An excerpt from An Eschatological Isolation.
At 12:11 p.m., the overhead speaker announced: “Code Blue, Three West.” She repeated, “Code Blue, Three West.”
Shit. I started my stopwatch and saved the patient note I was writing in the back office of Three West, the intensive care unit of a community hospital in Tampa Bay. Already wearing a sealed N95 mask, I grabbed my glasses, goggles, face shield, and gown and opened the office door to a rush of providers running down the central hallway; I joined the scurry.
Inside the room laid a 47-year-old woman. She had been admitted to the ICU for severe COVID pneumonia. CPR had been started; I looked at my timer: one minute and 27 seconds had passed since her heart had stopped beating. The respiratory therapist stood at the head of the bed; two nurses alternated chest compressions. Nurses in the hallway mixed vital medications and passed them carefully into the room. The door was shut to limit exposure of aerosolized virus. The attending physician stood outside the glass, giving specific orders every minute.
“Three minutes give first dose epi,” he shouted through the glass … another three minutes passed with continued CPR. “Pulse check …” “Dose epi … ” “Continue CPR.” The cycle went on.
“I think it’s a pulmonary embolism,” my attending muttered to himself. “… her lips are blue. The novel coronavirus has been shown to increase a person’s risk of blood clots; a pulmonary embolism can be a life-threatening blood clot within the lungs. “Order tPA! STAT! Mix it on their way!” he shouted at me. I turned to the nearest computer and inputted his exact orders while pulling out the phone to call the pharmacy.
The charge nurse kept a record of every medication given at what time. In a low tone, she stated, “We have to save her … she’s me!” She pointed at others in the hallway, “She’s you! She is all of us! She’s a teacher in her 50s.” I looked over her shoulder; her clipboard quivered in her grip; it had been nearly 17 minutes. 17 minutes without a heartbeat.
A pharmacist appeared, running down the hallway with tPA medication in hand, premixed in a small glass bottle. She handed it carefully through to the nurses within the room. We all watched as Mike, a tattooed and pierced nurse I had met that morning, hung the tPA on the IV pole next to an indistinguishable number of medications, attached it to tubing, let the blood clot-busting medication drip into our patient’s arm. CPR continued amongst rounds of epinephrine pushes and pulse checks.
At the thirty-minute mark, my attending called it, “Time of death, 13:41.” Her heart monitor flatlined, and the beeping of her many monitors was silenced one by one. The respiratory therapist covered her exposed body, but not before I saw her bright red chest, rubbed raw from chest compressions. I knew her chest and breasts would turn blue over the subsequent hours as blood settled around ribs broken by CPR. Her fingers and toes were purple from lack of oxygen. Her face was swollen, with open sores along her cheekbones marking the pressure points of the ventilator mask she wore for two weeks.
Mike closed her eyes just as I heard her family arrive on the floor. Seeing our expressions, her husband shouted in agony as he collapsed onto the floor in the middle of the hallway. Visitors had not been allowed into the hospital since the first wave of coronavirus except for the end of life. Every staff member had been pre-fitted with special masks and gowns to ensure our safety inside COVID+ patient’s rooms; the same cannot be done for guests, who under no circumstances were allowed into patient’s rooms. Our patient’s daughter ran past her father, now pounding his fists on the ground, and slammed her body against the door of her mother’s room. She shouted at her mother to wake. She shouted at the nurses to let her inside. She begged, and swore, and cried to feel her mother one last time. Tears streaming down his face, Mike held the glass door closed from the inside, intent on not letting this virus infect even one more person.
I walked down the hallway. A technician had approached the husband, attempting to scoop him off the floor in an embrace. I sunk into the back office, closing the door on the sorrow which had enveloped our ICU floor, and reopened my patient note. I had five more patients to check in with, medication lists to review, billing to complete. Typing away ICD codes, I barely noticed my coffee had gone cold.
July 17th had been the fifth day in a row our hospital ICU had a morning code blue for a COVID patient whose heart stopped beating. Some of them were young, like this patient or younger. Some of them were older. Most had been on ventilators. All had COVID pneumonia, and all of them died. Every single patient who had been on a ventilator for COVID pneumonia had died. My patient was one of 128 Floridians to die of COVID on July 15th, with nearly 14 thousand new confirmed cases and nearly 9 thousand hospitalizations throughout the state.
Ammura Hernandez is an internal medicine resident and author of An Eschatological Isolation.
Image credit: Shutterstock.com
