My worst night on call
Yes, one day I'll get back to the writing posts. The light and breezy posts that make folks giggle.
But not today. I need to process this night. Couldn't tell my parents because they are already horrified and I'm only telling them about 20% of what I'm dealing with. I told hubs, but he's already doing a lot to support me and doesn't need to be my counselor as well. Didn't make sense for a Twitter thread or Facebook post. (Knowing FB, the deniers will come out and try to explain why none of this is real.)
Trust me. It's real. And it's terrible.
Within the past week, I had the worst hospital call night ever. That's saying something, considering I have written posts about delivering stillborn babies at 3am. But this recent night was as bad if not worse but in a different way.
I had taken a 24 hour of extra call from my colleague who had gone on vacation (including Vegas (???WTF???)) a few weeks prior. Surprise, he was sick with COVID and couldn't take his call. So a partner of mine and I had to split his call days. I only had 5 patients in the hospital. Of that, 3 were in the ICU. But still. 5 patients should be easy. Right?
At 1am the hospital called. "We need you at the bedside now." I shoved on clothes and drove the few minutes to the small rural hospital. One of my admits from earlier in the day had deteriorated quickly, and now needed more fluids, oxygen, and drips. He had COVID and some other bad things going on. I spent two hours resuscitating him, calling his family to update them, arranging transport for a higher level of care than we could provide in a rural hospital. Only...we couldn't transport. No EMS availability until after 8am later that day because all crews were out on far-away transports due to regional hospitals not having any beds because of COVID patients filling all the beds. And because the patient was very large, he required special equipment that only 1 EMS outfit had. We had to keep this guy alive until 8am. Oh my god.
A few hours later, as I wrapped up the stabilization plan for this gentleman, the nurses ran over to me. "We need you in 130. We're about to start bagging her." ("Bagging" = starting CPR) This COVID patient had responded well to remdensivir + dexamethasone + convalescent plasma over the past few days. All of a sudden she needed way more oxygen, her chest XR looked like a white-out in a blizzard, and she was struggling to breathe despite maximum levels of oxygen. She was on maximum blood thinners so it wasn't likely an embolism. It was just COVID. Shitty, capricious COVID.
It was then, at 3am, that I had the terrible conversation you hear about in news articles about COVID. You know, the conversation where you hold the cell phone up on speaker, and then patient gasps for air as they try to say goodbye and I love you to their family. You clarify code status -- ventilator or not/CPR or not -- and answer questions with little data -- yes I think if you go onto the ventilator it's not a great chance you'll come off of it. What's "not great"? I don't know. I just know that there are so many other factors going on that most survival calculators put it around 10% for this particular person. So much of what we're doing is guesswork.
You know what isn't guesswork? The plan to keep this patient comfortable and make sure they're not suffering as they gasp for each breath and their lungs become edematous. I could reduce suffering. It was a terrible conversation, and I laid my forehead on the bed railing, trying to be unobtrusive as I held the phone inches away from this lady's gasping breaths. Somewhere in the back of my mind, I had the fleeting thought that if N95's, goggles, gowns, and gloves didn't work, then I would 100% get COVID based on the fact that this patient room was swimming in it with all the high flow oxygen and enclosed space and lady coughing right on my head while I held her phone. I finally wrapped up this patient's care at around 4:30 am, squeezed the nurse's arm because we can't hug because of stupid COVID, removed my own PPE, and took myself into an empty conference room to cry in private for a bit.
Then a page came in. A man with COVID in room 134 has suddenly taken a turn, can I come right away? Heart aching, eyes burning from tears, I blot with Kleenex and put on my mask and goggles as I run down the hall. Another patient struggling to breathe despite optimal treatment. Another conversation to clarify last wishes. Another terrible phone call between patient and family. I am so tired physically and emotionally, that I can't even put up the half-walls that protect me from these times. I can't hug the patient. I can't hug the family because they need to stay out of the hospital for their own safety. We do everything on the phone and it's terrible and necessary. I finish up at 6:30 am and text the oncoming physician to meet me in the ICU so I can hand off care in person. I'm too exhausted to cry. I fall asleep sitting in front of a computer, barely registering the nurses whispering their own check-outs at the next desk over.
7am. My partner arrived for check-out. All three patients had survived the night. I could walk away, having handed off care for the next day. But I couldn't function.
The dream-like blasts of images from that night have stuck with me and go on replay over and over at the worst times. One patient has recovered well, one is still critically ill, and one is on comfort care as they are actively dying. It's debilitating how I can be both sad and numb at the same time. This scenario is happening all over the country in every single hospital multiple times per day. I cannot imagine the collective injury to patients, families, and to healthcare workers. It defies the ability to visualize.
I'll leave this post with my PSA, and it's based on how one of those patients got COVID after staying home for months and months, only to have a visitor for the first time who stopped by for half an hour. That was enough for them to get COVID. I'm not going to tell you which patient it was. But keep any gatherings small and within your family unit/household. Please. It could mean the difference between your life or the life of someone you love.
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Author, daydreamer, and practitioner of trying very hard to duct tape folks together and help when I can.
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