The patients we’re seeing with severe COVID aren’t the usual ICU patients. Most of the time, the diseases we see in the hospital have been stalking the patient for decades. They’ve had time to think about disease and death. Their families have had time to prepare.

They’ve thought about whom they would want to make decisions for them, they’ve thought about resuscitation and ICU stays. They’ve been sick before. They’ve been in the hospital before. They know the routine.

The COVID patients are random people off the street. Most of them have never been hospital sick a day in their lives. They’ve never had to think about their own mortality in this way and neither have their families.

It takes time to get used to the idea that you— really you— are so sick you need to be on a ventilator; that you’re so sick you will probably never breathe on your own again.

They look different. The denial is deeper. The families can’t take the information in. They haven’t had time to get used to the idea that “everybody dies” applies to them, personally. Their families aren’t ready to understand that there isn’t anything more we can do

They never imagined we could reach the end of our technology.

The ARDS is ruthless, inexorable, intractable, and cruel. Three weeks ago you were a normal person waking around and now you’re surrounded by constantly beeping machines.

Ernest people lean towards you at all hours, worried, busy, dressed up like space aliens; your children peer at you from computer screens in other states. You are too weak to move. Everyone wants to help you and really nobody can and if the beeping machines stopped you would die