https://forums.somethingawful.com/showthread.php?threadid=3918863&userid=53835
Day 9
“You want to push another epi?” “Sure, why not.”
Overhead on the hospital PA: “As you know, today is National Doctor’s Day. Let’s conclude this quiet moment by standing where you are and applauding our heroic physicians.”
As that played, half a dozen nurses and I were frantically getting into our PPEs outside a suspected COVID room to rush into a Code Blue.
Surprisingly, no one stopped to applaud.
Inside, the calming voice was drowned out by the hiss of a nonrebreather, the labored expiratory moans of the patient, and the warning dings of the bedside monitor. The bedside monitor was not happy that the patient’s heart rate was somewhere in the high 160s and was letting the room know its opinion on the matter.
Narrow complex ventricular tachycardia. But the patient isn’t hypotensive or otherwise unstable. You don’t lay on the paddles of a defibrillator for that.
“You’re going to feel a little funny for a second,” is what the nurse says to reassure the patient. What she really meant was, “We’re going to stop your heart for a second or two to reset your circuit breaker, so if it feels like you’re dying briefly, it’s because you are.” The nurse draws up some adenosine, the other MD in the room slams the bolus into the patient’s veins, and everybody gets to watch the monitor flatline for a held breath before a heart rate returns. Takes two boluses for it to take.
Problem solved.
For 73 minutes.
Nothing was playing overhead for the second Code Blue. Thankfully, an intensivist was already inside running the show. I guess the Residents haven’t been left out to fend for ourselves yet. This time around the bedside monitor was simply furious that the patient stopped breathing.
Pulseless electrical activity, PEA. The heart’s wires are firing but the pump isn’t working. You don’t lay on the paddles of a defibrillator for that either.
Hollywood has lied to you your whole life.
“Do you think we’re going to be able to resuscitate him?” “He’s full Code.” “But do you think we’re going to be able to resuscitate him?” “No, but…” “Right, so it doesn’t matter. We’re running the Code.”
I get my exercise for the day by pressing on the patient’s chest for a couple minutes.
“I don’t really want to intubate him.” The patient gets intubated anyway.
A few people cycle through pushing on the patient’s chest. We haven’t felt a pulse since the Code began.
“How long has it been?” I suspect there’s a countdown timer in the intensivist’s brain that’s ticking towards an alarm labeled Ok, We Tried.
More compressions. Pretty sure I feel a rib break under my palms. That sensation never ceases to make me wince.
Another epi. Still no pulse.
The Doppler to check for a pulse is silent.
The timer goes off.
“That’s it.”
Time of death called.
…
Feels like COVID is eroding the edges off everyone’s souls in the hospital.
The initial novelty of sharp fear and apprehension standing outside COVID rooms before entering is giving way to a constant background dull dread as we gown up for the tenth or twentieth time that day.
I see my incredibly sharp attending boss distracted, needing to be reminded two or three times whose room he’s about to enter.
The lack of success in curing our patients is also taking its toll. “Successes” have mostly been defined as sending a patient home with personal oxygen tanks and explicit instructions on when to return if they get worse. We’ve had some milder cases that got sent home without oxygen, but they seem fewer than the number we send to get tubed.
I feel very bitter about this. It makes the sign out front, a sign that expresses nothing but pure gratitude and love, seem somehow mocking.
Day 12
“I will continue using military metaphors. We are at war with this virus.”
The greetings this morning were grim.
“Stay safe” has become the aloha of intra-Resident conversations. I heard that twice before reaching the front doors of the hospital just after sunrise.
“How was the night?” is the standard greeting to the two Residents just finishing their 12 hour Night Float shift. These are the two young MDs left to put out fires across half the hospital’s two hundred or so beds.
“We had the longest Code ever. Took an hour. We went through maybe 20 epi’s.”
Epinephrine is only given to people with either pulseless electrical activity or those who are asystolic – flatliners. (Once again, Hollywood has lied to you. You don’t put the paddles on anyone with a monitor next to them going BEEEEEEEEEEEEEP.) The ACLS guidelines say you push those every 3-5 minutes.
The Ok, We Tried alarm should have gone off about 3-4 epi’s in. Not 20.
“Was it a young guy?” “No, It was James.”
I curse a little louder than I mean to. I walk out of the room and wash my hands even though I’m sure I hadn’t touched anything.
James is- was a nurse at my hospital. He was maybe in his early 50s. Every Resident loved him because he was tough and always fought for his patients. He was a nice guy and a pleasure to work with. But he was fierce. He’d seek us out during Rounds, stare us down and make sure we put in orders for his patients ASAP. We all respected him.
