The Hopeful Future and the Patients Who Won’t See It

It takes nearly an hour to clean an intensive care unit room between Covid-19 patients.

The curtains come down first. Next the custodial staff removes the trash, disposable gowns and gloves, biohazard bins, leftover belongings. They wipe the room down with bleach. New sheets on the bed, hospital corners. Mop the floor until the splatters of bodily fluids are gone, until it shines.

I stopped to watch this process on one recent overnight shift as we prepared for a new patient. She was in her mid-60s, intubated with severe respiratory failure from Covid-19. In some states she might been vaccinated weeks ago, but not yet in Massachusetts, where 7.2 percent of the population has been vaccinated, a rate lower than in three-quarters of the rest of the country. And now she would enter the same freshly cleaned room where countless Covid-19 patients lived and died before her.

This is a time of hope. We have a new administration and safe and remarkably effective vaccines developed in record speed. But in the hospital, the excitement of the initial rollout is fading, replaced with an uncomfortable new reality. Though my colleagues and I are privileged to be vaccinated, many of our high-risk patients do not even know when they will receive their first dose. More than 3,000 Americans are still dying because of this virus each day. Even as new cases decline throughout the country, including in my state, we are now tracking highly infectious variants. It is a race. And in this strange moment, even as we allow ourselves to imagine a return to normality, all we can do is wait, and make sure there are empty beds to care for the patients who will fill them.

As I walked through the unit that night, a resident consulted me about a patient admitted a few days before, an older woman with Covid-19. Her lungs had grown so sick that one of them had collapsed, and air was filling the space under her skin, which was crackling to the touch, expanding like a balloon with each breath the ventilator delivered. The surgeons were about to put in a chest tube so that the air could escape — a move that might help her survive the night, until her family could see her.

The last Covid-19 patient I had cared for in that room was a father in his 60s who spent his final week of life with us. As we cared for him, he told us he wished he could dip fries in his hospital protein drink, as though it were some kind of delicious milkshake. At the time, we did not want him to eat, in case he needed to be intubated. Days later, when it became clear that his lungs would not recover, despite all the antibiotics and steroids we could give him, I was desperate to do something. I pulled on my protective gear and entered his room to announce my plan: I would get him that milkshake and fries. What flavor did he want? At least I could do this. He smiled at me, then slowly shook his head. No. He could barely breathe; of course he could not eat. My offer had come too late.

I received my first vaccine shot a few days after he died. At the time, I thought the vaccine would come quickly for our most vulnerable patients, that there would be something more that I could offer them, but that has not been the case.

At each juncture, this virus has shown us a new permutation of suffering. At first it was the essential workers who could not afford to isolate. As fall turned to winter, we witnessed the deeply human tragedy of patients who were infected at holiday gatherings by those who loved them. And now, even as we celebrate the arrival of the vaccines and look forward to life after this virus, we care for people who will never see that future. They were so close.

It was nearly midnight by the time I examined our new patient. Her lungs were stiff and sick. I do not know when or even if she will improve. But I do know that when she leaves this room, as she inevitably will, the custodial staff will come. The process is always the same, for a death or a discharge. They will take down the curtains, empty the trash. And they will clean the room until the floor sparkles, like new.

Daniela Lamas (@danielalamasmd) is a critical-care doctor at Brigham and Women’s Hospital in Boston, where she treats patients with Covid-19.

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