Dr. Nahreen Ahmed shares her perspective on A "Typical" Day in the Covid ICU

This month VaxTherapy is proud to feature our inaugural guest Dr. Nahreen Ahmed. Dr. Ahmed is a critical care physician based in Philadelphia, working as an assistant professor of clinical medicine at the University of Pennsylvania. In addition to her clinical expertise, Dr. Ahmed is currently a faculty instructor of Critical Care Ultrasound. She graduated with honors from Drexel University College of Medicine and she holds an MPH (Public Health) from the University of Illinois at Chicago where she completed her Internal Medicine Residency after which she completed a fellowship in Pulmonary & Critical Care at NYU. Dr. Ahmed has more than 10 years of diverse clinical experiences, Her clinical expertise comprises global health activities in the area of pulmonary and critical care including but not limited to Point-of-Care (POC) ultrasound training, curriculum building, and service and education in resource-limited areas and disaster response.

Dr. Ahmed is a proud, second generation Bangladeshi-American, born in the US but with close ties in Bangladesh where she has collaborated with Dhaka Medical College and Hospital in a teaching endeavor in the area of Critical Care Ultrasound and curriculum development.

From her work, one can conclude that Dr. Ahmed is deeply driven by the problems facing humanity. She has volunteered in Bangladesh, Sierra Leone, Yemen, and through other non-profits in Ethiopia, Uganda, Rwanda, and Tanzania. She humbly considers her humanitarian work to be a social responsibility.

“Volunteering across various countries has opened my eyes to the vastness of global health issues, and at the root of them is equity–or the lack thereof. Every trip I go on pushes me further to think creatively on how we can support capacity building to empower communities so they can sustain the solutions to improve their own health. I am amazed by the intelligence and ingenuity of every person I meet in a global setting, from community members to health care workers. It gives me hope that together we can create impact and improve the equity of health care.”
- Quote from Dr. Nahreen Ahmed

Without further ado, here is Dr. Ahmed’s post on A “Typical” Day in the Covid ICU:

A “Typical” Day in the Covid ICU

The day starts before the sun rises and ends well after the sunsets. Every morning I feel the weight of this pandemic in the decisions we have to make. Every night I feel the weight of the sorrow and suffering I’ve witnessed, letting the day sink in as I finally have a moment to grieve. I remember one particular day; I had a conversation with the daughters of a patient who was actively dying, despite our best efforts. Each day we would encourage her daughters to tell us about their mother and her life before falling ill. Each day they would give us tidbits of the vibrant life she led. But on this day that I remember, she took a turn. We were able to keep her alive with medications and a ventilator but she showed no signs of recovery and in fact on this day, was deteriorating rapidly, after nearly 8 weeks in the hospital. The visitor policy would only allow one family member at her bedside and her daughters said, “no if both of us cannot be there then neither of us can go”. They opted to sing and play gospel music via Face-time as their mother passed, as peacefully as possible. The entire medical team wept for her, as we did for so many of our patients who could not be comforted by their families. We would speak to and get to know patients who were fully functional at one time in their life and watch as we lost them to a disease we had yet to fully understand, sometimes over weeks, and sometimes over days. As the country continues to re-open, I know many of us on the front-line, or anyone who has been affected by Covid personally, is feeling anxious and apprehensive about gathering anywhere but a large open, outdoor space. The trauma that we have all faced is too difficult to forget nor should we.

Personal Challenges

**Breathing Tube**

This picture was taken and shared with permission. Seen here is Dr. Nahreen Ahmed preparing to place a breathing tube in a patient in distress from severe malaria in Black Lion Hospital in Addis Ababa, Ethiopia. The patient did survive and had a full recovery.