I knew he was on a vent as of the night before with settings that looked, well, dire, but it’s still a shock.
The night team leaves. I start mindlessly updating the cheat sheet summary of our 16 patients. I’m on autopilot at this point. 13 are COVID cases. COVID cases are, unfortunately, very easy to manage. You put in orders for medications that you’re pretty sure don’t work, you note how bad their oxygen saturation is on nasal cannula (NC) or nonrebreather (NRB), and you gown up and see the worst cases / people you think might need to be intubated in the near future.
The first Rapid Response comes at 7:40AM. I reach the door (of course it’s a COVID room, that’s all we have left) and realize I left my N95 at home. I’m not entering that room. I flippantly tell the interns to access the situation and head to pick up a new mask at the Command Center.
The nice nursing admin lady hands me a paper bag with a new N95. She tells me to sign for it in the binder just outside the door. Despite my autopilot brain, I joke, “Oh we’re on the honor system? You know I’m just going to sign ‘John Smith’ in the binder right?” She laughs and says it’s ok I left my N95 at home.
I pick up my mask and sign John Smith in the binder.
Just because I’m in shock doesn’t mean I can pass up a joke like that.
I head back up to the Rapid. I get a debrief that this was narrow complex ventricular tachycardia in the 200s. They pushed metoprolol (wrong decision) and adenosine (right decision). I go talk to the very bright and hardworking intern on my team. I explain that in situations like this where the patient is otherwise hemodynamically stable, metoprolol isn’t going to do enough to slow the heart rate. You’ve got to reset the circuit breaker. I asked who the attending was in the room.
There was no attending. The intern had to make the call.
I left my interns to the wolves when I walked off in a huff to go get a new mask.
My autopilot brain goes over how shitty I am of a senior Resident. When YOU were an intern, at least your seniors never walked away from a Rapid.
As I walk back to the call room to barricade myself behind a door for an hour or so, I come upon a nurse meeting where the news of James’ passing was being announced. I honestly don’t remember a single word of it. I do remember the occasional sobs coming from these amazing nurses.
Then there’s a Rapid and a COVID is intubated.
Table Rounds.
Then there’s a Rapid and a COVID is intubated.
I’m getting good at assessing whether or not a hypoxic COVID patient will get tubed and if we have time to get them upstairs before they crash.
Go me.
…
“The world breaks everyone and afterward many are strong at the broken places.”
I don’t think my fellow Residents or I will break in the near-future. Maybe, maybe not. A few of us are close though, including myself. Feels like it’s just over the horizon.
It’s what follows that quote which worries me.
“But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.”
James never broke. He was good, and gentle and brave and he was killed.
Day 11
“…unless it’s ’visibly soiled.’ Like we could see Corona.”
I’ve been known to flirt with the LD50 of caffeine, but this morning I’m slipping it some tongue.
I’m status post two pieces of 100mg caffeine gum and a cup of coffee by 6:30AM. I hit 70 on the back roads heading towards the hospital in the minutes just after sunrise. There’s practically no other cars around. My AirPods stream Andrew W.K.’s “Ready to Die.” A tasteless choice, sure, but it fits the energy of the day so far.
The 73M with multiple comorbidities who developed an NSTEMI, and who tested positive for COVID 4 days after testing negative has steadily been declining in the SICU. He’s refusing his medications despite his seasoned ICU nurse using the full spectrum of asking, demanding, and sternly admonishing him on his nonadherence. She even broke out the fake tears, she told me. She doesn’t do that for everyone. But no dice.
More importantly he’s doing poorly on a nonrebreather (NRB). If he takes the mask off, his sats drop to the 70s, a value you might guess correctly to be incompatible with life. He’s a little altered and he’s been put on dilaudid and a wrist restraint. Just the one, a CVA left the left arm safely useless.
One of the interns asks me what the plan was for our patient here.
“Palliative has a Goals of Care meeting with his family today. Our only plan is to keep him alive long enough for them to sign the DNI/DNR.”
I can blame the caffeine, I can justify it by saying his prognosis was dire and it’s reasonable to think Ok, We Tried, but I scare myself a little with how low my empathy’s dimmer switch is set.
But I don’t know how else to deal with this. The recommended treatment guidelines changed, yet again. Azithromycin is now actively counter-indicted for COVID patients. We take him off it. Steroids, which as of yesterday were counter-indicated for COVID are now the standard of treatment for all patients on NRB. We start him on Solu-Medrol 1.5mg/kg divided BID. For all the good that will do.
