This is just for now

My thighs ached like wet rags being rung out. The chills took hold.  My sense of smell dissolved. And the shortness of breath... the shortness of breath was unmistakable.

Count the respiratory rate. I instruct medical students, new interns. That's the vital sign you want to pay the most attention to.

I counted mine, last week, when I was sick. Like a systolic murmur it crescendoed to a peak on days 4 and 5, before normalizing again shortly thereafter. It was strange to be tachypnic -to be breathing fast- when I was walking to the bathroom, pouring myself some juice, simply lying still in bed. It was hard to ignore.

But with rest (and with time) it slowed. And with Tylenol (and 45 minutes of time) the chills and the aches and the sensation that my head was heavy and light all at once would cease. And during those moments of feeling better, I found myself looking -quite literally- to the past, as well as -a little more abstractly- to the future.

This, all of this, is just for now.

How to be so sure? While sick, I did a lot of scrolling through the photos on my phone, through thousands of squares of color and light. At those depicting medical school and residency, I stopped short.

In scrubs and long white coats. On night shifts and short calls. In clinic and the ICU. Each photo served as a launching pad, jogging memories of the moments seconds minutes hours that led up to the pose, as well as those that followed. I know we all have these images in our minds, and saved to our camera rolls. Of those days we worked relentlessly hard but yet found time to smile, to put our arms around each other, to be -without trying- care free.

There's a photo of me as an intern on night float, with a stack of patient lists in one hand and a birthday card in the other, because the clock struck midnight on my 28th birthday while I was on call.  There's a photo of an East River sunrise through smudged window glass and plastic blinds, signifying day break on another overnight ICU shift.

There are photos of the hospital decorated for Christmas. My friends and I gathering in the hospital garden. Of white boards with lesson plans I didn't want to forget. There are close ups of unusual CT and X-ray findings. Screenshots of Duke's criteria. Stethoscope selfies.

All these moments came, and went. As well as so many more that though not captured with a click nor easily recalled in photo-like detail, have still managed to invisibly contribute to who we are today.

Our emotions are defining this moment. Our actions and roles keep us present, bound to this phase in our careers and our lives. But it's been helpful for me to know this is not how it always was, nor how it always will be. 

This... this is most definitely just for now. And soon? Soon we will be close again, care free, with our arms around each other. Perhaps the future doesn't feel so abstract after all.

Pink sliver is the sun rising on a long call ICU shift

Luck in the time of corona

Like an obsession I check my hospital's electronic medical record app on my phone. Like a compulsion, the numbers keep rising. The names I know ricochet back and forth: their room numbers flip from those I know to be on the regular floor to ICU-capable beds, some back and forth and back again. Is this for real?

I felt that about my symptoms, too, that began last Monday. It's cold in here, right? I asked Michael, as we were falling asleep. Hours later I was up for the night with a feverish feeling, chills, and muscle aches. I trecked -ok I live in a studio apartment so in reality I walked the 10 feet- to my couch and tried to fall asleep there. I am achy and feel hot and cold, I texted one of my best friends, as well as my dad. I don't know what to do. Up hours later still feeling unwell, I emailed my department's directors. I'll probably be okay by the morning, but in case I'm not, I'm not sure if I should come to work. 

Michael and I have nicknamed it community covid, I think we like the alliteration. And though my swab has yet to result as the days creep forward it has become more and more clear that even if my symptoms may be slightly amplified by anxiety, even if I think this can't be for real, I'm checking all the boxes that make this disease process very likely. Muscle aches, fatigue, slight shortness of breath, joint pain, diarrhea, dry cough. All mild, but I have to say I've never quite felt like this before. I can't do half a jumping jack, I told my mom. Stop trying to do jumping jacks, she replied.

I am fine, though- because I am young and healthy. I am fine, though- because I speak English and understand health and illness, warning signs, the importance of staying hydrated. I am fine because my family and friends have sent me enough food and love to get me through 3 pandemics. Because I live in a luxury apartment and building staff are leaving my deliveries outside my door. 

Because last night, already in bed at 7 o'clock, I heard cheering outside. I made my way to my balcony -7 strides from my bed, 3x6 feet in size- and I realized from porches and fire escapes and open windows all around people were cheering, both literally but also symbolically, for the change of shift at the nearby hospital. I greeted my neighbor, on the balcony right next door. What are they cheering for? I asked her, more out of awe and marvel than because I didn't know. They're cheering for you, she said. I'm fine because this neighbor texted me shortly after to ask if I had a sore throat and would like some lollipops. 

