diary of a hospital

The Last Face They See Before They Die

“I found myself asking God to forgive me.”

Photo: Patrick Schnell M.D.
Photo: Patrick Schnell M.D.

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As the COVID-19 crisis continues to unfold, the medical staff at Mount Sinai Brooklyn is providing regular dispatches about the daily experience fighting the virus. Ronit Sternberg is an anesthesiologist just out of residency whose main job is to intubate COVID patients unable to breathe on their own, a majority of whom do not survive. Throughout the crisis, she found herself wondering if she was doing more harm than good in prolonging critically ill patients’ suffering and asking God for forgiveness for her part in it all. Below, her dispatch.

This is my first year out of residency as an anesthesiologist, and I wasn’t prepared for something like this. This virus is like an accelerant in a fire. It just robs you of time that you would normally have. I don’t want to sound childish, but I feel like this virus is really mean. It takes things away from you, and it takes them away so fast.

What I’m mostly doing now is I’m intubating. Anytime there’s an airway issue, that’s my job. With these COVID patients, these patients’ oxygen saturation, which should normally be like 100 percent, is in the 80s. As anesthesiologists, you start to freak out when it’s 90. When I go into these rooms, I’m thinking to myself: Am I the last face that these patients are seeing? It makes me really sad, and I feel sorry that it’s me. I found myself asking God to forgive me. They should be at home being made comfortable with people who they love, not me. I shouldn’t be the last person they see.

With us all gowned up, it can almost seem like sci-fi. We’re double gloved, we’re washing nonstop. It can make it feel almost like we’re not human anymore. But I always try to make sure I know my patients’ names. And even when I intubate them, I say to myself, Thank you for letting me be part of this, because every one I learn a lesson from. And they teach me a lot about myself, because this situation has been very stressful and you go into a room and you have to be calm. Sometimes I just find myself so mad because it’s just not fair. Everyone’s stressed, and we are working really hard — I haven’t seen my mom or dad or my sister, I don’t see anybody — so anger can flare up. I just try to remember that I have a patient here who really needs my help. And that’s what I can’t forget.

I think of an anesthesiologist as the one who watches, the guardian of those who are sleeping. A colleague of mine said that an anesthesiologist is sort of like being a spy agent, like for the CIA or the Mossad. We go into a room, do our thing, and we leave and no one really notices us. Most of the patients don’t even know our names. But whenever you enter a patient’s room, you sort of leave a part of yourself with that patient, and when you leave the room, you take a part of that patient with you.

Right now, honestly, it’s gotten quiet. But when we were on the slope going up, the worst night I had was in the emergency room. I’d never seen it so packed, and I was literally going from one bed to the next. I intubated one patient, and I look to my left and I see this woman — she’s curled up, and I could hear her breathing, and I said to myself: She’s next. So I cleaned up my scope and then she’s coding. I go to the head of the bed and I’m getting ready as she’s in cardiac arrest and they are doing chest compressions. And I was so taken aback that she had these stunning blue eyes. And I’m thinking to myself: She’s looking at me, and I’m looking at her, and this is it. Her eyes should have been looking at her husband or her kids. I intubated her, and she didn’t make it.

There was another patient — I walk into the room, and she says, “Please help me.” I’m wearing a respirator, which is this heavy tight mask, and you can’t really hear what I’m saying, so I have to yell. And I said to myself, because I think she couldn’t hear me: “I’m so sorry.” The next day, I went to her code as well.

When I was in the hospital during this flood and it was madness, I literally felt, When is it gonna be my turn? I’m 40. I told my sisters, “Listen, if I’m on a ventilator, and it’s not getting better, play some ’80s music and maybe that’ll bring me back,” but … I can’t believe I’m thinking like this.

Normally in my work, I make jokes, I have to get people’s trust really fast, and I use a lot of humor, I make people laugh. If you can make someone laugh when really they’re at a low point, that’s truly human. Now it’s not funny anymore. It’s super-sad. Because I just feel that these people are dying among strangers. I hope I get my sense of humor back, but it’s not funny now.

I can’t remember how many intubations I’ve done throughout this. I’d say upwards of 40. I’ve lost track. But I only know of two patients of mine, or three, who had a chance to do okay and were transferred out. The rest of them, none of them survived. At some point, I would walk into a room, and I could see a patient is agonal breathing, which is a kind of breathing where you are basically dead, and I walk in and I’m like, Why am I doing this? And I say to [my colleagues]: “We should really call the family. Someone needs to explain the family that this is it, and that by intubating, I’m not bringing them back, and it’s going to lead to a code and chest compressions.” That’s when I got to feeling like what I’m doing is kind of — not hopeless, but very sad. And I feel like it’s our fault for doing it because we should just let them be peaceful. I thought that my job as a physician was to do no harm. And it’s almost like I am.

I’ve been reading books like Atul Gawande’s Being Mortal and Paul Kalanithi’s When Breath Becomes Air and Simon Fitzmaurice’s It’s Not Yet Dark. These books are basically about end of life and what it means and how physicians should deal with it. I think that Being Mortal really taught me that there comes a point where we have to tell the patient and the family what’s going on. When you see someone who is not going to make it, I feel like it’s our job as a physician to explain it in a way family understands, and that’s the hardest part. How can you tell a family that the reflexes that they’re having are not reflexes that they’re consciously aware of, because of brain death, or that it’s beyond miracles at this point? Confronting this so early in my career gave me a feeling of hopelessness that I’m used to.

It’s still not really hitting me now. I wonder how months or years down the line this will be told in stories, in the records, in the archives. I think it’s important.

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Diary of a Hospital: The Last Face They See Before They Die