Tales From The COVID-19 Front Line: Katie And Katie
“At first, I was having nightmares every night, but now I’m so exhausted I’m just passing out on the bed. That’s better, I guess.”
“For two weeks, I didn’t sleep and I didn’t eat. It was just a constant onslaught of fear.”
Those are the voices of two women working in COVID-19 ICU units, but their sentiments are shared by medical professionals across the globe.
No one will ever know all of their stories, but I’m privileged enough to share two, each originating in one of America’s hotspots: New York City and Detroit.
For professional reasons, I’m not going to use their last names nor the names of the hospitals where they work. That leaves their first names, but by sheer coincidence, they are each among the 200,000 American women named “Katie”. Therefore, you will be learning the stories of “New York Katie” and “Detroit Katie” — the fresh horrors they see every day at work and how they’ve tried to cope with the ensuing waves of helplessness.
“All of our training is to do everything possible for every patient. This is the first time we’ve ever been told to stop helping.”
Other than their names and chosen professions, the two Katies don’t have that much in common. New York Katie is single, in her late 20s, and living alone in a studio apartment. Detroit Katie is about a decade older and lives with her husband and two kids in a quiet suburb. New York Katie is a nurse practitioner at a Manhattan hospital ranked among the nation’s finest, while her Michigan counterpart is a doctor of internal medicine at a smaller urban hospital in metro Detroit.
Two months ago, though, their lives began to merge. When it became obvious the coronavirus was going to make a significant impact on their hospitals, they were each chosen to start putting together plans for a COVID-19 Intensive Care Unit. Hospitals rarely invent new departments from scratch, much less with the deadline pressure put on the Katies.
“One of my colleagues said it was like the time between seeing the lightning and hearing the thunder,” Detroit Katie said. “We knew it was coming, so we scaled up and scaled up, but there was so much we didn’t know.”
It’s been more than 100 years since the Spanish Flu ravaged the planet after World War I, and 21st-century medical care is nothing like what was available in 1918. That added to the challenge facing the Katies and their colleagues across the country.
“We had to write the templates about how this was going to work,” New York Katie said. “This was a pilot program in the middle of a pandemic.”
New York Katie had a big advantage — her hospital’s new 18-story, state-of-the-art building with 374 single-patient rooms and digital technology almost unmatched in the United States.
“That building was exactly what we needed for something like this,” she said. “We’ve got the most room of any hospital in the city and it is all negative pressure. Every floor is either set up for acute COVID care or COVID ICU.”
The building was even equipped with Extracorporeal Membrane Oxygenation (ECMO) machines — an advanced life-support system that takes over for a patient’s lungs.
“You see young people going onto an ECMO machine and you know how bad it has gotten,” she said. “There’s nothing else we can do at that point.”
The death toll is having a mental impact on both women — New York City and Detroit both have per-capita death rates higher than Spain and Italy — but the inability to help is making it much worse.
“You don’t decide between being a doctor or an engineer,” Detroit Katie said. “You do this because you have that need to help people. Now that’s changed.”
The Katies each had stories about the need for prioritizing their own safety over their instincts to help.
“I was literally standing in the doorway between one of my residents and a coding patient,” Detroit Katie said. “I had to put the gown, goggles, mask, and gloves on her myself because everything she’s ever been taught is to rush to a patient who needs help.
“I told her I couldn’t let her go in there without protection, because we might be able to help one patient, but I need to keep her safe for the next patient and the patient after that.”
“I just want to help people,” New York Katie agreed. “It’s so hard to stop when a patient is crashing and take the time to put on the equipment. That’s not how we’re trained to do things.”
COVID-19’s terrifying ability to spread has forced hospitals to ban visitors, meaning patients die without their loved ones.
“Our hospital has a rule — ‘No one dies alone’ — and now we’re breaking that every day,” Detroit Katie said. “Not only are people dying without being able to see their loved ones, but I can’t even be there to support them. I’m used to sitting on the bed and holding a patient’s hand while I give them bad news. Now I’m doing it from 100 feet away with an iPad.”
Not only do the Katies have to watch lonely deaths, but the next task is also something just as emotional — informing the victim’s loved ones.
“I’m in charge of calling the families, and I’ve completely lost it a couple of times,” New York Katie said. “It is such a shitty thing to be doing.”
All of this is made worse because the disease progresses too quickly for the patients and families to properly consider end-of-life options.
“I don’t think this is what people want, but if you haven’t had the chance to tell your family that, it is a terrible situation,” Detroit Katie said.
“My husband and I have discussed it at length, just in case one of us gets sick.”
Both Katies have been working endless hours — Detroit Katie thinks she’s had a day-and-a-half off in the last month — and there are big holes in their lives when they do get away.
“I haven’t been able to see my dad and I don’t know when I’ll see him again,” New York Katie said. “I suffer from anxiety and mental health issues, and this has really been a challenge.”
Detroit Katie does see her husband — a firefighter who is being called to as many nursing-home deaths in a week as he normally sees in two months — but contact with her kids is strictly online.
“They are at their grandparents — my parents — and having a great time, but it is hard knowing it isn’t safe for them to be here,” she said. “It was even harder when they were here because we couldn’t let them see Mom and Dad being scared. Now we have the room to let out the emotions.”
Both Katies let the tears flow when they are away from the hospital, but they also search for distractions from the nightmare they are living. While New York Katie furiously pedals away miles on her new Peloton bike, they both search for something cheerful to watch on television.
“I’m watching a lot of British baking shows,” Detroit Katie said. “I can’t watch the news — I’d be too angry in the first minute. I don’t have the emotional space for anger right now.”
They are both hopeful that the last 10 days might have represented the beginning of a slow decline in cases and deaths, but they don’t expect the sharp drop-off shown in some models.
“There are still a lot of sick people and more coming in every day,” New York Katie said. “We’re going to be here as long as they need us and we don’t know how long that’s going to take.”
Detroit Katie has another worry about life after the peak.
“There are a lot of people out there with other medical issues who haven’t been able to see their doctors,” she said. “We’re going to be spending a lot of time catching up with all of the delayed care.
“That’s going to be a major issue.”
Both Katies are committed to helping COVID-19 patients until the last one goes home, but they fear it will be a long time before life returns to normal.
“When I cry at night, it is because of the patients,” New York Katie said. “But there are days when I wonder when I’ll see my family and friends again — when I’ll be able to go on a date again.
“I’m really worried about what life is going to be like after all this.”
(NOTE: An abridged version of this article was published on the blog of the Rochester Center for Behavioral Medicine.)