Op-ed: Reflections on our struggles inside a COVID-19 ICU

The following op-ed was written by Eduardo Oliveira, MD, executive medical director of critical care services for AdventHealth Central Florida, and has published in the Orlando Sentinel.

The first time that now-familiar look of fear in a patient’s eyes pierced deep into my soul, I was a medical resident in Rio de Janeiro, Brazil in the early 1990s at the height of the AIDS pandemic.

Pain, sorrow and death were all around as I cared for dozens of critically ill patients in under-resourced AIDS isolation wards.

More than 30 years later, those memories came flooding back as I helped lead our critical care units at AdventHealth Central Florida through multiple surges of COVID-19, a disease that while vastly different from HIV and AIDS also brought more questions than answers at first along with a heavy dose of misinformation out in the community.

As we enter the third year of the pandemic with the latest surge of cases upon us, I now see a new set of faces gripped with anguish when I close my own eyes.

Not long ago, I was on call in one of our Orlando ICUs when we admitted one such patient I won’t forget. He was about my age in his early 50s and, also like me, a father. He was on high levels of oxygen, fighting for every breath. Our team knew he could soon be intubated and on a mechanical ventilator because he had a higher risk of disease progression due to his unvaccinated status.

Before he could no longer speak, we learned his wife had also been admitted to a hospital with the virus.

As a father of two myself, I was crushed. Moments like this never get easier to process or accept.

“You will see your family again,” we told him, attempting to reassure ourselves as much as we wanted to reassure him.

When I left my last shift in the COVID ICU before a weeklong break that night he was stable, but on a ventilator in hopes of giving his lungs time to rest and recover from the virus.

After my time off, I returned to provide relief to our teams on that same COVID ICU unit to learn my patient was no longer there. Too afraid of what I would discover, I couldn’t bring myself to try to find what had happened to him.

The difficult questions and hard moments keep coming for our teams. But just as when I was a young resident, I also witnessed colleagues creatively solve for problems brought by a new disease without a proven treatment protocol and, in those earliest days, scarce resources. And even as Omicron brought a new wave of patients, each with their own story, it is amazing to see how our teams, battered and fatigued from two years of battling COVID-19, continue to place patients above themselves with remarkable selfless humanity.

As we approach the second anniversary of the first COVID patients in Central Florida, I can see a flood of images in my mind’s eye. But in addition to the piercing looks of fear in patients’ eyes, I also see endless moments of compassion, courage and love. I see the tears of both sadness and joy we shared with our patients and their families. And I see how allowing ourselves to be vulnerable and feel these moments is not a sign of fragility, but of strength and courage. I also know the lessons gained from battling COVID-19, like the trials of the AIDS crisis, will help us better care for patients in the future.

But I am looking forward to our experiences in the COVID-19 ICU one day being filed away as footnotes to history like those long-ago days spent battling HIV and AIDS. I truly hope that day is not far away – we know ii will come sooner if more people get vaccinated and boosted.

As for my patient – the father who was intubated -- I finally had the courage to look up his outcome. Our words of comfort weren’t hollow, and he did see his family again.

The fear and despair from this pandemic will never be far from my mind. But I’ve also decided to carry with me the joy and relief from the many cases where we were able to make a difference.