COMMENTARY

'No Miracles Here': A Week on the COVID Ward

F. Perry Wilson, MD, MSCE; Jeffrey B. Teitler, MFA

Disclosures

May 06, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

Day 1

It's April 27, 2020, at about 6:10 in the morning, and I'm here in the parking lot outside of my hospital. I'm getting ready to head into my first shift as the attending on one of our COVID-positive services.

I'm not entirely sure what to expect. This is a general medicine ward, so these patients are not on the ventilator. I'm obviously a bit nervous. This ward doesn't have negative pressure rooms. We are gowned up and masked up pretty much for the entire day while we're up there. As scary as it is—because there are so many unknowns about the disease—I can't imagine going through this period of time and not doing this.

It feels like...the hospital. The difference is that when you see the patients, they all have the same disease—at least, they have one of the same diseases. The patients are scared, even though most of mine are doing quite well; they know that things can go south quickly, and they miss their families. It's really hard on them.

Day 2

We've taken care of patients who are young, who are without comorbidities who end up in the ICU. To me, I think that variance is the scariest part. One thing I'm making a point of doing here on the COVID service is thanking the patients who are enrolled in clinical trials. You know, they are saving lives by evaluating all these different remedies.

Day 3

Wilson: So, tell us how you got here.

Carlyn: I am a licensed practical nurse, and I worked in two nursing homes in Connecticut.

We admitted another nurse today. Those are the ones you really feel, you know? This was a woman who was working in a nursing home in the area that's been pretty hard hit. She was telling me about a number of residents who have died in the nursing home, many of whom without even coming to the hospital. And she did everything right. She used the personal protective equipment that they had available for her, though it doesn't sound like it was ideal. As soon as she became symptomatic, she stopped going to work. That was almost 2 weeks ago.

Carlyn: I love my residents.

Wilson: How do you feel now that you're in the hospital?

Carlyn: I'm more concerned about them—still. Not being able to see them and just hearing about them passing away, and I'm not there.

Wilson: Well, we're gonna do our best to get you out of here soon, okay?

She's just thinking about her residents at the assisted living facility. She's a good nurse. I told her she's a good nurse.

Day 4

It's day 4 now. We're not just admitting patients from the emergency department who need a little bit of oxygen. That's maybe 50% of who we have on the floor right now. The other half are patients coming out of the ICU, so we're starting to see the downstream sequelae of really severe COVID-19 disease.

And, of course, these are the lucky ones. These are the 50% of the people who are ventilated and survive and come out of the ICU. For example, I have a patient who was in the ICU for 3 weeks, on the ventilator, on vasopressors, proned—the whole thing. And he made it out. But this was a relatively healthy, middle-aged guy living at home, who now can barely walk. And it makes me think about whether there is going to be a post-COVID syndrome.

Yale's protocol does use hydroxychloroquine for people who have an oxygen requirement. I can't say I've been incredibly impressed by the effects. I don't have enough personal data, but I certainly haven't seen miraculous recoveries with hydroxychloroquine here.

We were also part of a remdesivir trial, which also hasn't appeared to be particularly miraculous. And I say that in light of a recent press release that shows a potential benefit of remdesivir in these patients. So, at the time I'm recording this, we don't have that data yet. We don't have the full paper, just the press release. So we'll see. I'm sure that remdesivir will be prescribed more and we'll get a better feel for how well it works. I have had a few patients on it, and it's certainly not turning a switch and getting people better overnight, but it would be Pollyannaish to expect that anything would do that.

Day 5

I found out that a couple of the nurses on the floor are out sick today, as well as one [patient care associate]. So, I think that's on everybody's mind. But man, the nurses are cool under pressure. I can't even tell you. I'm so impressed.

Coronavirus complicates everything. If your patient needs an MRI, you've got to talk to four different people and get the approvals. And it's not unreasonable; of course you don't want to contaminate the MRI suite.

Carlyn: Yesterday wasn't so good. My O2 sats were low and I was vomiting a lot. But today it seems that I've had a turnaround.

Day 6

So, this is my personal PPE routine. I'm in the "COVID car" that no one else drives. I get to the parking lot outside the hospital and put on my hair covering and my personal N95 mask—this is my home N95 mask.

Some of the patients that I anticipated were on a good trajectory took a step back. Most people are just sort of treading water; it's just so slow, such a slog.

Day 7

Wilson: Ready to go home?

Carlyn: Yes, I'm ready to go home.

You know, I started the week feeling like all of my medical decisions were critically important all of a sudden, because I had to think about how everything was going to interact with the virus. I end the week sort of back in an old mode, where I feel like—medically speaking—I didn't do that much. The best medicine I gave anyone this week was supplemental oxygen therapy.

The nurse we admitted at the beginning of the week, who I told this morning that she could probably go home, was taken off her oxygen—and her O2 saturation dropped to 89%. So, she's going to stay one more day, despite being on remdesivir. There are no miracles here.

I feel sort of guilty. Tomorrow I'm going to be back doing what I normally do, which is clinical research. Meanwhile, everyone I was working with this week—all the nurses and the [medical assistants] and the [patient care associates]—are still there. There is no end in sight for them. For most of our healthcare workers who are clinical, this is the new normal. And they deserve tons of respect for that because their job just got way harder. And they deserve a lot for what they're doing.

Carlyn remains in the hospital.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @methodsmanmd and hosts a repository of his communication work at www.methodsman.com.

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