The worst has not begun and today, I found it hard to go on.

[Islesguy]

Your feelings are understandable. I can't even imagine what it must be like. It's as if we are all in a science fiction movie that we never auditioned for.

 

I recently came across an opinion piece in the NYT that I agree with. The blame that we are in this fix regarding short supplies is due to government and businesses prizing efficiency as the highest good. Unfortunately efficiency doesn't respond well to crisis because surpluses aren't considered efficient. My thoughts are with you and all the first line responders out there.

 

If I end up surviving this, I wonder if I will see changes in business and government so that hopefully we are more prepared next time.

 

Gman

Not just efficiency but profit motive and monopoly power. One company that started making cheaper ventilator was purchased by large corporation solely to close it so it could keep out competitors that threatened it's profitability.

[beachboy]

Not just efficiency but profit motive and monopoly power. One company that started making cheaper ventilator was purchased by large corporation solely to close it so it could keep out competitors that threatened it's profitability.

When people are dying for want of ventilators that is obscene.

[MikeBiDude]

One company that started making cheaper ventilator was purchased by large corporation solely to close it so it could keep out competitors that threatened it's profitability.

Link or cite for this info please?

[Islesguy]

Link or cite for this info please?

https://www-bloomberg-com.cdn.ampproject.org/v/s/www.bloomberg.com/amp/news/articles/2020-03-30/covidien-ventilator-merger-needs-new-look-ftc-official-says?amp_js_v=a3&amp_gsa=1&usqp=mq331AQFKAGwASA%3D#aoh=15858401619706&referrer=https%3A%2F%2Fwww.google.com&amp_tf=From%20%251%24s&ampshare=https%3A%2F%2Fwww.bloomberg.com%2Fnews%2Farticles%2F2020-03-30%2Fcovidien-ventilator-merger-needs-new-look-ftc-official-says

[+ azdr0710]

Let's keep politics out of this and keep it to being grateful for the health care workers on the front line. Note Guy Fawkes's admonition in another thread.

 

Believe me, there are plenty of threads about coronavirus policy in the Politics subforum (if you can imagine!)

[+ Gar1eth]

Not just efficiency but profit motive and monopoly power. One company that started making cheaper ventilator was purchased by large corporation solely to close it so it could keep out competitors that threatened it's profitability.

 

I read that article too.

 

Gman

[BasketBaller]

I do not usually have a difficult time coping. Life is hard and mine has been easier than most. But today, I have just hit the wall. Working in a New Jersey Hospital is not nearly as difficult right now as working in a NYC Hospital. We have most equipment. We have beds. We have staff. We have patients and each day we have more and more patients. Right now the numbers are not overwhelming but they are increasing and more and more compromises are being made. Most of the staff are just doing their job. But there is an air of anxiety and trepidation hanging around every corner. There are hollowed shells walking the halls. Fear and uncertainty is everywhere. There are no laughs not even at jokes with a dark humor,

 

I went into work today and started the day as part of a physician conference call. The conference call was to inform us that the governor has given physicians immunity. This is not being widely publicized. Essentially, within the scope of good medical practice, we cannot be be sued for actions that previously would have been not only malpractice but quite possibly criminal. That is, we were informed of the plans for the upcoming ventilator shortage. It is not first come first served as it is in the toilet paper aisle. There is no hoarding or buying for a friend, When the respirators are 90% in use, which is the case in several hospitals in New Jersey, then patients are assigned a color code. Green patients are those that get to keep the respirators. Yellow are the patients about whom clinical status and general condition are favorable. Red are the patients that are first in line to have their respirators removed should others in higher categories need them. Blue, well blue never get the respirator from the onset.

 

I could barely contain my anger, fear, frustration, and utter disappointment. We knew this was coming, I knew it was coming but now it is here and it is a palpable real pain, physical, mental, emotional and spiritual. We were given guidelines as to what to tell family members when it is time to take their loved one off the ventilator. They do no have the final word. There is an appeals process, but that process can only last 30 minutes while the patient waiting for the ventilator is manually ventilated, Two more hours will be needed to clean the ventilator and reequip it.

 

Three people will take turns manually ventilating the patient, Oh did I mention that once you are assigned a color, the person coming off the respirator would have had to be on the respirator for 5 days, so theoretically long enough to turn the corner and get themselves into a higher color group. However, the decision as to who comes off the respirator is made by random computer selection of those in the lowest category.

This is not to say that the assignment of the color group is random.

 

Patient's are stratified by a variety of factors, age NOT being one of them.

 

Today, I had a new patient with possible Covid admitted to my service. She is 87 with a touch of dementia and lives at her daughter's home with a loving family. I spoke with her daughter on the phone to get information about her mother. She told me to try and do everything to help her mother but that if it was clear that there was no hope of her returning to her previous level of functioning, or close to it, that her mother had decided long ago that she did not want to live that kind of life.

