“Most people here are unvaccinated,” says Dr. Ilya Kagan, head of the coronavirus intensive care ward at Beilinson Hospital near Tel Aviv, standing at the bed of a man in his 50s who is sedated and on a ventilator.
The unit has four such patients, two of whom are also hooked up to an ECMO heart-lung machine. The internal medicine ward has another 19 patients in serious condition, and in total, Beilinson has 34 COVID patients.
In comparison, during one 10-hour stretch in January at the height of the third wave, the hospital was treating 74 COVID patients, with 46 of them in the same ward.
“We expected to be packed by this point, but the situation has stabilized,” Kagan says. “We’re tired after a long year, and frustrated because this could have been prevented.”
Even through fogged-up goggles, the elephant in the intensive care unit was clear to see – patients who didn’t get vaccinated.
“It’s frustrating most of all for the patients themselves,” says Dr. Katya Orvin. “It’s hard to judge. Last week I had a patient who didn’t get vaccinated due to an allergy, and she died.”
Orvin runs the cardiac intensive care unit, but she also volunteers in the COVID ward. On the day we met, she had just dropped her daughter off for her first day of school; then it was straight to the ward. “I’ve learned so much more here than ever before,” she says. “The coronavirus has become a part of life.”
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Doctor Kagan says that treating the illness in the ICU has become almost commonplace. While doctors from other departments at Beilinson and other hospitals, may have experienced temporary placements in COVID wards for at most several months, the staff in the intensive care unit have no reprieve. They are constantly dealing with COVID in addition to providing care to other regular patients in the ICU.
According to Dr. Liran Stetlander, a doctor in the unit, “In early May I discharged the last patient from here. I hoped we wouldn’t be back.” The return came sooner than expected. “If not for the vaccines, this wave would have killed us,” Kagan says.
And Stetlander adds: “The vaccine works. Even when a vaccinated person gets seriously ill, it’s not as bad. If those million people who’ve refused the vaccine were vaccinated, there wouldn’t have been a fourth wave.
“So there’s anger at this group, but empathy always wins out. When you talk to their families, when you talk to the patients, when you see them, your heart breaks. I asked one patient why he didn’t get vaccinated. And he said, ‘Because I’m stupid.’”
Feelings of guilt
The doctors also note an important trend. The families of unvaccinated patients, some of whom also aren’t inoculated, are rushing to get vaccinated when they see their loved ones in critical condition.
“Someone who isn’t vaccinated also can’t come to visit or say goodbye,” Kagan says. “There was a patient who died while his wife was in quarantine. She couldn’t say goodbye to him. There are no words to describe what a catastrophe that is. A man in his 60s, who has a wife he has loved for decades, and he dies alone. No one deserves this.”
Dorin Shamir is the unit’s social worker; she liaises with family members who aren’t able to visit their loved ones. “There’s almost always a feeling of guilt – like an unvaccinated daughter who infected her father,” she says.
“I’ve been here for years and I’ve seen a lot of death," Shamir says, while noting that the guilt of surviving family members makes this especially difficult. "There is nothing normal about what’s happening here.”
At the end of the ward lay the only patient who was conscious, Michael (not his real name). A fit and healthy 40-year-old, he didn’t get vaccinated. He couldn’t really say why, though certainly doesn’t fit the anti-vaxxer stereotype; he’s not awash in conspiracy theories and doesn’t hold firm beliefs about the supposed dangers of the vaccine.
For over a week he has been lying on his stomach gazing at his phone and wondering how he got here. He missed his daughter’s first day of first grade. “It was foolish not to get vaccinated,” he says. “When you hear that everyone’s getting vaccinated but people are still getting sick, you take a step back.”
Michael says that if he could go back in time he would get vaccinated, but when asked if he would get a booster shot every six months if that’s what the Health Ministry recommended, he says “I’d have a dilemma.”
The emotional toll
According to nurse Aya Jabarin, who races from one patient to another, “There have been fully conscious unvaccinated patients who understand what’s going on around them. I explain to them how important the vaccine is, but I can’t do more than that. Not everyone will be convinced and get vaccinated. All you can do is shine a spotlight on it.
“I wouldn’t say that I’m angry. I’m not here to scold the patient, I’m here to take care of him. Yes, these people had a way not to be here, but they chose differently.”
Jabarin also lost her grandfather to the virus. “He followed the rules, he was older, and when it happened to him we were in shock,” she says. “It was really tough.”
There’s something else that the medical staff all agree about – the emotional toll on them. They recognize that something in them has changed.
“You just ask about it and I feel like crying,” says Pnina Artzman, the head intensive care nurse, who has more than 26 years of experience. “I’ve never experienced anything like COVID. I’ve never seen a disease that affects the lungs like this,” she says.
“You just receive the patient and immediately you have to intubate them. In the second wave it was very hard; many patients died. It was very frustrating for the team. And that was back when people were applauding the medical workers.”
But that time is gone – people have left their balconies. Public hospitals are still pleading for funding. And at this point, a year and a half into the pandemic, someone has to start taking care of the medical staff too.
Kagan, the head of the ICU ward, says the third wave hit them hard. “It really got to us because of the high death rate, because of the young people,” he says. “You take these things home with you. Like when you have a young patient who’s being intubated, and he asks when he’ll wake up, and you have to lie and tell him in a week, when you know there’s a good chance he won’t come out of it.”
Nurse Jabarin adds: “There are difficult shifts invovlign resuscitation, and I see it when I go to sleep. I hear the monitors all the time. But this is our life. I don’t think anyone who has been dealing with this pandemic will come out of it the same. It will leave its mark on all of us.”