'Heartbreaking ... exhausting ... frustrating': ICU doctor describes nearly 2 years of fighting COVID in Peoria
Both OSF Healthcare and UnityPoint Health Central Illinois are experiencing staff shortages as employees become sick with the virus, retire early, leave for travel gigs ... or quit the healthcare profession altogether.
In part 5 of WCBU's series on this current COVID surge, UnityPoint ICU physician and pulmonologist Dr. Ravi Kashyap sits down with Hannah Alani and describes the burnout his coworkers are battling.
The following is a transcript of an interview that aired Friday, Jan. 21, on All Things Peoria. It has been edited for length and clarity.
Dr. Ravi Kashyap: I oversee patients in the ICU of all varieties. I'm also a pulmonologist. So the weeks I'm not working in ICU, I work in the office seeing the pulmonary patients, like COPD, asthma, lung cancer, you name it. And we also see the patient, the non-ICU patients in the hospital, with the lung problems. Pneumonia, COPD, asthma, lung cancer, or anything related to the lungs.
Hannah Alani: I imagine as a lung expert, you were probably very, very involved with treating these [COVID] patients, right?
Dr. Ravi Kashyap: Yeah, we were the frontline workers with this right from the beginning. When it started, it was so new, and neither myself, my partners, or anyone in the country knew what to do with these people. It was very anxiety-provoking at that time. We didn't know how to protect ourselves, we didn't have vaccine. And so, it was a learning process for us. Despite the fact we have been in practice for such a long time. That got over within a month or two, at least we learned some, anxiety was less. We knew at least what we are trying to do.
Practice-wise at the beginning, we had to kind of stop seeing the patients … And we do a lot of virtual care, which we almost never did prior to the whole situation. And then came the “long hauler” syndrome. So as a part of the pulmonary practice, people will call, “Hey, you know, the patient got better, the people who were fortunate to get better, but they are needing so much of oxygen, what can we do?” And so that they've become “long haulers,” so we needed to help them with that.
The ICU has become very, very busy, very exhausting. Not the physicians only … also the nurses and the other providers, have been emotionally and physically, I would say, exhausted. Because it takes a toll on you. Especially in the ICU setting. The people who are getting better, are fewer than the people who are not doing so well. So that becomes a challenging emotional issue.
… When we look into the fact that this is a preventable disease, and people are either not doing well or even dying from a preventable disease, that becomes very hard, heartbreaking. At the same time, sometimes also frustrating, like … “Why could you not have done that?” Though we don’t say that, but in our heart, “You could have saved yourself, most likely, by taking a vaccine.” So, it’s sometimes frustrating. But most of the time, most of the time, it's heartbreaking … Talking to the children or the spouses or the significant others, to talk about this their loved one dying. Or in many cases, talking to the parents when their kids are dying – their children are dying, not kids, I shouldn't say that. Their children are dying. … Talking to the parents about the children dying is being a lot more common now than it had been in my entire life.
Hannah Alani: Wow. Before COVID, the typical ICU stay was between three to four days. Now the typical ICU stay for a COVID patient can be eight to 12 days. Is that lining up with what you see in the ICU? People are just in there for so much longer?
Dr. Ravi Kashyap: I agree. In fact, it could be – it's longer than that. In the past people, you know, let's say have congestive heart failure, or somebody has sepsis, or somebody has heart attack or pneumonia, and they are sick enough to be in the hospital … On average, they will be three to five days. Doesn't mean that some people may not be there for 10 or 15 days, and some people may be going out in two days. So I totally agree with the average length of stay.
… But we have had patients … once the patients are off of the ventilator, just because of COVID only, I'm talking about at least two weeks, 10 to 14 days, is a minimum. And we have had patients in the hospital for 5, 6, 7 weeks, in ICU.
Hannah Alani: Can you talk a little bit about what it's like to, just, still be in this place where you're coming to work every day and having to have those conversations with families – and even the patients themselves, if they're not intubated – to be having those conversations, and then to either see them die, or see them have long COVID, or the symptoms that are just, you know, their lungs are just in a state of disrepair? Can you talk a little bit more about that? Because I really, I want to impress upon our listeners that, you know, this pandemic isn't over, especially for our health care workers.
Dr. Ravi Kashyap: No, it's not over for healthcare workers. It’s over for the general population. Sometimes people who don’t have loved ones been affected or not in a healthcare field, it may just be the statistics for them. But the truth is, it’s there. It is there for general population. It is there for health care workers. … When we talk with a family, that's not the time to talk about why it happened. At that time we’ll be talking about what’s happening now, on a day to day basis. Are we making progress? … Talking about if they're not going to do well, and they are at a point where we know that there's nothing much that can be done, having that difficult conversation about either, “Do Not Resuscitate,” or even comfort care, to let the loved one go. So it's very hard.
