TRIP 3, JOURNAL #3

We’re having a more normal number of deaths now, too. I’ve been primarily in the non-COVID ICU over the past week, though we have had a few people pending tests in our department. It’s hazardous to do it that way — they were considered fairly low-risk, but the non-COVID ICU is located in a totally open unit normally used for post-anesthesia recovery. There are 25 beds here, about five of which are isolated together in their own room next to the OR. Those five are normally used for the critical care cases — patients that were either going to the ICU after surgery or who were difficult to manage postoperatively. The remaining 20 beds are in an open area, separated by short curtains. The beds are perhaps 5 feet apart. When the unit is full during the surgical day, it’s usually bustling and space is a commodity. It’s an infection risk, but almost anything looks good compared to the virtual guarantee of catching COVID by merely entering the hospital unprotected.

One of the patients, the one we staged the COVID circus for, might be approaching discharge. He’s almost entirely off his ventilator but is still oxygen-dependent. He has a particularly tough journey because he’s an undocumented immigrant, so he’ll have very limited to no access to the follow-up care he’s certain to need after discharge. A long-term facility won’t take him because of the payment issue, and he won’t be able to see a clinic or likely pay out-of-pocket for home oxygen tanks. He’ll be with us for a while yet, but we cannot responsibly discharge him while he’s still oxygen-dependent knowing he does not have access to life-sustaining care. The current plan is to keep him in hopes he is able to wean off the oxygen and go home with his tracheostomy. Even then, he’ll be in terrible condition, but the hospital will almost certainly discharge him once he’s not likely to die if sent home. He’s lost at least 50 pounds, including almost all of his muscle tone, and he will need to re-learn how to do everything: walk, feed himself with silverware, get dressed, brush his teeth, etc. If he’s lucky he might survive long-term — most patients in that condition are not long for this world because they’re at such high risk for other infections.