He’s also well past the 5 days of Plaquenil / hydroxychloroquine. You know, that drug that was supposed to solve this whole crisis?
We all remember that right? I’ve got photographic proof we used to believe it would work.
Look up the March 17th (or Day -5, if you’d like) National Enquirer cover.
CORONAVIRUS CURES FINALLY FOUND!
Warning! Surgical masks SPREAD INFECTION!
Take a look at every single intubated patient’s medical orders and you’ll see they either completed or are on Plaquenil and azithromycin.
And people still think we have any handle on this other than jamming tubes down throats and waiting.
No one will believe the history of this thing when it’s over.
The patient passed that afternoon.
His daughters had signed a DNI/DNR right before.
…
I’m reminded of an intro Stephen King wrote for one of his books, where he writes about fear:
"The shape is there, and most of us come to realize what it is sooner or later: it is the shape of a body under a sheet. All our fears add up to one great fear, all our fears are part of that great fear - an arm, a leg, a finger, an ear. We're afraid of the body under the sheet. It's our body. … And [the writer] takes your hand and he enfolds it in his own and he takes you into the room and he puts your hands on the shape under the sheet… and he tells you to touch it here… here… and here…"
A quarter million Americans (at least) are going to become bodies under sheets in the span of one or two months. And we’re talking about returning to work and a “miracle” ending to this in nine days.
Wake up and feel the corpses.
(PS: Yes, I owe Stephen King a royalty check given how much I crib his writing style.)
Day 14
“Alright we’re done.”
I wonder when the refrigerated corpse truck trailer will arrive.
Before my shift officially starts, at 6:50AM, a Code Blue is called. 90F w/ dementia and probably a fuck ton of other comorbidities is found essentially cold and dead when the day shift nurse first walks in the room at the beginning of her shift.
Because mankind is cruel and irrational, this lady whose last real conscious thought occurred several years to a decade ago is still Full Code. So half a dozen nurses and four doctors all gown up and rush into her room to break her ribs before she's pronounced dead.
Because we're doing everything to save her, don't you see.
I swear to Christ I'm not this heartless when I'm the outpatient Family Med doctor I was supposed to be.
By the time I find a gown (a shitty, blue plastic trash bag of a gown which makes me sweat profusely and leaves my back slick with sweat and my gloves full of sweat and I pray we get those breathable yellow paper gowns again) then put on my fashion statement eye protection and enter the room, the attending is already calling it quits.
The anesthesiologist asks if this patient (this corpse) needs intubation.
“If you want to intubate her that’s fine. If you want to put yourself through it.”
One push of epi.
There's no blood pressure, pulse was gone well before we got to work.
Time of death… who knows.
Does it matter?
…
I come back to my call room and look at the census. 22 patients, 100% COVID.
I scroll a third the way down the cheat sheet and see EXPIRED. At this point that just means alerting the attending of more paperwork to be done.
I round on all my patients. They're all miserable and can't catch their breath and have headaches. A very nice lady asks that if she and her husband are in the hospital, should her 90 year old mother who lives with them be afraid? The truth is if you flip a coin she's already infected. If she's symptomatic and needs to go to the hospital, she's got a good 1 in 5 chance of dying.
I tell my patient to call her mom and tell her to report an symptoms to her regular PCP.
Then there’s a Rapid and a COVID is intubated.
He was a younger guy, only in his 60s. He's got a chance.
Then table rounds.
Then there’s a Rapid and a COVID… isn't intubated.
88M w/ dementia plus many other things. He's never make it off the tube.
We're here now. We're running out of beds and ventilators and now the Tough Decisions are being made.
The guidelines the dictates of the Gods of the Empire of the ICU were that a patient could only be intubated if they were A) satting <90%, B) tachypneic >30RR, and C) prone when these were taken.
Now we're adding on if they've lived a life well into their 80s or if they've got dementia or if through "clinical judgement" you know they're fucked, then they won't be tubed.
It makes total sense.
I've had a few calls now where I've gone through the pre-written script for letting the typical patient's spouse of decades and decades know their world is about to end. How that soul they've nuzzled up against for comfort is close to depart since death is inevitable.
"Not a candidate for invasive intervention" is the exact phrase.
Rationing? Cold calculation in an unprecedented time of suffering?
Truthfully, I'm not making these decisions.
But I still ask that you please, please forgive me.
Day 16
“I don’t know how sustainable this is.”
