DEIRDRE CROKE, RESIDENT PHYSICIAN, TWIN CITIES
January 8, 2021
“Shut up” I say to my smart device as the alarm goes off. It’s the evening and I am facing another night shift at the hospital. It doesn’t respond to that, so I groan and politely say “Please stop” and the chirping halts. I feel particularly tired and chalk it up to working two weeks of long shifts.
My phone buzzes: a text from my friend Liv. “Any best finger to put the pulse ox on? Todd seems to be 91-92.” Her husband was diagnosed with Covid about a week ago. She’s one of the most even-tempered people I know, but had asked if there was anything they could do at home to monitor symptoms. I suggested she buy a pulse oximeter and check it periodically.
“Any finger is fine. The pointer is usually easier. Have him take some deep breaths and see if it comes up.” I begin to pack for the night shift. Go to the kitchen and get food together. Start making coffee. Come back in a few minutes to her text: “He can’t take a deep breath.” I reread it. She must have mistyped. As I’m staring at the sentence she sends more.
“His O2 is 90. His heart rate is 130. He can’t take a deep breath.”
I’ve known Liv for twenty-five years. We grew up across the street from each other in New York. We played on the same soccer team and our moms would trade off pick-ups and drop offs from practice. Our families vacationed together every summer. Had even been suckered into buying timeshares together. We spent weekends driving to Jersey for soccer tournaments, nights sneaking beers to the playground of the nearby school, days after school listening to the local boys’ punk band in their basement. My mom tutored her sister for her nursing licensing exam. I went to prom with her brother at his Connecticut prep school where I smoked weed for the first time. Her dad, a man who didn’t graduate high school and joined the military when he was seventeen, had beamed at me when I came back to the neighborhood with a medical degree. In his thick Brooklyn accent: “I never thought I’d know a doctor.”
I pick up the phone to call her and pronounce our usual greeting in my calmest voice: “Hey girl”.
She’s crying. “I’m so scared. I don’t know what to do. His breathing seems labored.”
I’m on speaker now and talking to Todd. “Take your first two fingers and place them under your jaw until you feel a bounding pulse. Set a timer on your phone for 30 seconds and count your pulse.” What feels like an hour goes by. Liv says “What is it Todd?”, and he answers “66.”
“Ok so multiplied by 2 is 132, so the pulse oximeter seems accurate. I think you should go to the emergency department. Hopefully they’ll just get some labs and an X-ray or CT scan, prescribe you steroids and send you home.” I try to sound reassuring. But I also tell him to pack a bag with extra clothes and his charger, because I know there’s no chance he’s coming back home tonight.
I send a message to my mom. Our moms are still best friends, and I want to warn her of the anxious texts she’ll inevitably be getting shortly. She responds “Oh that’s not a good sign. And the typical course. Need to rule out PE vs ARDS/COVID pneumonia.”
She’s been a medical ICU nurse in the Bronx my entire life, which means two things: she’s probably the smartest person I know, and she’s seen some things I can’t even imagine. When Covid hit the city, it hit her hospital hard, and she started working sixteen hour shifts for weeks in a row. Her employer even put her up in a hotel near the hospital just so she’d be able to stay later at work but still get some sleep.
One day the nurse manager approached her and said “I don’t know how this is my responsibility, but I need your help.” He led her to a room with the air conditioner blasting, filled with about two dozen dead patients. They had long run out of room in the morgue, recently ran out of space in the cooler trucks outside, and now were out of toe tags for the bodies. So my mom wrote their names in permanent marker on their feet, and went back to the unit and finished her shift.
I go to work, tired, but can’t stomach coffee for some reason. It’s a quiet night so after “tuck-in rounds” with the charge nurse I head to the call room to lay down. My muscles feel heavy. I’m exhausted but can’t sleep and blame it on my flipped schedule. I lay on the uncomfortable call room bed and reminisce about intern year, when I had a thirty-six hour stretch off between a day and night shift. I flew to South Carolina, where Liv and Todd had moved, and missed the rehearsal dinner but got ready with her the morning of their wedding. The next day I went from the airport straight back to the hospital to work.
