“She’s young,” I thought to myself one night as the intensive care physician on call in the hospital. I had been called to evaluate a patient in her thirties who had recently been confirmed as having contracted the (then) novel coronavirus. She possessed none of the attributes that medical school and residency teachings suggest are typical risk factors for the ravaging lung injury demonstrated on computed tomography and X-ray of her chest.

“Do you, or have you smoked cigarettes?” I asked.

“No.”

“Any illicit drugs?”

“No,” she answered, as if knowingly that I was searching for an etiologic explanation for her presentation.

She’d been placed on a form of supplemental oxygen that effectively delivers 100% oxygen through a mask. I took it off to see where her measured oxygen levels would taper off to. Almost immediately, the bedside monitor emitted its ominous alarm indicating plummeting oxygen levels. She remained calm; her husband stood by her with a persistent look of concern. I replaced the mask and waited for oxygen levels to normalize.

“You’re pretty dependent on this oxygen. For the next step, we’re going to need to take is to place you on a ventilator with a breathing tube to support you. It means you’re going to need to come to the intensive care unit (ICU),” I said.

“Are you sure I need something that’s aggressive, doctor?” she asked.

“No. I’m not sure. But I’ve never seen healthy lungs get this bad this quickly and I don’t know the direction you’re ultimately headed,” is what went through my head.

“The rate of your lung injury progression and your need for 100% oxygen suggests that you’re going to need significant ventilatory support in the pretty near future,” is what came out of my mouth instead. She ultimately agreed to endotracheal intubation and mechanical ventilatory support while receiving what we thought were the right remedies for this new and novel coronavirus.

She was one of the first of hundreds that would present to our hospital and that I would treat and of thousands that would go on to confound medical expertise and plunge the world as we knew it into unprecedented social, economic, and political turmoil.

Colleagues and I were preparing on the front lines of this pandemic as I watched the devastation wash over my old residency training stomping grounds in Elmhurst Hospital Center (a Level 1 trauma county hospital caring for the Queens, New York community of the same name) from my newest professional perch in a large hospital in Miami, Florida. We devised plans here at Baptist Hospital of Miami’s Critical Care Department for provision of personal protective equipment, enlisted the help of other physician specialties in the event that virus caseloads overwhelmed our already stretched Critical Care team and outlined schema to safely place breathing tubes into trachea expelling potentially deadly virus while ensuring our own safety.

And then we braced for impact. We would receive daily updates of case numbers and clinical tidbits outlining state-of-the-art diagnostic and therapeutic strategies. We would don and doff cumbersome protective suits to exact specifications of sealing at the neck and wrists. Physicians and nurses all emerged drenched in sweat after rendering care beneath layers of protective equipment necessitating several changes of scrubs each shift. We would read of others’ experiences and the crushing psychological and emotional toll to care for someone that you could not touch and had to veritably scream at to communicate through such enclosed protection. I had not consumed much of this content through the general news media, whom I would long ago decided was too sensationalistic to view. This was all delivered from the world’s newest medium, social media. Colleagues and friends would proclaim their own experiences and challenges and many of them rivaled my own in concern, sadness, and overwhelm.

In an effort to bolster our capacity, we enlisted more nursing staff sourced from other clinical departments (medical wards, emergency department, even pediatrics) as well as from temporary travel nursing agencies. Clinical care was rendered not only from the bedside but also from the glass-enclosed doorways of each ICU room; intravenous pumps generally placed at the immediate bedside of the patient were relegated to outside their rooms with eight-to-ten feet of extension tubing running to the patient. To the lay person observer, walking into our ICU caring for patients debilitated with COVID-19, it would appear as though our patients were ostensibly encapsulated in glass pods similar to movie scenes depicting alien life-forms being kept in secret government compounds. They were being cared for by staff in eye protection, masks and non permeable suits, dialing pump settings at each room’s doorway. Compounding this surreal scene was our need for placing patients on their stomachs (known as “prone position”) to help optimize their lungs for oxygenation and ventilation and obscuring their faces.

All of these measures were taken to care for some of the sickest patients I have ever seen, while protecting the caregivers. As a specialist in Emergency Medicine and Critical Care Medicine, one of the most frightening scenarios encountered is the lungs of a patient that cannot be oxygenated or ventilated, despite the most aggressive measures. It is a case that practitioners and educators of critical illness prepare for and are in constant fear of.

Circumstances like these have not been recounted in recent memory and for those of us subject to them, especially those accustomed to acuity of less severity, we were tested to our physical, psychological, and emotional limits. Skin breakdown was evident over areas under consecutive hours of pressure on caregivers’ faces, only to be framed with the solemn eyes of someone who has fought to maintain a person’s basic vital functions like adequate blood pressure to live or oxygen levels to survive. Some left, unable to reconcile the extent of disease, and the injury that our medical interventions caused with the seemingly unstoppable progression of multi-organ failure and eventual death.

For those of us that remained, we were lauded as heroic and brave. It did not feel that way. Despite the multitude of accolades doled out for those in medical scrubs, from evening noise by pot and pan banging in salutation, to murals on buildings, what went unnoticed was the overwhelming sense of futility and frustration at trying to understand a yet unknown disease process while watching its progression ravage human beings regardless of what we did.