 

When I went into see the patient, I gowned and gloved and on the way in , I noticed her lunch tray and decided to give a hand to the other staff by bringing it in. PPE (personal protection equipment ) is still sufficient but not plentiful so my act saved one set. I brought her lunch tray in with me and saw a pleasant looking woman who appeared about 15 years younger than her age. She had eyes closed and did not respond when I called her name. I put down her lunch tray next to her untouched breakfast tray and did my exam. She appeared to be comfortable and was definitely someone who was doing much better than her numbers (lab values vital signs and other measurable qualities). I went to leave and the empty breakfast tray and the new lunch tray just haunted me. I opened the packet for her utensils and the vanilla pudding put a bit on the spoon and placed it by her lips. She opened her lips and took a taste. Then another. Some of her fruit cup and then most of her mashed potatoes followed. A bit of meatloaf and then the rest of her pudding. She said nothing. She did not open her eyes, even as I tried to coax her to do so. Finally, on a bit of the meatloaf.

 

She refused to open. Another offer and another refusal and so I knew after 30 minutes of being fed, she was not taking any more. I said out loud to her, I guess that is it for now and as I left I heard her faintly say: Thank you. I turned and her eyes were open and then, a second later, they closed again. For that second they were so clear and blue and aware and I imagined her quite the beauty in her youth. After that second, she was back in that space where she was when I walked in, but she had let me know she was there.

 

Next week, her condition may worsen and she will be a blue. She won't get a chance at a life saving machine, She will likely pass alone in a hospital with a loving daughter sitting at home hoping for all the world for her mother to get better. Even if I could do more medically, which I cannot, I could not alter her course. Even now, the most I could do for her he be present, give her some pudding and hope that time and some combination of medications we are giving her make a difference,

 

I do not usually have difficulty coping, but today I hit the wall and next week this day will be the good old days when I had 30 minutes to spend with one patient.

 

I am in tears. Thank you for everything you are doing.

[jjkrkwood]

News reports today that request for WILLS is up 200%...even for people under 65. So scary and unspeakably sad..

[+ Hoover42]

I'm so sorry, PK, for all you're going through.

 

We're in a war against a terrible virus now, and you're on the front lines.

[liubit]

Thank you very much, @purplekow. The comfort you can bring to the suffering is just invaluable. I was very moved by your post, and I am glad you shared. Keep up your precious work, we all are grateful.

[+ stevenkesslar]

First Responders First

 

Thank you @purplekow. The stories of the doctors and nurses and hospital personnel, and their resilience and the support they give each other, are amazing to watch.

 

That's one way those of us staying close to home can help. I've donated several times. I found out about it from Trevor Noah on The Daily Show.

 

Before I made my first donation I spent about 10 minutes looking around online. This seems to be one of the primary ways to donate, run by and for front line health care workers. Most of the other ones I could find were individual hospital systems or state governments asking for donations. It is sad they have to do that in the middle of a pandemic.

 

The website states: "Donations to #FirstRespondersFirst will provide essential supplies and equipment for protecting frontline healthcare workers and their patients."

 

If anyone knows of other organizations doing this, could you let us know?

[+ purplekow]

Thank you, PK, for your beautiful, moving, and very human post. God bless you and all you work with. I am sure God is blessing so many others through you.

 

I lost my first friend to the virus today. When I worked in NYC in the early 2000s I was his mentor while he was doing his professional training. He did very well, was greatly loved in his work. He was in Queens. I will miss him. I take comfort in knowing you, and countless others like you, are helping so many now in need. Thank you.

My condolences on your loss. I hope your friend knew how loved and appreciated he was. Thanks for your support of me on a day when I was not my strongest. Today, I am a lot better and your note and the notes of the many men here who have taken time to jot a note or send a missive has really helped reinvigorate me. Thanks to all here and again my condolences/

[+ purplekow]

I know some of you are curious as to what is going on in the world, the numbers, the policies, the what ifs, the should have beens. I just want to give you an idea of what goes on down where the results of those decisions which have been made come home to roost. So I will be posting a brief update on what is going on here based on truth but changed enough so as to not have any patients identifiable. .

