COVID Tales

Night falls on the Emergency Department. Someone screams from behind the locked door of the psychiatric ward. Who knows what horrors haunt their mind.

Someone else screams from that ward, too. He believes he’s Jesus reincarnated and is commanding the first person to shut up, threatening eternity in Hell for disturbing him.

The drone of alarms becomes like the white noise of the rain on your roof. Who knows if the alarms are new, or if they are even accurate. You hardly hear them anymore.

But then you realize, beyond the background drone, the department is quiet.

The 10th busiest ED in the country. Is quiet.

Though we are still full.

On this blog, I’ve talked in the past about how there are some horrors we see in healthcare that will never leave our minds. A family member screaming while firefighters do chest compressions on her mother. A man in business attire hanging from a chandelier by an ethernet cable tied around his neck. A finger no longer attached to its owner’s hand.

COVID has become just the latest horror I can’t unsee.

How ironic. Just seventeen months ago, I was finishing the third year of medical school from home while my wife was fighting in the trenches on the front lines of the world’s biggest struggle. I had read about this virus. I had learned how it works. I had memorized its signs and symptoms. I stayed home, wore masks, and sat on Zoom.

When I went back into the clinic, I still didn’t see it. I was treating back pain and amputees. I was helping patients recover from life-altering events.

Then I went into the ED.

I was fully vaccinated, so I was not afraid. I’ve never known the fear my colleagues and mentors faced in the year before my arrival. I wore my N95 and paper gown, but only because that was the policy. I knew my body and antibodies were a stronger defense against this enemy than the millimeters of paper that surrounded my flesh.

I ordered swabs of people I thought had COVID. Some were positive, some were negative. We encouraged people to isolate even with a negative swab, since their symptoms fit the description under the wanted poster so classically. Generally speaking, these folks weren’t that sick.

Then I saw it. Then I saw what this monster could truly do.

As we sat at our desk laughing and joking, the charge nurse (who never once raised his voice or panicked) yelled “DOCTOR!” from a room, and we knew that meant it was game time.

What I saw was unlike anything I’d experienced in my thirteen years of working in healthcare.

He was blue. Like Papa Smurf would be jealous of his complexion blue.

He gasped for breath like a fish on the shore.

We tried to give him oxygen. 15 liters per minute by mask. Barely a dent in his oxygen deficiency. A pressurized mask. A slightly bigger dent. We dared not intubate him, because we knew this would mean almost certain death. But what was this man’s fate without the tube?

The attending doctor frantically called a nearby hospital begging for an ICU bed.

No one would take him, as he’d probably die in the helicopter.

She called the hospitalist. I know you don’t have any ICU beds here. But is there someone you can move to the floor so this man can have their room? Luckily, her request was granted.

And this was seven months ago. This was before Delta.

Delta is like COVID’s mean older brother who just came home from college crushing beer cans on his head, ready to protect anyone messing with his younger sister.

As I started my month in the ED as a resident, I felt nothing but excitement.

Finally, it was my chance to jump into the game. For more than a year, I stood on the sidelines yelling “PUT ME IN, COACH!”

The first few times I diagnosed someone with COVID, it was satisfying. I had read their chest x-ray and knew what was wrong, the swab just confirmed my suspicion. I counseled patients on next steps. I warned people wanting to leave to quarantine from loved ones. Finally, I was playing a pivotal role in this pandemic.

“What can we do to treat this?” one patient asked. “How long will I stay in the hospital?” asked another. “Will I ever taste or smell again?” asked a third. “Can you give me the vaccine and just get this all over with?” asked a fourth.

“We can give you oxygen and steroids, but otherwise there’s no cure.” “You may be here for a few days, or a month. It’ll depend on if you’re able to keep your oxygen levels up without that mask or not.” “Almost half of people still don’t have their taste or smell back, more than 6-months to a year later. I’m sorry.” “No, the vaccine prevents serious disease. It can’t fix it.”

Patient after patient asked for the vaccine.

Patient after patient had hurt, dejected, or offended looks in their eyes when I said it was too late.

Then, one day, everything changed.

I walked in for a morning shift, and all I heard were vent alarms. The Respiratory Therapists were exhausted and demoralized as they ran from room to room. I looked in after them, where they left and where they entered. One man lay alone in a room with a tube in his throat, a ventilator beside him, and a big circled + on his door. When I read his chart, he’d already been in that room for 30 hours. He was being managed by the ICU doctor.

In the ED. In a bed that shouldn’t be occupied for more than four or five hours at a time.

And beside him was another.

And another.

And another.

There were so many patients waiting for beds that we shut down one entire wing of the ED for their use.

The ICU and medicine teams sent physicians, residents, and nurses down to manage them.

And still our lobby was full. Eight hour waits. Ten hours. Twenty hours. Thirty hours. In our waiting room, just waiting.

It was no longer a surprise when the lab called with positive COVID tests.

“This is Dr. Blomgren. You have how many critical results? Three? Let me guess, COVID? *chuckles* Alright, what are their names.”

Some cases were quick and easy. I knew it by reading their xray. Never in medicine is one able to make a diagnosis from a single test, but a bad COVID xray is easy to see.

Others caught us off guard.

The altered guy found down by family, who said no more than three words to us until asked if he’d gotten a COVID vaccine, had no problem telling us (between labored breaths) how it was all a conspiracy and that the vaccine was a government ploy to poison us all.

We ran our differentials. Stroke? Seizure? Electrolyte problem? Infection? Injury? Brain bleed?

His xray gave us our first hint.

His oxygen needs were our second.

Two hours later, the lab confirmed our suspicion.

COVID.

During hand off (where ED teams pass on the patients to the new guys so they can go home), the attending said to his relief “That guy is probably going to die. We can’t keep up with his oxygen, he’s already altered, and his vitals are falling before our eyes.”

But that wasn’t the worst of it.

I walked in for a night shift. 10pm at night.

And the halls were lined with patients in hospital beds. On ambulance stretchers. Two ambulances were pulled off the street so their crews could be used to transport and watch over the lines of patients.

Some patients had been there for six hours. Too sick to wait in the lobby, too healthy to be rushed into a room.

Our zone was locked down. All but two patients were simply waiting for beds upstairs.

So I started searching the halls for patients. “Who is this?” “What’s their name?” “Is this Mrs. X?” “I’m looking for Mr. Y, they’re slotted to come to our zone, and I wanted to get their workup started.”

I had never felt so overwhelmed at work. I had never felt so helpless.

I had never felt so scared.

When I left ten hours later, the halls were slowly emptying, but not completely.

And that day’s ebb and flow of new patients was just about to begin.

The next night, the ED was quiet.

We were full. Every bed was occupied. Every third door was marked with a big, circled plus sign.

But with so many closed doors and so many people in isolation, the usual sounds of a bustling department were absent.

The 10th busiest ED in the country. Was quiet.

And yet, was bursting at the seams.