Suffice it to say, I am fine because I'm really, really lucky.

It goes without saying not everyone is getting this lucky. People of all ages are sick, and that they are sick alone in hospital beds is a heartbreaking reality that I think has made my colleagues and my heart ache as much as any piece of this. More than ever, in this age of digital connection we are appreciating the importance of true connection. Of our health. Of getting really lucky.  

My view from the E Team

I’ve been asked by all my loved ones, my family and friends, what it has been like. Now that I spent one day on ‘Team E’, the COVID team (both confirmed cases and those being ruled out but sick enough to require hospitalization), it still remains pretty hard to describe but I can try to write down some thoughts. Of note I’ve done so much less than other people.

Hospital life has truly turned upside down. Every aspect of what I’ve been trained to do -and do well- every convention and protocol and all the structure, is literally gone. Both physically and mentally, the space has changed in the most palpable way.

Almost every patient room door is now closed and has 4 signs on it- denoting that it is an isolation room with a COVID patient (again, either confirmed or being ruled out. A lot of the cases we’re ruling out, almost certainly have it though- we can already just tell based on signs and symptoms). For now, each COVID patient is being roomed separately. Though eventually (soon) we will probably have to cohort multiple positive covid patients together, just given the numbers. So on a door there’s a stop sign to catch your attention, a sign in sign (which we’re not really using- a pen would be another thing requiring disinfecting), and then a sheet or 2 describing how to wear our PPE (personal protection equipment) properly.

I haven’t been down to the ER or this area we denote the EW which used to act as a low acuity ICU but is now entirely a respiratory unit. As is the ER. They’re both only for patients with respiratory symptoms. I’ve heard they’re both very intense places now.

Basically yesterday, on Team E, my friend/colleague Jon, 2 PAs and I went down a list of 20 patients and saw all of them. The PAs stayed outside and wrote notes, fielded and made calls, handed us supplies, put in orders… and Jon and I (sometimes both of us, sometimes one of us) gowned up and went into each room.

Throughout the day, there were probably 5 SPRT (special pathogen response team) alerts. They’re like the rapid responses/codes I’ve told a lot of people about, but they’re on the COVID patients, and instead of a dozen or more people rushing in the room, since we are being careful with preserving our PPE, only 2 or 3 of us go in (2 doctors, a nurse, a respiratory therapist) and everyone else stays outside and peers in through the door window. The anesthesiologists (who intubate) are part of that group who stay outside- waiting for the go ahead as to whether or not we think the patient needs a breathing tube (a sacred vent) immediately. Thank gd no one needed that escalation of care at the SPRTs yesterday.

All the patients have similar symptoms (though they don’t all have all of them)- bad headache, myalgias (muscle aches), high grade fevers, dry cough, and difficulty breathing. A lot of them have diarrhea too. And we’re noticing that there are a couple patterns in terms of how patients do, like how their illness evolves. 

But the scariest symptom is the hypoxia -low oxygen- as patients just become more and more hypoxic over time, some leveling out and some crashing typically around day 7-10 (my sense at least). Again, that’s day 7-10 of symptoms, so if they come in on day 3 or 4 you have to account for that.

Now of note these people who are hospitalized have a coronavirus *pneumonia*, which is different from the pattern that people have in the community, the pattern -thank gd- my colleagues and I would almost certainly get.

It’s jarring how many patients there are… that we have a zero visitor policy in the entire hospital (so hard to be sick alone). During a SPRT yesterday with a 32 year old patient who was doing really poorly (she has end stage renal disease so has an underlying illness), in the room it was Jon, me, a nurse, a respiratory therapist, the patient (solely Spanish speaking), and on her sparkly pink iPHONE, her brother- translating and asking questions. Doctor, is she ok. Doctor, how are you treating her. Doctor, can I come in and be there with her.  In this moment, I think she will be ok. In this moment, we don’t know how to treat her. In this moment, I am so so sorry but no, you cannot be here with her. So incredibly stressful for patients and their families.

It’s a process to don (put on equipment) but also doff (very carefully take it off). It’s the doffing piece of it that matters, because at that point the equipment has come into contact with the patient. It’s hard to balance when we’re beside with the patients these priorities. Because I’m so wired by that convention, structure, skill, bedside manner that I mentioned earlier. You go in and you want to get close and hold the patients hand or stroke their shoulder. But you’re also making sure the patient has their own mask on, that yours is on tight, that you are safe.