At midnight last night, after I had written my patient notes for the day and before heading to bed, I got on line to check how my patients were doing so the number of surprises are minimal for the next morning. Just as I signed on, I notice one of my patients, a 51 year old man who had had Covid for 10 days and was at home and then started doing worse and had been admitted to the hospital 2 days ago, was reported as having a respiratory rate of 30. He was not oxygenating well and they had increased the oxygen and then changed from a nasal oxygen supplying cannula to a face mask. I called the hospital and spoke to the nurse caring for the patient. She had called the resident who was on call but he was in the room next door intubating a patient who was being sent to the ICU and being placed on a ventilator. She told me the patient, despite the numbers, looked significantly better than he had an hour ago. 6 hours early, when I left the hospital, he looked very well and when I spoke to him and then his wife by phone, I mentioned that he was doing better and a discharge to home might happen in the next few days. Suddenly, at 11:30 everything became worse. He still said he was well but clearly he was not. I asked the nurse to have the resident call me after the resident was done with his other patient. I scanned the other patient's charts and except for the elderly lady I spoke of in the beginning of this post, they all were fairly stable. The older woman was requiring more oxygen and was now a bit agitated whereas during the day she had been calm, sleeping, not easily roused. This kind of change in behavior is common in patients with dementia who are hospitalized or have a dramatic change in their environs. When I called her nurse, I was told the patient was just settling down and had shown some improvement.

After an hour or so, the resident had not called and so I called back and spoke with him. The patient had responded well to the additional oxygen. His breathing rate had dropped from 35 to 20 and he was oxygenating well on the higher concentration of oxygen, The patient did not feel short of breath but when he was treated, he admitted to feeling more relaxed. The resident went off to work and I went to bed. It was about 3AM.

At 7 AM I got out of bed and felt a bit warm and took my temperature as is that is now part of my morning routine. Wake up, hit the snooze alarm for another 5 minutes and then lay there as I take my temperature, listen to the news and generally see if body parts are working. Then I get up and into the shower. My temp was 99.3, Not a fever but higher than I usually have. I showered and as the water ran over me, I could not shake the temperature reading. I took it again. 99.5. Probably went up as a result of the how water in the shower. The phone rang and it was the morning check by the team leader. She told me that one of the local hospitals had closed to admissions and that we would be taking their overflow. I told her about my temperature and she quizzed me about my health, advised me to take it again and instructed me to stay home if I felt at all ill. I continued getting dressed. I told her I would drive over and if I felt unwell or the temperature was higher, I would go home.

I arrived, I sat in the parking lot taking my temperature and contemplating that perhaps I had contracted the disease. It is a thought all the care provides I have spoke with about this have several times a day. Standing on an elevator, at a stoplight, any second that you are not otherwise distracted that thought can jump up at you. I suppose many people get that thought.

The temp was down to 98.6 and I headed in. My first stop was the man who had had a bad turn the night before. He had improved before I went to bed but he was having some difficulty this morning. I was helpful on with my gown by the spotter that ensures that each person gowning up to see a patient is properly prepared. The patient had gone from droplet precaution which is basically a six feet away and basic protective apparel including a mask and gloves and gown, to aerosol protection because of the high rate of oxygen which aerosolizes the virus and gives it a wider spread in the room. So now it was gown, gloves,N95 masks, already in short supply at the hospital, I was reusing one I had cleaned and placed out in the sunlight. Sunlight may help kill the virus on surfaces and I had not worn the mask for a long enough time that it was probably safe to wear. Then a surgical mask, a plastic face shield and a quick entrance into the room. He greeted me with a smile but it was clear he was breathing more rapidly. After a greeting you might give a frequently seen acquaintance you meet on an elevator, we got down to the hard conversation. Things were not looking good. His oxygenation was poor. His respiratory rate was fast. His screening tests for activity of inflammation in the body were all going up after a few days of a plateau. I explained to him what this meant and then broached

the subject of a ventilator. I explained to him that it was likely he was going to need to be placed on a ventilator. We would try to do everything to prevent or postpone that, but we needed to be sure that this is what he wanted. I told him there was no guarantee even with the ventilator that things would turn around. He half asked half implored why this was happening to him. I had no good answer so I gave him the answer that I had, which was that I did not know why some people do worse than others with this virus. I did not have the answer to the question as to why he had been doing well and then suddenly was not. I did not have the answer to how long he might be on a respirator if he needed one but I did tell him it would more likely be weeks rather than days. As to what he could do, all I could offer is that he lie prone, chest and abdomen down, as that seemed to aid in this situation. It is called proning. He had tried it before and could not tolerate it. I encourage him to do the best he could and that half the day each day that way may make a difference. He asked why he could not eat or drink and I told him that if a tube was needed we did not want him vomiting as they put it in. He asked me to call his wife. I asked him how much of the details he wanted me to share with her. He said he wanted me to tell her everything, He then said: "I don't want to die". I am tearing up now as I type that but at that time, I needed not to show the desperation I felt for him. I offered him: "We will do our best to send you home to your wife" We will watch you closely. Lie prone. I will see you later". He thanked me as I left. He was sincere and I know I did all that I could, but I definitely did not feel that I was deserving of thanks. But if he had thanked me only to make me feel better, he had succeeded.

The next time I saw him, four hours later he was sedated, in the ICU and on a ventilator. He was prone. In the interim, I called his wife who had clearly been hitting the computer sites hard. I answered her questions, sometimes the same one twice or three times and then finally went on to the next patient.

