Last week, we ran our first code related to covid-19. A code on its own can be a high-stress situation. Someone is literally dying right before you, and you must do everything within your power to revive the person. The epinephrine, the bicarbonate, the crushing of the sternum and ribs for chest compressions, shoving the breathing tube down.
But a covid-19 code is an animal all its own. As our colleagues prepared to rush into the room of the patient who was clearly seconds from arresting, I yelled at them: “Get your mask on! Do you have a mask?! Stop and get your gear on!” The last thing we wanted was for any of our co-workers to be exposed, given the body fluids they were about to encounter.
A covid-19 code requires a “lean” team — i.e., as few people in the room as possible, to minimize exposure. Whereas a normal code can have up to 20 people in a room, we kept it to five. The code leader — one of my close friends — performed chest compressions with another resident, all while shouting instructions. The pharmacist, instead of bringing the code cart into the room, handed medications through the door. Truthfully, the team did an excellent job under the circumstances, but it was also one of the more bizarre codes we have experienced.
All the while, all I could think about was the health of the team members and how many minutes they had spent in there. Everyone did his or her job, like the heroes they are. But each of us knew, sadly, that this patient would not survive. And every moment we spent doing our job put us at greater risk of getting sick.
I feel a special frustration in situations such as these. My No. 1 priority is taking care of patients, just like everyone I work with. But when we review the guidelines and protocols on caring for covid-19 patients, along with the oxygen support, the medications and the ventilator protocols, we are also told, “Remember the goals of care.” GOC, GOC, GOC.
Goals of care refer to what a patient would want should he or she go into cardiac arrest, require intubation or experience other situations that require supportive measures. You might have heard of the means to communicate these: in a living will, for example, or advance directive. But you can also just talk to your loved ones about what they and you would want should the worst happen. Does your 80-year-old mother want someone cracking her ribs or intubating her? Maybe. But maybe not. You would be surprised by how many people do not have these tough conversations when they are well.
We are already in the doomsday situation, and it is not going to get easier. The number of covid-19 cases in New York is skyrocketing. The state might be short up to 25,000 ventilators when this crisis peaks. And though it might be hard to come to terms with this reality, we do not have the resources needed to care for everyone.
So I implore you — in addition to writing that next novel, calling your representative or stocking your pantry — remember that one of the most important plans you can make for the future is to talk about the future. Lives depend on people staying home and safe, but they also depend on conversations such as these.
So go use all that spare time you’ve come into.