Can I Open My Eyes??

Is it over yet?  Can I open my eyes??  Unfortunately, no.  It's not over and likely won't be anytime soon.  COVID-19 patients are still walking or riding through the doors everyday ... they're just easier to spot now.  We have a better idea of what to look for ... meaning symptoms, presentations, which labs and scans to order, etc. And now we can do our own rapid in-house COVID test that gets results within about an hour.  But they're still coming in and being diagnosed daily.

Side note ... the rapid COVID tests at this point are painfully inaccurate ... and it's probably most likely due to the administrators.  For those of you that haven't had the pleasure of enduring a COVID nasal swab, please consider yourself HIGHLY FAVORED.  I'm not going to lie ... it sucks.  And basically if you don't make your patient cry during the process, then you're probably not doing it right.  And because it is so painful for the patient, many staff are not administering the swab correctly.  They offer a quick apology and a three-second in-and-out of the nostrils just to get it over with ... but doing both the patient and the system a huge injustice.  Yes, it hurts!  And sometimes I've prayed with my patients before doing it because I've scared them so much in the name of honesty.  But you've basically got to shove that swab all the way up to their sinus cavity and swirl it around for 20 seconds .... on.each.nostril.  But because most tests are not being performed accurately, the number of false negatives is staggering.

I don't know if you've heard or read that there is some speculation that the virus may be attaching to red blood cells or hemoglobin in the bloodstream?  I've read various arguments on both sides and honestly it just made my brain hurt.  But what I can share is something I experienced yesterday first hand...

I had a patient who walked into the ED complaining of headache with associated high blood pressure because she had run out of her blood pressure medication.  That's it.  Headache and needed a med refill.  She conversed with ease.  Her breathing was not labored.  No other symptoms.  As I talked with her my eye caught the wall monitor mounted above her bed.  Huh ... that's not right.  I readjusted the pulse oximeter on her finger (it measures oxygen saturation).  It still read 66%.  I reached over to feel her fingers.  They weren't that cold.  Try another finger.  63.  Hmmmm ... is this thing working??  Unplug it and plug back in.  Try her left hand.  Damn, it's still 63.  "Hey Ms. So-&-So ... how are you feeling? Are you feeling short of breath?"  "No baby, I'm good.  But I'm sick of this headache and I'm sick of this place.  It's not that I don't like you but I don't wanna be here.  Can't y'all just give me something for this headache and get me home?"

I quietly finish my blood draws and assessments.  All the time evaluating her respirations and color.  I suggest that maybe a little supplemental oxygen might help with the headache until we can get some pain medicine on board.  I slip a nasal cannula under her nose and discreetly watch the wall monitor.  It starts to climb slowly ... 68 ... 72 ... 80 ... and stops.  Oh wow .... she's responding to the oxygen but it's not nearly enough.  A normal person with no respiratory disease should be in the upper 90s.  I increase her oxygen to 4 liters per minute ... it starts to climb again ... but maxes out around 89.  I double checked her triage stats and she was 97% on room air when checked in.  Uh Houston ... we have a problem.

I step out for a minute.  I bring the provider back in with me.  He orders an arterial blood gas to confirm her true oxygen saturation.  The first test results 38% PO2.  The patient wasn't having it ... cause those arterial sticks hurt too. They call in a second RT for a second ABG.  Then a third test is done.  All confirm Mrs. So-&-So is oxygen starved and doesn't know it ... literally suffocating and is oblivious.  She hasn't missed a beat ... or a breath.  She's been on the phone with her husband of 38 years and both her daughters.  She's now more than a little annoyed with all of us.  She doesn't understand what the commotion's about. "I don't care WHAT you say ... I'M NOT STAYING!!  I don't have that virus!  You can't make me stay!  You can't hold me against my will!"  All the time yelling like she's got more O2 than a scuba tank.

No baby ... you gonna die if you go home.  As in drop dead ... Cause you don't have the symptoms but every test result you have says you are extremely sick and will not survive if you leave.  To a woman sitting upright in bed yelling at you it's hard to convince her otherwise.  XR and CT scan show her lungs are full of COVID.  One hour later she is in ICU and intubated.  And it all started with a headache ...

Oh ... and she hadn't left her home in 8 weeks ...

I'm not saying this to scare anybody.  I don't believe in scare tactics and I'm not afraid myself.  But what I am saying is this happened to me yesterday ... in my ED room with my patient.  She literally deteriorated right in front of our eyes and we never convinced her she was truly sick.  And I think that speaks as to why some people are just dropping from this virus ... they don't know they're sick.    Both of my patients in the ED today had it ... and neither one of them believed it.  One was admitted.  The other left AMA.

So ... the virus is walking around or laying on surfaces all around us.  It's not going away and I believe we will see a second wave once the public resurfaces again.  I disagree with the Governor's order to end shelter-in-place.  It's too soon from a healthcare perspective. However, God gave me the grace to put the shoe on the other foot and hear it from a different perspective over the weekend.  A friend came to my house to cut my daughter's hair.  I've known her for 20+ years.  As she shared what her family is going through as her husband has been laid off from his job, losing his company car and company cell phone.  Three children.  One in college.  Private school tuition.  Just bought a new house 6 months ago.  Unemployment hasn't kicked in.  The pressure of watching their income source be cut off and questioning how the bills will get paid ... what could happen to the house ... only have one car now.  God opened my eyes to the other side of this struggle ... and I was convicted.

I still think it's too early from a healthcare perspective to reopen the state.  But I also saw the stress and fear in my friend's eyes and realized they can't keep going without income much longer.  Many of my friends can't.  She looked straight at me and said, "I mean I get it ... but I'd risk my health to put food on the table for my family."  Yes ma'am, I would too ...  I see it now ... and at risk of being a Debbie-Downer I'm just gonna put it out there ... this is a lose-lose situation.  Damned if we do, damned if we don't.  People are going to suffer either way.  And it sucks.

I don't have an answer.  I'm just thankful that my kids and I are still healthy and that I can pay my bills right now.  That's got to be enough.


And since sometimes you have to laugh just to keep from crying,  I'll share a little of what we've dubbed #coronacockfighting  ... because often laughter is the best medicine!