I am a healthcare worker who has volunteered to be a part of the COVID ICU “proning team” at the hospital where I work. I am writing this because my colleagues and I had a long discussion today about how disconnected the public is when it comes to the harsh reality of this virus and what it does to people. I will describe in as much detail as possible what you should expect to “experience” when you get critically ill from COVID-19.
By the time I meet you in the hospital, you’re already intubated in the ICU. This means that you likely started feeling terrible enough to get yourself to a hospital and then got admitted into said hospital. Your condition worsened to the point that the medical team determined that your best chance of survival would be to place you in a medically-induced coma and hook you up to a ventilator that literally breathes for you. The process that leads up to this point is traumatic, terrifying, and lonely. You are allowed zero visitors and your only interactions are with strangers that come into your room unannounced, wearing what look to you like hazmat suits. The hospital you’re staying in isn’t equipped with enough “negative-pressure” rooms to contain the virus and keep it from spreading to the hallway so there will be a giant window unit that pumps all the air from your room out the window vs allowing it back into the hospital. This window unit is LOUD (similar to a generator) and it will drive you absolutely insane because it MUST be running 24/7. So, you’re just going to have to accept that. As terrible as all this external hell feels, it’s nothing compared to what’s going on internally. Your body is deteriorating. Every breath is a gasp. Turning over to face the door when you hear a knock is impossible because you are literally THAT exhausted. Your oxygen levels continue to drop, even though you are being pumped MASSIVE amounts of pure oxygen through your nose (which is now bleeding constantly because it is completely dried out). The oxygen levels drop so low that the only course of action is to make you comatose, give you a paralyzing agent so you don’t thrash, and place you on a ventilator. Ok, so NOW let’s get to the bad part.
You’re laying on a bed, on your back. Unconscious, naked, Foley catheter in your urethra, and maybe (if your nurse is lucky) a FlexiSeal in your anus to collect all your diarrhea (look it up if you have questions). A ventilator is placed down your throat, somewhere between 20-28centimeters down. It will probably move around if it’s not tethered, which is a no-no, so it will be taped to your head/face. We’ll come back to this later, because that tape will eventually mess up your face, maybe permanently. A feeding tube goes down your nose because comatose people can’t eat, obviously. So your diet is now a nutrient-packed yellow mushy soup. Yum! Ok this is the basic setup.
Even with all this medically-engineered hoopla, you continue to deteriorate. The ventilator is running 100% oxygen down your throat, into your lungs but still not enough is getting into your blood. This is where organ failure starts to happen. Kidney failure, brain damage, etc. And this is where me and my “proning team” show up at your door.
Prone = laying on your stomach.
Supine = laying on your back.
Proning = turning you from your stomach onto your back.
Why do we do this? Well, to simplify it, the back of your lungs are bigger and better at oxygenating your blood. But when you’re laying on your back, all the fluid (LOTS of fluid) in your lungs accumulates and fills the back of your lungs – thus drowning them and making them much less effective. Flipping you onto your stomach causes that fluid to move to the front of your lungs (because gravity), freeing up the back of your lungs to do their better job. Honestly, it’s pretty amazing to see how quickly you will go from 79% oxygen (SpO2) to 93% as soon as we turn you onto your stomach. It’s very satisfying for us. Makes us feel proud. We’ll pat you on the back, literally, and give you kudos for this oxygen accomplishment.
We will plan to leave you in this prone position for somewhere between 12 to 18 hours. Your head is turned to the side, otherwise the ventilator tube would be rammed through the back of your mouth. Don’t worry, we will position this for you, you’re paralyzed, remember?
Once those 12 – 18 hours are up, the prone team comes back in to flip you back over to supine. This is where things can get ugly. Being paralyzed and on your stomach leads to A LOT of swelling/edema. Especially in your face. Your tongue has swelled up to ~5x it’s normal size and it doesn’t fit in your mouth anymore. Lips swell x5 times, too. Your eyelids have been taped shut but they’re swollen too. It looks like you have golf balls under your eyelids. Now, remember that tape that holds the ventilator tube in place? Well, it’s still holding tight. And with all the face/mouth swelling, I should emphasize the word TIGHT. You’ll be in this condition for a while. Maybe a week, maybe two, maybe three. That tape will get replaced daily but it will do some damage to your skin, especially your lips and ears. And since your blood isn’t getting proper oxygen, your body isn’t great at healing wounds. So, expect your face to look a little different for a LONG time, if you make it out alive. I now can say that I have seen a living person’s cheekbones. Not the form of the cheekbones, but the ACTUAL bones, because their wounds on their cheeks got so bad that the flesh necrotized and sloughed off during the friction involved with a head turn.
