Dr. Philip A. Verhoef

Opinion contributor

I’m an ICU doctor in Honolulu, and my wife is Hawaii's deputy state epidemiologist. She handles public health, and I handle the clinical medicine. Needless to say, she hasn’t had a day off in the past six weeks. But now, coronavirus has come to the intensive care unit.

The shift from trying to contain the illness to treating those who have been infected, one at a time, is eye opening and heart rending. What do you do when there are vastly more sick patients than you can care for?

This pandemic is like nothing else any of us has ever experienced. At the personal level, I must limit my use of masks to just one — for the whole day. Previously, I would have only used a mask for certain patients, and I would have changed it every time I went into a new patient room, out of an abundance of caution. Similarly, if I use a face shield, I need to wipe it down and reuse, as much as possible.

When I am caring for COVID-19 patients, I change into hospital scrubs when I arrive at the hospital. Before I leave, I change out of those scrubs, shower and wipe down my glasses, phone, shoes, stethoscope and work bag with sanitizing wipes in the hope that I don’t inadvertently bring disease home and expose either my kids (ages 4 and 6, who would probably be OK) or my wife’s parents (who are over 70 and almost certainly would not).

The risks that keep us awake at night

Every one of us working at the front lines is afraid to cough, for fear of becoming a pariah; and whenever we feel a little scratchy throat, or sneeze, we think, “Is this it? Have I finally gotten this? Have I been spreading it to my patients or to other health care workers or my family? Does this mean I have to stay home for the next two weeks, when I’m needed the most?”

This angst keeps me (and many others) up at night.

We are afraid of the disease itself, both for ourselves and for our loved ones. I have cared for hundreds of patients with respiratory failure like we see with COVID-19. If patients are conscious, they may feel like they're drowning, and we force them to breathe with the smallest amount of air possible. This nearly always means inducing a coma and sometimes using medication to chemically paralyze them. They require a breathing tube, which is painful and uncomfortable, and prevents them from being able to talk.

For COVID-19, we have found that flipping patients onto their stomachs is particularly effective, so once or twice a day, a team of nurses, respiratory therapists and physicians find ways to turn these comatose patients over and back. We feed patients through additional tubes in the mouth or nose, and we infuse medications to optimize the support of every organ in the patient's body.

It is an honor to care for critically ill patients, but it's also terrifying. What if we make a mistake that costs someone their life or causes irreparable harm? Can we keep them from dying, and at what point do we acknowledge that, in spite of our best efforts, we are losing the fight? Having the skill set to care for these patients means we have a responsibility to do our best, but also to realize that our best might not be good enough. This can be a difficult pill to swallow.

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We are anxious as well about how we will cope with the wave of critically ill COVID-19 patients we anticipate. According to one model, the number of expected sick patients will exceed the number of hospital beds in Hawaii between April 20 and May 10. This would have disastrous consequences.

Hospitals must ensure that they have adequate personal protective equipment to keep their staff safe; by most accounts, we have approximately two weeks’ worth of supplies. In addition, we could deplete the entire supply of ventilators in Hawaii, and more of them likely won’t arrive for several weeks.

Preparing to ration limited resources

Hospitals are also rethinking the roles of every single health care provider. This means that outpatient primary care doctors may be recruited to work in the hospital, and doctors who normally care for hospital patients who are not critically ill (hospitalists) will be needed in the ICU.

Intensivists (like me) would normally be heavily involved in every aspect of care for ICU COVID patients, including performing procedures, managing ventilators and speaking with families. However, there is a finite number of ICU doctors in any given hospital, and it is simply impossible to have one of them at every bedside all the time. Ironically, I may have the least amount of patient contact because I will be responsible for directing teams of hospitalists caring for dozens of critically ill patients.

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Finally, hospitals have to establish protocols for rationing the limited resources that we have. If there are 10 patients at a given time who need a ventilator, and only five ventilators available, there must be a rational process for literally deciding who will live and who will die. I can assure you, no physician ever wants to be faced with this decision, but we might not have a choice.

Perhaps the worst part of trying to prepare for the next few weeks is simply that this is a brand new disease. We have vast experience caring for patients with acute respiratory failure, but COVID-19 appears to have a number of unique features: It is more severe, it lasts longer, it is unpredictable, it may impact the heart and, most important, there is no cure.

The virus continues to spread, and my wife is still working seven days a week. But now it’s my turn to be overwhelmed. I’m frightened, for my patients, my colleagues, my family and my own health, both mental and physical. Please do not relax your efforts to “flatten the curve.” They give us the best chance of having the capacity to care for each and every person who gets sick.

Philip A. Verhoef is an intensive care unit doctor and a clinical assistant professor of medicine at the University of Hawaii John A. Burns School of Medicine in Honolulu. Follow him on Twitter: @DrPhilipVerhoef