Monday, January 18, 2021

'I needed something good to happen'

Dec 20. 2020
Dr. Val Briones-Pryor, an internal medicine specialist, is pictured outside of the University of Louisville hospital in Louisville, Ky., on Dec. 17, 2020. MUST CREDIT: Photo by Luke Sharrett for The Washington Post
Dr. Val Briones-Pryor, an internal medicine specialist, is pictured outside of the University of Louisville hospital in Louisville, Ky., on Dec. 17, 2020. MUST CREDIT: Photo by Luke Sharrett for The Washington Post
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By The Washington Post · As told to Eli Saslow · NATIONAL, HEALTH, SCIENCE-ENVIRONMENT, HEALTH-FEATURES 

I was one of the first people to get vaccinated in Kentucky. The whole thing was surreal. It happened in a small auditorium, and the governor gave a speech. I walked onstage and pulled up my sleeve with the cameras rolling. A few people clapped when the needle went in. Some of us were crying. It felt like this amazing victory celebration, and then I went back to check on my patients.

One coded on me that morning. Oxygen deprivation. He was my 27th covid death. Then I had another guy who's been with me 14 days, and I thought he was finally getting better, but covid schools me all the time. Suddenly, he couldn't breathe while he was doing physical therapy, and we had to rush him onto 100 percent oxygen to get him stabilized. Then I checked on a patient who can't keep anything down. She's young, and her breathing is fine, and she should have gone home by now, but that's not how this virus works. Lately, it feels like my batting average isn't very good. I sent one patient home, but I had four more going in the other direction and getting worse, so I transferred them to the ICU.

So, yeah. That's how it's gone lately. I guess the best part of my day was a little arm soreness.

I'm desperate for this to be over. That's why I'm so thankful for this vaccine. It's safe. It's effective. It's incredible. I wish I could sit here and say: "OK! That's it! We're done!" But even with the vaccine, the reality in our hospital hasn't changed, and we've got months more to go. I've been in charge of our covid unit since we opened March 17th. It's wave after wave. Treat covid. Study covid. Worry about covid. That's all I do. I shower at work, change clothes, and wrap my son in a blanket before I give him a hug so I don't bring covid home.

We started our covid unit with 15 beds, and that was enough for a while. Then we moved to another unit that had 22 beds, and now we need both. I usually get patients in that eight-to-14-day window after they've contracted the virus, when they could go either way. They come through the emergency room and get admitted to me. Most of them are here for a while - could be a week or 10 days. We use steroids and sometimes an anti-viral, but a lot of hospital medicine comes down to observation. You're examining a patient and looking for clues. What are their breathing patterns? How do they look when they're eating? Has their color started to change? Our nurses are so dedicated, and they monitor these patients 24 hours a day. They're not allowed to have any visitors, so I try to sit in their rooms when I can. I get to know them. I do a lot of watchful waiting.

I started thinking back over some of my patients while I was getting the vaccine - my list of 27. In a normal year, I might lose a total of four or five. It's been a lot to handle. A few weeks ago, I had nine deaths in nine days. It's been a lot of older people, and some had made the decision that they didn't want to be on a ventilator. We had an older Hispanic gentleman, and he didn't speak English, so I had to communicate to him using an iPad as our interpreter. He got so scared at the end that he couldn't be alone. He didn't want the nurses to leave his room. I had a 33-year-old who kept getting worse for a while, and then I had to tell him he was going to the ICU. He tried to negotiate with me. He was wearing this high-flow oxygen mask, and he was crying all over it. He said: "Please, give me one more day. I know I can get better."

One of my first deaths was a Catholic priest. He'd come from a nursing home that had an outbreak, and four of those patients died. It was my mission to make sure he got anointed before he passed. I called up my supervisor and said, "I know we're not allowing visitors, but I really need this favor." Luckily, we were able to get a priest who volunteered to come, and we got him all dressed up in PPE, and he gave last rites. It was beautiful. I'm Catholic, and after everybody left, I sat there and held his hand. I'm a cantor at my church. I sang to him and told him it was okay to go.

I try my best to be connected. It's an honor to be with someone in those last moments, but it should be a loved one. It shouldn't be me.

This pandemic has taken me through the stages of grief. There was that initial denial, and some people got stuck there. Then it was anger, and I definitely had that. I was mad at my neighbors because they were having people over. Then I was bargaining - maybe if we lock down or do this or that, it won't be so bad. Then depression. Then acceptance.

But the problem with acceptance when you're in the middle of a pandemic is you start to get numb. I've gotten numb to where I almost couldn't feel anything. For a while, I could just come in to work and do my job and put that smile on my face and deal with it, but eventually it gets to you. I worked 21 days in a row at one point. You get beaten down. It's never-ending. You discharge four people and then five more cases come in. At some point, you almost have to depersonalize it, and that doesn't feel right, either. You start thinking: "I'm done. I'm on empty. I don't know how much longer I can do this."

A few weeks ago, I started having heart palpitations. It's something I see in my patients, because covid can impact your heart, so the first thing I thought was: "Oh no. What if I finally got it?" My son overheard me talking to my husband, and he started to cry. He said, "I don't want you to die." He's 7, but he's smart, and he pays attention to everything. He sees how we've changed everything to avoid this virus, so now he thinks that way.

I got tested and it was negative. I went to see my cardiologist. My blood pressure was up. My doctor said it was probably stress built up over all these months. We were up to having, like, 35 covid patients between the two units at that point. My husband was getting worried about me. One of my partners said: "You can't keep going like this. It's too much." We decided I'd hand over the second covid unit, so now I'm just in charge of one, and that's enough. I'm exhausted.

I needed something good to happen - something to pull me out. As soon as I heard we were getting a shipment of the vaccine, I put my whole heart into that. I've been waiting for this a long time. I mean - I'm tearing up now just thinking about it. It's great to know I'll have protection against this virus, but it's more than that. It's a profound relief. I can finally see a way out of this, even if we aren't there yet. It's a reason to hope.

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