Last weekend, my partner witnessed some of the pandemic’s collateral damage in an upsurge of violent deaths via car wrecks and shootings. A patient of mine, chief of the local SWAT team, had predicted as much: he gave people two weeks at home before they started acting out. I expected a similar weekend and was pleasantly surprised at how few calls I received by late Saturday night. But it doesn’t take many to change things. At 3 a.m. on Sunday morning, I was called about a man in his upper 70s with a brain hemorrhage, presumably from a ruptured aneurysm. He was getting sleepy and less responsive, and as I arrived, the ER doctor was preparing to place a breathing tube to protect his airway. This process is now fraught with danger, as aerosolizing the virus is a great way for everyone to get infected. The staff looked ready for battle. I barely recognized the ER attending under her face shield, goggles, and N95 mask covered with a Level 1 mask, the rest of her swathed in a plastic gown, and gloves. She must do this now every time she intubates a patient. Normally crowded and noisy, the ER was quiet. There were no families waiting: only masked patients, on their own, behind closed doors. Among the staff, there was palpable anxiety and little of the usual humor. Some seemed accepting; others determined, even defiant. All radiated intensity, and I understood that all these reactions are what courage looks like. Everyone was careful about where they sat and put their hands. By the time I arrived, the patient with the hemorrhage was waking, and we decided not to intubate him. I called his desperately worried wife to tell her what was going on, putting my cellphone on speaker and holding it up so they could talk. They professed their love in a conversation made poignant by forced distance and by their fears that this might be the last time they ever spoke to each other. We admitted him to the neuro-ICU, and the next morning, my partner performed an angiogram: no aneurysm. Today, the patient is more lively, no longer in excruciating pain. He will likely get through this unscathed. I typed my notes at the nursing station, next to a large, crudely fabricated plexiglass box, not sure what to make of it but more worried about whether the keyboard was contaminated. A patient across the hall suddenly went into cardiac arrest. I watched, transfixed, as the team performed CPR. The doctor who only moments earlier had prepared to intubate my patient raced into the room, still in full combat gear. A nurse ran over and grabbed the plexiglass box: I realized it was made to place over the patient’s head for added protection during intubation. Alarms beeped, and a tech ran blood samples to the lab. A nurse performed chest compressions. As in any unexpected code, many people were crammed into a tiny space. Two hours later, I was called about a woman in her early 50s with a large subdural hematoma and a blown pupil who was progressively less responsive. She was on Coumadin for a previous pulmonary embolism. The normal INR for someone on this drug is 2 to 3. Hers was 6. When someone’s blood is this thin, they tend to bleed spontaneously. The ER doctor rapidly reversed the blood thinner and intubated her trachea to protect her airway. We rushed her to surgery. Something in the history her husband gave us disturbed me. She’d had a cough and low-grade temperature for the last few days and stayed in bed all day Saturday. She had no fever in the ER, but playing it safe, I asked everyone in the OR to assume she was COVID-19 positive even though she was considered low risk. We all wore N95 masks and protective gear, but we didn’t use the OR set aside for COVID cases since we thought it unlikely she was truly infected. Our patient’s surgery went well. Her blown pupil came back to normal size. I called her husband afterward—he hadn’t been allowed to see her, and I could tell he was desperately worried. Her husband works in manufacturing and was concerned he might expose her, so they had begun sleeping separately, given her general ill-health. Saturday, he called throughout the day to check on her. At midnight, she had seemed ill, so he let her sleep. When he went to check on her later, shortly before he called 911, he discovered her lying in a pool of vomit. We recently gained the capacity for rapid testing in our hospital and have a 2-hour turnaround for results. Based on her history alone, we tested our patient after her surgery. It came back positive. By my calculation, this patient had come in contact with 30 health care workers. My partner was planning to pull her breathing tube the next morning, assuming the blood didn’t reaccumulate. Without knowing her COVID-19 status, everyone caring for her would have had a major viral exposure. They would have had to self-quarantine for two weeks. For a health care worker, even a low-to-average average exposure is terrifying, though not knowing is even more so—testing with rapid turnaround is crucial. That afternoon, the infection control department would call each of the staff members who cared for our patient to notify them they had been exposed. The team, now wearing full protective gear, wheeled our patient from the neuro-ICU to the newly designated COVID-ICU. While our patient is doing well from her neurosurgery, she is now in for the fight of her life. Home after what proved to be a long weekend and obsessively reviewing every move I had made in the preceding hours, I stripped off my clothes and retreated into the shower, hoping I could scrub away any possible trace of the virus along with the stress and anxiety of everything I had just lived through. Joseph Stern is a neurosurgeon. His upcoming book, Grief Connects Us: A Doctor’s Lessons on Love, Loss, and Compassion, will be published in Spring 2021. Source
