“Transitioning to comfort care,” it read. “Discontinue all medications. Patient requesting a glass of scotch.”
He was a Toronto-area high school teacher in a previous life. His immunity was compromised, and he was waiting for his booster when he fell ill.
Each day after he arrived at the hospital, I wriggled my way to the head of his bed, between the wires that monitored his wavering vitals, to turn the tiny knob on the wall that controlled his oxygen. I followed the tangle of tubes that delivered his medicines to the clear bags above him that contained them.
Dexamethasone. Tocilizumab. Remdesivir.
This is an entirely different pandemic from the one that health-care workers started in. We have monoclonal antibodies and antiviral tablets that will find their way into hospital formularies and onto the shelves of local stores. We also have vaccines. Some people are even participating in trials for a fourth dose of those vaccines. The spirit of scientific inquiry over the past two years has been nothing short of remarkable.
But that has come at great cost to our minds and bodies.
As I looked after my patient, the two plastic prongs that sat in his nostrils soon became a bag and mask that pressed tightly on his face. I watched nervously as the soft breathlessness of his sentences grew softer, floating into the same air that struggled to find space in his virus-addled lungs.
The need to intubate him — to pass a breathing tube into his throat and connect him to a ventilator that would relieve his failing lungs — became obvious. In the moments before they would broach this idea with him, a small and exhausted cadre of gowned doctors and nurses gathered in the ward to prepare their equipment and run through their steps.
It’s hard to look into the eyes of a colleague and see the same person I saw last week, or last month, or last year. Our emotions have run the gamut. In the initial waves of the pandemic, when we faced a scarcity of personal protective equipment, we feared transmitting the virus to loved ones.
Now, with the omicron surge, we feel burnt out. Moral distress, increased workloads and poor treatment from patients, and our institutions have dwindled the hospital workforce to a stressed, skeleton crew.
The evidence is all around: In the wing of our inner-city emergency department that eerily sits in the dark because of a lack of staffing on a busy Saturday night. In the tense quips between nurses and physicians when an order is unclear. I don’t need a study to tell me that nearly 1 in 5 doctors and 2 in 5 nurses intend to leave their practice altogether in the next two years. I see it. I feel it.
So when I read that my patient refused to be intubated and instead requested a glass of Scotch, I was surprised. It allowed for a deeper realization to set in. And it cut so deeply through the hardened shell I had surrounded myself with that it split open the seed of my buried, neglected humanity.
In recognizing his limits, he spoke to my own. Feeling compassion for those who remained staunchly unvaccinated. Enduring the physical and psychological toll of working 26 hours straight. Maintaining a blind ambition in treating diseases that had gone too far in the selfish hope of a miraculous recovery.
Each of these has limits. And I had crossed all of them.
Health-care workers trudging through this pandemic might not need the deluge of political pep talks, or placating emails, or plastic-wrapped muffins we are now being offered to see ourselves through the hardships of this wave, and beyond. Instead, what we should look for is a frank honesty for how far we are willing to press on — in ourselves, and with one another. And, who better to lay it plain than our patients?
“Thank you for everything you’ve done,” my patient said when I asked how I could help. “Now, for one last drink.”