I was boarding a plane from Bangladesh at the tail end of February—unaware that a pandemic was coming, and that this was the last time I would be boarding an international flight for almost a year. At that point, Covid had yet to reach America, and I was naïve to think that it might not. Within weeks of being home, the narrative changed. There was a flurry of emails to plan for an overwhelming number of patients as well as how to sustain personal protective equipment (PPE). Meanwhile, my colleagues in New York City were already feeling the brunt of this disease, sharing harrowing stories that left me sleepless and anxious. By April, the ICU I was assigned to was filled with Covid patients on ventilators. The soundtrack of our days was the recurrent ventilator alarms and overhead announcements of “Code Blue” or “Rapid Response”. Typically rounds would include the family members of our patients which is how we could efficiently communicate the medical plan. Rooms would be filled with remnants of visitors, family members who could stay with their loved ones at the bedside as they walk the line between life and death. But not this time, the rooms were void of family members, void of life outside of the ICU. Every day we would do our best to hold the hands of our patients in difficult moments, trying to show them that they are surrounded by those who cared about them, but we knew we could never take the place of their family members and loved ones. Each day I would don my PPE, wondering if this would be the day I might be exposed; is today the day I inadvertently put my family at home at risk? Constantly harboring the fear of endangering others, I went months without seeing anyone, my parents, my relatives, my friends. My colleagues in NYC were separating from their spouses and children to keep them safe. As medical providers under great duress, our mental health teetered at times; we felt helpless fighting a disease that was constantly creating unforeseen challenges, humbling us as physicians, showing us, we have so much to learn. The staff break room in the ICU was like therapy as we would all do our best to console each other, cautiously sharing our stories and feelings. At the end of the day, we would all change into a fresh set of scrubs and shoes to avoid contamination outside of the hospital—yet still, early in this pandemic many of us encountered suspicious looks from passersby as if they were silently accusing us of being responsible for transmission. Funnily enough, as quarantine was taken less seriously more and more people felt emboldened to wander the streets without a mask or take wonton risks such as weddings and large gatherings. Social media posts showing big mask-less group dinners were a slap in the face to those of us working diligently to keep people alive. Workplace discussions were dominated by frustrations of the public perception of how the Covid-19 pandemic is a “hoax” and about the timing of a vaccine to help mitigate the fact that even the easiest of interventions such as social distancing cannot be maintained. But knowing what we know, the road to a vaccine is a long and labored process and as such, we assumed that such a preventive measure was far from ready. But, we trust science, we trust the process, and are hopeful for the day we have an effective vaccine. In the meantime, we are left with the only preventive measure we have seen to be effective- wearing masks, hand hygiene, and social distancing.

Covid Aftermath

And so, life as I know it has changed. Any social interaction happens outdoors, from a distance. Phone calls and Face-time have become so much more prevalent as we all work to maintain closeness without physical proximity. As time passes, we learn more and more about the virus and watch as the type of cases evolves in time. Though children were thought to be safe at the beginning of the pandemic we soon learned of the entity called Multisystem Inflammatory Syndrome. In the beginning, the messaging was that only the elderly with chronic disease were at risk and now cases of previously healthy, young people are being widely reported. Because we are dealing with such a novel disease, we are only just learning about long term sequelae. Though many people have recovered without incident there are many still who have exhibited persistent injury to the lungs or cardiac complications or even just the prolonged loss of taste and smell. Apart from the physical aftermath is the psychological aftermath of Covid-19. I can report that experientially I have seen a dramatic increase in the number of suicide attempts, drug overdoses, and relapses with substance abuse. For patients who survive long enough to share the source of their despair the story is often the same: unemployment, financial insecurity, shelter insecurity leading to growing anxiety and depression, and then sheer hopelessness without resources to provide a safety net. Lastly, it is not lost on any of us the discrepancy in presentation and outcome of Covid-19 in persons of color, further widening the already existing gap in our health care system.

Lessons Learned

This picture was taken and shared with permission. Seen here is Dr. Nahreen Ahmed training physicians in the use of ultrasound for the clinical management of patients in the ICU in Sayoun, Yemen.

The future is scary, we do not know what to expect nor how long this may go on. We have yet to understand how long antibodies last or whether re-infection is possible. The unknown of Covid-19 is terrifying and what it has taught me is that we must remain ever vigilant and we must trust the experts. We live in a world where information is rapidly dispersed but much like any other disease process in the medical world we are constantly learning and unlearning things. Through experience and research, the data continues to roll in and we continue to expand our knowledge of this disease. What feels like back peddling or misinformation to the public is merely the scientific process unfolding in detail in front of the eyes of the public. To achieve certainty we must wade through some uncertainty still. But after all, is said and done, one fact remains true: life is precious and unpredictable. We must stay present, we must cherish the time we have and the people we have it with and we must, above all, show kindness to each other, if even by just wearing a mask.

Author: Dr. Nahreen Ahmed

Link to her Linkedin Profile
Link to her UPenn Med Bio Page

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