The rest of the night is a blur of answering pages, distraught texts from Liv, phone calls from nurses, wondering why my throat feels scratchy and realizing I forgot to take my allergy medication, updates of Todd’s vital signs and lab results, taking ibuprofen for a headache that must be caffeine withdrawal, but no sleep. The sun rises and on the drive home my throat feels raw, and I start coughing. I tell myself I’m being dramatic, but by the time I’m at the door I have chills in my spine and make an appointment for a Covid test.
I call in backup coverage for my last night shift and feel guilty and like a fool. It can’t be Covid. All I’ve been doing is working, and I’ve followed the PPE protocols. I’ve worn a mask so much my face is littered with maskne. While I wait for my test results, I convince myself the symptoms are just allergies combined with working nights for a few weeks.
I toss and turn the rest of the day. Todd is on four liters of low flow nasal cannula, his oxygen saturation hovering in the low nineties. He started dexamethasone last night. The hospital is full, so he’s admitted but won’t leave the ED for a while. Liv wants to bring him a pillow to make him more comfortable but has their eight month old son to take care of and wouldn’t be able to see him anyway. They’re probably going to start remdesivir tomorrow.
At two in the morning I wake up clammy. I check my phone and see a new email: “You have results in MyChart.” My face goes numb. I try to log in but my shaking fingers can’t correctly type the password. I get it right on the fifth attempt and read the results, my heart pounding and then a pause: positive.
KRISTINA KROHN, HOSPITALIST, MINNEAPOLIS
JANUARY 6, 2021
ONE DAY TOO LATE
“Could be COVID?” I asked
“She’s been here 142 days, it’s not COVID”
Standing outside her room, N95 on mere hours later. “Her husband got Covid“ the nurse tells me.
For 135 days you came to her side. You protected her. You prayed for her. You did everything. for her. She was your life.
You stayed until the very last moment of the very last day before we forbid you, or any visitors, from returning.
Two days later you sneezed. You thought you’d been careful. It was just a sneeze.
Three days later the coffee tasted bland. You knew.
You got tested.
A day later you told us your result.
At the same time, she was getting worse. The nurse handed me the phone, “ The doctor wants to talk to you.” You already knew what I was going to tell you.
“I’m Dr. Krohn. I’m one of the night docs.”
“Thank you for taking the time to talk to me“ you say. Neither of us want to have this conversation. We both know already what I’m about to say, and what I leave unsaid. You’ve already been crying. Probably since the moment you couldn’t taste the coffee. You’ve known. And you knew it was already too late.
“She’s not doing well. We’re going to intubate.” There is no way for me to be kind, so I just lay it out there. The sounds on the other end of the phone, … I can’t repeat that sound of anguish, but I felt it.
Through cancer. You were there. Through the various infections. You were there. Every day. You tried to be safe. But you still needed food. You still needed gas to get to the hospital. You still needed to work.
Her body could not handle one more thing. Especially not Covid. We both know that she won’t survive if this is Covid. For now, we don’t say that.
We wait on the test.
She in her room, on a machine.
You alone at home.
Me alone in a night workroom.
You came every day we let you. Until we forbade it. And you and I both know we probably stopped you one day too late.
ANDREA TATLEY, PALLATIVE CARE CHAPLAIN, MINNEAPOLIS
Prayers in the ICU
Writing before the sun comes up. It is quiet, only a wandering deer near the line of pines searching for a frosty apple or two from the small grove. A lonely cat sits by the computer screen looking at me, purring in request of a soft lap for a nap. Sirius to the East, Arcturus to the South, and a brilliant beaver moon gently blanketing the garden where tomatoes reddened, just a couple months ago. The spirit of the land has rested and speaks in soft tones only heard in the pre-dawn hours.