This is when things start getting bad.
“Basically they wanted me to lie to the family. Say ‘we did everything we could.’ But we didn’t.”
Did I feel it when I walked in? The shift in the air?
One of our patients, a lady in her 80s, has been steadily degrading, gasping for air on a nonrebreather for close to two weeks. Palliative was brought on board yesterday.
Palliative calls the patient’s husband. It’s documented right there in the chart: “Pt has living will expressing no aggressive measures including CPR and Intubation however her husband appointed HCP does not want to place limits. Call placed to pt's husband for follow up. He is unwilling to talk further than ‘I want my wife home.’”
Overnight, the patient remained febrile, 102.7F despite Tylenol and cold packs. Hypotensive, 50/20s. Agonal breathing. Even the cold definition of it is disturbing: “…characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus.” ICU evaluates her and says she’s not a candidate for pressers, intubation, or CPR. But still, no DNI/DNR order is placed.
The Night Float calls the patient’s husband. He remains adamant that he “wants everything done.” Night Float is essentially told by the Emissary of the ICU to not even enter the room should she Code, then call up the husband and reassure him we tried our best.
There’s a piece of me that empathizes with the patient’s husband. He’s been married to her for who knows how long. He was probably terrified, in denial, and isolated.
But a bigger piece of me thinks he’s a fucking monster for extending his wife’s suffering explicitly against her prior wishes.
At 09:24, we get a call that she has stopped breathing. Code Blue goes off.
The nurse at the door says something about how she knows it’s futile but she didn’t feel right not calling the Code. Because FULL CODE and DOING EVERYTHING TO SAVE THEM is sacred. Or it was. Or something. I don’t know anymore.
I tell everyone the plan. “Two people and two people only in the room.” I point at my interns. “Stay outside.”
I put on my gown and gloves. Did I put on the stylish lab glasses I wear around my collar as an apocalyptic-chic fashion statement? No, I remember now. I kept my regular glasses on instead. Because a good 30 seconds into breaking this woman’s ribs someone else entered the room and put a plastic shield over my face.
But before that I asked for a backboard under the patient. She was wide eyed and dead but I still asked for it.
And before that I pointed at the clock and said, “In five minutes, at 9:32, we’re stopping the Code.”
I’m pretty sure I felt ribs pop in succession like a zipper when I started compressions.
I think it was only two or three minutes into the Code before the intensivist walked into the room. He asked the patient’s age (82) and if she had dementia (she did) and after learning so told us to stop immediately.
Time of death… who knows.
Does it matter?
…
I leave the room without making eye contact with anyone. I try to remain cognizant of my hands and the right way to take off my PPE without buying a metaphorical scratcher ticket for the slight chance of intubation or death.
My poker face must suck because I’m asked three times in a walk of 300 feet if I’m ok. (Not even poker face. It’s all covered with a mask. My eyes are giving me away.) A nurse, the Chief Medical Officer of the entire hospital, and the Medical Director of the entire hospital. They all ask if I’m ok. I’m not, but I lie. I tell the truth to my patients and I lie to my colleagues and bosses.
The nurse who called the Code in the first place asks me if I’m ok as I’m walking out of (fleeing from) the unit. “Thank you, Dr T. Thank you.” I can’t summon any words to respond. Thank me for what? is the only thought I have.
The Chief Medical Officer stops me and asks me if I’m ok tells me we’re going to have a meeting sometime today to discuss end of life issues.
The Medical Director asks me if I’m ok and sees right through me and does his best to boost my morale.
He knows I’m a big fan of the food being offered to the Heroes of the Hospital (I assure you I bitterly laughed while writing that) and insists I go get some food. I half-heartedly say I had a piece of a donated heart-shaped Danish earlier, but he goes out of his way to physically walk me over to the Command Center where some breakfast burritos were delivered.
I appreciate this gesture so much. I’m just a little ashamed he had to spend time on me when he’s dealing with quite literal life and death decisions on an hourly basis.
I soft coded a person and got a breakfast burrito for the trouble.
Go me.
I soft coded a person.
I was protecting my team and the nurses and it didn’t matter if we put on pacer pads not or if we even tried epi and she was dead when I walked in the room.
Please forgive me.
Day 17 Quote
"Do me a favor?"
"I can tie you up."
"Patting me down for weapons?"
<She giggles>
"I might bring a shiv into the room for this guy."
"He's trying to run his own show. He's been here for weeks and weeks and he goes down in the eighties and it's failed, and he needs to go down on a nonrebreather and-"
"It's why I'm taking it not the interns. I know, I know, I know."
