Gloomy Sunday: More Tales from the 10th Circle of Hell

One’s reporter, donning his PPE

It’s been six weeks since my last report from work (here). At that time my hospital had 2–3 positive COVID19 patients and the tension was thick. Since then we seem to have crested, about a week ago, at 67. We’re down to 53 now. We still await the “surge,” but for now, at least, we seem to have flattened the curve. One hopes, anyway, that the light at the end of the tunnel is not a locomotive. Of course it could be, due to the politicization of The Plague by our Dear Leader, whom I complement by referring to him as an imbecile.

I haven’t written in the interim because I have been very busy, but tonight I am at home, quarantined for the second time in a month while awaiting COVID19 test results. I didn’t have it the other time. I doubt I have it this time. I could, though. Either way I am quarantined again and I get quarantine pay for being told to stay home, just as I get furlough pay if there is (rarely) no need for my regularly scheduled services.

My hospital and its flagship sister are run by one very excellent new healthcare system. They take care of their people and their people take care of their patients.

Recently (I work every other weekend) I was consigned to the Emergency Department (hereinafter referred to as the ED) to observe a young woman who had gone to bed one evening her usual self, and wakened the next day obtunded. No internal, medical cause had been found, and since we do not currently have a psych unit, transfer to a place with one was frantically being sought.

We get a lot of psych patients, via the ED, and most don’t have any physical comorbidity, so are “farmed out.” That will end when we open our own psych unit. Meanwhile those unfortunates who wind up with us often spend days (and nights) in our own Snake Pit (reference is to an Oscar-winning 1948 film about a woman who finds herself in a state mental hospital unable to recall how she got there. It happens all the time). So there I was.

During the next seven hours, before my patient was transferred out, I was in the odd position of being able (nay, forced) to observe what went on down there. The ED is my natural cultural element, professionally speaking, and I like it the best by far. It is never boring, it is often chaotic, much like a basketball game, with everyone primed to grab a loose ball. This day I wasn’t one of the players, though, but a captive audience. It was a Sunday in the midst of the 2020 COVID19 pandemic. Things seemed to be falling apart outside the bunker that is the hospital, while inside they were held together by a heroic and grim determination to play as many overtime periods as necessary, as well as possible. We were winning, but the strain was showing.

As I sat in my vantage point it was like the experience of depersonalization, a psychological phenomenon most of us have felt if not known there was a word for it, a state in which everything suddenly feels unreal, as though we are simultaneously watching a movie and acting in it, but having forgotten most of our lines. The show began, for me, about ten minutes after I was seated in the theater du Grand Guignol, when a local ambulance crew brought a patient in who was what is known in the business as a “working code.” This means the patient was either not breathing or that and without a pulse as well (one usually will follow the other in short order). The patient was placed in a treatment room and the evaluation began. The charge nurse (who sometimes that day resembled the conductor of a dissonant orchestra) meanwhile approached one of the paramedics and asked him “Why was he brought here?” as though seeking clarification. The paramedic looked confused, and the maestro asked “What’s his problem?”

“Not living, “ was the paramedic’s response.

There followed the appropriate academy award performance on the part of at least eight staff, including a doctor of emergency medicine (they are some of the best and brightest — and also bravest) and a machine known as “the thumper,” which is designed to carry on CPR better and longer than one or two humans can. I noted the thumper was working much better than the earliest ones I remembered from the early days of EMS field service, which often would “march” up the victim’s chest, breaking ribs and crushing internal organs as it wandered off the mark. That was 35 years ago, a vivid memory similar to the 65 year old memories of myself as a child watching the mechanical resuscitators failing to save lives in my old Washington, DC, neighborhood. In both eras I recalled wondering “Why bother?” and now here, at last, was a thumper I would trust. Of course it was employed in what appeared to be a lost cause, and as the ED staff worked and the thumper thumped and no pulse was detected, the futility of bringing back the dead struck a familiar but dissonant note, since I once coded during emergency heart surgery and was revived (though I was unconscious and didn’t find out about the little digression until days later. And then I was angry, not that I was alive, but that I had missed the whole thing).

