Life & Death in the ICU.

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I'm An ICU Doctor And I Cannot Believe The Things Unvaccinated Patients
Are Telling Me "My experiences in the ICU these past weeks have left me
surprised, disheartened, but most of all, angry." Thanh Neville, M.D.,
M.S.H.S. By Thanh Neville, M.D., M.S.H.S., Guest Writer 08/01/2021
09:00am EDT.

“We can’t let COVID win.”

This was my colleague’s mantra when the pandemic started last year. And
for the almost 18 months since, health care workers have rallied to the
battlefields, even at times when we had no weapons to brandish.

We took care of the infected and the critically ill when no one else
would. We reused N95 masks, carefully placing them in labeled brown
paper bags in between shifts. We witnessed lonely deaths and held up
iPads for families to say their heartbreaking goodbyes. We created
elaborate backup schedules and neglected our personal lives. We stepped
up during surges and when our colleagues fell ill. Camaraderie in the
ICU had never been stronger because we recognized that this was a team
effort and all of humanity was battling against a common enemy.

But as health care workers, we also were painfully aware of our own
vulnerabilities. We can run out of ICU resources for our patients. We
can run out of personal protective equipment for ourselves. We can be
exposed on the job and get sick. And we can die — many of us did, more
than 3,600 from COVID-19 in the first year.

Many of us quarantined away from our families to protect the ones we
love. We counted the risk factors of our children, our elderly parents,
our spouses, and came up with our own formulas to decide whether to come
home at the end of the shift or hole up in a hotel room. One of our ICU
directors wrote and rewrote our COVID-19 clinical guidelines to keep up
with the evolving literature and somehow she carved out the time to
write her own will.

I worked daily to adapt our end-of-life program to the changing needs
and restrictions of the pandemic and signed up for a vaccine clinical
trial as soon as one became available. I also updated my own advance
directive and printed it out for my husband, just in case.

Then, effective vaccines became widely available in the U.S. — I briefly
saw light at the end of the tunnel. The number of patients with COVID-19
in ICUs across the country plummeted. It looked like our sacrifices and
commitment as health care workers had paid off. We believed herd
immunity could become a reality and we could return to some sense of
normalcy.

But the relief was short-lived, the hope was fleeting, and we are amid
another surge. A surge that is fueled by a highly transmissible variant
and those unvaccinated. My experiences in the ICU these past weeks have
left me surprised, disheartened, but most of all, angry.

I am angry that the tragic scenes of prior surges are being played out
yet again, but now with ICUs primarily filled with patients who have
chosen not to be vaccinated. I am angry that it takes me over an hour to
explain to an anti-vaxxer full of misinformation that intubation isn’t
what “kills patients” and that their wish for chest compressions without
intubation in the event of a respiratory arrest makes no sense. I am
angry at those who refuse to wear “muzzles” when grocery shopping for
half an hour a week, as I have been so-called “muzzled” for much of the
past 18 months.

I cannot understand the simultaneous decision to not get vaccinated and
the demand to end the restrictions imposed by a pandemic. I cannot help
but recoil as if I’ve been slapped in the face when my ICU patient tells
me they didn’t get vaccinated because they “just didn’t get around to
it.” Although such individuals do not consider themselves anti-vaxxers,
their inaction itself is a decision — a decision to not protect
themselves or their families, to fill a precious ICU bed, to let new
variants flourish, and to endanger the health care workers and
immunosuppressed people around them. Their inaction is a decision to let
this pandemic continue to rage.

“I am at a loss to understand how anyone can look at these past months
of the pandemic — more than 600,000 lives lost in the U.S. and more than
4 million worldwide — and not believe it’s real or take it seriously.”

And meanwhile, immunocompromised people, for whom vaccines don’t
generate much immunity, are desperately waiting for herd immunity. I
have no way to comfort my rightfully outraged transplant patients who
contracted COVID-19 after isolating for over a year and getting fully
vaccinated as soon as they could. With angry tears, these patients tell
me it’s not fair that there are people who are choosing to endanger both
themselves and the vulnerable people around them. They feel betrayed by
their fellow citizens and they are bitter and angry. I cannot blame
them.

I am at a loss to understand how anyone can look at these past months of
the pandemic — more than 600,000 lives lost in the U.S. and more than 4
million worldwide — and not believe it’s real or take it seriously. But
the unhappy truth is that there are people who do not. They did not in
the beginning and many are doubling down now.

I thought when this pandemic began that we were all in this fight
together, engaged in a war against a common enemy. Now, I painfully
realize: Perhaps we were never on the same side and we never had a
common enemy. Perhaps the war has been among ourselves all along. We
have won many battles but unvaccinated America is choosing to let COVID
win the war.

Thanh Neville, M.D., M.S.H.S., is an ICU physician and researcher at
UCLA Health. She is also the medical director of the UCLA 3 Wishes
Program (an end-of-life program in which clinicians elicit and implement
final wishes for dying patients and their families). You can follow her
on Twitter at @thanh_neville.