Yesterday I received a request. Not an odd request, but a very simple, quite normal request. They usually start with the same words, “I have a patient for you to see….” The phrase is then followed by, “I know you are busy…” or “if you have time…” A story follows, part tragedy, part complexity, sometimes with a dash of hope because after all, these folks are really sick by the time they land on our doorstep. But this request was not complex. A daughter, hundreds of miles away, her mom swept away to another state, to a hospital equipped to care for her when the local hospital ran out of answers and beds. Mom and daughter both alone with miles separating them in the midst of a pandemic; a virus standing in the way of being together… This is a common and heartbreaking occurrence.
The request? A prayer. That was it. A prayer, tearfully requested by the daughter. Of course. Of course I will go pray with your mom, in the ICU, on a breathing machine, sedated. Theory has it that one of the last senses we maintain is hearing. I share this with patient families all the time. “Assume they can hear you. Say whatever you need to say. Say it all.” Grabbing the mask I hate, shoving my claustrophobia into the depths once again, I head up to the ICU.
Arriving, there are two beautiful nursing souls tending to the body of mom. Gently moving her, guiding tubes, moving cords, changing sheets, checking monitors, adjusting IV bags and on the IV pole, next to a clear liquid filled bag, hung a beautifully simple rosary. Pale pastel beads held the pieces together, Hail Mary full of grace…
I asked the nurse if we could place the rosary in her hand; she tenderly wrapped it around the weathered hand, “I’m not Catholic, she said.” “Me neither…” I replied. Hail Mary, full of grace. The Lord is with thee…
Masks make it difficult to hear and so to pray, even with the knowledge that she might be able to hear me, above the drones of the breathing machine and the bells and whistles of the intensive care unit…Blessed art thou among women, and blessed is the fruit of thy womb, Jesus…my prayer was loud, it felt as if it reverberated down the hall, wafting into neighboring rooms, soaking into wounds physical, emotional…
The nurse shared an “amen” with me, and the rosary was replaced on the IV pole as to not get lost in the sheets. I thanked the nurse who had remained, joining the prayer while she was changing the urine bag. Warm water and soap suds flowed over my hands as I looked around the unit. Social workers on the phone, doctors in consultation, nurses in and out of rooms, it all looked the same as when I had walked in just moments before.
The visit wasn’t long, it wasn’t complex. Prayers through a thick mask, for someone on a ventilator, whom I hoped heard at some impossible level of awareness above all the noise of the ICU feels like screaming a prayer to a deaf God.
The spirit of the land speaks in soft tones only heard in the pre-dawn hours.
Holy Mary, Mother of God, pray for us sinners, now and at the hour of our death. Amen.
JON KENKNIGHT, GENERAL PEDIATRICIAN, DULUTH
December 16, 2020
Winter seems good, seems like typical flu season
Hearing whispers of trouble overseas
I hear the story of the Ophthalmologist in China
His life, snuffed out by a Monster
Trying to spread word to the rest of the world - sound the alarm, this is serious.
It’s in Washington State.
Is it already here?
I’ve been seeing kids with prolonged illness, presenting like influenza but negative.
My kids are in school, the chronic runny nose never ends.
Is the Monster here?
A simple sore throat starts in me. Normally an annoyance but now seems terrifying.
I have asthma and sarcoidosis and I am not the most healthy and I don’t want to leave my wife and kids and I can’t stop it I can’t stop thinking about it and I don’t want to stop thinking.
I get tested. I wait. And wait. I feel guilt for leaving my patients as I wait over a week at home. I worry about my patients coming to clinic - is the Monster in the waiting room? We strip it bare. The usually happy toys and books in the waiting room are gone. The families are gone. We all fear each other, our food, everything we touch. It feels so alien and lonely.
We transition to the new normal - video visits from home, only seeing kids in the office if necessary. I wear the same sweatpants all week. I still don’t have the right PPE. I frantically order CPAP filters and an anesthesia mask and cobble together my own elastomeric mask. I hope it works. My eye is twitching. It won’t stop.
I drink more than I care to admit, to drown my fears, stop my twitching eye. I have panic attacks. I tried meditation, it didn’t really work for me. I wait patiently to become numb.
I’m ashamed of the numbness.
