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April 12: NYC Letters from the ICU

By Andrew D. Thomas, MD

April 12, 2020

It would be reasonable, but perhaps not correct, to think that this has not been a patient I will call Joshua Klinner’s favorite Passover.

He is 39 years old, married, and the father of 7 with the 80’s metal band haircut of those who fear God in the fashion of the Hasidim. And if God had been treating me like he has Josh, I would fear him too. Metastatic esophageal cancer is something most people are in no race towards, but Josh got to it early and managed to pick up the full package. Brain mets, ureter stents, obstruction, TPN, chronic bleeding into the stomach and a tendency toward seizure have joined the main attraction. And now This. Virus, respiratory failure, and the dark night of positive pressure ventilation.

Being intubated as he has been for the last 5 days is troublesome enough, but at least until yesterday he was sailing through the experience, blissfully enjoying a rocurionium, fentantyl midazolam cocktail (no ice).  Yesterday, however, his lungs looking better, we took him off the sauce and though we were happy he was improving, it was hard not to think that the joys of his return to consciousness and improving health were somewhat mitigated by his view.

He is crammed into an operating room containing three patients, three ventilators, a deafening negative pressure fan, and three poles as big as Christmas trees adorned with garland of tubes and pumps. Mr. Klinner faces one of the other beds in the room square on and he seems to be observing things there quite carefully, which is not surprising since there isn’t much else to watch. The problem is that since Mr. Klinner has woken up, each of the three patients who have been opposite him, filling his field of view, have died. Mr. Klinner, as best as I can tell, is nonplussed by these happenings. He is alert, his pulmonary function continues to improve, and  there is a good chance we will get him off the vent tonight or tomorrow.

It is possible that there is no one in New York right now who feels more lucky than he.

Meanwhile, the team braces itself. We resolve that the next patient placed across from him is the one who will be there for him to say goodbye to; when he leaves this place for the riot of the coming Spring.

Stay well!


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