'This Is Very Real' -- A COVID-19 Day in the ICU

John Whyte, MD, MPH; Megan L. Panico, MD


February 09, 2021

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • COVIDLAND is a short documentary, posted on Medscape, that chronicles a day in the life of critical care physician Megan L. Panico, MD, as she treats COVID-19 patients during the second wave of the pandemic.

  • The sheer volume of patients with COVID-19 can be overwhelming. At times, every patient in all of the hospital system's ICUs has been COVID-19-positive.

  • Many of the patients who had COVID-19 in the spring of 2020 are still struggling with long-term effects.

  • Fewer people are being intubated and more people are living longer on high-flow oxygen, but what does that mean for their quality of life?

  • A newfound sense of teamwork and camaraderie throughout the hospital has helped the ICU team manage, but everyone is exhausted after almost a year of the pandemic.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Hi, everyone. I'm Dr John Whyte, chief medical officer at WebMD, and you're watching Coronavirus in Context.

Have you checked out the short film called COVIDLAND? It chronicles a day in the life of Dr Megan Panico, a critical care physician at Hartford Hospital in Connecticut. You're definitely going to want to check it out.

I'm delighted to be joined by its star, Dr Panico. Thanks for joining me.

Megan L. Panico, MD: Thank you for having me.

Whyte: Why did you decide to be part of this short film?

Panico: That's a really good question because I don't think most critical care docs are comfortable in front of the camera. Before 10 months ago, we worked behind the scenes, and that worked really well for me. But I realized that it was important for us to be able to tell the story of what is happening in the ICU. We don't know what's going to happen day to day in the ICU; it's very unpredictable. In the film, we were able to capture and tell the essence of what's been happening for the past 10 months in most ICUs around the United States.

Whyte: You show the conversations with patients, even when you have to have those difficult conversations about whether or not you need to put in a breathing tube, and it may not impact how long they live. What do you say to folks who will argue, "This is all fake, it's not real"? How does that make you feel when you're talking to people every day about life and death?

Panico: It's really tough to hear that. Unfortunately, this is more real than any of us would wish, ever. It's sad. Every day we're having conversations with people about life and death, over and over again. We went into critical care and this is part of the job, but it is nothing like what any of my colleagues and I have ever experienced before this past year. And so it's really hard to hear that.

I worry for many people who aren't taking it seriously that they could lose their own life or someone that they love. Unfortunately, this isn't going away, and we need to take it seriously. Hopefully, the vaccine will change that, but we have a long way to go until we get there.

Whyte: Is it the sheer volume of patients? Is it the issue that patients can be okay one minute and then quickly desaturate and their oxygenation goes down very low? What's different about COVID-19 than other conditions you've dealt with? As you've talked about, you deal with life-and-death issues every day.

Panico: I think it's both of those things and more. I mean, it's the volume. At times, every patient in our ICU (and in every other ICU in our hospital system) has been COVID-positive. And that's unheard of. You usually have multiple, different diagnoses that you're dealing with, but over and over again, everyone that comes in has COVID or has complications from COVID. The volume is great. And there's the frustration with losing so many people that shouldn't lose their lives right now.

Many of these people had comorbid conditions, but they were living wonderful lives (functionally in the community, as members of society) and shouldn't be dying right now or have lifelong problems. Many of them that survived COVID in the spring are still dealing with struggles from it, and they didn't have those struggles before. That's the most frustrating thing to see.

The other really tough part is that we still don't have great treatments. We have more options than we had in the spring, and we've learned. We don't intubate as many people and many are able to survive longer on high-flow oxygen. That's opening up a whole other can of worms: We can keep you alive on high-flow oxygen, but can we give you your quality of life back? I'm getting very worried about that. We have a whole population of people now that are stuck on 40%, 50%, 60% oxygen, who, if they move just in the bed, desaturate and require 100% oxygen. How are we going to give them their quality of life? That's a huge struggle that we're currently facing.

