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. They have remained in Drafts for over a month, but now I am going to start publishing these diary entries mostly just to document the strangest, most unexpected experiences of my medical career.

I have lost a lot of patients. We all have. A lot of them were people I never knew. Consults in the ICU with a patient intubated and sedated in kidney failure. You don’t get to know these patients. The ICU discouraged going into the room to examine the patient unless it was absolutely necessary both to protect us from infection, and to minimize consumption of personal protective equipment. There was no family at the bedside. No visitors in the waiting room. I have never had thinner connections to my patients. We worked hard to save them. Most of them died. I can only remember a few of them.

But there are patients I do remember.

The first patient that I Iost was a dialysis patient. She was an older lady that had been taking care of for a few years. I remember the last time I saw her. I was rounding in the dialysis unit and she was sitting in her chair, mask on, and I told her that I was seeing patients with COVID and that it was really bad. I told her not to believe Fox News telling people it was just like the flu. She nodded her head. She was in total agreement. he last thing she told me was to be careful. She lived in a nursing home. Nursing homes are COVID tinder boxes. A week later she was gone. 😥

Another dialysis patient was a young (my current definition for young is anyone born after 1969) man. He was a rabid Michigan fan. Every time I saw him he would be hot about the latest U of M athletics story. Satellite camps, Louisville forfeiting the championship over Michigan, trips to the Vatican, sleep overs in tree houses, Beilein leaving for the NBA, it didn’t matter how minor the issue he would get completely worked about it. I loved his passion. He was one of only a handful of my patients that still worked and he was an essential worker at a grocery store. And then one day…he stopped coming to dialysis. We sent the police to his house and he was gone. 😥

Not all of the hospital patients were so isolated. I remember an older gentleman who came in because he fell. He was tested in the ER because we are testing everybody. He tested positive. He had just a small oxygen requirement but he was otherwise nearly asymptomatic. I saw him the day after admission for some mild acute kidney injury. After my evaluation I asked him he needed anything and he asked if I could get him some grapes. One of the strangest asks I have received. I couldn’t. The next day he was moved to the ICU for intubation and a week later he was gone. 😥

I lost a few patients from my advanced CKD clinic. These are patients that I see every four weeks to fight for every milliliter of clearance as we try to hold off on dialysis. The mantra of that clinic comes from the first season of Game of Thrones, paraphrased.

What do we say to the God of Dialysis? Not today.

One that I lost was a patient I had been working with for years. I helped him lose weight after learning about weight loss medications on The Curbsiders. I think it was the first time I consciously changed my practice based on a podcast.

He used to come to clinic with his wife and sometimes with his school-aged kid. He was kind and gentle. A good guy taken too soon. 😥

Another long time patient was a woman who would come to clinic with her sister. I always saw them together. In my clinic. I the hospital. Always together. She had terrible heart disease and we were forever adjusting her anti-angina medications and diuretics. Sometimes winning, sometimes losing. She had tough disease but she was a fighter.

One of my favorite memories of her was she used to wear an iPod nano as a wrist watch for years before finally getting an Apple Watch. loved that look.

Another one taken too soon. 😥

Another patient was not a clinic patient, or a dialysis patient, but a patient with pretty bad CKD that our group knew from frequent admissions. He would repeatedly come in with decompensated CKD and we would nurse him back to health and not see him for a few months until he came in again. Then he came in with COVID-19. 😥

Then there was the man who was shot in the bely. We see too much of that in Detroit. He required all the resources of St John’s trauma center. He was going to make it. He was recovering , still sick, but recovering. Then COVID was everywhere. And he no longer was recovering. Nothing feels more like a failure than a lethal nosocomial infection. 😥

The transplant patient who came to the ER because they thought they had COVID. They didn’t. Sent home. Patient returns days later convinced they had COVID. They didn’t. Sent home. Returns a third time convinced they had COVID. This time they did. I don’t know where they got infected, but I think the ER waiting room was a possibility. Another lethal nosocomial infection. 😥

I already wrote about patients that we thought were wins but we ended up losing. Those hurt. 😥

Then there was another long-term patient of mine. Another one in the advanced CKD clinic. One we were fighting for every milliliter of clearance. Like Al Pacino in Any Given Sunday fighting for every inch.

That patient was admitted with a viral illness at the end of February. The swab was positive for influenza. We didn’t have much capacity to test for COVID-19 and the protocol said that a positive influenza test meant no test for COVID. But I wonder. I haven’t lost a patient to influenza for years. I know it happens, but I wonder if this patient was actually the first patient I lost to COVID-19. 😥

There have been others. Too many other. The numbers are still piling up. Just last week I lost six patients. Six patients. One week.

As the US death toll spirals past the total from Vietnam, I keep thinking about how my medschool roommate, Tim Lamb, described the Vietnam memorial

You start walking and there are just a few names and as you walk, step by step, the names pile up until you are surrounded by names. Drowning in death.