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Cleavon Gilman2 hrs
4/4/2020 9am
57,160 cases in NYC 1,867 deaths
Title: My heart hurts so much
The emergency room was busy when I came on shift, with approximately 40 patients in the bay. Yesterday, we had a large amount of patients in the emergency room who were intubated on ventilators, which put a strain on our nurses. Today, the hospital responded by pulling nurses from the pediatric emergency room to help manage the patients. With this extra coverage, I was able to spend more time with patients and get to know them better.
I had just evaluated a patient and was walking back to my computer, when I heard a patient say, “Can I get a cup of water?”
Normally I would get frustrated if a patient asked me to get a cup of water, because I'm usually juggling 10 critical tasks at the same time, but today I had time. On my way back from the water cooler to give the patient a cup of water, I walked past another patient’s room.
“Can I get a cup of water too?,” he asked
Sure sir, I’ll be right back.
Off to the water cooler I went again.
“Can I get a cup of water too?,” asked another patient down the hall, lying on a journey between the two bays.
I had seen the man walking with another physician, a few minutes prior. He was getting a walking oxygen saturation to see if he needed further work up. He was a tall man, 6 foot 4, in his early 40s, with light brown skin. He reminded me so much of myself, except he was very short of breath when he walked.
“Sure! Brother, I”ll get you a cup of water,” I said, as I raised my hand to acknowledge him.
“I’m going to bring this cup of water to another patient and I'll be right back.”
“Here you go sir, a cup of water”
Thank you so much doctor!, he replied with gratitude
In his eyes, I saw my brother. My brother is half Puerto Rican and White and when he was a child he had very bad asthma. I would watch helpless as my brother became short of breath, clutching his asthma inhaler. Years later, while in medical school at the University of California at San Francisco, I heard a lecture from Dr. Esteban G. Burchard that has always remained with me. Puerto Ricans and Blacks are disproportionately affected with asthma.
As promised, I returned again to the water cooler to get another cup of water.
“You're way too tall for this bed, your feet are hanging off,” I said, “Here's your cup of water”
I'm going to grab you a pillow to make you more comfortable.
“Thank you brother,” he said
“I'm sorry that you're spending the night in the hospital, it’s the least I can do” – I replied
The patients that I treat in the emergency department are working class. They are the ones who have been hit hardest by the coronavirus pandemic. They are barbers, nannies, construction workers, bartenders, waitresses and retail store employees. They are Black, Dominican, Puerto Rican and Mexican. They live in the housing projects, where it’s not unusual to have heat and water without days. A lot of them don’t have enough money to pay for a subway ride home from the hospital.
Given that family members are not permitted in the emergency department, I treat patients as if they were my family.
My first patient was having a really hard time breathing. She was 70 years old, but otherwise healthy. She came to the emergency room with a printed note, that said
“I've been having a fever for one week and have been short of breath . My husband is hospitalized here for the coronavirus. please call my daughter at XXX-XXXX.”
[ring, ring]
Hi this is Dr. Gilman, I'm calling up from the emergency room
Are you the daughter of _____?
“Yes, yes, Oh my God thank you so much for calling us....We were so scared we didn't know where mom was at,” she said
I continued, “Well she's here in the emergency room, her oxygen levels were very low. Although I don't have the results of the coronavirus test yet, given that your dad is hospitalized for the coronavirus and her oxygen levels are very low, she likely has the coronavirus.”
I added, “We have her on a non-rebreather oxygen mask, and she looks comfortable, however she's very fragile and if she moves her oxygen saturation drops.”
“Usually we watch patients for a few hours in emergency room to determine if they need to go to the intensive care unit versus the floor,” I said.
“Okay doctor thank you,” she replied
“I'm so sorry that this is happening to you. It must be very difficult to have both your mother and father hospitalized with the coronavirus.”
I could hear her tears through the phone, “yes..yes it is!”
I reassured her “Well I want you to know that I'm treating your mother as if she was my mother. I got her a blanket and she's all tucked in!”
I walked into the patients room.
Ms____, I’m talking to your daughter on the phone. I updated her with what's happening.
She smiled and said thank you.
The patient who shared a room with her was 45 years old woman and otherwise pretty healthy. She was also very short of breath. She only spoke Spanish. I tried to use the translator, however every time she would talk, then her oxygen saturation would decrease to 80%.
“It's fine,” I told our translator, “I have enough of the story.. sounds like the coronavirus.”
For the entire night I was worried about these two patients. Their cardiac monitors continued to beep abnormally throughout the night. I would stand outside their room watching them breathe at 40 times a minute with an oxygen saturation of 85%, and then improve to 95%.
Treat the patient, not the number.
Treat the patient, not the number - I would remind myself.
Notification!!!! Hypoxic respiratory failure.
I hustled to triage to assess the patient!
