Yesterday I came home in a mood that was hard to describe. I'd seen a battle zone, a Covid death, and exposed myself to the virus. I haven't had the maxine but I've most likely had the Covid early on in 2020. I was in shock, I suppose, but knowing that it's my job and I'm going to have to do it again, I didn't feel safe enough to process my grief and my pain over what I saw.
I suppose in a way, like most physicians do, I compartmentalized it.
My job on some days, isn't to give anesthesia. It's to sit in a call room, waiting, for twelve hours, to run to someone who is in need. Someone who is dying from the Covid. Someone who needs a breathing tube in them for them not to die.
I heard an overhead page while I was talking with a friend. I couldn't hear it. I had to call the operator to see what it was.
It was only a urgent response team call.
I didn't have to go. To that, to code blue, no. But Code 19, yes.
The call had ended, a close friend was texting me, and I heard my call. Code 19, and they said the bed. It was actually four floors above me. I have to take the elevator, because the stairs will lock you out of the building. If you go across the courtyard like always, then there's a chance someone who didn't have their temperature taken would go in. So I ran to the elevator.
A large, heavy-set young worker had a huge cart with linens on it. She was waiting. I didn't say anything to her, but when the door opened I went in and I closed it.
She reopened the door, and slowly pushed her cart in.
I looked at her, I'm holding my gym bag with my PPE CAPR in it, and with panic in my eyes said, 'I'm going to the Code 19, I have to go, the patient will not make it because of this delay!'
She looked at me like she was on another planet, as if my words had slapped her, and yet kindly she agreed with me. I looked at her with puzzlement?
She slowly explained, on that long elevator ride, that her brother had been in ICU for four months, and finally, beat the Covid. She thanked me for what I do.
And I understood.
I ran from the elevator to the new purple door I've never seen on that part of the step-down unit in the hospital.
I opened it and started putting on my next layer of PPE. Shoe covers, another head cover, another mask to wear over mine, eye protection, double gloves, a gown. Like a surgeon, I stood there while two nurses assembled my CAPR--I don't know how to put it on to be honest. They put my shroud over my head to protect my neck and shoulders, Then the CAPR, where they peeled the sticky layer off the eye shield and stuck it on my chin to seal the airtight seal to protect me, and hooded like an astronaut they made sure the battery that drove the fan (I guess that makes it a PAPR) was clipped on my gown tie.
Pharmacy had to be called twice to provide the intubation drugs. They showed up. And the bigger Glide Scope was summoned from the ICU because the screen on the portable hand-held was too small.
I step in the room to see an elderly asian male, ghastly color, and even ghastlier tracing on the monitor, connected to a BiPap machine. It's like a CPAP people wear for sleep apnea, but a little more 'oomph'. That means that Covid is flying around the room, everywhere--there's no breathing tube.
The nurse, thankfully, pointed to the lack of EKG and we checked for a pulse. The heart had stopped. The code status was 'breathing tube only'. No pushing on the chest, no electricity to restart the heart, no emergency code drugs like epinephrine. She called the family and asked me to wait there. Gently, kindly, she let them know their loved one wasn't doing well. And that we aren't allowed to put in a breathing tube after the heart has stopped.
Instead of the life-saving intervention like I did before, I was asked to pronounce the patient dead. I did. And the team turned the BiPap off and disconnected it. It's hard to describe that moment when you've been on medical teams your whole career. It's poignant. A life has passed. It touches us each deeply. We have respect for what happened, and at the same time, responsibilities for our other patients. There is a whole series of events that need to take place afterwards, more tasks, so that then after the pause--is set in motion. The system doesn't allow for emotion, aside from saying, 'that's sad' and moving on.
In those few moments, waiting for the nurse, I was searching, searching, searching in the realm of Spirit. I said the Reiki Transition symbol at the foot of the bed. Remember, to work effectively, it's said/done three times. Not one. I'm not sure in my video if I explained that part clearly.
Then I was listening, listening for the soul to speak.