The next patient was the elderly lady who had been looking worse last night and did indeed look worse this morning. I will likely report on her tomorrow if there is interest in this kind of posting. IF not, I will not burden you guys with all of this if I get the sense that this is not of interest, but I think it was important that you at least get a sense of the minute to minute horror of this.

I did report that I am doing better today. I am doing better. My temperature never went up to over 99 again and I am home now The onslaught from the closed hospital was not very severe today and up until now, no one under my care died today. That pretty much is the best day I could have. I am going to be finishing up my notes, doing a quick computer check on the patients and then try to get some rest.

Edited April 3, 2020 by purplekow

[rvwnsd]

I know some of you are curious as to what is going on in the world, the numbers, the policies, the what ifs, the should have beens. I just want to give you an idea of what goes on down where the results of those decisions which have been made come home to roost. So I will be posting a brief update on what is going on here based on truth but changed enough so as to not have any patients identifiable. .

At midnight last night, after I had written my patient notes for the day and before heading to bed, I got on line to check how my patients were doing so the number of surprises are minimal for the next morning. Just as I signed on, I notice one of my patients, a 51 year old man who had had Covid for 10 days and was at home and then started doing worse and had been admitted to the hospital 2 days ago, was reported as having a respiratory rate of 30. He was not oxygenating well and they had increased the oxygen and then changed from a nasal oxygen supplying cannula to a face mask. I called the hospital and spoke to the nurse caring for the patient. She had called the resident who was on call but he was in the room next door intubating a patient who was being sent to the ICU and being placed on a ventilator. She told me the patient, despite the numbers, looked significantly better than he had an hour ago. 6 hours early, when I left the hospital, he looked very well and when I spoke to him and then his wife by phone, I mentioned that he was doing better and a discharge to home might happen in the next few days. Suddenly, at 11:30 everything became worse. He still said he was well but clearly he was not. I asked the nurse to have the resident call me after the resident was done with his other patient. I scanned the other patient's charts and except for the elderly lady I spoke of in the beginning of this post, they all were fairly stable. The older woman was requiring more oxygen and was now a bit agitated whereas during the day she had been calm, sleeping, not easily roused. This kind of change in behavior is common in patients with dementia who are hospitalized or have a dramatic change in their environs. When I called her nurse, I was told the patient was just settling down and had shown some improvement.

After an hour or so, the resident had not called and so I called back and spoke with him. The patient had responded well to the additional oxygen. His breathing rate had dropped from 35 to 20 and he was oxygenating well on the higher concentration of oxygen, The patient did not feel short of breath but when he was treated, he admitted to feeling more relaxed. The resident went off to work and I went to bed. It was about 3AM.

At 7 AM I got out of bed and felt a bit warm and took my temperature as is that is now part of my morning routine. Wake up, hit the snooze alarm for another 5 minutes and then lay there as I take my temperature, listen to the news and generally see if body parts are working. Then I get up and into the shower. My temp was 99.3, Not a fever but higher than I usually have. I showered and as the water ran over me, I could not shake the temperature reading. I took it again. 99.5. Probably went up as a result of the how water in the shower. The phone rang and it was the morning check by the team leader. She told me that one of the local hospitals had closed to admissions and that we would be taking their overflow. I told her about my temperature and she quizzed me about my health, advised me to take it again and instructed me to stay home if I felt at all ill. I continued getting dressed. I told her I would drive over and if I felt unwell or the temperature was higher, I would go home.

I arrived, I sat in the parking lot taking my temperature and contemplating that perhaps I had contracted the disease. It is a thought all the care provides I have spoke with about this have several times a day. Standing on an elevator, at a stoplight, any second that you are not otherwise distracted that thought can jump up at you. I suppose many people get that thought.

The temp was down to 98.6 and I headed in. My first stop was the man who had had a bad turn the night before. He had improved before I went to bed but he was having some difficulty this morning. I was helpful on with my gown by the spotter that ensures that each person gowning up to see a patient is properly prepared. The patient had gone from droplet precaution which is basically a six feet away and basic protective apparel including a mask and gloves and gown, to aerosol protection because of the high rate of oxygen which aerosolizes the virus and gives it a wider spread in the room. So now it was gown, gloves,N95 masks, already in short supply at the hospital, I was reusing one I had cleaned and placed out in the sunlight. Sunlight may help kill the virus on surfaces and I had not worn the mask for a long enough time that it was probably safe to wear. Then a surgical mask, a plastic face shield and a quick entrance into the room. He greeted me with a smile but it was clear he was breathing more rapidly. After a greeting you might give a frequently seen acquaintance you meet on an elevator, we got down to the hard conversation. Things were not looking good. His oxygenation was poor. His respiratory rate was fast. His screening tests for activity of inflammation in the body were all going up after a few days of a plateau. I explained to him what this meant and then broached

