Prone: Tales from the COVID ward

“He’s maxed out on the vapotherm, 100% at 40L. His oxygen dropped in the middle of the day, so they ended up putting the non-rebreather OVER the cannula, just to try to bring him up again.” The off-going nurse shrugs. “See if you can get him to prone again; he got up to the high 90’s on his belly.”

I have on my scrubs, my hair covering, my N95, another mask over it with with ear-savers pulling the elastics back. I pull my goggles over my eyes and wrap myself in one of our “Hefty Gowns” – plastic isolation gowns made from the same material as a thick, industrial trash bag.

They are the only disposable isolation gowns we have left.

We are already re-using our N95s across shifts.

Gloves over that, knock on the door, and enter his room.

More than half of the hundreds of rooms in this hospital now house only patients suffering from COVID-19.

Our ICU rooms are full, and here on med/surg/tele we know that once we overflow the ICU and ER, the ventilated patients are coming to us.

~ ~

His blood oxygen saturation is holding steady at 88% on 40L of 100% oxygen being forcefully shoved into his nose by the machine. He lies limply on the bed, head up at 45*; he cannot breathe if he is not sitting up. His hair is greasy and limp on his forehead because he cannot be off the machine for any length of time, certainly not long enough to shower.

He is a lovely, beautiful human being, and he smiles at me. “I’ll try not to be too much trouble tonight.”

He has to pause twice to take a breath while trying to speak that sentence.

I help him use a urinal, which exhausts him and leaves him gasping for air and drops his oxygen saturation to the low 80’s. Sitting at the edge of the bed, he breathes and coughs for a while. Then he says, “I pray for you, for all of you. I want God to keep you healthy, to not get you sick with what I have.”

I don’t believe in God, and I never have, because the God this country seems to want to believe in would never have made this man sick, nor killed Erwin or Val or Dr. George or Isatu or Sweet Baby James or Mr. O, or let four-year-olds be raped by their uncles. So He can’t be real.

But I don’t say that.

Instead, I say, “Imma going to take that prayer, and I’m sending it right back at you. God and you and I are all on the same team now, and our goal is to get you well and get you home to your family.”

He nods. “Yes.”

I say, “Think you can prone for a while?”

He says, “I will do whatever it takes.”

~ ~

Proning is very uncomfortable. His telemetry leads are squished against his chest, and I have to re-wire and re-clip his cannula and his oximeter wire and support his chest and neck and chin with pillows and towels, but finally he is face down on the bed, and his his oxygen saturation is in the toilet again from the exertion.

I flash back to New York, to the provider in a horrifically overcrowded ER performing pulmonary hygiene on a terrified 25-year-old who couldn’t breathe. I make a split second decision.

“If you’re ok with it, I’m going whack on your back for a while. I want to try to loosen up all the crap that’s in your lungs, get some oxygen back where it belongs.”

“Let’s do it,” he says, and I cup my hands and wallop him.

It is exhausting. My arms are tired within 30 seconds of starting, but I’m not stopping until I’ve percussed over all his lung fields a few dozen times. I’m not hurting him — I check constantly — but this isn’t a back rub. I’m hitting him pretty hard, because I want his lungs to open and the virus inside them to die a horrible fucking death at the metaphorical hands of his immune system.

I wonder if the remdesivir he got earlier is working.
I wonder if we’ll get any more convalescent plasma.

We had some yesterday; I gave it to a patient on a different unit, but we ran through the supply in a few hours.

When I’d picked up the thin bag of yellow fluid from the blood bank, more precious than gold, I’d realized the donating agency was the Blood Center of New York.

I’d thought for a split second about crying right there in front of the technician, but instead I ran it back upstairs and ignored my phone until the transfusion was done.

~ ~

I finish percussing him, and say, “Do you think you can make it for thirty minutes?”

He says, “I’m going to try very hard.”

I leave him with his call light close by, and turn off all the lights. It’s dark by then, and the only sounds in the room are the soft murmur of the television, his rapid, gasping breaths, and the whoosh of the oxygen machine keeping him alive.

~ ~

My phone rings. I sidestep out of another patient’s room — them holding steady on only 4L via a regular cannula – to answer it.

It’s his daughter. She’s polite and friendly but a high thin tone of fear etches its way across her voice as she speaks.

“My dad….he calls me, every night, from the hospital. Every night. He didn’t call me tonight. He always calls. Is he OK? Has something happened?”

“He’s fine, and I know exactly why he didn’t call you,” I say, but even as I say it I realize that it’s been way more than 30 minutes, and he hasn’t put on the call light, and suddenly I’m very, very nervous. I walk quickly down the hallway, and open the door to his room.

He’s asleep.

He’s sound asleep, prone on the bed, breathing easily, his oxygen levels in the high 90’s.

I explain the proning, and his daughter is grateful and thanks me and hangs up the phone.

Were my family in the hospital with this disease, I would be mad with fear.

I am the only bridge between a patient who can’t breathe, and everyone outside the hospital walls who loves him with everything they are.

~ ~

It is silent on the unit in the early hours just before the sun rises. The unit is two wings connected by a skybridge, and we can see into the other side through our respective sets of floor-to-ceiling windows.

Messages have been written to the sister units on the windows in dry erase markers. Written backwards, mirror-style, so the staff on the other unit can read them.

One said, “HERE WE GO AGAIN!” but sometime in the past 24 hours someone had put a line through “again.”

This time around is different.

~ ~

We sit and wait and watch the oxygen monitors and instead of seeing blue pleth lines we see a metaphorical ocean, pulling away, quickly quickly, far out to sea, far beyond the edge of our vision.

But instead of running for the hills, we sit in silence and wait, knowing there is a tsunami coming, knowing the wave will drown us all, knowing we will stand our ground regardless.

And we listen to each other breathe.