"This Is Very Real" - A COVID-19 Day in the ICU

[MUSIC PLAYING] Hi, everyone. I'm Dr. John Whyte, Chief Medical Officer at WebMD, and you're watching Coronavirus in Context. Have you checked out the short film called COVIDland? It chronicles a day in the life of Dr. Megan Panico, a Critical Care Physician at Hartford Hospital. You're definitely going to want to check it out. And I'm delighted to be joined, I guess by its star, Dr. Panico. Thanks for joining me.

Thank you for having me.

I want to start off with why did you decide to be part of this short film?

That's a really good question, because I don't think most critical care docs are comfortable in front of the camera. I think, before 10 months ago, we worked behind the scenes, and that worked really well for me. But I think that I realized it was important for us to be able to tell the story of what is happening in the ICU. We don't know what's going to happen day to day in the ICU. It's very unpredictable. And I think what was able to be captured here really was able to tell the essence of what's been happening for the last 10 months in most ICUs around the United States.

And you show the conversations with patients, even when you have to have those difficult conversations about whether or not you need to put in a breathing tube, and it may not impact how long they live. What do you say to folks who will argue, this is all fake? It's not real? How does that make you feel when you're talking to people every day about life and death?

It's really tough to hear that. This is, unfortunately, more real than any of us would wish ever. It's sad. Every day we're having conversations with people about life and death, over and over again. We went into critical care, this is part of the job, but it is nothing like what I've ever experienced, or any of my colleagues have experienced, before this last year. And so, it's really hard to hear that.

And I worry for many people that if they aren't taking it seriously, that they could lose their own life, or lose someone that they love, because, unfortunately, this isn't going away. And we need to take it seriously, and hopefully the vaccine will change that, but we have a long way to go until we get there.

Is it the sheer volume of patients? Is it the issue that patients can be OK one minute and then quickly desaturate their oxygenation, go down very, very low? What's different about COVID-19 than other conditions you've dealt with, as you've talked about? You deal with life and death issues every day.

I think it's both of those things and more. I mean, it's the volume. It's, at times, every patient in our ICU, and in every other ICU in our hospital has been COVID positive. And that's unheard of. You usually have multiple, different diagnoses that you're dealing with, but it's just over and over again, everyone that comes in has COVID, or has complications from COVID. The volume is great.

And the frustration with losing so many people that shouldn't lose their lives right now. Many of these people, yes, had co-morbid conditions, but they were living wonderful lives, functionally in the community, members of society, and they shouldn't be dying right now. Or they shouldn't have lifelong problems. Many of them that survive this in the spring are still dealing with struggles from it. And they didn't have those before. And that's the most frustrating thing to see.

The other really tough part is we still don't have great treatments. We have more options than we had in the spring, and we've learned, from the spring, we don't intubate as many people, people are able to survive longer on high flow oxygen, but that's opening up a whole other can of worms here, is that we can keep you alive on high flow oxygen, but can we give you your quality of life back? And I'm getting very worried about that.

We have a whole population of people now that are stuck on 40%, 50%, 60% oxygen, who, if they move just in the bed, they desaturate and require 100% oxygen. How are we going to give them their quality of life? And that's a huge struggle that we're currently facing.

How's it changed the work environment? You talk about there's now an attitude of, let's just get it done. That nurses are sitting with patients 12 hours a day.

It's very different. There's good and bad to it. I have learned so many amazing things about my colleagues and the teamwork that has come out of this between nursing and respiratory therapy, and the people cleaning the rooms, and everyone in the hospital, is something I didn't realize was there before. We always work together, but this forced us to just step back and say, how can we get the job done? And what everyone has done has just been amazing.

At the same time, we're 10 months into this, and I think everyone is tired. It's hard, day after day, to keep losing people, to do everything that you can for them, to be their family at their bedside because their families can't be with them. It is very, I think, draining on all of us. We lean on each other a lot, and thank God we have each other, because I don't think we could get through this otherwise. But it really, I think, has taken a toll on everyone who has been doing this for the last 10 months.

There's a very personal piece in the documentary where you're talking about your nine-year-old daughter, and she says, mommy, you've abandoned me. And you say, that's not OK.

It's definitely not OK. I think that's a tough piece for all of us to deal with, is the connection with our families throughout this whole thing. They've sacrificed a lot. We've all been in the hospital much more than before. We don't know when we're going home each day. And that's hard for them. And I think the kids don't understand. They've had so much taken away from them, just their normal lives, and then to have parents that are nurses, or respiratory therapists, or doctors that are living this every day, and then come home and can't step away from it.

I still worry about these patients when I get home, and so I can't step away from it. I need to know what's going on. I need to be available. And I think our children see it and are absolutely suffering from it. And I hope in the end, they'll be able to look back and be stronger for it, but I don't know, and I do worry about the lifelong impact that they are going to have from this also.

You've talked about that, how it may impact how children view the world, as well. We've talked a lot on the show about burnout and how it's impacting clinicians. It was a problem pre-COVID, and now, even worse. How are you and your colleagues dealing with burnout?

Well, I think we're trying, and I don 't know how good we're doing. We're all still here. So I think that's a good sign. We are an extremely supportive group. I think that being there for each other, checking in on each other is an important part of all of our days. I get calls from my colleagues just saying, are you OK today? We've all cried with each other. We are very open about that. I think sitting down with each other and just checking in is the biggest thing. And when someone needs their space and their time, we've given that to people. And I appreciate it personally, and I think my colleagues appreciate it also.

The psychology service and psychiatric service at Hartford Hospital has done check-ins with our ICUs, which I think has been beneficial for people and allowed people to voice concerns, and for everyone to realize they're not alone in this, for what we're feeling. That's probably been the biggest feedback that I've gotten from this is that, thank You for telling the story of what's really going on. People really understand what I'm going through now on a day to day basis, and I'm happy about that.

As tough as this story was and losing Brian was horrible and telling the story of what is really happening with our families is tough, but I think everyone is experiencing that. And so I hope that this gave a voice to that.

What do you say to those viewers who believe, it's not that big a deal, it's not much worse than flu, the media is making this all up? What's your message to those viewers?

So I think my message would be that this is very real. . It's very different than the flu I hope that we have a cure for this soon, but in the meantime, I think to save lives, to save your loved ones lives, and to be able to let our families and our loved ones get back to their lives, we all have to do anything we can. If that saves one life right now, that's one life that may be your loved one, and that's important.

So I would beg everyone to get the vaccine, to wear masks. And I think in the future we will all grow from this and we will be better people, but we have to be here to be better people.

Dr. Panico, I want to thank you for letting us have a look into your daily work, as well as how COVID is impacting you and your family. Thanks for taking the time to do this.

And thank you guys for having me. And thank you for sharing the story. I think it's important that people are able to see what's actually happening in the ICU, and hopefully this will make a difference and will help other people save their own families' lives.

So check out COVIDland on Medscape, and if you have any questions about COVID, email them to me, [email protected]. Thanks for watching.