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COVID-19: Tough Calls

By Dr. Juan Del Cid Fratti

I remember hearing on the news that in China there was an outbreak of a new respiratory virus. Shortly thereafter, this virus propagated all over the world. I made video calls to my family members back in Guatemala to discuss the importance of isolation and the use of masks. They were really scared because the virus was killing hundreds of people around the world and had just reached my home country. I was training in Chicago, Illinois at one of the biggest hospitals in the city. Cook County serves a large population of immigrants and non-insurance patients. It was a time of great uncertainty for many. The virus continued to spread and one day I received a phone call from my chief resident, indicating that I would be reassigned to the first medical COVID-19 response team. I agreed without thinking because I wanted to help these patients. After the conversation, I told the news to my wife and she started crying because she was worried about my safety. I decided not to tell my parents because this was relatively new, and they would have been very scared for my safety.

I started working with the COVID-19 team over the next few days. It was a relatively new condition that we did not know much about managing back then. We had started to see patients under investigation (PUI) or confirmed COVID-19 cases in the general medical ward. The experience was different than what we were used to, with the encounter starting with a phone call to the patient room followed by the use of personal protective equipment (PPE). As soon as I entered the room, many patients showed concern and asked why a family member could not be with them. My words to the COVID-19-positive patients were generally something like, “Be brave, we will do our best, and let’s keep the hopes high. We will help you to beat this.” Unfortunately, this was not possible for all patients. After those initial days, I quickly realized that when oxygen saturation would drop, while on oxygen using the nasal cannula, things would typically go downhill. We would increase oxygen, prone, add oxygen mask with reservoir, and finally transfer to the ICU. Sadly, several patients died before arriving in ICU.

I usually started my day early in the morning by changing regular clothes to scrubs, then calling the patients, rounding, discussing cases with medicine and infection disease attendings, calling the family of patients, taking new admissions, transferring patients to ICU, and discharging patients. Every fourth day we were on call, taking new admissions and taking care of the patients throughout the night. After my night call, I would shower in the hospital, putting my used scrubs in a plastic bag with others until I washed them at the end of the week. Trying not to expose my household to COVID-19, I slept on the couch.

After several more days of experience, we knew which patients would decompensate soon and we monitored them closely to call the ICU when needed. Once in the ICU, many patients were placed on mechanical ventilation, and after several days some passed away. I saw some patients die on the ward, some transfer to ICU, and some were discharged to go home. One of the most important parts of the day was not the rounding or the medical decisions, it was calling the family to give them updates. I was in the COVID-19 unit for one month, then I was moved to the medical ICU.

The medical ICU, which back at that time was called the COVID-19-ICU because other cases had been moved out to other ICUs, was filled to the maximum. It was a different experience than a regular floor. There, a regular day consisted of pre-rounding on patients, adjusting ventilators, rounding, taking new patients, and making phone calls to the family of patients. After several days I realized that a phone call was not always enough for a family member who was so concerned about their loved one suffering from a severe medical condition. I started to make video calls instead. When a patient did not have Doximity or another medical app, the hospital would arrange a video call, but this took some time. I decided to start video calling the family members with my personal cell phone. Some of the patients were extremely ill, so much so that we knew time was of the essence. I expressed this to the family members, before connecting them to talk one last time to the beloved one via my cell phone. These phone calls were difficult to make. I would hear the family on the other side crying, small kids talking to their parents or grandparents, and saying goodbye. Not all the phone calls were sad, we had several cases with great outcomes and the family members over the phone gave strength to the patients and to us as caregivers.

I will never forget taking care of one Hispanic patient in his 50s, in the ICU due to severe COVID-19. The only phone number that I had was for his roommate, which I called, and he told me that the patient had no one in the United States. I asked the roommate for a phone number to call the patient’s family, which he did not have, but was able to find within a day. I made the international video call, to a family that had not seen their father in more than 10 years, to see him for one last time and to say goodbye.

During this period, COVID-19 hit my country hard, it is a place that was not prepared for this pandemic. I had several family members and close friends in my country experience severe COVID-19. My work did not end when I left my hospital at the end of the day, I still had to call doctors back home to ask about my family and give some advice. I knew the suffering, but now I was on the other side of the phone, seeing my close relatives in the ICU from a distance.

The days passed, and we gained more experience with better outcomes. I completed my internal medicine residency, and we had a virtual graduation ceremony. Saying goodbye to the close friends that I made during residency was done via a phone call. As I reached Peoria, Illinois to begin my new cardiology fellowship at a big hospital (OSF Saint Francis Medical Center), COVID-19 numbers were again climbing and now I began to learn more about the cardiovascular complications of COVID-19.

Someone asked me when everything started: “Why did you agree to fight COVID-19 early on when PPE was almost nothing and when the risk of infection was higher?” I told them: “Because someone had to make that last video call.” During the last part of my internal medicine training, I lost several patients, close friends, and family members due to COVID-19. This experience and those people will never be forgotten.