Opinion: Hard lessons from a year in the COVID-19 ward

I strip off my clothes in the garage and run through the snowy backyard in my underwear. I dash straight to the shower, my wife trailing behind me with a spray bottle of bleach, disinfecting everything I touch along the way. 

This is March 2020 and I’m in my first week working the COVID-19 ward at Denver Health. We had been following the news from China and Italy and Seattle with dread. Now it is here. 

At first there are only a handful of patients, but the sense of fear and anxiety, compounded by the emptiness of the hospital is palpable.

I divide my time. A week in the COVID ward. A few days of staying at home. I pause to listen to the 8 pm cheer for medical workers, but this work feels the furthest from heroic imaginable. 

We soon have dozens of patients and nothing to offer but an isolation room and high flow oxygen pumping into their lungs. “Lay on your stomach if you can,” I say, “it seems to help.”

Another patient arrives on the fourth floor, formerly our surgical wing, with fear in their eyes: “Am I going to die?” I try to reassure them, but the truth is, we don’t know. 

In April there was so much we didn’t know and so little we could do. We held conferences every morning, convening critical care doctors and infectious disease specialists and hospice providers. Grasping at straws. 

Should we try aggressive blood thinners on this dying patient even though there was no clear evidence of a blood clot in their lungs? Was another patient stable enough for a transfer to receive ECMO (extracorporeal membrane oxygenation)?  

The foundations of medicine — taking a history from your patient, placing your stethoscope on their chest, forming a bond at the bedside  — can be overwhelmed in the COVID-19 ward. 

Through gown and mask and face shield, and often through an interpreter phone, basic human connection feels near impossible. For my elderly patient with advanced dementia, this is incomprehensible. Every day we have to explain why he is held in this room and why he can’t go home.

Down the hallway, another patient begs me to go home so she can be with her children. She seemed to be doing better, so I acquiesce. Two days later she returns with opaque, whited-out lungs and is intubated that night.

I ride my bicycle home from the hospital and for a moment I am able to clear my head. Aside from the ubiquitous delivery trucks, the streets are eerily quiet in the midst of lockdown.

Working at a safety-net hospital, disparities and inequalities always simmer under the surface, but the pandemic has thrown them wide open into the blinding spotlight. 

“Stay at home,” we tell our friends. The meat packer in our ICU couldn’t afford to stay at home. He’s essential. Staying at home can be deadly, too, with siblings, parents and grandparents hospitalized together after COVID spread through their close-quartered homes.

But in spite of all the darkness, we are learning some lessons. At the height of this pandemic, it is no longer acceptable to discharge a patient to the streets without a roof over their heads. 

We are opening shelters and renting hotel rooms. Anything to facilitate a safe quarantine or to keep someone at risk from being exposed on the street. These are things we should have been doing all along, but the pandemic forced our hand.

Ten months later, I am among the first to be vaccinated. Relief and guilt. Shouldn’t the shot go to the grocery store clerk who doesn’t have a ready supply of N-95 masks and face shields? Couldn’t this shot go to my kids’ teachers so schools can stay open? 

These questions are not for me to answer. I take the shot.

Dr. David Mintzer is a Denver Health physician.