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Dr. Nick Boulis, associate professor, Emory University department of neurosurgery: The thing about the ICU is, it’s like you’re visiting your executioner. But every time you gown up and you go in there and you’re examining these patients, or you’re doing a procedure on these patients you’re — you’re looking at your potential fate, which is really ugly.
Dr. Sanjay Gupta: Dr. Nick Boulis is a friend of mine. We trained together as neurosurgeons and we now work together at Emory University’s School of Medicine.
Recently, Nick volunteered for several shifts on Emory’s Covid-19 intensive care unit. I asked him to record some of his thoughts and his observations from the experience.
Boulis: I was just in there talking with, uh, my patient, who’s a Covid nurse who was infected, and, uh, she’s coughing. I can just see the cloud of virus coming out of her mouth. So that’s the first time I’ve actually felt scared.
Gupta: Typically as doctors, even when we’re taking care of the sickest patients, we’re not at risk ourselves, from getting sick or even dying. I can tell you, as a neurosurgeon myself, the type of work that Nick was doing in that Covid-19 ICU was very different from what he normally does.
And on top of that, as of Saturday, cases of coronavirus have been increasing in 18 states.
So today I wanted to take a moment and look again at where the critical work is being done to fight this virus that is now projected to take 200,000 lives by October. I wanted to share Nick’s experience because it is a stark reminder that this pandemic is far from over.
I’ll take this opportunity to tell the audience that Nick and I have known each other for over a quarter century now. Hard to believe. And you’re a neurosurgeon, a brain surgeon. You specialize in operations of the brain and the central nervous system and the peripheral nerves and all that.
And yet, most hospitals in the country, pretty quickly, became Covid hospitals primarily taking care of Covid patients. So what do you, as a specialist of the brain and the spinal cord, do in a situation like this? How — what is your role at that point?
Boulis: So first and foremost, I began adapting my own behavior for life in this hostile environment. It’s a little bit like living on Mars, right? You wouldn’t go out without your, your spacesuit on, your appropriate protective gear. Suddenly, the world became a fundamentally hostile environment. And in some environments, more hostile than others.
And so my first role was to try to communicate to my friends and do so through social media. Simply say, “This is how I’m dealing with this. If any of you are scared and wondering how you should behave, I can’t tell you the right way, but I can tell you how I’m dealing with it.”
And I think as doctors, it was incumbent on us to be outspoken about what we believed to be the right way to handle this on a national level, on a local level, at the level of the hospital, and then to do so, and I think that that last piece involved behaving in a fashion that was effectively irreproachable with regard to accepting responsibility, personally.
That, for me, led into initially volunteering to help the residents and then volunteering in the Covid units, which are quite different than what I do on a daily basis.
Gupta: We also, I think, are obligated in some ways to remind people that the virus is still out there. It hasn’t really changed. It still poses a huge threat. Some states are now seeing record numbers of cases being reported.
And so I want to play a bit of one of your recordings where you talk specifically about what this disease does to the body.
Boulis: I mean, this disease doesn’t just kill you. It guts you. It f—ing tries to smother you. And then it tears through your body and it takes chunks out of your various organs.
And either you come out the other side and you might be whole or you might have little pieces of you scattered around or maybe you’re dead.
Gupta: It’s tough to hear. And I think a lot of people, especially people who, who haven’t worked in hospitals, haven’t really been exposed to anyone who’s had this disease, it really is eye opening in terms of how, how deadly and also how significant the disease is in terms of what it does to the body.
Can you describe what you saw? What was going through your mind?
Boulis: One thing’s for sure, though, those days were exhausting in a way that it’s exhausting to be in a foreign country where you don’t speak the language. But you absolutely have to communicate.
You know, we, I, I think we’re making great strides in understanding this disease, but it felt like this was a tornado, like a hurricane blowing through. And you just hunker down and maybe you make it to the other side. But there’s going to be destruction, you know?
Notably, you know, thinking about the nurse who came into the ICU, and watching her trying to breathe through this thing, proning her, you know, dealing with her back pain and her discomfort in these various positions and watching her fight this thing and then watching her lose and go on the ventilator.
It’s hard to separate yourself from it. Because she’s there, because she was doing exactly what you’re doing.
And then seeing the cross-section of people at different stages of this. You know, it’s not just you go on the ventilator and either you make it or you don’t. It’s you go on the ventilator and then you begin forming blood clots that make it very hard to put the various important kinds of lines, IV lines in that are necessary for care. And then renal failure kicks in and then maybe you have a heart attack or not because of the thrombotic aspects of this.
And it’s definitely affecting the brain. Some people are thinking better. Some people can’t. You’re trying to sedate them so you can breathe better for them. But it really was as if there was a vortex that patients were being sucked into, like a whirlpool and you’re trying to reach in and hold on to them. But they’re slippery. You know?
And you and they know that you can’t necessarily save them. And that, that process of watching it, being aware that this is that situation where you could be sucked in too, and being the go-between with their families was just simply incredibly intense.
Gupta: I do want to spend a couple minutes, Nick, asking you sort of a little bit about the future. People, they sort of get the sense that, you know, as things open up, that we’re through this. The tornado, the metaphor you used, has passed. What do you think?
As someone who not only is a doctor, but now has worked in a Covid unit, where are we in this thing?
Boulis: I think one thing that strikes me as glaringly obvious is that, yes, people want to pretend that this thing is over. It’s a lot of stress and it has exceeded our collective attention span. And so the question is, are we getting back to work in a careful and rational fashion because our economy needs it and our country needs it? Or are we just engaging in denial and diving back out there and pretending it’s not happening?
And you start to get those stares that people kind of don’t want to see you wearing that mask. They don’t want to be reminded that it’s not over. And I believe that masks are as much a symbol, as much as a mechanism. If you’re wearing a mask, it means you’re thinking about it.
And if you’re thinking about it, you’re doing a better job than if you’re not thinking about it. And wearing that mask means I’m protecting you. I would appreciate it if you did that for me. And when I step out of your way, it’s not an insult. It’s me watching your back. And I think that it’s going to take us a while to get this.
And probably is going to take more spikes before people really adapt their behavior.
Gupta: I do want to play one more note that you recorded, and this was after your third shift, taking care of Covid patients. Here’s part of it.
Boulis: Was the intensity of the experience worth it? No. Why is it worth it? To know that you’re the kind of person that will step up.
Gupta: Now that you’ve had a little bit of time to reflect. Were there some emotional takeaways that these shifts left you with?
Boulis: This was a distinct experience because you are aware that you are at risk. But it was very hard to nail down, to focus on where the risk was coming from. It’s a general hostile environment, and, you know, when you go home at night, you’re not even sure you survived. You know, you’re driving home and going, “Well, I hope that went well.” But you don’t know.
And what I was trying to communicate when I said that in the tape was at every moment in it, I was sure that this was the right thing to do. This was that time when I had the inherent training and preparation to step up. And I would not had wanted to look back on this and think I could have done more.
Gupta: I’m so proud to be Nick’s friend. We’ve known each other for over 25 years, and I saw a side of him I’ve never seen before. I saw the confusion, the vulnerability, that Nick and so many health care workers are dealing with right now, as they try to help people who have been sickened by this virus.
We need to remember the virus is still here. It is still taking lives. I’m worried that in too many places, we seem to have forgotten the virus. But as you can hear from Nick’s experience, the virus hasn’t forgotten us.
It’s crucial for all of us to do our part to help mitigate it.
We’ll be back tomorrow. Thanks for listening.