"And he's insisting on-"
"And he's pigheaded and wants to run the show and Rush fucking Limbaugh told him we have some miracle drug and he already had five days of it."
"Doctor ___ spoke to him already and-"
"She came in and chewed me out in the room."
"She walked in there and-"
"Yeah, I'm going to go in there and say we've not having a conversation about the Plaquenil and already how we've tried this thing-"
"He's talked to Dr ___ and he screamed at her."
"Tell me I look pretty in yellow?"
<Crosstalk that all approved of my fashion statement>
"Some fancy heels and you're ready for a night out on the town."
"You want some booties or a hair net?"
"No, look, I don't plan on licking my shoes or my hair, I'm fine."
<Giggles, door closes.>
"Mr ___, what are you doing with your mask off? You're scaring me."
"I just got off the phone with my wife, she-"
"Let's get that back on your face."
"I got a problem."
"I got a problem too. Imma get a chair. OK, what's going on?"
"Yesterday, I got up to the bathroom, six liters and I passed out."
"I know you're focused on the days where you were on the nasal cannula, but you've been a nonrebreather since March. Let's be very, very clear about that. If you walk around, especially without the oxygen, you'll pass out and hit your head. And we don't need you to hit your head in addition to everything else."
"I feel that I'm failing. Do I have- do I have the virus in me yet?"
"You've had the virus in you for three weeks."
"It's still in me?"
"Yeah."
"How can I-"
"It's not just the virus. Your body is fighting it off but the issue with COVID is your own immune system is attacking your lung cells. It's what we're afraid of."
<The sound of his nonrebreather is almost overwhelming>.
…
"I have requested many times, I'd like to try the-"
"We're not doing it. You've had this conversation with multiple people. This is directly from our infectious disease doctor, ok? This is above both of us. I started it back up last night for stupid reasons. I was going by your wife and your's decisions. Against pretty much all reason. To be very honest, it was a stupid reason to restart it."
...
"Also, sitting up? This isn't helping your situation at all. I've been doing this for 3 weeks. People who lie flat on their bellies? Their numbers look great. People who lie on their backs have numbers that look shitty."
...
"You're sitting here with your mask off and its nuts."
"Married 50 years and I talked to her and she's scared to death-"
"Yeah, she should be. I'm scared to death."
"Twenty days ago, I'm walking five miles a day."
"Yeah. Then you got sick."
"I can't even- I can't even stand up. I'm sick, I'm real sick.. I can feel, I can actually feel…"
I don't owe you anything. Finish the story however you want.
.
.
.
Day 18 “You’re trying to save the world and I’m trying to save you.”
Premeditated. That's the word I'm worried about.
75M w/PMH of CVA, nonverbal, bed bound, resident of a NH. Presented w/ fever of 103F, found to be COVID positive. He was doing well this morning, only on 2L via NC.
While responding to a different patient's Rapid, my intern is called off to assess this guy. By 14:00 he was satting in the 80s. Started on NRB. She orders a CXR and a ABG. I return from the Rapid (60F w/ alcoholic pancreatitis, COVID negative, hypoxic, watched her get tubed) and take a look at the patient. Junky lungs on auscultation. Agonal breathing. Clearly. Despite the NRB and sats in the upper 90s, the guy looks scary. Scary enough that I think he's going to crash in the next 10 minutes or so.
He's Full Code, of course. Before he had been transferred to our service, Palliative had already been consulted. After a few days of unsuccessfully trying to contact the patient's only living relative (his daughter), she signed off on the case. No Goals of Care meeting for this man.
I don't want to Code him. I don't want my nurses or I needlessly exposed to a droplet bomb of a resuscitation that I know for certain the ICU would never accept. He won't get tubed, and if he's not getting tubed he's dead. He's dead regardless of whatever we try.
"Full Code, COVID positive. Probably going to have to do chest compressions." "Yeah. Limit the people in the room. Five minutes on the clock." "Then we'll call it."
I didn't hesitate when I said that.
It wasn't a spur of the moment decision. I have thought over the previous Code and my decision then to limit it. And I'm repeating it.
God help me.
It doesn't sit right with me so I go to the medical director of the hospital (the very nice gentleman who got me a breakfast burrito, as you remember). I present the case.
"This is a big ethical dilemma." He exhales with the same exacerbation I feel. He offers the choices of treatment as usual (CPR / maybe intubation) or possibly two attending doctors attesting could sign off that CPR/intubation would be pointless. He tells me to see the CMO.
