I was only back for a few days. Then flew out to SoCal. I'm starting another contract although I'm already pretty sure this job could be quite different than it was presented to me. We'll see. It wouldn't be the first time. This one is only three weeks. For now I'm going to try to stick to jobs with a short duration, high pay, and facilities with enough integrity and resources to protect their staff.
The last job went reasonably well. How much I dealt with COVID had everything to do with which ICU I was assigned to. I spent a few shifts in one of the medical ICUs that was basically all COVID all the time. And on the opposite end end of the spectrum I sometimes worked in the Neuro-Surgical ICU with only the occasional rule-out COVID pt. You could almost forget about COVID working there. And some others were in between. I moved around a bit too much to really closely observe the progress of specific COVID pts. But I was able to see that the first COVID pt I had there was able to improve over the course of weeks despite a couple of setbacks. That pt had a number of comorbidities and advanced age working against them but was eventually well enough to get off the vent and out of the ICU.
I saw the first visitor in the ICU in weeks. She just started wailing as soon as she saw her husband. I wasn't very familiar with the pt except to know that he there a long time and was unlikely to make it another 24 hours. So they must have called the wife in, who probably hadn't seen him in weeks. The crying was extremely loud. A lot of grown people make weird noises when they cry, different than kids. I just grabbed a chair and a box of tissues for her while that pt's nurse tried to console her. Eventually she collected herself enough to get in a PAPR and gear so she could go in the room with the nurse. She was in there a while and then was silent when she came back out.
I wish I could say we were getting a lot better at treating critically ill COVID pts. There seems to be a concerted effort by the docs to avoid intubation and ventilation for as long as possible. And I think there might be something to it. Proning strategies seem to be of some help when it comes to avoiding intubation. The early evidence on remdesivir is mixed, but not very promising overall. My guess is that if it is to show any significant benefit, it will only be in the cases where it is used very early, like other anti-virals.
