Covid at 40
The eyes stay with you
Written by New York City Nurse
Published April 22, 2020, 11:15 p.m.
The eyes stay with you. In peace time most of those we intubate are chronically ill, or profoundly confused, or unconscious and unaware of the world around them. Covid has changed the equation. Most of my patients now remain awake and alert until the end. These days the ER is permeated with frank conversations about death and dying and what a chance to live entails. It is a hard thing to tell a healthy and functional person who felt fine and well six days ago they may be dead in a day or two and humbly ask how aggressive they want us to be. A chance to live comes with the risk of dependence on life support and pain. The alternative is the guarantee of an imminent but peaceful death. I have never had more harrowing, more frequent, more brutally honest, more meaningful, more exhausting conversations in my life. Complete strangers open up to you in profound ways during such times and you can only hope both your expertise and your humanity serve them well. And the eyes stay with you.
For those I intubate, those who choose intubation, I often find myself having a final stare. After all the words are spoken, the decisions made, the medications drawn, the bed positioned, the tubes and drips and ventilators readied, there is a final stare. It is a stare of intention. It is a moment of humanity. It is a shared space, a hallowed space, the final moment of someone’s awareness, possibly forever. It is a space where fear and hope mingle, where autonomy fades into trust, uncertainly into acceptance, and all they have left is placed firmly in your gloved hands. It’s brief, and you’re busy, and time is essential, but you find a few seconds to share this final breath. That stare lasts a moment. That stare lasts a lifetime. And the eyes stay with you.
I see them often in my mind, and although haunting I am glad to keep them with me. I warm my hands on the raw humanity inherent in such moments and they empower me to carry on. For carry on we must because the room is full of agony and sickness and fear that must be attended to quickly and humanely.