April 30: NYC Letters from the ICU
By Andrew D. Thomas, MD
April 30, 2020
After a string of night shifts, deliverance can arrive in any number of forms, this evening it took the shape of a chicken pot pie. Thank you, Serena! After annihilating the pie, most of an associated chocolate cake outstripped even my ambition and so to the hospital we went.
Walking over, I passed clusters of masked people facing the Hudson, most of them holding up cell phones. Being a good New Yorker I ignored them, assuming they were just rubber necking another triple homicide. Big mistake. I nearly dropped the cake in surprise when the afterburner explosion from a squadron of F-18’s hit me in the chest as the fighters jets flew by over the hospital.
I have got to start watching the news. This was almost as bad as last Friday when me and Ann Rogers, a fellow surgeon/volunteer, were walking back from the hospital and heard that welcome classic NYC sound of irate honking. Ann turns to me and said, “Finally, The City is coming back to life.” I replied, “Yeah, it’s about time this place got back to being impatient and rude.” The weird thing is that the sound just kept getting louder and louder and then we started to hear yelling. A three-card monte game gone wrong? A knife fight? Couple old ladies in the middle of the street hitting each over the head with their canes? I looked at my watch, it was 7pm. OMG. I turn to Anne, my former boss and residency director, celebrated coast to coast for national leadership in minimally invasive surgery and, more importantly, once rising to a self-imposed one-month challenge to work the phrase “c*ck ring” into a sentence twice a day. I tell Ann, “I think they’re making all that racket for us.” “No shit,” she says.
I think she was touched.
Walking over with (most of) the cake, I pass the front of the hospital’s entrance on 168th and Broadway. There are two big tents set up there with metal cordons to create a queuing corral like what you might see getting in line to enter a rock concert. I had been in that part of the hospital a week ago and it was still something of a madhouse with sick patients in line with their stressed-out families and tons of security covering the exhausted heath care workers. I was there yesterday twice and both times and it was dead quiet, just bored health care workers and even more bored securities guys. Just the way we like it. I get some looks but the cake stays safe.
Through the maze of the hospital to the OR ICU I reach the lounge. It’s the usual smattering of coffee cups, half empty pizza boxes and maybe 10 doctors in various stages of PPE watching bad television. In the daytime it’s a race to the entertainment bottom around here. Should we head back to the COVID or linger to watch the segment about the guy who was in love with his car (yes, that kind of love)? No contest, that arterial blood gas can wait a minute. Frozen? Never seen the place so empty. Episode four of the Michael Jordan series last Sunday night? Standing room only. People sitting on each other laps. Social distancing? Come on, we are going to spend the next 11 hours wading through virus up to our thighs. A 5′ 1” radiology resident who was in diapers during the Bulls ’98 run actually takes my seat. Kid, please, my nostalgia for this is real! Youth is served, she needs a dose of MJ more than me. I stand.
The cake goes in the center of the table. I put on some PPE and round Core E and F for the last time. The place is notably decanted. Rooms now half full, the plan to open the operating rooms back up in full swing. I look at the places side by side where patients I’ll call Sonia Rivera and Maria Guzman had been. Ms. Rivera is in her early 40s and was never was without her bright yellow scrunchy her entire ICU course. She had a cytokine storm, she failed extubation had a tracheostomy, sidestepped complication after complication and then left the hospital 2 days ago. They played a song on the speaker system as she was wheeled out. Maria Guzman, 63, was on full pressors and increasingly difficult to oxygenate when we got word the family had signed a DNR. The arterial line fails and now we are dosing the levophed by cuff. Advice from the oversight is not to replace the line, she’s going to die in few hours. Holden’s been taking care of her for weeks. He hears this, turns away from us, gears up and gets an A-line kit. He spends the next hour struggling to get the wire into her collapsing left femoral artery as we watch on silently. The transducer is connected and when the tracing comes up, it’s beautiful. “Cuff pressure. That’s not good enough.” He says.
I’m glad he was off the next shift when the tracing went flat.
Now back in the lounge the residents and the fellows are talking about the future; promising news out of England about a vaccine trial, remdesivir possibly useful if it gets started early enough. We volunteers are setting up exit dates and making quarantine plans. There are constant rumors about when the hospital will come off its COVID footing and reopen itself to some type of normal care. Ongoing speculation about the guy in “love” with his car. Chatter is lively and free, here in the ICU, belly to belly with the virus, almost the only place anyone gets to be where the pandemic recedes, the virus ubiquitous and anxiety about it pointless. Attention stays directed to what’s important; the patients, the coffee supply, and what things to eat have materialized. A volunteer from California sees what’s in the middle of the table, cuts off a slice and takes a bite. She smiles and pauses, then sitting back in her chair amidst the bustle of fearless strangers who have become her comrades and friends, she says to no one in particular, “I came for the COVID, I stayed for the cake.”
Thank you everyone for all your notes, your support and your kindness. Tomorrow I’ll head back to MN for a quarantine at my fellow hand surgeon and friend LT Donovan’s generously donated lake house. Can’t wait to see you all again in mid-May!