Last time I posted something like this, I was asked to make it shareable. I guess I'll make it so this time.
7/16: Last time was bad in a terrifying, panicked way. We were seeing how this thing was rearing its ugly head.
Now, the terror is gone. And in its place, dread. Cold, empty hopelessness.
It's hard to panic now, when almost everyone that I place on a ventilator has died or will die. It's hard to feel terror when the last time we had more than 1/4 of the emergency department actually flowing, actually moving patients, was more than a week ago.
Tonight? We had 2 beds to work with in the emergency department. 2 beds to see 12 hours worth of COVID, trauma, medical, and psychiatric emergencies.
We are slowly transitioning from ED doctors to ICU doctors to Hospice/Palliative care. It is not uncommon for me to answer phone calls of panicked family members as we are prepping to put patients on ventilators and life support. Their cell phones lay on their laps as they struggle to breathe and eventually lose consciousness, and I remind myself to take the phone and try to call back. It's become part of the checklist: after I intubate, and futz with the ventilator, and stand there staring at the monitor hoping their oxygen level rises to some acceptable degree, and try to figure out what sedation medications we still have in stock...call back the last call.
After all, more often than not, we have become the proxy of their loved ones last words.
Remember when I said we had run out of beds? Well, we made more. We turned a 30 bed ER into a 40 bed one. We thought we had figured it out. We sectioned of half of the ER to keep the COVID patients isolated. Surely they would be under control, and we would tamp down numbers.
Oh, man, we were proven so wrong.
In our 40 bed ER, we are now holding 40 COVID patients. Some have been here for a few hours, some have been on life support here for days. Many are no longer in rooms, but line the hallways to make room for more. To say nothing of those patients who are not COVID, but are waiting for a clean bed; they face limbo in a place where the virus is so concentrated.
Why? No more ICU beds. No more regular beds, for that matter. No more COVID beds. No more anything beds. We call to admit people, and the hospitalists sound exasperated. They all angrily ask the same question:
Where would you have me put this patient?
Tonight, we got a call: good news, we can transfer some patients out of the ER!
How many do you have, holding, that need beds?
40? Well, we can move 4.
I hang up the phone. In the time we were talking, 6 people with suspected COVID sign in with respiratory distress.
One step forward, two steps back.
I got a text from an ER doctor friend of mine in Amarillo Texas. He said he got a transfer from the Valley, because he had the nearest open bed to transfer that patient to.
He asked me to keep fighting the good fight.
My medical school friends from Houston, who've all kept in touch for 4 years, update me on the difficulties they are facing in the metropolis of Houston proper. They seem frustrated. Then, they ask me how the Valley is.
They all grow quiet. They tell me it sounds like a nightmare.
I envy their nightmares.
They ask me to keep fighting the good fight.
Our relief nurses are leaving. They feel unsafe, because we are running out of... well, everything at this point. PPE, basic IV materials, medications, ventilators, high flow nasal cannulas. They see the Valley reusing masks and they are appalled.
I guess we got used to it. N95 respirators used to be thrown out after about 5 minutes of use. Now, you are lucky if you only use yours for 7 days without replacing it.
So our hopeful help dwindles.
I split my 12 hours on shift between seeing new COVID patients that are losing oxygenation needing hospitalization and stabilizing those that have been stuck in the ER and are deteriorating. We have become mechanical in managing code blues, the alarm that tells us where a patient is dying has become so much background noise.
I see people on this website write that death numbers are going down, that everything is fine! We are almost out of it.
Nope. People are dying. Fast. Here, right here, right at home. All from complications of COVID. Our medical examiners can't keep up. Many of our hospitals have acquired freezer trucks to keep the dead.
That last sentence sounds like alarmist, apocalyptic fiction. I wish it was.
I see people say that masks are dangerous. That they are the next step in communism. That they are abutting their freedom.
Our grandparents and great grandparents used to have ration cards, capitalistic restrictions during the height of WW2. Endured drafts and conscription during Vietnam.
But today, in 2020, I have friends and family members complain about wearing a piece of cloth. They wear their dissent with pride.
Fools. They will be our death. And they will continue to think they are right.
It may be hard to help a COVID patient, or to revive a code blue.
But it is impossible to fix stupid.
I wonder how blind the public is to the reality in the valley's hospitals. Or Texas, for that matter. Because I don't ever remember a time before this that it was commonplace to see so many die from the same infection every single day.
Or even just to see so many die in one day in the ER. At all, of everything, combined.
It used to be a bad day when I had 1 code blue die in any given day.
Now? I'd be happy to just see 1. Hell, I'd be happy to see only 4.
My partner just ran into the office, saying her patient needs to be intubated. She goes to our charge nurse and asks for a respiratory room to intubate.
We don't have one. She will be placed on life support in a low acuity room. None of the typical equipment, not in those rooms. And cramped. The big rooms have been holding ICU patients, some for almost 1 week.
She will not have a bed upstairs. We may not have sedatives to keep her on life support. We are lucky to have an open ventilator.
Charge nurse is doing judo with the beds, trying to find a place to keep this patient on life support.
(20min delay)