“Elderly woman found down by the family with hypothermia, hypotension, hypoxia and confusion,” said EMS
Sounds like septic shock and the coronavirus – I replied
Hey EMS, is there any family around?, I asked
Yeah doc they are in the waiting room
I hustled to the waiting room to get key information, because having a family member provide collateral information is invaluable.
Hi, I’m Dr. Gilman
I'm helping take care of your mother and grandmother.
what happened at home?
The grandson in his 30s translated for his parents, who only spoke Spanish.
“Well my dad was sick three weeks ago with a fever and a cough, and then my mom got sick last week with very similar symptoms. Yesterday my grandma was doing fine and then today we found her very weak on the floor.”
“She's a very strong woman,” he added.
I gave them my personal phone number because I wanted to update them on the status of their mother and grandmother throughout the night .
Thank you so much doctor! Make sure you do everything to save her life! Please!
We put the patient on a cardiac monitor, gave her antibiotics, and placed her on a bear hugger to warm her up. She really perked up afterwards. She opened up her eyes looked around the room and was awake. Indeed, she was a strong woman.
About an hour later her labs began to trickle back. Her troponin was 20,000, lactate 10, bicarb 9, creatinine 5 and her chest x-ray showed a multifocal pneumonia. She was in multi organ system failure.
I called the family to prepare them that she will likely not survive.
“Her body is shutting down from the coronavirus. It attacks the heart and lungs and makes people very sick. It’s really destroying our community.”
“Okay doctor, she’s a strong woman,” he said
30 minutes later, I got a text on the phone from her grandson, who placed me on a group chat with the entire family. They wrote:
“our grandmother is a very strong woman, she loves life and nature. Can you please tell her to get better so we can go to my house for bbq and watch the birds.”
I ran to the patient’s bed to honor this request, where I found her awake and looking around the room.
I got close to her and said, “your family says get better so you can go to their house for bbq and watch the birds.”
She smiled and nodded! “Thank you,” she said
I stepped away for a few minutes to review the labs.
“OMG, OMG! her heart stopped, I cannot feel a pulse,” yelled a nurse!, “She’s not breathing.”
A little while later, I pronounced her dead
“I’ll call the family and tell them the bad news,”
“This is so fucked up that I’m doing this every night,” I said, fighting back tears.
“Hi this is Dr. Gilman, I’m sorry to tell you that your grandmother passed away”
I heard him cry through the phone.
I could hear his mother and father, who were close to the phone say, “que dijo el”
“El doctor dijo que la abuela está muerta,” he translated to his parents.
“I’m sorry this happening to your family. I want you to know that your grandmother was the strongest woman that I’ve ever seen. She fought to the end and didn’t suffer.”
I hung up the phone and tried to continue my shift and see the next patient, but I couldn't. I was overcome by tears. I told my program director who was the attending on shift, that I had to step out of the emergency room. I went out into the ambulance bay, and let the cold air dry my tears. However, no matter how quickly the tears dried, new tears flowed.
The coronavirus is pure evil. It attacks the lungs and hearts of its victims. It spreads grief through the community. If you try to embrace a loved one then it will use your body to infect others, repeating the cycle.
My heart hurts so much. I stand helpless as I watch patients drop dead at the snap of a finger. In the past week I've seen so many patients die. I've called so many loved ones and delivered bad news and each time a piece of me chips away.
So many people are going to die and we can't save them.
I returned back to my shift 45 minutes later. The deceased patient was laying on the stretcher with a white sheet draped over her body. On the white sheet lie death tags. I didn't realize this before, but in the room to the right of her were my two other patients who had the coronavirus and trouble breathing.
I was looking at the monitor of the 45 year old woman, when I noticed that every time she made a slight movement her oxygen would decrease to 80% and she would compensate by breathing very very rapidly. She asked me if she could walk to use the bathroom, however I was concerned if she walked then she might drop dead, so I recommended that she use a bedpan.
I stood outside the room, with my heart racing watching the cardiac monitor of both patients.
Treat the patient, not the number.
Treat the patient, not the number - I reminded myself.
The 45 year old woman was having more difficulty breathing. I could tell that she was scared as well because she couldn't catch her breath. She kept looking down at her belly shocked by how quickly she was breathing.
“Let’s intubate her!” I said, “call anesthesia STAT”
Within minutes, the nurses moved her to a negative pressure room for intubation.
As I stood outside the room, her previous neighbor, the 70 year old woman whose husband was hospitalized for coronavirus, rolled past me and was being transferred to the floor.
I ran down the corridor to tell her “take care”
She smiled with her eyes then said, “thank you.”
When I left my shift this morning, the sidewalks were wet from rain. I couldn't help but think about all the patients I cared for overnight, and how suddenly the woman passed away after I told her “your family says get better so you can go to their house for bbq and watch the birds.”
I walked with my head low in tears from the hospital to my house.
My heart hurts so much!
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