I thought I had an understanding of the impact of COVID - my exposure to date had been prehospital. I thought I’d seen it & understood the effects on frontline HCWs. I was wrong . Last night I worked my first ICU shift. Thread ..

I’ve spent today trying to put words to all I feel after that shift - but I end up in tears. I’d diligently followed the numbers , seen the pts in their homes, in our ambulances. I’ve read & heard the first hand accounts of the desperate fight against this 2nd wave.

Turns out I was just scratching the surface of the horror that is Covid. Until last night I was still blissfully ignorant. I thought I was prepared for this shift. I’d done the online CMEs, I’d read & researched & studied & mentally rehearsed. Pre- hospital, I do my job well.

I stepped into a ward rapidly converted into an ICU it was not designed to be. Each bed occupied. Not enough staff. I was assigned an elderly critical pt. I read a chart of plummeting sats and BPs, of lists of meds. I saw raw fear in her face as she struggled for air.

Now COVID had a name and as face. And she was lovely. And scared. & she needed a vent. There wasn’t one. You can’t advocate for yr pt for what’s not there. And nothing I’d learned or mentally rehearsed made any sustained difference as I tried to keep her sats from plummeting more

Practical vs theory. Sats of 68 - i opted for HFNC - sats to 72. Added awake proning - briefly thought I was winning. Sats to 92% But she was restless, uncomfortable. She weighed >100kg, poor mobility & unable to prone herself easily. It sounds so easy on paper: prone the pt

With staff shortage it was just me there. I knew the exertion of proning wasn’t good for her, but proning would help. So we tried. Dobutamine infusion IV dislodged - I didn’t initially see it as her hand was tucked under the pillow . She turned lateral - her BP & sats plummeted

Resited IV, stabilized BP, revisited proning with HFNC. Didn’t know what else to do. We tried all for hrs - it didn’t work - sats wouldn’t pick up. A vent for NIV suddenly became available but the wall 02 regulators were jammed in the ports. There was no way to connect vent to O2

There was no other bed with an O2 port free. So it was back to HFNC, proning, watching her desaturate with fear, fatigue & confusion on her face. Glued to the monitor & silencing each desat alarm to let her rest. I was supposed to be helping her. And I wasn’t. I couldn’t.

And so my shift ended. My patient - a mom, a Gran, a wife - no better for the time in my care & facing the possibility of dying. And I didn’t know how to keep her alive. My commitment to patient care & advocacy feel so hollow, naive & idealistic now in the face of this virus.

And to realize this isn’t just my experience with my pt. This is every COVID ICU / ward, every treating practitioner. I’m heartbroken, scared & overwhelmed at the magnitude & intensity of this disaster & beyond awed & humbled at the strength of those who face this every day

To helplessly watch yr pt desaturate. To be out of options. To bite back tears. To hunt for depleted critical stock & meds. To know each contextually inevitable glitch in efficiency may alter the course of a life, but to still carry on as you do. THANK YOU