Day 12
“I will continue using military metaphors. We are at war with this virus.”
The greetings this morning were grim.
“Stay safe” has become the aloha of intra-Resident conversations. I heard that twice before reaching the front doors of the hospital just after sunrise.
“How was the night?” is the standard greeting to the two Residents just finishing their 12 hour Night Float shift. These are the two young MDs left to put out fires across half the hospital’s two hundred or so beds.
“We had the longest Code ever. Took an hour. We went through maybe 20 epi’s.”
Epinephrine is only given to people with either pulseless electrical activity or those who are asystolic – flatliners. (Once again, Hollywood has lied to you. You don’t put the paddles on anyone with a monitor next to them going BEEEEEEEEEEEEEP.) The ACLS guidelines say you push those every 3-5 minutes.
The Ok, We Tried alarm should have gone off about 3-4 epi’s in. Not 20.
“Was it a young guy?” “No, It was James.”
I curse a little louder than I mean to. I walk out of the room and wash my hands even though I’m sure I hadn’t touched anything.
James is- was a nurse at my hospital. He was maybe in his early 50s. Every Resident loved him because he was tough and always fought for his patients. He was a nice guy and a pleasure to work with. But he was fierce. He’d seek us out during Rounds, stare us down and make sure we put in orders for his patients ASAP. We all respected him.
I knew he was on a vent as of the night before with settings that looked, well, dire, but it’s still a shock.
The night team leaves. I start mindlessly updating the cheat sheet summary of our 16 patients. I’m on autopilot at this point. 13 are COVID cases. COVID cases are, unfortunately, very easy to manage. You put in orders for medications that you’re pretty sure don’t work, you note how bad their oxygen saturation is on nasal cannula (NC) or nonrebreather (NRB), and you gown up and see the worst cases / people you think might need to be intubated in the near future.
The first Rapid Response comes at 7:40AM. I reach the door (of course it’s a COVID room, that’s all we have left) and realize I left my N95 at home. I’m not entering that room. I flippantly tell the interns to access the situation and head to pick up a new mask at the Command Center.
The nice nursing admin lady hands me a paper bag with a new N95. She tells me to sign for it in the binder just outside the door. Despite my autopilot brain, I joke, “Oh we’re on the honor system? You know I’m just going to sign ‘John Smith’ in the binder right?” She laughs and says it’s ok I left my N95 at home.
I pick up my mask and sign John Smith in the binder.
Just because I’m in shock doesn’t mean I can pass up a joke like that.
I head back up to the Rapid. I get a debrief that this was narrow complex ventricular tachycardia in the 200s. They pushed metoprolol (wrong decision) and adenosine (right decision). I go talk to the very bright and hardworking intern on my team. I explain that in situations like this where the patient is otherwise hemodynamically stable, metoprolol isn’t going to do enough to slow the heart rate. You’ve got to reset the circuit breaker. I asked who the attending was in the room.
There was no attending. The intern had to make the call.
I left my interns to the wolves when I walked off in a huff to go get a new mask.
My autopilot brain goes over how shitty I am of a senior Resident. When YOU were an intern, at least your seniors never walked away from a Rapid.
As I walk back to the call room to barricade myself behind a door for an hour or so, I come upon a nurse meeting where the news of James’ passing was being announced. I honestly don’t remember a single word of it. I do remember the occasional sobs coming from these amazing nurses.
Then there’s a Rapid and a COVID is intubated.
Table Rounds.
Then there’s a Rapid and a COVID is intubated.
I’m getting good at assessing whether or not a hypoxic COVID patient will get tubed and if we have time to get them upstairs before they crash.
Go me.
…
“The world breaks everyone and afterward many are strong at the broken places.”
I don’t think my fellow Residents or I will break in the near-future. Maybe, maybe not. A few of us are close though, including myself. Feels like it’s just over the horizon.
It’s what follows that quote which worries me.
“But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.”
James never broke. He was good, and gentle and brave and he was killed.