After three weeks of caring for a patient on life support, Dr. Christina Bastin De Jong knew it was time to call the family in so they could say goodbye. The ventilator could no longer support him.
A photo of the patient with his kids hung on a wall of his unit. The picture offered those caring for him a glimpse into his life before COVID-19 took over his body.
“This was his life before he was sick,” said Bastin De Jong, a critical care specialist at Essentia Health-St. Mary’s Medical Center in Duluth.
Bastin De Jong called the family to tell them they could come into the hospital to spend time with him before he died. But before she dialed, she thought about the family and what she learned about the patient through them.
“I think everybody was crying in the ICU that day,” she said.
That day, over a month ago, stands out to Bastin De Jong because of the mark the patient's family left on her and her colleagues.
She grows close to patients and their families. She knows whose spouses are stuck at home quarantining and who just bought a tractor they will never get to ride. She’s watched people lose a parent to COVID-19. She’s watched people lose both parents.
Every day is hard.
And every day, despite not having had a true day off since March, Bastin De Jong finds energy, optimism and a will to carry on in serving families. She calls it a privilege and an honor to be present with them through their most trying times.
“That's where I'm finding my energy to go forward. I know this won’t last forever,” Bastin De Jong said. “I know we can all hang in there. And I'm so hopeful that each individual will take it upon themselves to make choices that will stop spreading the virus.”
Before the pandemic, critical care doctors at St. Mary's Medical Center in Duluth typically saw about 15 patients a day. Now they’re averaging 25, and at one point, they had over 30 patients in ICU. While coronavirus case numbers have decreased in St. Louis County and around the region, hospitalizations and deaths have not, but Bastin De Jong is hopeful they will.
Patients with COVID-19 stay in the ICU much longer, often two to three weeks. Because of that, the number of hospitalizations can lag behind any decrease in new cases in the community. Bastin De Jong was used to ICU patients staying in her care for four or five days.
“This is unprecedented,” she said. “I’m sure that’s a word that’s overused, but we haven’t seen this before and the patients stay with us so much longer.”
Patients are moved to the ICU when they need to be put on a ventilator. Before that happens, Dr. Krisa Keute at Essentia may be one of the doctors who cares for them in hopes of preventing ventilation. Keute starts every shift by checking in and going through the hospital’s COVID-19 protocols. She enters the COVID ward already dressed in her personal protective equipment.
She’s handed a list of 15-20 patients assigned to her. She tries to communicate with each of their families once a day. If someone’s health has taken a turn for the worse, their families could receive multiple calls a day.
Before the pandemic, it was easier to communicate with family members. Now most of the communication has to be done virtually. On top of that, the health of a person with COVID-19 can deteriorate quickly. Doctors have had to figure out how to convey the situation primarily through phone and video calls so the family can make decisions.
“The more frequent communication, especially because they can't be there, the better,” Keute said. “That's the trick of practicing medicine in the middle of a pandemic is how well you communicate with the patient and the family.”
It’s not uncommon for Keute to tell a family in the morning a patient is doing fine and a few hours later have to call them back with news that the patient needs to be put on a ventilator.
"It's a mysterious virus that we don't understand and we can't understand,” Keute said. “It's very humbling. I hope I'm enough, you know, in this whole thing."
None of this has deterred Keute from feeling called to work with COVID-19 patients. During the course of the pandemic, she has cared for family of people she knows. His illness was prolonged and he later died outside of her care. She wasn’t ready to speak in much detail about that experience.
“That interaction with his family, to me, was tremendously precious. I'll never forget it,” she said. “It's a very different thing to live in this world and see illness and death. I think it's a privilege … It’s a service. My job has a purpose in this world.”
The virus has strained health care workers everywhere. More than 300,000 Americans have died due to COVID-19 and its complications. More than 4,000 of those people were Minnesotans.
There also seems to be a politicized debate around mask wearing, even though the Centers for Disease and Prevention said in a scientific brief last month that universal masking can help avert future lockdowns, especially combined with social distancing, hand washing and adequate ventilation.
So when Keute saw a woman refusing to wear a mask and vaping inside while she was waiting in a lobby to get her vehicle’s oil changed, she surprised herself and snapped.
Reflecting back, she wished she would have taken the time to talk to this woman and try to understand why she felt wearing a mask was something she didn’t need to do.
Keute wrote about her interactions with the unnamed woman in a blog post as an outlet for her frustrations. She told the News Tribune that she took some “writer’s liberty” with the post to protect the privacy of patients.
After handing her car off to the mechanics, Keute went inside the building to the small waiting space where a couple of people were sitting. So Keute moved to an empty hallway and watched driverless cars roll through the touch-free wash.
“Numbly, mindlessly I watch the cars roll by, lost in the bliss of no thoughts, something I have little luxury of during my day,” Keute wrote in her blog post. “I smell her before I see her. I catch a distinct smell of a sweet vape, and then I see the smoke in the hallway.”
Keute saw a woman who wasn’t wearing a mask, vaping while typing on her phone.
“She is pacing the hallway without regard to anyone else, and she passes right behind me. I hold my breath, exiting the hall quickly,” Keute wrote. “I glance back again, and she is pursing her lips, blowing her vape smoke straight into the hallway toward another customer further down the hall. I head straight toward the clerk.”
Keute asked the clerk to enforce their mask policy, which he did by taking a disposable mask to the woman and asking her to wear it. Keute said the woman put the mask on, saying she had just forgotten her mask in her car.
About three minutes later, Keute smells the vape again.
“I can hardly believe it,” Keute wrote. “I look to my right, and there she is, wearing her mask around her chin and blowing her vape toward where I am sitting.”
That’s when Keute said she lost her usual patience and discretion.
She told the woman to stop vaping and wear her mask “with obvious annoyance in my voice.”
The woman’s response according to Keute: “It is my right. This is my freedom.”
“That night I just felt so forlorn with this feeling that we are so divided,” Keute told the News Tribune. “Since I’ve written the piece I have reflected a lot on what made the woman be so defiant and angry and I’m trying to understand where she’s coming from, too.”
Keute said she’s constantly astonished and saddened by the fact this pandemic has divided people instead of acting as a unifier.
“I really do think that as more time passes, more people will experience the disease and probably the loss that is occurring in our world because of it,” Keute said. “I just wish I could reach those that have this need for freedom (of not wearing a mask) and intertwine it with a love for one another where we might protect each other and still try to live our lives the best we can.”
This story originally mischaracterized Dr. Keute's relationship to a patient. It was updated at 4:15 p.m. Dec. 16. The News Tribune regrets the error.