Notes from the surge: Love in the time of covid

2 months in. 

My buddy Matt texted our group when his team was still doing contact tracings at LAX as the first covid cases landed in US airports. I don't even remember when it was, and can't find the texts anymore because they're now buried in a million exchanges since then. I wanna say January. Matt's CDC Epidemic Intelligence Service. If there were such a thing as CDC black ops, he would be it. And he told us about this thing called "flattening the curve" months before it became the trendy internet meme it is today. 

It feels like so long ago. Kealia was still in school, stores were still open, and I wasn't living in my parents' basement. A few weeks later they shut down flights and travel. My friend Carlos, who is an NCSP fellow at UCLA, couldn't fly to Rochester to see his wife Katrina, an ob/gyn chief resident at my former hospital, for their anniversary. "Love in the time of covid," he would say. It became kind of a catchphrase for my residency friends. 

Then all the work emails started coming. Surge preparation. Re-deploying hospital staff, restructuring workflow, new trainee and student roles, new unit structures. Supplies, and rationing PPE. The call for extra help, extra shifts. People immediately began losing their minds, questions and theories about covid19 pathophysiology began pouring out, and the system was flooded with so many emails that they had to ask us to dial it down. We still only had a few cases back then. 

I remember the night the NBA shut down. Rudy Gobert had just contracted covid19 and also made an ass of himself on national television when he touched all of the locker room reporters' mics as a joke just before being diagnosed. It was mid-March. Kobe had just died less than 2 months prior. I had a fight with my wife the next day about my wearing scrubs home from work. I signed up for extra shifts, and then we fought about that too. We canceled our trip to Disney World as the shutdowns engulfed the country. Her aunt, who was staying with us to help with the baby, had her flight home canceled as well. A week later I was re-deployed to the covid unit. And that was pretty much the start of this whole thing for me. 

A former mentor in residency once had a couch talk with me about career advice. It was when I was figuring out whether to apply for pulmonary/critical care fellowship. I'll never forget one of the questions he asked--"So there's a house on fire. Do you run into it, or run to get help?" 

"I'd run in," I said quickly, immediately feeling like an ass-hat after. Like one of those douchey doctor types that goes around wearing their white coat or ID badge in public. "I mean, I'm not trying to be a hero or show off or anything." He nodded in understanding. It was just my psychological illness, he said. Something along those lines. 

It was hard convincing Angie though. 

- They have plenty of other people. Just work the shifts you already have. Who cares about the extra pay. Your family needs you too. Stop telling me it's safe, you literally just said they have a PPE shortage. Why you. You're only a first-year hospitalist, they can just find someone else. What are you trying to prove. 

- I'm not trying to prove anything. Why're you being so difficult about this. I don't care what other people think, but it'd be nice if YOU were a little proud of me. 

- I AM proud of you, you idiot. I can't believe you would say that. And now you're making me the bad guy. You are such an idiot. 

So, no surprise to anyone, I'm sure, but yes, I am an idiot--as it turns out, no one supports me more than my wife. I am an idiot that is still married though. 

But I'm 2 months in now. I've been living in my parents' basement ever since. Not that we think it's completely necessary or anything, because not every doctor or nurse is doing this. But our apartment is too small to avoid a ton of contact with everything as I walk in the door. Her aunt is also from China, and doesn't have health insurance. So while she's stranded here, we can't risk getting her sick. It's also not just a few cases anymore. It's an almost-constant overwhelming surge that feels like it has no end in sight. They tell us the numbers are getting better. It sure as hell doesn't feel better. 

We wheeled a guy in his 40s with covid19 to the ICU the other day when there was no space. They had to wheel a guy out who had just been extubated to make room, so our guy came in red hot with just barely enough time to be intubated. The floor unit has also been tight on staffing lately, so there was only one nurse available to transport him--I gowned up and went with her, one hand pulling the bed while the sterile hand held a clean ambu bag in case he went down in the hallways. All I could hear was my pulse bounding in my ears, and Jess behind me calling "Left! Right! Hit the button!" as she steered. 

Earlier in the course, covid patients on hospice or other end-of-life care (meaning they were dying and nothing could be done, so we would only give meds to keep them comfortable, letting them pass away peacefully and naturally) would sometimes pass away without staff knowing right away. They'd be found after the fact, on the next routine nursing check. In normal circumstances, end-of-life patients can be checked in on frequently by nursing because you can simply walk into their room and assess them in less than a minute. Families could also sit with them until the end. In the era of covid, it's not that simple. Donning PPE properly takes time. Once you go in, you can't just walk back out then go back in, because you have to waste a set of PPE each trip in and out. You also can't go in every couple hours. You can't leave the door open to watch them from the hallway. And you can't have families come in and sit with them for hours. If they're not trained to use PPE properly, they touch their faces and their masks, rip their gowns accidentally, mess up their gloving and de-gloving technique. 

So yes, some end up dying alone, but not of anyone's choosing. Quite simply, we don't have the means or the manpower to constantly look in on them. We've worked on solutions. Accommodations for last visitations by families, setting up video chats and phone calls in the rooms. Video monitors. Using rooms with windows. Last month we moved a couple patients to window rooms where family could see them while standing outside the hospital. There's always unforeseen problems though. I sent up the chain an idea to use cardiac monitoring on end-of-life patients. We normally don't do that, because we can just watch them physically instead of wasting a cardiac monitor on someone who doesn't need it. But in this case it helps alert us to when their heart rate slows, so we can gown up to sit with them in their final moments. 

It's worked relatively well so far, but on one case, we failed to get into the room on time. We saw her heart rate drop from 90 to 30s, and knew it was coming. I went upstairs to grab my PPE and print a handoff while her nurse went to grab a few other supplies, and by the time I was down, she was already in flatline. Her hand was still warm when we got into the room. We literally missed her by seconds. Fucking seconds. 

Her granddaughter later asked me over the phone if anyone was with her when she died. I told her that we were. It's one lie even God would forgive, I think. 

But the house is still burning, and people are getting pretty exhausted from running in. Even when you're off duty, it's tough to let go. The first day off is always the worst. I spend mine chart checking, texting people in the hospital, emailing neurotically. I pace circles in the basement. I scan headlines and read updates on clinical trials. I ask friends at work if they need help and they say thanks, but never actually ask for anything. I suppose I wouldn't either. I sleep less on my first day off than when I'm actually on. 

Angie told me again last night how proud of me she was. My parents texted me the same from upstairs earlier in the week. I don't know what to say. Matt and his wife Brooke are having a baby girl later this month. We sent them an infant dress a couple months ago. River turned 4 months old, he's teething now. My mom cut my hair last week. Angie cut bangs for Kealia. A couple friends in Houston got married with a Zoom reception last month. 

Love in the time of covid. I don't know what to say. Life goes on. 

Strangers I've never met say thank you to me these days. Love in the time of covid. I don't know what to say. 

Maybe "Amen."