CHESTThought Leader Blog"It’s OK. I’m ready doc.”

"It’s OK. I’m ready doc.”

By: Fiore Mastroianni, MD

His demeanor is calmer than most. His family on FaceTime is understanding of our urgency and equally poised. I direct another high-risk intubation for a patient with COVID-19—a success. But in another way, it is a failure, since he died, just like more than half of my ICU patients did.

I am sure that the previously calm room I saw through an iPad is now full of crying and grief. A wife without a husband, young children now without a father. Guilt over who infected whom at home. I am a supporting character in so many of these stories. After the crying and the death certificate, I sign out and go home to cartoons and books with my toddler, and I cook dinner with my wife. The next day I return to work, where my masked face will be the last thing someone sees before they die.

Seeing more than half of my patients die month after month was traumatizing. That first wave of COVID-19 took me by surprise. I felt bolstered by the adrenaline of living through a pandemic. A once-in-a-lifetime event unlike anything anyone had known: The “Heroes Work Here” signs, the nightly 7 pm clapping throughout New York to honor our work, the lack of traffic, and the eerie calm as I went to my essential job. It was surreal. It was like a high—life or death stakes all day, every day. When my wife was sick and quarantined, and our son was far away with my in-laws, I worked even more. There was nothing else to do. Every day was frantic and wild.

And tragic. So infinitely tragic. All I could think about were the patients who died. I thought about them before I went to bed. They were all I could think about at work. Every day in the ICU became a reminder of the terror that used to be there. Until I just stopped thinking about it. A new summer came, cases went away, and I tucked away the spring like a fever dream to forget.

Fall began with a trickle, and then another tidal wave, of cases. It was a matter of when, not if, we would reopen our 50-bed surge ICU. And that is what broke me. Not the months of fear and uncertainty. It was the sudden thought of doing it all over again that made me panic. Physically unable to continue driving home, I pulled over. This would never end.

It took that panic, that physical and visceral loss of control, to make me seek out help. And wow, was it easy to get help. All it took was a brief conversation with an inpatient psychiatrist I saw on a medical floor to get myself an appointment. Months of trying to make myself forget did not help. Months of telling myself that I was “being resilient,” a “health care hero,” and a “COVID Warrior!” were lies that everything would be fine. But really, I was dying inside.

Any death can be traumatic for trainees. I have seen more patients die in the last year than in the previous 5 years of training combined. That degree of daily trauma, the broken families, and the crying children on iPads will absolutely produce anxiety and PTSD. How could it not? Finding a resource to talk about those feelings is important. The wellness rooms with candy, sparkling water, and lavender candles can be a brief respite during the day, but they are not nearly enough to deal with the year of trauma we all experienced. After getting help, I have been so much more present at home and a more effective fellow. Acknowledging how bad I had been feeling was the first step to getting better. I wish I had done it earlier.

Mastroianni, Fiore 
Fiore completed medical school and a PCCM fellowship at Hofstra/Northwell. He is thankful for his internal medicine residency at Montefiore Medical Center in the Bronx. He thinks there is always time for one more ultrasound, another patient question, and a check-in with the nurse. You can reach him on Twitter at @FioreSono.