Where were we? Oh yes, we just flipped you back to supine. The 5 of us will be doing some routine care on you: wiping you down with Chlorhexidine Gluconate (CHG) wipes, putting Venelex cream and Mepilex patches your bed sores (think bony prominences – knees, clavicles, sternum, shoulders, nipples, shins, cheeks, etc.), using a suction device to suck up all the secretions from your mouth and nose, cleaning up your diarrhea from EVERYWHERE and changing that pesky face tape. Don’t worry, we’ll be gentle.
Now, it’s been maybe 10-15 minutes on your back. We stand back and assess how you’re doing. If you’re a champ, your oxygen levels stay in the low/mid 90s and we can leave you like this for 1 to 8 hours before you start deteriorating again, at which point it’s back onto your stomach.
The idea is that each time we put you back in supine, you’ll be able to maintain longer and longer periods of time before your oxygen drops to the 80s or 70s (or 60s, 50s, 40s, you get it).
The longer you’re in this ICU situation, the worse it gets. Eventually, we have to start doing all the routine care from the side-lying position, because putting you on your back could literally kill you. The supine position becomes intolerable – your blood pressure starts to plummet, your heart skips beats or shoots up to the 200s (or just stops) and your oxygen level drops immediately. So, unfortunately, you go back onto your stomach. More swelling, yay! Repeat this process daily and hope for better results each time. The more often we have to repeat, the less likely you are to survive, because it’s an indicator of how poorly your lungs are recovering.
Now, this is the point where someone might ask, “why are you keeping this person alive? Isn’t it inhumane to prolong this person’s suffering? What quality of life will they have when/if they survive?” Unfortunately, that’s not our choice. Even more unfortunately, it’s likely not even YOUR choice. Who’s choice is it? Your Medical Power of Attorney (MPOA), which 9 times out of 10, is a family member. Now, remember, there are zero visitors allowed for COVID-19 patients. That means that your family is getting ALL the information about your condition from a phone call or texts messages from someone on the healthcare team. Your family can’t see you and they can’t talk to you. Thus, they simply cannot appreciate just how much you are suffering. How could they? It’s not their fault. They love you. They’re praying for you. They’re wondering if they are making the right choice but they are doing so without all the information, because a phone call from a doctor or case manager can only go so far.
Above all, they are holding on to hope. Hope that you’ll come back from this. That you’ll be that patient in that next news video that gets the standing ovation as they’re wheeled out of the hospital because YOU MADE IT. And I hope you do, too. We all do. We care about you. If you make it out of that ICU, you’ve got months of rehab ahead of you. Your fight for life has JUST started. The success story is that, against all odds, you didn’t die.
Or, maybe you did. As I write this, 170,000 people have died from COVID-19 in the US alone. Each one of those people had a story, a life, a family, dreams, goals and a future. So many of them suffered tremendously through their last days, with strangers. Now they’re gone, forever. And that ICU bed is ready for the next one. I hope it’s not you. I hope it’s not your mom, dad, grandpa, aunt, sister, child or neighbor. But if it is, you can count on me and my coworkers to be gentle with you and treat you with dignity and respect. We will do everything in our power to get you home. This virus doesn’t care about your political affiliations, your plans, your freedoms. It doesn’t care about you at all. So we will.
Now, if I may…..please wear your damn mask.
Edit: The title says “when you get critically ill.” Emphasis on the “critically ill.” This is NOT what the average person should expect when they test positive. Most people DONT get critically ill. The VAST majority of people will never even see a regular hospital room, much less the ICU – I tested positive and I recovered at home with no medical intervention. Most will have mild symptoms and then recover. That being said, this post reflects a real possibility and a current reality for many people. I want people to understand the harsh reality of COVID-19. It affects everyone differently and taking small, practical precautions can keep you from ever having to wonder “is this going to happen to me?” or “did I get grandma sick because I didn’t take this seriously?” I apologize that this came off as fear mongering. The post reflects my experience as a healthcare worker and I feel that the public hasn’t had enough of that experience other than “we are overworked and tired.”
Disclaimer: This is a guest post and it doesn’t necessarily represent the views of IWB.