'I'm TIRED.' it said.
I didn't see anything but I knew Ross and my teams were there.
I wrote a note documenting the death. No breath sounds, no heartbeat, no pupil reaction to light.
The nurse had taken my PAPR off me and was cleaning it. Again, I was there with only eyeglasses to protect my eyes. Exposed again. But truly, in the room, I saw the charge nurse of ICU without her gloves on, and the face shields seriously don't do much to protect the rest of the team, not like my PAPR does. In ICU, RT and RN and I all three had on the PAPR/CAPR things. It made me sad.
Yet at the same time, I was thankful for the courage of the nurses. They were so pleasant, the whole team of about four people at the bedside. One was RT. These are the true heroes, not in the trite sense of the word, but in the deeper meaning of selflessness, and love.
I've known many who have retired or avoided the Covid Unit like the plague. It is a plague. It's from a lab. It's not natural. But those of us who have to go in it, we share a bond, like brothers in battle--because together we face the danger side by side.
This was someone's grandpa, undoubtedly. He died alone in a bed, surrounded by strangers, and he was unresponsive. Nobody comforted him, or held his hand. We were all waiting for the news from the nurse as how to proceed next.
Even if there was a volunteer, the hospital wouldn't allow it.
My friend from high school, who is a high ranking nurse practitioner for the hearts program, had said their team had offered to help the pulmonologists with the critically ill patients and help manage them. They went through all the recredentialing but at the highest levels, the hospital said no because the teams who knew them as cardiology would be confused if they were doing what pulmonary does at our hospital.
She had just gotten over it herself three weeks ago. It wasn't easy and she had proned (lie on your tummy) herself. Her sats never got below 94%. But she was still feeling it, the tiredness and struggle to breathe when she returned to work.
Two other cardiologists had it.
At lunch inside while I was in line for my pho bowl--I overheard doctors talking about the ER doctor we know who caught it. One of the surgeons shared he had trached (put in a tracheostomy) him. I had just looked online for obituary for the doc, and didn't see it, and had breathed a huge sigh of relief.
In the O.R. now, scrub techs share that they have had it. It wasn't bad, etc. etc.
Covid is making its rounds not only with the patients, but with the staff at the hospital. There's kind of a lot of secrecy who had it. Unless they self-report, you don't know.
There are only a few beds, half wards, that are not Covid. Our PreOp Holding now has six unit patients. (ICU, unit, same thing). We are not allowed to open any of the double doors at the end of the hall.
Fortunately, the Covid call is only twelve hours. And my group has been kind to allow me to take the call during the days so I am home with Anthony.
Bless him. He cooked the chicken for us like I asked. I showered, and in my pj's finished cooking brussels sprouts, made a salad, and reheated the baked beans that were leftover. We sat at the table, instead of in front of the TV, and it was a very happy time to share and talk. I opened my Palm Rosé eighteen dollar bottle of wine a nurse at the surgery center had given me. It was so beautiful in the glass, and very good quality.
For dessert, I made blueberries fresh, a little angel food cake slice (lowest calorie of any dessert seriously), whipped cream until the can ran out--it was on the end, and I drizzled what was left of the sweetened condensed milk over the cake. He was thrilled and thought it looked so good!
I went to bed at ten.
Today is backup call. I'm in my pajamas, my services haven't been needed yet.
We will have homemade pork sausage patties, biscuits (from the cardboard thing already made you just bake) and maybe a little gravy. And lots of fruit! Strong coffee too. I need it.
Ross wants you to remember the ties, and also, he reminds us of the importance of being who we are, where we are, at any given time. He wants us to turn off the social media as well as the conventional if it is disturbing us. He points out that I turned off the big TV in the doctor's lounge when no one was looking. It was blaring and so negative! He says it's the little things like that which make a big difference in the overall scheme of things.
clap! clap!
Aloha and Mahalos,
Namaste,
Peace,
Ross and Carla
The Couple who are familiar with death and life which follows death