the subject of a ventilator. I explained to him that it was likely he was going to need to be placed on a ventilator. We would try to do everything to prevent or postpone that, but we needed to be sure that this is what he wanted. I told him there was no guarantee even with the ventilator that things would turn around. He half asked half implored why this was happening to him. I had no good answer so I gave him the answer that I had, which was that I did not know why some people do worse than others with this virus. I did not have the answer to the question as to why he had been doing well and then suddenly was not. I did not have the answer to how long he might be on a respirator if he needed one but I did tell him it would more likely be weeks rather than days. As to what he could do, all I could offer is that he lie prone, chest and abdomen down, as that seemed to aid in this situation. It is called proning. He had tried it before and could not tolerate it. I encourage him to do the best he could and that half the day each day that way may make a difference. He asked why he could not eat or drink and I told him that if a tube was needed we did not want him vomiting as they put it in. He asked me to call his wife. I asked him how much of the details he wanted me to share with her. He said he wanted me to tell her everything, He then said: "I don't want to die". I am tearing up now as I type that but at that time, I needed not to show the desperation I felt for him. I offered him: "We will do our best to send you home to your wife" We will watch you closely. Lie prone. I will see you later". He thanked me as I left. He was sincere and I know I did all that I could, but I definitely did not feel that I was deserving of thanks. But if he had thanked me only to make me feel better, he had succeeded.

The next time I saw him, four hours later he was sedated, in the ICU and on a ventilator. He was prone. In the interim, I called his wife who had clearly been hitting the computer sites hard. I answered her questions, sometimes the same one twice or three times and then finally went on to the next patient.

The next patient was the elderly lady who had been looking worse last night and did indeed look worse this morning. I will likely report on her tomorrow if there is interest in this kind of posting. IF not, I will not burden you guys with all of this if I get the sense that this is not of interest, but I think it was important that you at least get a sense of the minute to minute horror of this.

I did report that I am doing better today. I am doing better. My temperature never went up to over 99 again and I am home now The onslaught from the closed hospital was not very severe today and up until now, no one under my care died today. That pretty much is the best day I could have. I am going to be finishing up my notes, doing a quick computer check on the patients and then try to get some rest.

 

I, for one, am interested in hearing more. It is easy to get lost in a sea of numbers, predictions, and risk assessments. It is not so easy to get lost in a real-world account like yours.

 

Thank you for your service and for your compassion.

[+ sam.fitzpatrick]

PK - thanks for sharing your journey in this unusual time. Please know, we will read whatever you wish to share. As insightful as reading these posts have been to me, I pray that they also provide some relief to you.

 

Sending a great big virtual hug your way.

[Guest]

I know we don’t always agree on things here, but I sincerely appreciate your story, your commitment, and your compassion. I hope the best for you and everyone you interact with in coming weeks.

[+ José Soplanucas]

I will likely report on her tomorrow if there is interest in this kind of posting. IF not, I will not burden you guys with all of this if I get the sense that this is not of interest

 

Please, keep reporting. I know I am interested and besides it is not only about us but about you. It may really help you to cope with this challenge.

 

Thank you so much for being in the trenches.

[Islesguy]

I know some of you are curious as to what is going on in the world, the numbers, the policies, the what ifs, the should have beens. I just want to give you an idea of what goes on down where the results of those decisions which have been made come home to roost. So I will be posting a brief update on what is going on here based on truth but changed enough so as to not have any patients identifiable. .

At midnight last night, after I had written my patient notes for the day and before heading to bed, I got on line to check how my patients were doing so the number of surprises are minimal for the next morning. Just as I signed on, I notice one of my patients, a 51 year old man who had had Covid for 10 days and was at home and then started doing worse and had been admitted to the hospital 2 days ago, was reported as having a respiratory rate of 30. He was not oxygenating well and they had increased the oxygen and then changed from a nasal oxygen supplying cannula to a face mask. I called the hospital and spoke to the nurse caring for the patient. She had called the resident who was on call but he was in the room next door intubating a patient who was being sent to the ICU and being placed on a ventilator. She told me the patient, despite the numbers, looked significantly better than he had an hour ago. 6 hours early, when I left the hospital, he looked very well and when I spoke to him and then his wife by phone, I mentioned that he was doing better and a discharge to home might happen in the next few days. Suddenly, at 11:30 everything became worse. He still said he was well but clearly he was not. I asked the nurse to have the resident call me after the resident was done with his other patient. I scanned the other patient's charts and except for the elderly lady I spoke of in the beginning of this post, they all were fairly stable. The older woman was requiring more oxygen and was now a bit agitated whereas during the day she had been calm, sleeping, not easily roused. This kind of change in behavior is common in patients with dementia who are hospitalized or have a dramatic change in their environs. When I called her nurse, I was told the patient was just settling down and had shown some improvement.

