After finding that traditional medicine was oftentimes no match against the most severe cases of COVID-19, Dr. Evan Shaw explored a new strategy to help the battle against the raging pandemic.
He decided to share stories.
The stories of patients whose conditions spiral so fast they can’t be treated.
The stories of doctors and nurses who become impromptu family members as patients struggle in a hospital bed all alone.
And the stories of how medical professionals, who generally have an array of options at their disposal, find themselves with an empty toolkit.
“There’s usually something else we can do, someone else we can call,” Shaw told The Kansas City Star. “Another test, another procedure.”
But since the coronavirus made its way to this area, he has too often concluded there are no more options for the most severely ill patients he treats at Research Medical Center in Kansas City. An internal medicine doctor, Shaw wrote down some of his observations on a public Facebook post that has been shared hundreds of times.
He said he didn’t want to get preachy or political about the pandemic. He didn’t want to debate the economic repercussions. Rather, he just wanted to share the real-world experience of healthcare providers fighting the disease inside his hospital so those outside of it could make their own decisions about how to carry on in these uncertain times.
“It’s just showing you what they are dealing with on a daily basis, what they have to see, what the outcomes are and how hard it is,” he told The Star. “That’s maybe the most important thing I can do. That’s within my power.”
In the trenches of fighting the disease, Shaw said he often feels powerless.
He began a run of six shifts last week with eight COVID-19 patients. By the end of that span, six had died. One patient had been discharged and another remains critically ill.
Many coronavirus patients will only suffer mild, cold-like symptoms. Researchers say many patients will spread the virus before exhibiting symptoms, and some may never even know they were infected.
But for patients in Shaw’s care, things are often much more serious. So far, he hasn’t seen one person relying on a ventilator recover.
As the disease takes its hold, organ systems fail one by one. Patients burn up with fevers that can top 105 degrees. And they can decline quickly.
Shaw said one patient remained stable on a ventilator for days, with her blood pressure and oxygen levels holding steady. But when her blood pressure began sinking, her condition exponentially declined. As soon as he would order a drug for one problem, another would arise.
“She went from stable to dead in a matter of four hours,” he said. “It accelerates so quickly, it’s impossible to stay ahead of it…It is the most frustrating and terrifying time to practice medicine right now.”
Shaw, 43, said he became a doctor because he loves science and people. He prides himself on his ability to comfort the dying and their loved ones.
“And now I feel emasculated because our science doesn’t work and because I can’t comfort anyone,” he wrote on Facebook. “Not the patient, not the family. Not even my own wife, or least of all myself, as I know I have to try to sleep, to keep my system strong, but can’t help to wonder how I might feel, stuck behind glass, tended by people whose faces and smiles are hidden, knowing what may be coming, knowing we have no answer, no power to stop it.”
The presence of death is not new for him. But these deaths are different.
He believes the end of life is just as important as the beginning. Handled in an honest and compassionate way, families in ordinary times can find solace sitting by their loved one’s beds, holding on as they draw their last breath.
As Shaw puts it: death can be a wound that heals, rather than a scar.
“This is…so horribly different,” he wrote of the coronavirus.
Because of the isolation mandated to help the virus from spreading further, patients suffer — and die — without their families. Healthcare workers must limit their physical contact. When he does visit patient rooms, Shaw said he’s so covered in personal protective gear that he looks like an alien.
Doctors and nurses communicate with family members over the phone, an impersonal workaround when a patient is slipping away.
“They die completely alone in the most inhumane ways,” Shaw wrote online.
Like firefighters and police officers familiar with tragedy and mayhem, healthcare workers can learn to compartmentalize their work. Shaw said he normally tries to set aside whatever sadness he sees at the hospital when he returns home to his wife and kids in Lawrence.
“And with COVID you can’t,” he said. “In a lot of ways, my stress level gets higher when I get home.”
Early on, he was exposed in the hospital. As he awaited a coronavirus test result, he quarantined in the basement of his home. He’d come home and hear his 2-year-old son get excited that daddy was home. But he couldn’t see him.
“It was killing me,” Shaw said.
His 2-year old has asthma and he said the idea that he might put his family at risk is a new feeling, one he never wants to experience again. He eventually tested negative.
Shaw’s Facebook post was shared wide enough that a relative of one of his patients read it on her own feed. She told him that it scared her to think her mother, whose condition was declining, would die alone.
So the doctor got an iPad from the hospital. With a nurse, he went into the patient’s room and made a video call to the daughter.
They paused the video as they removed the ventilator tube and made sure she had enough medicine to stay comfortable.
With the video streaming again, the daughter said some prayers and sang to her mother on the iPad.
The doctor and nurse held the patient’s hand at the end.