When it became apparent that COVID-19 would not just be a medical event that happened over there but was going to affect everything I started jotting some notes here. They have remained in Drafts for over a month. I am going to start publishing these diary entries.
I remember the first patient at St John Hospital that had COVID. We had been hearing about this disease. First in China, then in Italy and Iran. Then Americans had it, but they were on cruise ships. Then it was nursing home patients in Washington and then it was here, in Detroit. It was a long build up. I remember reading about the doctors in Italy and thinking, “Is it possible that I’m sitting comfortably in suburban USA and in two weeks it’ll be World War One Trench warfare”
Well the two weeks ticked off and here was the first patient. We already had a number of people that were getting ruled out for COVID. But we didn’t know what we were doing and the disease prevalence was so low we were ruling out some people that were low risk; people that obviously had alternative explanations for a fever. It was like we were sick of getting ready and just wanted to have a patient in isolation. So there were those “fake” covid’s and then there was the patient in the ICU, the patient with white-out on chest x-ray. The patient on a PEEP of 17, 100% FiO2 with PaO2 in the 70s. That was the real one. The test wasn’t back yet, but everyone knew, that was the disease. That was what was waiting for us.
That patient, patient zero, the first one with real bad ARDS also had kidney failure so they became my patient. A few days later we got PCR confirmation of the diagnosis. I took a screen shot of the report. It felt important. I remembered reading in the Italian reports how they were excited by the first positive reports and then a week later that was all they were seeing, positive after positive.
The patients began to trickle in. One by one and then two by two. Fellows were banned from seeing patients in order to conserve PPE, and protect them, so my fellow began carefully highlighting he patients on the list that were COVID-19. By the end of the week she shifted to highlighting the ones that weren’t COVID to conserve her pen, and the next week she stopped the ritual all together; our consult nephrology list was entirely COVID.
As our list mutated from the nephrology consult service to a COVID-Nephropathy service the hospital also transformed. We found ourselves taking a short cut to the inpatient dialysis unit and walking through a door and all of sudden we weren’t in our familiar hospital but some facsimile of a biocontainment unit. All the doors were shut. Everyone was in masks, hair nets and gowns. One wrong turn and you were transported to the set of Contagion. Same thing would happen in the ER. or the first week they segregated the ER to COVID and not COVID modules but the COVID patients quickly over ran their alotment and the whole ER became COVID-land.
Besides the isolation strategies the other part that made the hospital feel eerie was how quiet it became. Everyone assumes that the hospitals had to be crazy, but the truth was once they stopped allowing visitors and stopped elective surgeries, the wards became still. The cafeteria was empty. The hospital was quiet, still, and nearly empty.