After an hour or so, the resident had not called and so I called back and spoke with him. The patient had responded well to the additional oxygen. His breathing rate had dropped from 35 to 20 and he was oxygenating well on the higher concentration of oxygen, The patient did not feel short of breath but when he was treated, he admitted to feeling more relaxed. The resident went off to work and I went to bed. It was about 3AM.

At 7 AM I got out of bed and felt a bit warm and took my temperature as is that is now part of my morning routine. Wake up, hit the snooze alarm for another 5 minutes and then lay there as I take my temperature, listen to the news and generally see if body parts are working. Then I get up and into the shower. My temp was 99.3, Not a fever but higher than I usually have. I showered and as the water ran over me, I could not shake the temperature reading. I took it again. 99.5. Probably went up as a result of the how water in the shower. The phone rang and it was the morning check by the team leader. She told me that one of the local hospitals had closed to admissions and that we would be taking their overflow. I told her about my temperature and she quizzed me about my health, advised me to take it again and instructed me to stay home if I felt at all ill. I continued getting dressed. I told her I would drive over and if I felt unwell or the temperature was higher, I would go home.

I arrived, I sat in the parking lot taking my temperature and contemplating that perhaps I had contracted the disease. It is a thought all the care provides I have spoke with about this have several times a day. Standing on an elevator, at a stoplight, any second that you are not otherwise distracted that thought can jump up at you. I suppose many people get that thought.

The temp was down to 98.6 and I headed in. My first stop was the man who had had a bad turn the night before. He had improved before I went to bed but he was having some difficulty this morning. I was helpful on with my gown by the spotter that ensures that each person gowning up to see a patient is properly prepared. The patient had gone from droplet precaution which is basically a six feet away and basic protective apparel including a mask and gloves and gown, to aerosol protection because of the high rate of oxygen which aerosolizes the virus and gives it a wider spread in the room. So now it was gown, gloves,N95 masks, already in short supply at the hospital, I was reusing one I had cleaned and placed out in the sunlight. Sunlight may help kill the virus on surfaces and I had not worn the mask for a long enough time that it was probably safe to wear. Then a surgical mask, a plastic face shield and a quick entrance into the room. He greeted me with a smile but it was clear he was breathing more rapidly. After a greeting you might give a frequently seen acquaintance you meet on an elevator, we got down to the hard conversation. Things were not looking good. His oxygenation was poor. His respiratory rate was fast. His screening tests for activity of inflammation in the body were all going up after a few days of a plateau. I explained to him what this meant and then broached

the subject of a ventilator. I explained to him that it was likely he was going to need to be placed on a ventilator. We would try to do everything to prevent or postpone that, but we needed to be sure that this is what he wanted. I told him there was no guarantee even with the ventilator that things would turn around. He half asked half implored why this was happening to him. I had no good answer so I gave him the answer that I had, which was that I did not know why some people do worse than others with this virus. I did not have the answer to the question as to why he had been doing well and then suddenly was not. I did not have the answer to how long he might be on a respirator if he needed one but I did tell him it would more likely be weeks rather than days. As to what he could do, all I could offer is that he lie prone, chest and abdomen down, as that seemed to aid in this situation. It is called proning. He had tried it before and could not tolerate it. I encourage him to do the best he could and that half the day each day that way may make a difference. He asked why he could not eat or drink and I told him that if a tube was needed we did not want him vomiting as they put it in. He asked me to call his wife. I asked him how much of the details he wanted me to share with her. He said he wanted me to tell her everything, He then said: "I don't want to die". I am tearing up now as I type that but at that time, I needed not to show the desperation I felt for him. I offered him: "We will do our best to send you home to your wife" We will watch you closely. Lie prone. I will see you later". He thanked me as I left. He was sincere and I know I did all that I could, but I definitely did not feel that I was deserving of thanks. But if he had thanked me only to make me feel better, he had succeeded.

The next time I saw him, four hours later he was sedated, in the ICU and on a ventilator. He was prone. In the interim, I called his wife who had clearly been hitting the computer sites hard. I answered her questions, sometimes the same one twice or three times and then finally went on to the next patient.

The next patient was the elderly lady who had been looking worse last night and did indeed look worse this morning. I will likely report on her tomorrow if there is interest in this kind of posting. IF not, I will not burden you guys with all of this if I get the sense that this is not of interest, but I think it was important that you at least get a sense of the minute to minute horror of this.

I did report that I am doing better today. I am doing better. My temperature never went up to over 99 again and I am home now The onslaught from the closed hospital was not very severe today and up until now, no one under my care died today. That pretty much is the best day I could have. I am going to be finishing up my notes, doing a quick computer check on the patients and then try to get some rest.

Keep updating us. It helps put this in the proper perspective for us.

[+ nycman]

Purple you are a hero.