The family is very emotional. Of course, with the situation. Especially, if you can imagine, if we started talking to a parent about the child who is not doing. This is very emotional. So it does take a toll. The nurses are emotionally challenged many times because they spend a lot of time with the patients, I think the nurses are more attached with the patient, because they are spending 12 hours a day, at one time, and on a day by day basis. So they get very emotionally involved with the family, with the patient. So yes, I mean, it’s taking a physical toll on us because a number of patients, and equity of patients … a lot more than when we started 20 years ago, on a regular basis. And it’s taking an emotional toll, you know, talking with the family, knowing that the patient's not going to do well.
And then it does affect the family life as well, for with family members. Because you want to, to kind of avoid taking your emotions, and the home, to home. But it's hard. It's hard to totally separate that.
Hannah Alani: We're hearing about a lot of health care workers who are so burnt out and so demoralized at the end of this that they're leaving. Have you had any coworkers who have done that? Kind of give us a temperature check of what things are like right now among staff in the ICU.
Dr. Ravi Kashyap: So national data shows about 13-15% of healthcare workers have completely left the healthcare. ICU nursing is a very special branch of the nursing. They know a lot, they have a lot of skills to acquire. So they're – with due respect to all the nurses – this is a very special skillset required. So when we go into the phase in spring, pretty busy last year, and then, some nurses said, “I’m gonna be here til this is over. I’m going to leave after that.” So you can see the dedication they have. “I'm here. But once this is done, I'm leaving, I can't do it anymore.”
I know personally about five nurses the left because they just say, “I cannot do that.” Some of them left for a different nursing job. Like I know a nurse, a very, very good nurse I’ve know for many years, when she left, she said, “Dr. Kashyap, I cannot do it. So I’m going to go to … plastic surgery. Botox injections.” I laughed at her, because I said, “You know what? Are you kidding me? That’s a very noble profession as well … But you will be bored. I don’t see you not running around 24/7.” But that’s what they did.
[Another] person I can speak for, this was a mid-level provider, who, as you just mentioned, who as of this month, early this month, left the profession all together for a year to go to bakery school.
Hannah Alani: Bakery school?
Dr. Ravi Kashyap: Yes. Bakery school. She said, “I might come back in one year.” … And many of these senior nurses, and I'm sure, senior physicians as well … they just retired. I know a lot of physicians, they wanted to work because they want to work, and then it’s a health issue for themselves, and an emotional issues for themselves. They might have just left, said, you know, “I just cannot do this anymore.” So yeah, it is taking a physical, emotional toll. And people are reassessing that, you know, “How long we can do this?”
What I admire about our team, our ICU nurses, they know they're burnt out. They know they are, day in and day out. They're working very hard, and it's taking a toll on the family, but they say, “This is what I signed up for. That’s our job. How can we leave?”
Hannah Alani: As a community member this, you know, hurts my heart to hear. And I'm wondering, is there anything … beyond getting vaccinated, which I did … What can the greater Peoria, Tri-County community do to support you all, at this time?
Dr. Ravi Kashyap: You know, we feel supported. I think that we have a great community. I think the most important thing we need help is, to get vaccinated, as you did, but also try to convince your loved ones, or the people who are reluctant, in a very loving way that, you know … It will, number one, save save their lives, which is the most important part. But also, this is the biggest support we can give to the communities, to spread the right knowledge, the correct information to the rest of the community. So you know, [saying,] “This is what the truth is, and you should take the vaccine because it is going to help you.” I think, I cannot ask for any better support than that.
Hannah Alani: You mentioned that never before in your career, you've had to comfort so many parents whose children are dying. You're talking like, 60-year-old parents, 30-year-old kids?
Dr. Ravi Kashyap: Correct.
Hannah Alani: Wow. And that's because their children are dying from COVID?
Dr. Ravi Kashyap: To the COVID. There are some younger patients dying, the children are only 18, 19, 20. Or … We’ve have had situations where we're talking to a 21-year-old child about a mom who's dying, because he's a decision maker, or she's the only one who can make a decision. They’re adults, they're very mature, but at the same time, when it comes to the, you know, making a decision about life and death … I don't think any age can prepare you, but at that young age, is too young.
Hannah Alani: Is there one kind of main message or takeaway, you kind of just want to blast out to the community right now?
Dr. Ravi Kashyap: I would say that people need to know the vaccines are safe and very effective. They should take it. And also the fact that the people who are dying in intensive care unit are overwhelmingly non-vaccinated. So if, if the patients are vaccinated, they may become positive, no questions about it. But the chance of having a severe infection, severe enough to go to hospital ICU is extremely, extremely low. So I can speak with confidence that the vaccines are working and saving lives. So please take the vaccines. And ask your loved one and the family members and friends, in a very loving way, for them to take the vaccine.