Yet, in this haze, there was good. In spite of national division and derision about this viral pandemic, in our microsphere of Critical Care at Baptist Hospital of Miami, the exhausted, determined, facially scarred care providers became galvanized. Spirits came together in unity over what seemed to be an abundance of donated food (lots of pizza). With increasing familiarity of the natural history of critically afflicted patients by the novel coronavirus, we began to see outcomes in patients that we were proud of.

An initial significant test of our mettle came when several cruise ships that had been denied port at other countries were accepted to the Port of Miami. Several large hospitals in the area (including the Baptist Hospital) had agreed to take patients off of these cruise ships, some of which had been at sea for weeks. We received notice and again, braced for impact. Estimates of patient caseloads varied wildly. Patients included travelers as well as staff from these cruise ships. Their ages ranged from staff in their 1930s to travelers older than 75 years old. There was no compass with which to effectively prognosticate; we would support their cardiopulmonary systems day by day and could only see how things would go. But, day by day, those who appeared destined to not survive began to improve. Ventilatory support requirements would decrease. Blood pressure support would decrease. Their vital functions began to return. Ultimately, we repatriated many of these patients to their origin nations, including a young 40-year-old male to his family in the Philippines, a gentleman in his 1970s back to his wife in New Zealand and another to his home country of the United Kingdom. A most gratifying case was one of a 40-year-old gentleman that had recently been seen by an infectious disease colleague of mine in her outpatient clinic after getting home from hospitalization in the ICU because he had burning pain on urination; a benign complaint that I was happy to hear he had lived to complain about at all.

It was during this relatively elated time that I began to feel increasing fatigue and generalized weakness overall. I had suspected it was simply working exhausting hours with weeks that regularly exceeded 80 h. I checked my temperature at home. 103.5 F. No, it could not be. I checked again; it was real. I went to the emergency room where a rapid nasopharyngeal swab confirmed my worst fear. I had contracted the novel coronavirus. And worse, with symptoms, I was developing the COVID-19 syndrome. I knew what was coming. Visions of those I had cared for; those in medical comas on mechanical ventilators, paralyzed, sedated, and placed in prone positions to optimize their ever so frail lungs. And the resultant death. I had never had to truly face my own mortality with the fund of knowledge and understanding that I had with this disease.

The typical disease trajectory for those with competent immune systems goes like this: first, general malaise with fever, Maybe a cough, body aches, decreased appetite and loss of sense of taste and smell. Those less fortunate may develop serious conditions like stroke or heart attack from occlusion of their respective arteries, cerebral, or coronary. These are the usual signs and symptoms for the first 3–6 days.

Then, things get scary. If the lungs are going to feature prominently, they will declare at around 3–5 days in. Breathing will become more difficult. Oxygen levels will plummet. I was unable to get to the bathroom or kitchen in my condominium unit without becoming winded. Measured oxygen levels read as low as 88% (normal is around 100%). I should have presented to hospital, but like every doctor that makes for a terrible patient, I waited. Luckily for me, things began to improve beginning on the fifth day, and I was without fever or symptoms by 10 days after diagnosis.

I now live my life with a renewed sense of vulnerability and realization of my own mortality. And having cared for patients clinging to life, some who lost that battle and some who won, I also live my life with new humility. We train as medical doctors to heal and comfort. We have been hurtled into a chapter in history that tests that very resilience. To pronounce previously, vivacious people dead after attempting extreme lifesaving measures is difficult enough. To do it within the context of an unknown pathophysiologic adversary in repeated fashion will take some of us to dark places in our own psychological recesses. It was not long after I resumed caring for COVID-19 patients that I heard the name Dr. Lorna Breen. She was a fellow emergency physician who claimed her own life after describing scenes, she observed of the toll this novel coronavirus took on her patients.

This story lifted the lid on another morbidity and mortality toll in addition to the many ill patients stricken with the disease; the mental health and wellness of the people caring for them. We operate in a domain of great stress, high stakes, and easy criticism from any not immediately beside us. The intention is pure; we want to save lives and cure disease. But when that intention is tested and we are unable to carry this purpose to bear, the helplessness experienced by such empowered professional individuals can be crippling. I say this not to incite sympathy but to realize that, while some of us will deny it, we all need the unity and support of society for all of us to endure this. To divide this pandemic on the basis of misinformation, lack of government leadership or guidance will only serve to fracture the institution of the sick from the nonbelievers further. Please believe me, I have seen it. We just want the critically ill to get better and to return them to the loved ones that weren’t allowed to visit them and, failing that, we need to be able to cope with our own perceived failures when we cannot do so. And we cannot do that without your support and understanding.

This novel coronavirus has killed individuals of all ages, socioeconomic status, gender, and has similarly brought the world’s civilizations to our collective knees. We no longer travel by plane in the same fashion that we did, we are wary of anyone with a slight cough, innumerable households worry where they will find money to eat. But in this time that will be marked as one of the darkest in modern history, we have a chance now to reunite and join as global citizens to protect each other, and most importantly, respect each other. If it’s possible for the provider teams of nurse, physicians, and all other staff to galvanize in a surreal war zone of human suffering and death while still saving lives in the face of a ghost adversary at Baptist Hospital Critical Care, then surely it can be extrapolated to unity of citizens of a society facing one of the largest pandemics in recent history.