By: Dr. Romulo Babasa III
“History will remember this war. A war that was fought by doctors and nurses, not soldiers.”
March 2020 has been a particularly difficult month to wake up to. As I prepare for a shift at the Emergency Department (ED), this question always comes to mind “Is this the day I finally catch COVID?” It’s a heart-wrenching moment every single time. You think of the mortality this pandemic has produced. You are reminded of the case fatality rate of your age group and the colleagues who have fallen ill to this virus. Afterwards, there is a hesitancy to show up at work and just stay home...but quite remarkably, the sense of duty and sworn responsibility always kick in. Before, I could only imagine how a soldier must feel when he is deployed to fight in a war. Now, more than ever, I am aware of that feeling. I fear for my health. I fear for my wife and family. I fear for those who I will leave behind if ever I succumb to this disease. But inevitably and with some reluctance, I soldier on.
It is Thursday, March 12, 2020. It’s the start of my night shift wearing the ED’s new battle gear. As I tried to clear the fogging in my glasses caused by my ill-fitting N95 mask, my co-consultant gave me the first bad news of my shift during our hand-off rounds.
“We are all out of ICU beds. Pedia Crit 1 is deck 2 for a bed. 60’s male, PUI.”
Suddenly, I am hit by the irony of that statement. We have an adult male occupying a bed reserved for a critically ill pediatric patient - if ever one does arrive. And there is no telling when our PUI (Person Under Investigation) will be able to vacate that bed since he is second in line for one upstairs. We have trodden this line many times before, but tonight it seems the situation is a desperate one. In the span of a 12-hour shift at our ED, the outgoing consultant has received 5 patients who were all in respiratory failure and all intubated within minutes upon arrival. These 5 patients quickly used up our critical care complement of 3 beds and now even extended to the peds area.
Five hours into my shift, the triage nurse wheels in a 57-year-old male diabetic complaining of difficulty of breathing. From the Nurses’ Station, I could see the patient struggling to get off their car and sit on the wheelchair. The patient’s companion, his wife, was visibly worried. As I approached the critical care area where a vacant bed was being prepared, I saw the patient’s labored breathing. I quickly turned to the wife and asked what had happened.
“We ate out for lunch and he was perfectly okay, then all of a sudden he had trouble breathing. Then it got worse and worse,” the wife explained. “Until he asked to be brought here.”
It sounded like he was having a cardiac event. The patient’s oxygen saturation was worryingly low at 85%. His BP was high at 190/100. All these ultrasound findings pointed to cardiogenic pulmonary edema. But in the back of my mind, I was also suspecting COVID pneumonia. The patient’s oxygen saturation further went down. We had to act fast. I told my resident to prep the patient for rapid sequence intubation.
Our first attempt to insert the ET tube failed. At this point, the patient’s oxygen saturation dropped to 60%, his heart rate was bradycardic and his lips cyanotic. He also had frothy secretions which further complicated laryngoscopy. I had to take over the procedure and immediately realized that it was indeed a difficult airway. I could not see the glottis. I pulled on the laryngoscope handle as hard as I could but to no success. The heart rate dropped to 50…40…30…the patient was nearing peri-arrest. My goggles fogged up and I instinctively took them off and proceeded to intubating the patient. I made a calculated move and advanced the endotracheal tube blindly. It worked and his oxygen saturation as well as his vital signs improved.
I was flooded by a myriad of emotions when I learned of my results. Among them were denial, anger, helplessness and fear. Several of my co-consultants messaged me and inquired on how I was doing. One advised me to get admitted. He mentioned another EM doctor who got exposed to a COVID-19 patient in a similar way – by intubation. That doctor unfortunately developed severe pneumonia and was put on mechanical ventilation. Even though I had very mild symptoms at the time (a sore throat and beginning dysgeusia), the unpredictability of this illness coupled with my risk factors (hypertension and diabetes) made the decision to get admitted very easy.
I stayed at the hospital for 4 days, finishing a regimen of Hydroxychloroquinone and Azithromycin. I did not develop any symptoms of pneumonia, but I did lose my sense of smell and taste. My attending physician told me I should do well while at home quarantine. None of my inflammatory markers further increased, and my chest x-ray was normal. I was discharged midnight of March 30th.
What followed next was my recovery period, which also happens to be the most distressing and most miserable 2 months of my life. Early in the COVID-19 pandemic, the Centers for Disease Control recommended that healthcare workers who have recovered from COVID-19 disease should test negative in 2 successive PCR swabs before they can return to work.
I have now the unenviable task of holding stable COVID-19 patients seeking admission and diverting them to other hospitals. We are now 5 months into this pandemic, and the burnout has drawn lines upon our brows. Some have gotten sick and recovered. Some have left. But many of us are still here, resilient and seemingly tireless. Still braving the dangers of constant exposure to a now more transmissible strain of the virus. Still struggling with a far more overwhelming battle within us - to leave our families at home and serve the patients who can likely put us in harm’s way. Again, the same question comes to mind, “Is this day I catch COVID, for a second time?”
I tighten the Velcro straps of my face shield and I put on a second pair of latex gloves. The ED is now a symphony of pulse oximeter beeps and respirator alarms, punctuated by PA calls for a nursing assistant. Another patient is brought in, slumped on a wheelchair, surgical mask on with anxious relatives flanking him. I alerted my resident and motioned him to accompany me. As I walked towards this newest patient, weary but determined, I muttered these words through stifled breaths: “The war continues.”