 

Please take care of yourself as well. Long days in N95 masks are hard on the body and the mind.

Yesterday my twice daily temperature check was 99.2. The quite panic in my head was hard to

control. You are not alone. 98.7 this morning. I had flashbacks to the near hourly checks for

posterior cervical adenopathy that haunted most of my 20’s during the late 80’s. I can still feel

the sore spot where I rubbed the living fuck out of that one prominent lymph node that I just

knew was my death knell.

 

Writing is therapeutic. If for no other reason than to talk to the void. I encourage you to keep sharing

your story as much as you can. Most people don’t really understand the epic tragedy that is now

sealed behind our locked hospital doors. Your writing is important. For you, and for us.

 

There is no end in sight, but that doesn’t mean we shouldn’t keep fighting. In fact, we must fight,

as best we can, with what we have. No one can ask or expect anymore of us than that. That doesn’t

mean it won’t take its toll. No doubt the world will never be quiet the same again. We will lose friends,

patients, and comrades. We are fighting a war with very little ammunition. If it’s not the lack of N95s,

its the number of ventilators, or its the drugs to sedate them, then its the oxygen tank running low......

some days it seems like everything is running out.

 

Nonetheless, I have met many hero’s this week. Colleagues have risen to the occasion to a degree I

would have never guessed a week ago was even possible. And yes, I’ve closed my office door and just

fucking cried more than a few times.

 

Stay strong and know you are not alone.

Edited April 3, 2020 by nycman

[+ Autumnal]

What we all need more than anything right now is the truth, and you are providing that to your patients, and to us. Thank you for your selfless dedication, and thank you for these posts.

[TruthBTold]

Yesterday I watched a PBS documentary that I had recorded the night before. As the first few moments were being narrated I thought to myself, "OMG, this is now." It was about polio a disease that struck everyone and every place randomly. Even one of the most privileged people in the USA , Franklin Delano Roosevelt, could not escape its clutches. Roosevelt began a warm water clinic where other polio patients could be given treatment to attempt to recover from polio. Eventually Roosevelt asked his law firm partner, Basil O'Connor, to take control of the rehab clinic and to begin a campaign in order to secure funding to maintain it. Because the country was in the grips of the Depression attempts to get funds from the wealthy was not enough, so he reached out to the public who was now suffering the most from the epidemic and through various means asked for each person to send a mere 10 cents to the White House to fund a way to find a vaccine against Polio. I never really knew what the March of Dimes was but it arose from the thought that it was everyone, including the government, that had to work together to cure polio. It took a long time to find a vaccine. I highly recommend the documentary.

 

https://www.pbs.org/wgbh/americanexperience/films/polio/

[+ Eric Hassan]

this brought tears to my eyes. thank you for your humanity - for being that person for that woman, and for being that person for us. this is a painful time, and in telling us what your day was like, you allow us to be part of your support system and you lend a face to this crisis which (fortunately) remains out of sight for most of us right now.

[Becket]

Bravo. Thank you. In other news, there is a commercial on TV that features a purple cow. Have you seen it? It made me smile.

[wearytraveller]

I know some of you are curious as to what is going on in the world, the numbers, the policies, the what ifs, the should have beens. I just want to give you an idea of what goes on down where the results of those decisions which have been made come home to roost. So I will be posting a brief update on what is going on here based on truth but changed enough so as to not have any patients identifiable. .

At midnight last night, after I had written my patient notes for the day and before heading to bed, I got on line to check how my patients were doing so the number of surprises are minimal for the next morning. Just as I signed on, I notice one of my patients, a 51 year old man who had had Covid for 10 days and was at home and then started doing worse and had been admitted to the hospital 2 days ago, was reported as having a respiratory rate of 30. He was not oxygenating well and they had increased the oxygen and then changed from a nasal oxygen supplying cannula to a face mask. I called the hospital and spoke to the nurse caring for the patient. She had called the resident who was on call but he was in the room next door intubating a patient who was being sent to the ICU and being placed on a ventilator. She told me the patient, despite the numbers, looked significantly better than he had an hour ago. 6 hours early, when I left the hospital, he looked very well and when I spoke to him and then his wife by phone, I mentioned that he was doing better and a discharge to home might happen in the next few days. Suddenly, at 11:30 everything became worse. He still said he was well but clearly he was not. I asked the nurse to have the resident call me after the resident was done with his other patient. I scanned the other patient's charts and except for the elderly lady I spoke of in the beginning of this post, they all were fairly stable. The older woman was requiring more oxygen and was now a bit agitated whereas during the day she had been calm, sleeping, not easily roused. This kind of change in behavior is common in patients with dementia who are hospitalized or have a dramatic change in their environs. When I called her nurse, I was told the patient was just settling down and had shown some improvement.

