ALL MY PATIENTS ARE UNDER THE BED CODE

I have been trying to recommend vaccination to all of my patients. I mentioned that the CDC recommends getting the vaccine after she fully recovers from the infection, and she nodded in agreement. I had to warn her that she needed to isolate for 10 to 14 days, away from her children, and that any time she spent with her kids would put them at risk of getting sick. A few hours later, she was stable enough to return home. For now, we would focus on making her feel better. I decided to lean in, and I told her that we could talk about the vaccine later. A space opened up between us, and I could feel two choices: I wanted to find out why she had resisted the vaccine, but in that moment, she looked so fragile. Her 1-year-old daughter had spiked a fever the day before. When I asked if anyone else at home was sick, she started to cry. Her whole body ached, and I could see her wincing with each cough. She had been too nauseated to hold down food or water, and she was now dehydrated. I saw a young mother who looked terribly ill and was barely able to walk. I couldn’t help but wonder: if more people around her had been vaccinated, could she have been spared the virus? When I told her the bad news, her face completely crumbled. Everyone at home was vaccinated, too, but she tested positive that day. I met the sweetest older woman on chemotherapy, who got both doses of her vaccine months ago. I usually enjoy reading up on patients a few days after shift to learn about their hospital course, but I haven’t been able to bring myself to look them up because I am afraid of what their notes will say. I want to be proud of my learning, how I’ve gotten more comfortable with the equipment and all the steps, but a lot has to go wrong for a patient to need intubation. Intubation is a difficult procedure and securing an airway is a lot of pressure. I have intubated more patients since – more than I expected to one month into my residency. When her uncle’s tests came back, we realized COVID hypoxia had caused his heart to stop. I told her that she did everything right, and I hoped she believed me. His niece had watched him fall, called 911, and stayed with him while the paramedics arrived. Talking to his family was the first time I had broken tragic news as a new doctor.

We performed multiple rounds of chest compressions, and we tried to use a ventilator on him, but we could not bring him back. My first intubation was on a patient brought in by ambulance for a cardiac arrest. We pulled out our stethoscopes to listen closer, and as I glided my bell across his damp skin, I hoped that we would not have to intubate him. We watched how our patient’s belly shook with every breath, a sign that his chest wasn’t strong enough to breathe by itself.

I pointed out the muscles in his neck that were pinching with each breath, accessory forces recruited to help breathe when the diaphragm is starting to tire out. We could see the sheen of sweat across our patient’s forehead. “Have you ever seen respiratory distress?” I asked a new medical student. We watch as our patients’ saturations dip low and their respiratory rates climb up high, a frantic beeping of the monitors the background music to our work. The nurses scramble to get them on the monitor, and my senior resident rolls in the BiPAP machine himself because the respiratory therapists are tied up across the hall.

ALL MY PATIENTS ARE UNDER THE BED CODE

There are days when we step out of a code to find a line of patients, gasping for air, wheeled into the department. Now, every shift I watch patients fight to breathe. I started my emergency medicine residency on July 1, when we barely saw COVID patients and when the pandemic almost felt like an afterthought. All of these patients are alone in their beds because it’s too dangerous to allow visitors for most patients. In Room 4, there was a critically-ill patient who tested negative for COVID but had suffered a stroke and needed an ICU bed that we just did not have. She had told me about her journey in life and all that she has had to overcome, but it doesn’t look like she’s going to survive COVID. In Room 3, a patient who I saw 20 hours ago has yet to be moved from the ER to a room. She’s stable for now, but could potentially decompensate quickly so she will have to be monitored closely. In Room 2, there is a young woman who is breathing for her life. In Room 1, we have an unvaccinated COVID-19 patient, intubated a few hours ago, who now needs an intensive care unit (ICU) bed his family has no idea because we couldn’t reach his emergency contact.

At Jackson Memorial Hospital, each shift begins with a sign-out, where we review every patient in the emergency room with the medical team about to leave.

All my patients are under the bed