not have been so surprising. She taught them to work hard and put others first, above all else.

Last summer, in the third week of June, Dr. Seija received a call from his mother, then 70, who wanted to let him know that he had a cough. His first idea was to “go here”. A wave of coronavirus that struck New York City was transmitted to Houston, where his family lived. He told his mother to go to the clinic as soon as he got out of the door and be examined there. She called him as soon as the results came out: Positive.

“There are several Amazon packages,” he told her and shipped a pulse oximeter and sphygmomanometer.

Dr. Seja knew that he should ask his mother all the questions he normally asks patients. “If pushes come in, do you want to be intubated?” He asked.

“Sweety, I’ve never thought about it,” she replied.

He told her it was time to start collecting the harsh tones normally reserved for patients who wanted to avoid these nasty inquiries. He took notes while his mother was telling him about her medical preferences – she wanted to be marked “no resuscitation / no intubation” – and everything she took Medicine. She had high blood pressure and diabetes, and he knew too that these conditions put her at high risk.

A few nights later, around 3 am, Dr. Seija trembled from sleep on the phone. His mother said her pulse oximeter reading was below 90.

“It’s time for you to go to the hospital,” said Dr. Seija. His heart was heavy, his throat was tight, and Houston felt the world as well as a few miles from New York City. But he had to stabilize his voice. This was what doctors did during the crisis. Just because the patient was his mom, it didn’t make any difference.

His mother was rebellious because she declared she was not interested in being admitted to the hospital. “That’s where people die,” she said.

It was one of the moments when a child became a parent. Dr. Seija told her that she had no choice but to go directly to the emergency room.

When she arrived at the ER, she became unreachable. Dr. Seja called the hospital front desk, but no one seemed to be able to track his mom. The receptionist made a vague excuse-“I’m sorry, I’m covering for someone, so I don’t know where she is” or simply “I’m sorry, I can’t help you”-and Dr. Seija Feeled full of new empathy for everyone. A frustrated family who called Mount Sinai in recent months.

He wanted to say “Jesus Christ.” “I just want to know if she’s okay!”

Forty hours later he got the answer. She was hospitalized for Covid pneumonia, which was even more worried about her age woman and her underlying condition. With that diagnosis, Dr. Seija rushed into an eight-week worrisome phone call. Every day he went back and forth between the phone call to his mother’s doctor and the phone call to his patient’s children.

He tried to remind a Houston doctor that his mother was a human being, not just a medical case. “She is a retired librarian,” he told one of them. “Do you have a book?” Her favorite was the murder mystery by James Patterson.

He also tried to maintain the patience of the doctor, but found it particularly difficult as he had already experienced the new face of the doctor in the overwhelmed Covid-19 ward.

“I have a burden on a very busy patient,” a doctor told him and apologized for not being able to communicate one day. “They are all Covid.”

Dr. Seija had to close his mouth to avoid snapping. He was in the Sinai ward when they had maximum capacity. Houston doctors benefited from all the lessons learned during the horrifying first wave of New York. “New York City walked for Houston to run!” He thought.

Eight weeks later, Dr. Seija’s mother was discharged and went to a rehab facility to continue her recovery.

BIn New York, the heat of summer turned into the cold of autumn, and the number of Covid-19 cases began to increase again. That meant Dr. Seja faced a new round of critically ill patients and more “goal of care” conversations to promote.

Palliative care was not an integral part of Dr. Seija’s medical school curriculum, but he said that Covid’s long months of caring for patients, and caring for his mother, were end-of-life care that he had never experienced. I began to feel that I had provided fellowship. I signed up.

As he communicated with the patient’s loved ones through the zoom, he became very aware of his tone and hand gestures. These were even more important because they couldn’t see his look behind the mask. When he spoke to the patient and their worried relatives, there was a new voice in his head: “If the patient was my mom, how would I approach this exchange? What would I want to hear if I was in the position of a medical agent? ”The answers to these questions are now much easier.

He learned to find comfort in the smallest bright spot, like a family who was able to enter the hospital in time to say goodbye. In particular, there is one discharge summary he wrote, which remains in his mind. Other years it may have looked like a tough note, but during the pandemic it felt like a victory:

“I was surrounded by loved ones and extubated him relaxedly.” Dr. Seija wrote about his patient. “They had to say goodbye.”

Through the medical school, Dr. Seija thought he was studying to save his life. But sometimes, in the Covid-19 ward, his job was only to help patients die with dignity.

Dr Seija had the same nightmare for months. He was out of breath and woke up, imagining Covid-19 being ill and unable to see his family. He now knows that being a doctor means exposure to loss as well as risk. Sometimes he plays Marc Anthony’s song Vivir Mi Vida in his studio apartment and he feels the sadness of the first few weeks again.But Coronavirus cases have been declining in New York City for several months, and now, with a positive test rate, daily cases are beginning to increase again. Meanwhile, Dr. Seija has moved to internal medicine-pediatrics training. He no longer spends his days taking care of his dying. But those Covid Moon lessons haven’t left him. “Start thinking about your care goals,” he advises anyone who listens.

Dr. Seija’s mother has fully recovered. He is now thinking of his own preference for end-of-life care. “I want to go home,” he said. “I will die in my mother’s arms.”

Life Lessons: What Doctors Learned from Death and Death in the Covid Ward | Life and Style

Source link Life Lessons: What Doctors Learned from Death and Death in the Covid Ward | Life and Style

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