After an hour or so, the resident had not called and so I called back and spoke with him. The patient had responded well to the additional oxygen. His breathing rate had dropped from 35 to 20 and he was oxygenating well on the higher concentration of oxygen, The patient did not feel short of breath but when he was treated, he admitted to feeling more relaxed. The resident went off to work and I went to bed. It was about 3AM.

At 7 AM I got out of bed and felt a bit warm and took my temperature as is that is now part of my morning routine. Wake up, hit the snooze alarm for another 5 minutes and then lay there as I take my temperature, listen to the news and generally see if body parts are working. Then I get up and into the shower. My temp was 99.3, Not a fever but higher than I usually have. I showered and as the water ran over me, I could not shake the temperature reading. I took it again. 99.5. Probably went up as a result of the how water in the shower. The phone rang and it was the morning check by the team leader. She told me that one of the local hospitals had closed to admissions and that we would be taking their overflow. I told her about my temperature and she quizzed me about my health, advised me to take it again and instructed me to stay home if I felt at all ill. I continued getting dressed. I told her I would drive over and if I felt unwell or the temperature was higher, I would go home.

I arrived, I sat in the parking lot taking my temperature and contemplating that perhaps I had contracted the disease. It is a thought all the care provides I have spoke with about this have several times a day. Standing on an elevator, at a stoplight, any second that you are not otherwise distracted that thought can jump up at you. I suppose many people get that thought.

The temp was down to 98.6 and I headed in. My first stop was the man who had had a bad turn the night before. He had improved before I went to bed but he was having some difficulty this morning. I was helpful on with my gown by the spotter that ensures that each person gowning up to see a patient is properly prepared. The patient had gone from droplet precaution which is basically a six feet away and basic protective apparel including a mask and gloves and gown, to aerosol protection because of the high rate of oxygen which aerosolizes the virus and gives it a wider spread in the room. So now it was gown, gloves,N95 masks, already in short supply at the hospital, I was reusing one I had cleaned and placed out in the sunlight. Sunlight may help kill the virus on surfaces and I had not worn the mask for a long enough time that it was probably safe to wear. Then a surgical mask, a plastic face shield and a quick entrance into the room. He greeted me with a smile but it was clear he was breathing more rapidly. After a greeting you might give a frequently seen acquaintance you meet on an elevator, we got down to the hard conversation. Things were not looking good. His oxygenation was poor. His respiratory rate was fast. His screening tests for activity of inflammation in the body were all going up after a few days of a plateau. I explained to him what this meant and then broached

the subject of a ventilator. I explained to him that it was likely he was going to need to be placed on a ventilator. We would try to do everything to prevent or postpone that, but we needed to be sure that this is what he wanted. I told him there was no guarantee even with the ventilator that things would turn around. He half asked half implored why this was happening to him. I had no good answer so I gave him the answer that I had, which was that I did not know why some people do worse than others with this virus. I did not have the answer to the question as to why he had been doing well and then suddenly was not. I did not have the answer to how long he might be on a respirator if he needed one but I did tell him it would more likely be weeks rather than days. As to what he could do, all I could offer is that he lie prone, chest and abdomen down, as that seemed to aid in this situation. It is called proning. He had tried it before and could not tolerate it. I encourage him to do the best he could and that half the day each day that way may make a difference. He asked why he could not eat or drink and I told him that if a tube was needed we did not want him vomiting as they put it in. He asked me to call his wife. I asked him how much of the details he wanted me to share with her. He said he wanted me to tell her everything, He then said: "I don't want to die". I am tearing up now as I type that but at that time, I needed not to show the desperation I felt for him. I offered him: "We will do our best to send you home to your wife" We will watch you closely. Lie prone. I will see you later". He thanked me as I left. He was sincere and I know I did all that I could, but I definitely did not feel that I was deserving of thanks. But if he had thanked me only to make me feel better, he had succeeded.

The next time I saw him, four hours later he was sedated, in the ICU and on a ventilator. He was prone. In the interim, I called his wife who had clearly been hitting the computer sites hard. I answered her questions, sometimes the same one twice or three times and then finally went on to the next patient.

The next patient was the elderly lady who had been looking worse last night and did indeed look worse this morning. I will likely report on her tomorrow if there is interest in this kind of posting. IF not, I will not burden you guys with all of this if I get the sense that this is not of interest, but I think it was important that you at least get a sense of the minute to minute horror of this.

I did report that I am doing better today. I am doing better. My temperature never went up to over 99 again and I am home now The onslaught from the closed hospital was not very severe today and up until now, no one under my care died today. That pretty much is the best day I could have. I am going to be finishing up my notes, doing a quick computer check on the patients and then try to get some rest.

 

Your patients are truly fortunate to have someone as caring and conscientious as you; they may not always be able to tell you that but I think you know they would if they could. God bless and stay safe.

[+ tassojunior]

It's horrible optics and loneliness.

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