“Sorry, we can’t catch a break-- Just got another intubated COVID patient and are swamped down here. Three admissions in the last hour. Can you come line her up?”
“Sure, have the supplies by the bedside. Just finishing up another patient and I will come down.”
“Will do, thanks. See you soon.”
It had been busy. I was tasked with the job of placing central lines and arterial lines in all the newly intubated COVID patients to help the ICU teams stay afloat with all their new admissions. I had only been at work for 4 hours and had already placed central lines and arterial lines in 5 patients. And the consults kept coming in. It seemed like a COVID patient was being intubated every few minutes.
I finished up my paperwork and headed down to one of the makeshift COVID ICUs to line up a new patient. When I arrived, the nurse was there getting the patient settled- “she just came to us about 30 minutes ago so I am still settling her in,” she apologized. “No problem,” I responded. “Can you stay in here with me while I place these lines to give me a hand?” “Of course,” she answered.
I gathered my supplies and began to set up the sterile field. Immediately, my heart dropped when I saw the patient. “Oh my god. I know her,’ I pleaded to the nurse. “Oh, you do? Yes, I was told she is a nurse here.” I struggled to fight back the tears.
Lying here, intubated and critically ill was one of us- and one of the best.
As a resident, a good recovery room nurse is your best friend. And Jane (name changed) was the best. A real veteran, she was always one step ahead. If labs needed to be drawn, she would have them drawn before you even ordered them. If a patient needed OR supplies for a dressing change, she would figure out how to get them. If she knew you wanted to send an ambulatory patient home, she would without fail, get the patient out the door, safely answering all of their questions with a smile and usually without your help if you were busy. She could be trusted with anything. And always, her response was “You got it, girlie, I’ll take care of it. Don’t you worry.” And she did. She always took care of it.
Most mornings, I would see Jane in the locker room while we were changing into our OR scrubs. Her locker was right by mine. Often, we would trade funny stories. “Where are you operating today?” she would ask. “Oh, you will be seeing me-- I’m going to deliver you patients all day long. I’ll keep you in business and bring you my loopiest post anesthesia patients” I would joke. “You got it, girlie,” she would laugh.
Seeing her in the ICU, I was speechless. Almost ten days into the COVID pandemic in New York City, I had been consistently fronted with the severity of the situation. Our hospital had been turned into a warzone with all hands-on deck. Patients were being intubated and were dying at an alarming rate. Yet despite being in the center of it, until that moment I was able to distance myself from it. Not anymore. Someone I knew had fallen ill. This was very real.
I placed my lines quickly and efficiently, apologizing to her as I stuck her even though I knew she could not feel me with all the medication drips she was on.
Before I left, I wiped the sweat from her brow. Under my breath with my eyes watering, I looked at her one last time. “You got this, girlie” I said.
As I left, I pleaded with the nurse to do her best to take care of her. “She is one of our best,” I reminded her. Let me know if I can help with anything, I’ll leave my pager number with the team.
And then the tears fell. Yes, this was now very real.
“Hi, this is Tom (name changed), one of the doctors taking care of your husband. I wanted to call to give you a daily update on how he is doing.”
“Thank you, thank you. God bless you.” The muffled voice on the line offered.
Since the start of the pandemic, family members had not been allowed to visit their loved ones in the hospital. Given how overwhelmed we had been taking care of these patients, we had been limiting conversations with families to once a day phone calls to update them on the status of their loved ones. This was my once a day call to Mr. V’s wife to let her know how he was doing.
“He is doing better today actually!” I started enthusiastically. “The ventilatory settings we are using have been going down, his kidneys appear to be working better also. The medications we are using to keep his blood pressure up have also been decreasing. Overall, these are all very good signs.”
“Thank you, thank you, doctor,” she responded.
“Do you have any questions?” I asked.
“No, no, keep doing god’s work. I delivered to the hospital a case of cold brew coffees and red bull for you and your team as a thank you, did you receive them?”
“Yes, wow, I didn’t realize that was you. Thank you- we have been really grateful to have them, it is so kind of you to think of us,”
“Yes, yes, of course. Thank you and god bless you,” she stated as I hung up the phone.
I was touched by this act of kindness- not only was it clearly expensive, but she had made the effort to have cases of drinks delivered to the hospital in the middle of a pandemic. “What a lovely woman,” I thought.
Over the next few hours, things had changed for Mr V. All of a sudden, he needed increasing doses of vasopressors. And his blood gasses continued to show a progressive acidosis despite increasing ventilatory support. It appeared that he was in septic shock. At 2am, he was maxed out on all pressors and it seemed that I would need to call the family to update them on his deterioration.
“Hi Mrs. V. I am so sorry to wake you, but I wanted to update you on your husband’s condition,” “It isn’t good, is it?” she asked.
“No, it seems that he is very, very sick. We are doing all we can but we are concerned he will not make it through the night,” I responded.
She started to cry. “I am so sorry to be telling you this over the phone,” I started.
“No, no, its alright. God bless you. God bless you,” she responded as she hung up.
At 5am, he expired. Again, I called the wife to let her know. She was audibly crying. “God bless you, god bless you and thank you for all you did,” she replied.
I opened one of her Starbucks cold brews and drank it down quickly. I didn’t know what else to do.
“Rapid Response to Room 432, Rapid response to Room 432. CODE 99 to Room 432. CODE 99 to Room 432. Anesthesia STAT to Room 432. Anesthesia STAT to Room 432.”
The overhead pages were endless. A few times an hour it felt like someone was coding and dying at the county hospital where I was working.
Walking into the hospital in the morning we had to pass the refrigerated trucks used to house the newly dead. Built up alongside the trucks were wooden ramps to more easily deposit the bodies. There was an American Red Cross truck parked in front presumably to help with this morbid task.
I looked down every time I passed. As if not looking, meant it wasn’t really there.
One afternoon, I got a call from my attending. The first patient we had successfully extubated with COVID-19 was ready for discharge this afternoon. He wanted to be the one to escort the patient out of the hospital- could we help get the patient ready?
With the help of two nurses, we positioned this frail, previously healthy 29-year-old into a wheelchair to wheel him to the exit where he would be the first patient intubated at this hospital with COVID-19 to see the sunlight after being bedbound for over a month.
As we passed the refrigerated trucks, this time, there was hope.