AN EMPTY CITY AND A PLAGUE TENT

I’ve had numerous patients die under my care now. Yesterday, I admitted an elderly man who seemed to be doing fairly well on an oxygen mask. He deteriorated rapidly. In a span of about 30 minutes, he went from alert to confused and agitated to cardiac arrest. I felt sorry for doing chest compressions on him, even for the short 15 minutes we did CPR, but his next of kin wanted “everything done” to keep him alive. Hopefully he was too far gone to feel the pain of all his broken ribs as we compressed his chest. The resuscitations we’re attempting on the elderly are almost certainly a futile effort. Even in the unlikely event they do survive COVID, they’re even less likely to live for a meaningful length of time or with any quality of life with the injuries inflicted from resuscitation.

I started yesterday’s shift in the same way I ended Saturday’s: by assisting resuscitation efforts on a patient. We have so many patients who become pulseless that they’ve stopped calling for the resuscitation team overhead every time. The process has changed from a specific resuscitation team of three people who respond to all cardiac arrests to a free-for-all in which whoever’s available hops in. There are just too many cardiac arrests and intubations happening to rely on the availability of a designated team, and we don’t have the staff to have a team set aside to respond solely to resuscitation. I ran my first resuscitation independently yesterday. Under normal circumstances, the MD usually medically manages them, but the one covering was just exhausted. He poked his head in when he heard we were starting CPR on yet another person, looked at me, and asked if I was good to medically manage it. I said yes, and he left to go do something else. We worked harder on that one than we had on others. He was young, in his 40s, and had a breathing tube placed and was on a ventilator that we didn’t know was faulty. We realized it quickly, only about five minutes after the ventilator malfunctioned, but not quickly enough to reverse course. We couldn’t save him. It was especially hard because one of his roommates, a dialysis patient in his 40s with every comorbidity under the sun, had regained a pulse twice from CPR in the span of about two hours. The deceased probably even watched us get the other guy’s pulse back the first time; there’s no privacy whatsoever in these rooms.

Tonight they reopened the tent hospital, so I was solo in the plague tent throughout the night. Somebody must have complained about the lack of security, because there was a security guard sitting near the tent for most of the night. The tent was full all night with eight patients, several of whom rotated in and out throughout the night. One guy got confused — I was uncertain whether from hypoxia or dementia — and started wandering around the tent adjusting everyone else’s oxygen settings. Another patient’s oxygen abruptly dropped, and they had to be sent in for BiPAP. At one point, all four of my oxygen tanks ran out at the same time. I couldn’t get any help for most of the night –the department was too busy managing back-to-back resuscitations and intubations — so I had to leave my patients alone in the tent numerous times to get supplies or deal with problems. I ran all night long.