Back in the ER today. Jump on an empty subway at 7:30 a.m. The streets are quiet. At the hospital, the somber symphony of monitor alarms is the only sound. Their cadence is perfect and predictable. Beep. Beep. Beep.
One monitor, on repeat, is unsettling. Now, it’s dozens. Each with an independent rhythm. A sea of similar sounds. It hits you as you walk in. Even since your last shift, the whole place has been transformed.
The kingdom of coughing has been silenced. Because patients can't cough when they’re intubated and on life support.
Now there are two beds and two patients in rooms only meant for one. You check on every patient, every bed. Many on multiple IV drips — sedation, saline, blood pressure support.
1a: 72y female. Intubated.
1b: 84y female. Intubated.
2a: 64y male. Oxygen face mask. Breathing fast.
2b: 67y male. Oxygen face mask. Better than his neighbor.
3a: 54y male. Intubated.
3b: 48y male. Intubated.
4a: 42y male. Rapid heart rate. Low blood pressure.
4b: 57y male. Intubated.
5a: You know her well. She's been here many times. Now she's intubated.
5b: 63y female. Oxygen face mask. On the phone. Breathing hard.
You’re not even halfway done. All covid-19. As you walk around, you flash back: Not since treating Ebola in West Africa have you seen so many sick patients. So many who will die, no matter what you do for them.
You asked yourself then. You ask yourself now: Are we doing the right thing? Are we having an impact?
“Flip them over. Maybe that’ll work?”
“Turn up the oxygen. Maybe that’ll work?”
“Turn down the drips. Maybe that’ll work?”
“Try these new experimental meds. Maybe they’ll work?”
“Try these old-school meds. Maybe they’ll work?”
We struggle. Because we still don’t know what works. Last week, a colleague cared for a woman with cardiac arrest from covid-19. And the woman’s daughter. At the same time.
Today, one of your patients is on oxygen struggling to breathe. You try to talk to her. But she is watching her mom, intubated, on a ventilator, in a bed across the ER.
The head nurse comes to you. Another new patient. Very sick. “He’s in bed 9. Same thing. Low oxygen.” You try to concentrate, but your thoughts are interrupted by the loudspeaker:
RESPIRATORY STAT TO THE ER.
ANESTHESIA STAT TO THE ER.
On repeat. Like the alarms. All day.
You approach this new patient. It’s immediately clear how bad this is. He’s breathing 40 times a minute, double the normal. He can hardly speak. His oxygen dips. You put him on a face mask. His oxygen level slowly climbs. You put your hands on him. But the purple gloves feel so cold, so distant. Maybe better not to?
You want to tell him it’ll be okay. But you don’t think it will. You want to tell him you’ll help him. But he can’t hear you. The mask muffles your voice; the sibilant hiss of oxygen pouring from face masks all over the ER drowns out your words.
You try to look him in the eyes, but your goggles fog. “Hey, is there anyone I can call for you?” You get his wife on FaceTime. She sees her husband of 47 years. Breathing fast. Struggling. Alone. She hears the alarms of patients on life support in the background, struggling to stay alive. She sees you in a mask, gown and gloves.
You flash back. You remember: 19 days in isolation when you were treated for Ebola. All that time, all you saw were masks. All you felt were gloves. You felt toxic. No matter what they said. No matter what they did. You felt toxic.
This is what they see. This is what they feel. So you try to connect. You want to comfort. But how do you connect when you cannot really touch? How do you comfort when they can hardly see through your foggy goggles? Or when the mask muddles every word?
When you end your shift, you walk around. Still so many struggling to breathe. Still so many on life support. You can’t help but wonder. Would they still call us heroes if they knew we felt so helpless?
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