NSights Blog

The calm before

Dr. Sam Dugan offers a look into the life of a resident physician during the pandemic

It’s a longer walk than usual, still cold outside, snow dancing through the night air. The straps of a backpack have replaced the usual leather bag. The cowboy boots that normally provide some rhythm are instead plastic contraptions that are easier to clean.

Your phone rings, and looking down, you see notifications for seven new text messages, three missed calls, 17 unread emails. You’ve time to open your inbox, and the subject lines are all too familiar: Disregard previous email, UPDATE: IMPORTANT MUST READ. The same sender authored another email an hour earlier, that subject reading: **Reporting COVID MORTALITY**. The first email gave us 24 hours to report another dead father or mother. The newest version states it must be done IMMEDIATELY. We’re so used to ALL CAPS these days that it doesn’t sound like shouting anymore.

In your plastic shoes, feet from the door, it’s time to mask up. Your ears are still bleeding from the night before, but after you read the texts from your folks and sister – so funny when she worries – you put the mask straps over your ears once more. Your fingers only shake a little.

They ask when you come in –  How are you doctor? – but they don’t wait for the answer. The next three questions are what they really want to hear. Have you been outside the state in the last two weeks? Do you have a fever? Do you have a cough? You’re sure the answers are no, but what about that cough this morning? Was it really just the coffee going down wrong? They swab your forehead and you wonder why – it’s 18 degrees outside, so of course it will be negative – but this is the gatekeeper.

Dr. Sam Dugan looking tired after a day on shift during the coronavirus pandemic
Dr. Sam Dugan. Photo by UNR Med/Brin Reynolds.

Your badge opens the door, and just like the night you’ve left behind, the hallway is silent. Gone are the people asking where Starbucks is, or where the pre-op area is. Gone is the puppy with the vest saying “pet me,” and the man who played the big piano in the lobby. The only audible sound is the faint call of the hammer. That’s why the walk is long. You used to park closer, but the garage can make way for beds, and so it must.

The only person you see on the way is a good friend who wishes she could give you a hug. Instead you ask about the shift. She’s a resident, too, and she tells you about three intubations, two dead. Maybe you’re in for an “easy” night. It’s hard to tell if she’s smiling because all you can really see around the mask are eyebrows.

Luckily we still have N95 masks, but functioning in them is challenging. You think back to the phantom cough from this morning and remind yourself that it’s just the mask making it hard to breathe. On you go, your face clean where normally a beard would’ve sat. Backpack down, clean scrubs on and wait. It’s not long. The phone rings, and your admit begins. Respiratory, slight fever, 40-year-old male, no real medical history, works in Seattle. You tell the ER doc you’ll be right there and put a disposable mask over the N95 to keep it “cleaner” since you’ll need to wear it again.

The ER is quiet mostly, as empty as the hallways, with no family members to chat with. It’s hard to recognize the nurses and staff behind the mask, so you just nod and smile, then chuckle to yourself because they can’t see the smile anyway. The patient is behind the plastic, which has been taped to the walls and ceiling with red duct tape. A nurse asks if you know what you’re doing going behind it. “Yes, I was here last night, too.” “Oh, that was you. How are you?” “Living the dream!” It’s the line you use when you don’t really want to stop and explain.

Behind the plastic, there are no family members in the room. The patient doesn’t look that sick. Just a bit of oxygen, chest x-ray with some peripheral haziness, no other medications. He looks familiar and you realize – it’s that guy from the gym. You see him there a lot. It’s only day two of symptoms for him. You ask him to write down anyone he has been around recently, and he sheepishly adds that he and his wife went to a friend’s house the other day for a beer, being home so much was just a bit too much to take. You discuss the plan, make sure to get a cellphone number for his wife and ask if he would like chest compressions and intubation should it come to that. You try to normalize it, “I ask everyone this – it’s just part of the hospital procedure. We’ll get you right upstairs, sir.” Then it’s clean the PAPR, outer mask off, disinfect hands, and repeat that because you can’t remember if you actually did it.

On your way out you stop and ask the charge nurse if there are any ventilators left, and she knows as well as you do that there will be one less tomorrow. You call the patient’s wife. This doesn’t usually happen over the phone: There’s a hand on the shoulder. You usually end with, “We’ll take good care of him,” and pat the patient’s leg. Simple touch goes a long way, but not over the phone. You remind the worried wife that the hospital doesn’t allow visitation right now. You save her number in the chart and add a note to “Please notify via phone if patient expires.”

You go back to your room, passing through empty halls. The rest of the night is quiet, except for a call to the NICU for a newborn with hypoglycemia. The NICU nurse is upset you’ve also been in the ER tonight, but so far there isn’t a hospital policy, so you change scrubs and promise to scrub down before you head down.

You take a phone call from a clinic patient. Poor girl, she’s 18 and has a sore throat. She’s hard to understand through her tears. Hurts to swallow. No fever though, no cough. Likely just strep throat. There will be no swab, no clinic visit, best not to come into the office. You send a script in for antibiotics. She’ll probably get better quickly. “Call back if you get worse.”

Nobody else all night. Where are the chest pain complaints? Where is that guy who always wanted the Norco? Where is that lady who never makes it to dialysis? No matter, quiet nights are good. You’re on for a month, so take them when you can.

You head out – it’s still freezing. Put the bag by the truck, take the scrubs off quickly, hope nobody sees, into the bag go the scrubs and the mask. New clothes are waiting in the truck. The sun peaks over the mountains just in time for the drive home. You head straight to the shower once the scrubs are in the wash. A Willie Nelson tune begins as the water starts warming up. You glance at your phone. There are still 17 new emails, one proclaims: Peak expected in next 7-20 days.

Sam Dugan
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