The patient I was watching while watching my own deeply apathetic patient, had descended into something worse than apathy. In time efforts were stopped, the time of death was noted, and the doctor who had been in charge of trying to bring him back to the living was on the telephone speaking to a relative, delivering the news from a distance, since during all this, at least in my locale here in the hottest spot in Maryland, COVID-wise, as in most places, visitors are simply not allowed, which is more tragic by far than the simple fact that someone has died; they have died alone, or at least separated from anyone who may have loved him or her. It’s happening all over, scarring the psyches of a great swath of the population.

Withing a few minutes, while I was still musing over the paramedic’s description of his patient’s medical problem (“not living”) a couple of men were brought in from presumably the same auto accident. I couldn’t see the injuries, which is torture to me, not to be able to insert myself into as many peoples’ sufferings as possible (yeah, I may have a personality disorder), but could hear one of them whining and keening about how badly something hurt. I looked from his direction to where the still body of the first arrival on my shift now lay in an empty room, and shook my head. Not judging, mind you. Just measuring.

There were a number of auto accident injuries that day, which is extremely odd, because it was a Sunday, and not any Sunday, but a Sunday during the lock-down of the state. What the hell was going on outside? How was that even possible? Then I recalled that on the way in that morning, though there had been very few vehicles on the Capital Beltway (which I travel to and from work for 35 miles, round trip, five days a week), that of those out there, a number were driving rather wildly, just as if there were other vehicles out there (there were a few here and there), cutting across the paths of others, driving inordinately fast (I drive fairly fast myself, though not insanely so, and do not mindlessly change lanes or kamikaze dive for exits from the leftward lanes). I have my theories about this behavior, but they don’t involve the lock-down and lack of traffic.

As I sat and watched and pondered my patient and tried and failed to engage, I heard the occasional “WhuuuoooOOP!” of the overhead signal that precedes announcement of a code blue somewhere in the hospital. The sound is cartoonish, and is followed four quick beeps and then a calm human voice repeating five times “Code blue, room XXX” Later, if one remembers to notice, some voice will follow four beeps minus the cartoonish alert sound, telling us “Code blue clear,” meaning either the response to a dying patient was successful — or maybe not. We often find out the stories later, unless it is on a floor or unit where we actually are. We are all busybodies, nurses and technicians alike.

There were a number of codes in the eight hours I was there, including the last hour when my patient was gone and I was just killing time, wandering around the ED, saying hi to the wonderful people who work there, grabbing something for someone, probably just being in the way, since I was extra at that point, so eventually I decided to run out the clock in the break room, where some of the best gossip and funniest stories are exchanged. I was listening to some of that (and playing Can You Top This insulting the president), when screams could be heard just outside the break room. The ED was well staffed, and sometimes a patient will snap and start screaming for any one of a vast number of reasons, most of them perfectly understandable.

The screaming went on a tad too long this time, so the three of us stepped outside to find a patient in a treatment room directly across from the break room was doing the screaming, in Spanish, behind sliding glass doors, so it was difficult to know what was going on. One of the techs standing at the nursing station suggested “Maybe she’s having a panic attack,” but it was lasting too long for that, and those rarely result in really loud wailing. There were a couple of RNs over by the room, and one went in, took a cell phone from the woman inside, the screamer, looked at it, then began talking to someone:

What is wrong with you?” she asked someone angrily, then “Don’t you realize this is a hospital? Who does something like that?” She came out, still holding the phone, and said “You know that code a while ago on the fifth floor? That was her mom. She died. This fool just called to let her know that.”

This is where things get really ugly, when two members of a family have been struck by the plague, an elder first, then a daughter, and while one is being treated as an inpatient another is brought in to the ED with the same problem, and very likely someone who delayed being seen because they both were Latinas, and the imagination runs wild here, but the bottom line is they were both stricken by this perverted, highly intelligent and adaptable virus, and one was taken and within minutes some disembodied voice had told the still-surviving one her mother was dead, dead of the very same thing that had brought her to the hospital.

The screaming stopped. The clock ran out. I left for home.

The nightmares would begin later.