Disclaimer: This articyle is the opinion of the author and is not the official policy or position of the Uniformed Services University, Defense Department, or US government.
We all thought he would die. There was no way he could survive this; not even someone so healthy, so young, so previously full of life. Yet no one considered giving up—not until we had tried everything. He had given us his best—a healer like the rest of us—and now we owed him the same. I looked around at my team. Even with faces obscured by masks and plastic shields, I could see their determination to claw back life from death’s steady advance. I could also see weariness etched around their eyes. This was our new reality: so many critically ill patients, fewer resources than usual, and unrelenting stress. We had all carede for patients in crisis, but this was different. We worked for hours trying extraordinary, novel techniques. No one gave up.
But he died anyway. Another of thousands of casualties swept up in history’s march. While his loss shook us all, I had never felt a more profound sense of purpose, camaraderie, or shared mission with another group of people than at that moment.
This story could be from New York, or Milan, or Wuhan, or anywhere that COVID-19 has taken lives and stressed medical teams. But it isn’t from any of those places, and this patient did not die from the coronavirus. He was a young Army medic who suffered devastating injuries from a roadside improvised explosive device in Iraq in 2009. Our team at the Balad Air Force Theater Hospital tried everything possible, but nothing could save him. Eleven years later I think about this young man often. I think about the horrors of war that we saw—burned children, multiple amputees, violent suicides—and then I remember the light that glowed in that darkness. The light was us. It was our teamwork, our determination, our willingness to help each other, and to do everything for any patient. This camaraderie, a sense of shared mission and purpose, is one of the key ingredients that allow our all-volunteer military to succeed. In Iraq, we stepped out of our normal comfort zones and worked together for something bigger than ourselves, making the experience noble and hopeful, even if sometimes futile and heartbreaking.
COVID-19 has plunged the United States, and much of the rest of the world, into a period of fear, frustration, and grief during the past few months, and understandably so. This infection is scary. We have no cures or vaccines. There is an entire global population that has never had the disease before and lacks immunity. We have an incomplete understanding of the virus’s transmission and infectivity, and an unclear mortality rate. Death, at times, seems random. It disproportionately affects our most vulnerable people—the elderly and chronically ill—but it also sometimes affects the otherwise young and healthy without a clear reason. It has already killed tens of thousands of Americans, and there are grim models that predict many more deaths and hospitalizations despite our best efforts.
Physicians, nurses, and the rest of the health care team are scared and stressed too. I can see the worry around their eyes and hear the change in their voices. Masks block smiles and muffle sounds, making normal communication more challenging. Stories pass quickly, via medical journals, social media, texts, and word of mouth, about rapidly decompensating patients with copious secretions and perilously low oxygenation who need ventilators for a very long time.
Despite the fear and uncertainty, the same light that I saw in Iraq is now shining from my hospital and others all around our country. Emergency physicians and intensivists, housekeepers, and radiology technicians have gone to work, donned used masks and face shields, and met their fears head-on. Emergency medicine in particular is always performed in teams, but now the teamwork has reached new levels. Colleagues check in on each other frequently, health systems are sharing people and advice, volunteers of all stripes are making masks and dropping off food to their local hospitals, and unrelenting administrative requirements have been pared back to focus on what’s truly important.
My hospital, spared from an early surge, entered an eerie “calm before the storm.” And in those very first PUI encounters, I saw an unmistakable camaraderie emerging. Not long ago, I treated a young man with a high fever and influenza-like illness. Normally, his care would have been fast and efficient: a brief assessment and orders, and then a discharge home without even needing to talk to his nurse. In our new reality, on the other hand, everything was different. His nurse and I strategized each step of our approach. After a phone interview, a “buddy” helped us don PPE and we entered the room. We stayed only briefly: a quick exam, specimen collection, and treatment with Tylenol and fluids. He would go home soon—one of the lucky ones. We breathed a small sigh of relief as we doffed gear under the watchful eye of another buddy. Four people bonded to aid this patient in a way that would have been inconceivable the week prior. We literally watched each other’s backs. While these simple encounters will fade from memory, the growing sense of working together to face adversity will not.
Wars and pandemics are terrible, shattering lives and creating innumerable hardships. But, in dark places, there are often sparks of light if you look for them. I felt a profound sense of hope seeing the spirit and teamwork that carried us through difficult times at war in Iraq, and I feel the same sense of hope now seeing our physicians, nurses, respiratory therapists, and medics rallying together to face and defeat this invisible challenge at home.