By the end of my shift, every patient begins to blend into a single patient. “Fever and cough,” “fever and cough and shortness of breath,” “cough and trouble breathing,” “sent by doctor’s office for Covid rule-out,” “sent from urgent care for Covid test.” I can’t even keep track of them anymore. Usually I remember patients by their faces, but they all have masks on too, so all I see is their eyes, which more often than not are closed.
I become obsessed with oxygen levels, which seem to be the only reliable indication of how patients are doing. Is 92 percent much better than 90 percent? Should 93 be the cutoff to send someone home, or should I make it 94? I used to be able to rely on my gut and clinical judgment when I walked into a room and looked at the patient, but coronavirus is lawless. It obeys no rules. What is unusual, in this illness, is that many people come in talking to you, even as their breathing worsens. They can speak, but their oxygen readings are frighteningly low. As the hours tick by, they rapidly get sicker, to the point where they need a breathing tube. In most other situations, people who require breathing tubes in the E.R. arrive at the hospital too ill to interact with me, needing mechanical ventilation right away. That makes it a little easier.
Patients’ oxygen tanks run out. (It’s impossible to know unless you bend over, look behind the stretcher and glimpse the thin black needle ticked over to the red zone on the gauge.) Or whatever oxygen you did give them becomes suddenly insufficient, as their lungs grasp for ever more. Maybe an alarm bell sounds because their oxygen level has dropped. Or more likely, they’ve become disconnected from the monitor, a far-too-frequent occurrence, and you see them frantically trying to breathe. Or most likely, the oxygen, even if it’s blowing, is of no use, because they’re unable to take it in, barely inhaling at all, silently dying, alone.
What may have been unimaginable even a week ago seems completely possible, even likely, now. A colleague informs me that she had to push aside a dead body to plug in a ventilator for a new patient who was recently intubated. Is this how the dead leave the world now?
Before, I would check in with the Italian doctors, concerned for their and their patients’ well-being, but our roles have now reversed. I am now at the receiving end of their grief and sympathy. “How are you?” one texts me. “We hear it’s so bad there.” Yes, it really is. “Stay strong,” another says.
We’re unable to reliably predict who does well and who doesn’t. Old or young, all seem wholly vulnerable. Politicians, epidemiologists, even doctors have been saying that people in their 20s and 30s who get sick already have medical problems or are obese, but then, right after I hear that, I need to put a young and fit patient on a ventilator. The virus is impulsive, attacking one person more ferociously than another. I feel the compression from all sides — the I.C.U. is full, the E.R. is full — I just don’t see the end of this in sight. When I think about that, I feel submerged, and my instinct is to rip off my mask and leave the hospital. Then I try to convince myself that it’s like running. When you start off, your lungs burn and your legs ache, but as your stride hits a rhythm, you start to feel good, and you know you can go on for miles. I hope intensely for that moment to come soon.