I go to the Chief Medical Officer. I repeat the story. He's a good man, a pediatrician by trade. Used to do our 8AM peds didactics. He's on the ethics board. He chews over the ethics of the case for a while.
As much as the conversation about end of life was enlightening, I'll spare you the filibustering.
The CMO meets up with my team (fuck, I never meant for this to escalate like this). He again filibusters the ethics of the case. Ultimately, he chooses to write a note as an Ethics Consultation advising that if two physicians are in agreement, a DNI/DNR order can independently be made.
After he leaves, my attending: "Once you make someone DNR yourself it's a civil case, but it can be a criminal case against you."
We all agree that he has no chance of surviving the Code, and even if he magically made it to a vent he'd die from respiratory failure. Or the kidney failure. Or maybe heart failure.
The other attending, my program's inpatient director for the hospital and "Physician of the Year" also balks at signing the form. Because he's not involved in the case, you see.
My attending says he'll talk to the ICU attending to maybe get a signature.
"Don't call it a soft code. Never say the words 'soft code.' But…"
I won't write the rest of what he said because I respect the man too much.
I am fighting uphill to do the right thing. Or what I think is the right thing. I don't know anymore.
...
Before I leave for the night, I text my attending asking if he signed the DNI/DNR. He replies "No. It’s a tough decision."
As I'm walking out I tell the nurse handing off this patient to the night shift that he is still full Code. She's incredulous. She had put out that bright pink MOLST form right in front of the attending to make sure it was signed two hours ago.
"Why didn't he sign it?"
"Because he's a moral coward."
…
I come home, watch Westworld, call up my best friend and weep.
Not the pretty tears of a Hollywood doctor overcome with their episode's brush with mortality who goes on to eloquently explain their sorrow.
No. It was ugly, wordless, choking crying.
Not for anything in particular. I couldn't say why today was the day I broke a little. Maybe a lot.
The only words I remember saying are "They all keep dying."
.
.
.
Day 19 The Story of Me
The absolute arrogance of you.
You thought you knew this thing. This fucking monster. And yeah, you caught and exposed one case. You could probably catch every case from 100 yards out at this point from just basic labs and an O2 sat even without a COVID test.
But you had no clue early on that this was EVERYWHERE. That this would spread so quickly and would overwhelm the census this thoroughly. The ED was right to start testing everyone who entered the doors and it wound up protecting you and your team.
And you denigrated them for ordering those tests. Day 4, it's there in black and white. And now your census is 100% COVID even if they came in for a fall. You wrote that on the same day as you proclaimed your mastery of this plague. Idiot.
You can manage the cases on the floor and order all the meds that whatever today's recommended shotgun approach to management has advised. You can know each and every single COVID patient's SpO2 and if they're NC or NRB by heart and it doesn't matter.
The monster causes DVTs even in patients on blood thinners. How many people did you admit that were placed on SCDs instead of heparin or Lovenox because their clotting score was essentially nil? How many people on Lovenox still threw clots? How many did you discharge home two weeks ago without a 30 day prescription for Lovenox? How many of them are going to die?
And the sudden deaths. You didn't notice a pattern in all those Code Blues? How pretty much all of them were PEAs? You coded a guy on the fucking floor because he dropped dead walking to the bathroom. How many did you send home are going to drop dead from that?
You advocated for a man to not receive CPR or be tubed like everyone else. What do you possibly think gives you the right? All you did was piss off your attending. Nothing changed. The patient will still end up getting Coded.
Every other doctor in the hospital is ok with pointless interventions, so why aren't you?
You're not doing well. And you want to forego one or two weeks of scheduled vacation to go volunteer for more of this suffering?
Your mentor got sick, and you could be sick. You already suspect you're an asymptomatic carrier like every other Resident.
Why stick with this?
The absolute arrogance of you.
…
But don't forget the good parts.
Don't forget going to an impromptu party you just had next door with your fellow residents.
Don't forget drinking Coronas and laughing with your friends.
Don't forget commiserating with them over this catastrophe.
Don't forget being open and honest with your interns and knowing they don't think you're an asshole.
Maybe you're doing a good job.
You can't get that Starfleet Medical tattoo on your left deltoid in Brooklyn right now like you wanted, but you will eventually. And getting a permanent reminder of those three red lines of split skin on your left 5th digit knuckle from washing your hands constantly would be a nice memento of this shitshow.
The eyebrow gash you got from that botched piggyback ride last night is pretty funny though.
Hugs and kisses,
You