Bearing witness

In infectious diseases we find ourselves practicing medicine in spaces where to practice “better” medicine we need to recognize the limits of our abilities. There are the cool “House” like cases. But so many other times we need to recognize and help patients and families honor life’s last moments. Many of these moments are what I witness when our team comes in to assess a patient in consultation. And then that relationship builds in these intense spaces. When I began practicing medicine over 20 years ago, I thought it wasn’t my place to engage in some of these conversations with patients and families. But at some point as an emphathetic human being — the right thing to do was not to stay silent simply because no one had instigated the conversation. So in I jumped.

I will never forget the first patient that I cried with. It was not the first patient I had cried over- in the space outside of the room, or at the bedside in the ICU with family- I hade certainly cried many times. Crying with takes a different time and space. He had HIV and AIDS—- it was early in my career and he was simply not responding to treatments any longer. He was young, bleach blond surfer hair; family not supportive of his life choices and only a sister in touch as his life ended. I had rounded on him for a few weeks in the hospital; there were no other options for treatment. Shadyside Hospital had started a palliative care program (Kudos Beth Chaitan) and their team came in to help him plan. That day he was going to hospice in transfer I simply remember his tears and my tears. He didn’t want to die. I just hugged him. There weren’t words.

There still aren’t words.

So I bear witness to death. But now I am bearing witness to so much death, so much anger. It is hard for all of us to offload it.

The 54 year old male who comes in with Covid, unvaccinated and angry. Not aware that some of his anger is even there. Angry because he is healthy, on vitamin D3 and K2, exercising daily with ZERO comorbidities. So I witness his anger towards the nurses because he cannot even get to the bedside commode without assistance, his oxygenation saturation drops so quickly. He is on as much oxygen as we can give before we use the ventilator; no one wants to go down that path. He lashes out about the food, the visitation policy. But truly he is just scared. So my quick visit to check in is heavy. But all are worthy of patience and grace; we try to find it.

The daughter of the 87 year old who yells at me when I ask if her mother with Covid and fairly lethargic has been vaccinated. Her anger is truly at the politics of the infection (and of course if you have read anything that I have written, you have heard my reminders that viruses are not political life forms) and not at me. But her tone is exhausting and thick in the room; I simply need to know what we have to buckle up for, how much I have to worry. The single best predictor of outcome from Covid is vaccine status. That is a fact. (not anecdotal)

Does that mean that vaccinated individuals are not dying? Of course not. But when they do in my experience (anecdotal) it is because they are very immunosuppressed (lymphomas and leukemias; Rituxan is my ARCH nemesis) or they are simply so weak. Before Covid we frequently had frail patients who died from fairly innocuous viruses— rhinovirus and the old school coronavirus did kill. But when they did it spoke more to the patient as a weak host than the aggressive nature of the virus. I would say that this is the case for the MOST of my vaccinated Covid patients now. Though morbid obesity and uncontrolled diabetes is still a huge risk factor even for the vaccinated and boosted. To talk only about vaccine and NOT address our unhealthy lifestyles does our country a huge disservice.

So again at the end of a long week, we lost a number of unvaccinated young Covid patients (40s and up). It sucks the life out of the bedside clinician. Those of us left (because tons have quit) are bearing witness to death and anger. If we the people don’t start to recognize our own issues and have insights as to what we bring to the table when we are ill or as we care for and love our people; this is going to get worse.

Everyone is somebody’s person. And with your choice not to vaccinate, we stand helplessly at the bedside after having dealt with your emotional issues and fear, with the ones who love you. The ones now who would stick that needle into you themselves if they had known you were going to be here. The one who died.

So I continue to try to encourage with grace and compassion. Hoping that people will do better risk math. But also reminding the snarky judgers that their tone doesn’t help our work. That person who actually knows someone who died from a vaccine is real. Fear is paralyzing. And politics are the new religion. We take care of everyone. That should be the message. But know that there are more times than not these days that we cannot fix you.

That has always been our truth but the numbers never looked like this.

And it is exhausting and underpaid care.

Be kind.

“Without you, the ground thaws, the fain falls, the grass grows.

Without you, the seeds root, the flowers bloom, the children play.

The star gleam, the poets dream, the eagles fly, without you.

The earth turns, the sun burns, but I die without you. “

Without you; Rent.