Whyte: How has it changed the work environment? You talk about there now being an attitude of, let's just get it done, that nurses are sitting with patients 12 hours a day.

Panico: It's very different. There's good and bad to it. I have learned so many amazing things about my colleagues. The teamwork that has come out of this, between nursing and respiratory therapy, the people cleaning the rooms, and everyone in the hospital, is something I didn't realize was there before. We always work together, but this forced us to just step back and say, "How can we get the job done?" What everyone has done has just been amazing.

At the same time, we're 10 months into this and everyone is tired. It's hard, day after day, to keep losing people, to do everything that you can for them, to be their family at their bedside because their families can't be with them. It is very draining on all of us. We lean on each other a lot, and thank God we have each other because I don't think we could get through this otherwise. It really has taken a toll on everyone who has been doing this for the past 10 months.

Whyte: There's a very personal piece in the documentary where you're talking about your 9-year-old daughter, and she says, "Mommy, you've abandoned me." And you say, "That's not okay."

Panico: It's definitely not okay. A tough piece for all of us to deal with is the connection with our families throughout this whole thing. They've sacrificed a lot. We've all been in the hospital much more than before. We don't know when we're going home each day. That's hard for them, and the kids don't understand. They've had so much taken away from them — their normal lives — and then to have parents that are nurses, respiratory therapists, or doctors that are living this every day, who come home and can't step away from it... I still worry about these patients when I get home, and I can't step away from it. I need to know what's going on. I need to be available. Our children see it and are absolutely suffering from it. I hope in the end that they'll be able to look back and be stronger for it, but I don't know, and I do worry about the lifelong impact that they are going to have from this.

Whyte: You've talked about how it may have an impact on how children view the world as well. We've talked about burnout a lot on the show and how it's impacting clinicians. It was a problem pre-COVID and now it's even worse. How are you and your colleagues dealing with burnout?

Panico: Well, we're trying, and I don't know how well we're doing. We're all still here, so I think that's a good sign. We are an extremely supportive group. Being there for each other and checking in on each other is an important part of all of our days. I get calls from my colleagues just saying, "Are you okay today?" We've all cried together; we are very open about that. Sitting down with each other and just checking in is the biggest thing. When someone needs space and time, we've given that to people. Personally, I appreciate it and I think my colleagues appreciate it also.

The psychology service and psychiatric service at Hartford Hospital has done check-ins with our ICUs, which has been beneficial for people. It allowed people to voice concerns and for everyone to realize that they're not alone in this, what they're feeling. That's probably been the biggest feedback that I've gotten from this film: "Thank you for telling the story of what's really going on; people really understand what I'm going through now on a day-to-day basis." I'm happy about that.

As tough as this story was (and losing our patient Brian was horrible), and as tough as it is to tell the story of what is really happening with our families, I think everyone is experiencing that. And so I hope that this gave a voice to that.

Whyte: What do you say to those viewers who believe that it's not that big a deal, it's not much worse than the flu, and the media is making this all up? What's your message to those viewers?

Panico: My message would be that this is very real. It's very different from the flu. I hope that we have a cure for this soon. In the meantime, I hope to save lives, to save your loved ones' lives, and to be able to let our families and our loved ones get back to their lives. We all have to do anything we can. If that saves one life right now, that one life may be your loved one, and that's important.

I would beg everyone to get the vaccine and to wear masks. In the future, we will all grow from this and be better people, but we have to be here to be better people.

Whyte: Dr Panico, I want to thank you for letting us have a look into your daily work as well as how COVID-19 is impacting you and your family. Thanks for taking the time to do this.

Panico: Thank you for having me and thank you for sharing the story. It's important that people are able to see what's actually happening in the ICU. Hopefully, this will make a difference and will help other people save their own families' lives.

Whyte: Check out COVIDLAND on Medscape, and if you have any questions about COVID, email them to me, drjohn@webmd.net. Thanks for watching.

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