 So this week, I just got done finishing a whole week working in the COVID ICU. Here's my reaction. All right guys, welcome to the MD journey. A channel completely dedicated to helping people succeed on the Michael journey, but doing it with less trust. My name is Lakshman, internal medicine physician and resident training. And today's video and episode is all about basically what I've learned after working a week at the COVID ICU. Now in this video, I'm going to share with you five surprising things that I learned while working in the COVID ICU that I didn't expect to. Now I'm hoping that by sharing these for those of you that are joining medicine or just wanted to experience and understand what it's like working with COVID patients, ideally, you can take these lessons in your own life. And I know for sure I'm going to do the same. So we're going to get right into it. I'm going to go into number five, which I didn't really understand the severity of the disease itself. Now, honestly, this is a little bit of kind of admitting to my ignorance. I'm a physician by trade. I do this for a living. I know kind of the consequences that come with somebody getting COVID. But you don't really understand it until you experience it in ICU. And when you have to present in front of the team, and then you say that a patient has been there for 80 days, for 30 days, for 15 days and 10 days. If you say somebody has been there 10 days, you know that they potentially can be there much longer. That part just did not stick with me until these patients were actually my own. If you know even a little bit about COVID, then you probably know about the damage that I can do to your lungs. But sometimes we don't think about what the damage to your lungs can do to the rest of your body, whether it's related to COVID or not. And I'll talk about that a little bit later in this video. But I just got to appreciate how severely sick these people are. Probably more sick than any any patient population I've ever taken care of my life. And it's just so remarkable. And I'll get back to this point, but you don't really understand it again until you have to present that a patient has been with you and your hospital team for 80 plus days. And you're still making strides potentially to move them in the right direction. Some people are just kind of stuck in one area where they're supported by the same level of ventilation and you haven't been able to make any progress. And that's just kind of the course of the disease. And I didn't get to appreciate that until I really started to actually take care of these patients this week. Number four, again, kind of admitting to my ignorance. I didn't understand the sacrifices that frontline healthcare workers are making. Now, again, I'm a healthcare worker, but by no means that I ever consider myself to be a frontline or a central worker. I was pretty much protected from my residency program because I'm an internal medicine residency right now. From taking care of COVID patients and making sure that the rest of the hospital was functioning while those physicians who were designated to take care of these patients could do so. So while I was busy taking care of non COVID patients, I never actually got to experience, take care of a COVID patient until this specific week. And I knew about the sacrifices I read about the different experiences, especially in physicians in Italy, when the pandemic was hitting them hard early in 2020 of things that physicians were doing in terms of sacrifices of not seeing their families and how long they were working and the risk of getting sick themselves. But again, I didn't really get to appreciate that until I worked with attendings and CRNAs and nursing staffs. I've been only doing COVID for nine plus months. And you really understand that they just look a war in town. It was burnt out and it's sad. You know, you understand how sick these patients are. And sometimes that progress that we're looking for in our patient population to do better also keeps us motivated. But when you don't see enough examples of your patients doing well, because of the disease is just so horrible once it gets really bad, it really starts to hit a toll on a physician. And you can see that in your attendings. You can see that in the nurses. You can see that in the CRNAs. And I didn't appreciate kind of how much they had put themselves through. Now, again, I'm done with this rotation after this week. I've had my COVID experience, but there are people who are going to continue to do this until this is over. And it's not going to be over any time soon. So for those of you guys that are truly frontline workers in the emergency rooms and the COVID wards and the COVID ICUs, just by putting myself in your shoes for seven days, it can only imagine what kind of sacrifices and mental stress that has done to you over the last few months. So thank you really doesn't do enough. But to say that I hope that after this is a little bit calmed down, that you're able to go to some sense of normalcy. I'm hoping that's the case for you. But by any means, I've learned that your hard work or definition of hard work can truly be for me. Now, the third thing that really surprised me working in the COVID ICU was the importance of team compartmentalizing. I'm not really sure if compartmentalizing is a word probably is, but basically the way my COVID IC worked is that my job was basically to be the intensivist for the week. So I managed the ventilators, I managed the pressers. I managed basically what was keeping these people alive, as well as doing the medicine like managing their diabetes, managing their lower high blood pressure, managing infections. That was my job. And so while you're dealing with all of these patients on the COVID ICU, with the other tasks that you may also be doing as a physician, like talking to families, understanding where their goals of care for their family members are, especially if patients have been there for 30 or 40 days and things aren't getting better, having those conversations with families take a long, lengthy time and you have to build reports that has to be consistent. So it's hard for me as a physician to be able to take care of these patients, as well as call families other, and I pretty much will be in the hospital all the time. Thankfully the way that my ICU was structured is that my job was really just to manage the acute stuff and keep these patients alive and potentially do better. I had a team of residents and palliative care faculty who would then take over the interactions and communications with the family. So they were in our rounds. They basically understood if the patient was getting worse, the thing to stay in, even potentially getting better. And then they were able to give updates to the families on my behalf, on the team's behalf, so then I could just take care of the medicine part. And in addition, we had a great and fantastic team of CRNAs, which is basically a nurse, a anesthetist, or an anesthesia nurse, and they did a great job of also being able to take care of the ventilators and the sedations for these patients. So then again, I can manage blood pressures, I