A Glass Half Empty
Bargaining for life
At first he denied that he was sick. After all he had taken the ivermectin that he’d purchased from the feed store. All the news claimed its great efficacy. A dewormer had wormed its way into the news. He came to the ER only because his wife had insisted he come. He wore no mask. A bold move in light of the death and pestilence stirring all around him.
He had a fever. He looked fit but unwell. He could not control his dry cough. Luckily I was wearing my respirator. I knew just by his appearance that he either had COVID or he had the flu, but interestingly the flu cases were few to non-existent as if the new guy on the block had run the old germ off. I did a battery of tests to verify his diagnosis.
I ordered a COVID PCR test which took over 45 minutes to return. A series of blood tests such as a CRP and ferritin would be included in the order set which might suggest a viral infection. Nonspecific and useless - after this I would stop ordering them. A waste of money and time. His chest X-ray was clear (no bilateral pneumonia or double pneumonia, as if there were two baddies involved). His oxygen saturation was 94% on room air and did not change with ambulation.
His COVID test came back positive. Well, sir, you do have the COVID infection but you do not meet criteria for admission. “I don’t have COVID!” “ It’s not possible. I took that ivermectin.” He did indeed have the Covid infection. I discharged him with instructions to return to the emergency room for any problems or if his condition should worsen.
He returned the next day. Less than 24 hours had elapsed since our previous encounter. When he saw that I was his doctor again, he angrily stated that he should’ve been admitted yesterday. I attempted to explain to him that the hospitals in the area were overrun with patients, and we were housing patients in the hallways with few to no rooms upstairs. He demanded to be admitted again, but I explained we would have to repeat the bloodwork. Moreover, we had many more patients much sicker than him. “I am a well respected attorney here in town and if you don’t admit me, I’m going to sue.”
I reviewed his chest x-ray which now revealed the telltale sign of Covid pneumonia. Specifically, his x-ray had changed from the day before and now revealed bilateral infiltrates consistent with the viral pneumonia associated with the SARS virus. This worried me as his progression had been marked over the past day. Even though the COVID pandemic had only still been in its infancy, such a progression was not a good sign. In an attempt to alleviate his frustration and anger, I informed him that I would call the hospitalist on call and see if they would make an exception in his case. The Hospitalist over-worked like most of us again stated that he could not possibly admit this patient given the surge of patients needing beds and much sicker than he.
The patient pleaded to be admitted. I discharged him with realization that he more than likely would be back within the next day or two. I reiterated that should he worsen he needed to come to the emergency room immediately. Less than 12 hours later, he returned and saw my colleague. He had gone home and had had a syncopal episode (he had passed out). His oxygenation was now in the 70s. For perspective, this degree of hypoxia is what a lot of high altitude climbers see when climbing Mount Everest above the death zone while ascending without supplemental oxygen.
He was confused with a blue pallor. His EKG now demonstrated atrial fibrillation an abnormal heart rhythm suggesting a Covid associated myocarditis and his blood work revealed an acute renal failure. His condition did not improve even with oxygenation. His face was wan and reflected a great sadness as if he had much still to do and accomplish. As he was wheeled upstairs, the last thing that escaped his lips echoed his earlier sentiment, “ I can’t have COVID.” The tenor was now different. This was more of a plea. He needed to get his house in order.
The next morning there was a code 7 over the loudspeaker to which I responded. A code 7 is the same as a code blue at most other facilities. As I got off the elevator and ran to the ICU room, I ensured the fitting of my respirator by tightening the straps and put my stethoscope in my ears as I entered the room. CPR was in progress as I proceeded to intubate his lifeless form. The agony on his face mirrored the agony in my soul. Had he accepted his fate in the waning hours of his life?