I am pricked back to alertness at the death of a black man by the police. The streets rage. The Monster is present. How can this year get worse. I want so badly to scream and to stop all the hate the cruelty the racism the division. I am appalled when a militia blocks the hospital because they think masks infringe on freedom. I want to yell, it’s not the mask it’s the Monster. The Monster took our freedom, our grandmothers, our grandfathers, our friends, our mothers, our fathers, our brothers, our sisters, our sons, our daughters. US. It took us.
It took us.
And now as I reflect on the journey, the Monster and how it has changed us, on the eve of a life giving vaccine, I am ashamed of my numbness. I see my colleagues stuck in the fight against the Monster, in the never ending hospital shift, the holding of hands as the life flitters away, comforting strangers when no one familiar is near, trying to fill the emptiness left by the Monster.
I sit in clinic seeing kids with symptoms. Families thankful for seeing me as other clinics and urgent cares turn them away. I see their fear in their eyes when I tell them their children may have COVID, that the Monster may be here. I struggle and am awkwardly apologetic after telling families of babies with low grade fevers and coughs that even though it *may* be teething or a cold, the Monster doesn’t care. It shows up as anything.
I am proud to help these families. They need reassurance, guidance, to feel grounded.
But that pride is smothered by the numbness.
It continues. I don’t know when it will end. I know the numbers - hundreds of thousands. And yet I am numb. There are murmurs of other feelings - rage, fear, and sometimes, if it’s a good day, I find just a bit of hope shining through the gray as I look to coming changes next year, as I look at my children smiling faces when I come home, when my dogs wag their tails so hard I think they may pee on the floor, the comfort provided by a warm hug from my equally exhausted and understanding wife and partner.
But for now the numbness continues like a warm blanket protecting my fragile soul, letting it drift asleep on a dreamless sedative.
And I’ll get up and do it again tomorrow.
See you there on the path.
January 4, 2021
Happy 2021! We want to kick-off the new year with a contemporary dance video from MN Dance Company. Performing to a song by WOODKID titled "LAND OF ALL", we hope this pause will get your energy going and push you to work towards all of your new year's resolutions. Take a look at the company's other videos (linked on Instagram above) if you want more inspiration to get moving.
December 14, 2020
Today we pause with another incredible short piece from the TPT Hippocrates Cafe: Reflections on the Pandemic lineup with Gao Hong playing an excerpt from her original composition “Flying Dragon”. The pipa is a pear-shaped lute which has four strings that are plucked. Gao Hong is a master pipa player, composer, and professor who began her career as a professional musician at age 12 at the Central Conservatory of Music in Beijing. We are so lucky to be able to share her incredible talents with our community. If you haven’t already watched, you can check out the full Hippocrates Cafe offering here.
December 11, 2020
To end the week, we take a trip to Zürich’s Main Train Station to see GaiaMotherTree by Brazilian artist Ernesto Neto. GaiaMotherTree is a monumental sculpture made of brightly colored hand-knotted cotton strips. It resembles a tall tree and extends right up to the ceiling of the station concourse. GaiaMotherTree is not only a sculpture, but also a walk-in structure that functions as a meeting place and a venue for interaction and meditation. A program of events takes place inside the installation, including concerts, workshops, talks, and guided tours.
December 9, 2020
Our next art installation from around the world is found in the National Art Center in Tokyo: “The Forest of Numbers” by Emmanuelle Moureaux. This installation uses more than 100 colors and more than 60,000 pieces of the numbers 0-9 suspended in the air, with paths to walk through. The installation is meant to visualize the future over the next ten years. Inside the forest, two girls and one cat were “lost inside'' for explorers to find. Check out this futuristic and whimsical use of numbers today!
December 7, 2020
This week, to combat quarantine blues, we are going to feature some art installations from around the world to give you a dose of culture and creativity. Today, we pause with Tili Wiru Tjuta Nyakutjaku (looking at lots of beautiful lights) by British artist Bruce Munro. Installed in Uluru, Australia and on display until 2018, this interactive outdoor exhibit featured thousands of tiny beautiful lights set up in Australia’s Northern Territory. Viewers could walk through the installation and even share a meal under it. Paired with the beautiful night sky in Australia, this is a true visual masterpiece.