can manage infections. So it was a great kind of, this is my role and this is what I'm gonna stick to. There's a family that wanted an update. I was able to then triage them and point them to the palliative care team and the team of residents that were then able to do the communication. So it truly was a collaborative team effort and I'm sure it's taken some time for it to look the way it did for me this week. I'm sure it's gonna make more improvements in the future but really when you go back to a normal medicine and kind of service, it's there to some extent but you as a physician, they're really doing the family conversations, the acute management, the chronic management, the disposition and there's a lot of stuff in the background that you deal with and this sitting just doesn't work. And so I was so thankful for truly having a team to take care of every single patient. Now getting into number two, which is really learning the extremes of medical management. Now when you work as a physician in an ICU, really start to see the extremes of what the body really needs to support itself to stay alive. So you may find yourself putting a patient on multiple different forms of life support. This includes an ventilator to help them breathe, medications to keep their blood pressures up and maybe multiple medications to keep their blood pressure up as well as things like dialysis to help their kidneys functioning, other medications to keep their heart pumping. There's so much support that you can give to a patient but I probably have not seen that level of extreme on basically almost every patient than you do here in COVID. So for example, when I was managing somebody on a ventilator, there is a level of kind of dial turning that I'm allowed to do. So I know kind of this is what those patients lungs are able to do. And here is me giving a little bit more support by turning these respective settings and giving them more support. I was finding myself more often than not of putting basically the max settings that I could do safely for somebody through the ventilator and still not able to give them enough support to help their lungs. That's how sick these patients were. I was finding people who were pushing their kidney disease and their respiratory status and their volume status and their blood pressures to the extreme. And despite what I did, I was still having to take basically 50% of what I normally would. So for example, in a normal situation, even an ICU patient, I'd be like, this is the acceptable line. At which point, you know, I'm hoping that my max support does something. Well, in a COVID patient, even with that max support, that line kind of goes a little bit down and I have to say, okay, well, I hope that they can turn a corner because I can't really do much for them. And this extreme of how sick these patients are also leads to very creative ideas of how you can manage them. For example, in my institution, I was basically hooking up half a bypass machine to a dialysis machine to basically create a fancy kind of bypass machine to then be able to surpass the work that somebody's lungs and hearts were doing at the bedside. And this was basically just makeshift. We were using technology that was meant for one thing and technology is used for another thing and trying to put it together and hopefully it would work to take care of these patients that were more secure than we're used to. And so really getting to practice that extreme level of medicine, then when I go back to a real ICU, you know, I will feel so much more comfortable because I've seen what max settings on a ventilator do or max settings on medications do and I just feel much more comfortable. So I really am thankful for this experience because I've seen extremes of extremes. And now when I go back to probably like a normal ICU with non-COVID patients, I'll be able to do it with much more confidence. And finally, number one, the most important surprising thing that I've learned is I truly had a humbling week. And I don't know how to put that in a phrase that's saying this is surprising, but I really just felt myself humbled throughout this whole week. I admitted my ignorance early in this episode, but really it came to grips with how much I can do as a physician. And sometimes, especially as a training, you feel discouraged, you feel stupid because you feel like you can't do enough to make that patient better. But that just comes with acceptance that the fact that your medical knowledge and what medicine can do for that patient is kind of at its limits. And you just hope that time and a little bit of luck goes in the direction for both you and the patient. There's a little bit of humility you have to accept that you can only do so much. And the more and more I experience with sick patients, the more I've learned that. Well, I've learned that really fast this week because I had a bunch of sick patients which regardless of what direction I was turning the dials on the ventilators or changing their medications or making small creative adjustments, often I didn't really do much. And I just had to kind of accept that either my bar had to be a little bit lower and I just had to accept that they may turn the corner and just give them some time. Sometimes the best thing in medicine is not to do anything, it just wait. And there's a little bit of humility that you have to take. So it was a very humbling week as a physician who's always kind of trained to do something. In this situation, sometimes I had to just do and wait and watch and just see what the course, the body took and what these courses for the patients took. So to say that it's been an educational week and an enlightening week is an understatement. Hopefully for those of you guys that haven't really experienced interacting with patients that are extremely sick with COVID, this was a little bit helpful. This is just one spectrum of somebody with COVID. Obviously there's people who get the disease and are completely asymptomatic. There's people who get the disease and go to the hospital, feel a little bit short of breath and get medications and then potentially are able to get better. But those who unfortunately get to that far extreme are just so sick. And to be able to have this experience, take care of them as a physician and to be able to share that with you, hopefully you found that to be a little bit educational and enlightening. I know I have to surely have, but I'm gonna stop babbling. Usually at the end of this video I'll have some kind of call to action for you guys to do, but really just stay safe, wash your hands, make sure you're wearing a mask. Be mindful of who you interact with and try to limit your interactions while this is still getting a little bit settled over the next months to potentially a year. And we don't know how much time. Let me know what questions you guys have down below about taking care of COVID patients or working in these ICU. They'll be happy to answer them. But with that being said, thank you guys so much for joining me on my journey of reflection. Hopefully I've been a little helped to you on yours. I'll see you guys in the next one. Peace.