Covid-19

 

There is a tube near my patient’s mouth that releases moisture from his inhalation and exhalation that drips and tickles the bare skin of my arm as I scan the patient in front of me. My PPE is supposed to shield my skin, eyes, and mouth from the droplets of Covid-19, but the gowns are not long enough for my arms and as I evaluate his vessels for the blood clots so consistently found in patients with the disease, the yellow gown hikes further and further up, exposing the skin of my forearm to the excretions of his breath. As I work, I think of the drip, drip, drip of a leaking faucet and I envision the appearance of the droplets as they slide moistly downward. He is thirty and unvaccinated with no pre-existing conditions; I overheard the nurse talking to his family who is from Wyoming about trying to get him off the ventilator and ECMO machine as soon as possible to preserve brain and respiratory function if he recovers.

The rooms of those who face the toughest battle with Covid are filled with dozens of IV lines which enter the body from access points in the arms, chest, and neck and there are so many devices plugged in that there is barely room to navigate my machine. Unlike x-ray which can be performed quickly and at a distance, ultrasound is intimate. It is the nature of the work that our bodies touch our patient’s, that we lean over them in a hug-like maneuver to evaluate left-sided organs like the spleen, and that our exams are often 30 minutes or longer as we methodically search for abnormalities.

I liked the intimacy of my work before Covid, but now our forced proximity is that which threatens my own health and that of my pregnant patients, my transplant patients, and my own young children who are not yet eligible to be vaccinated. I have become accustomed, over the years, to patients telling me phenomenal tales in the darkened hum of the exam room; I have heard stories from an activist of the civil rights movement in the sixties, salacious details of a love affair which spanned the distance of oceans, and have wept with a patient who revealed the depth of suffering they still experience at the loss of their wife of fifty years. These are the secret whisperings of my work before Covid-19 and the beauty of the darkened trade I became enraptured with nearly a decade ago. 

But in the years of Covid, my patients are mostly silent and intubated and the rhythm of my work is that of the whirring of the ventilator as oxygen is forced into their scarred and failing lungs and the thumping of the ECMO machine as it pumps deep red blood from a line in their body to the machine for oxygenation in lieu of the ceaseless choreography performed by a healthy person’s heart and lungs. The body of my patient shakes in rhythm with the machines keeping him alive, it is a mechanical and unnatural rhythm as his body absorbs the forced breath and forced blood and forced life as his weakened body clings somewhere between here and whatever comes after.

In the wake of the vaccine, the work has become an ethical mental juggernaut. The bulk of my patients are now those who willingly disavowed the vaccine in favor of a cow dewormer. They are placed in the care of physician and nurse teams who are exhausted by the ceaselessness of all this death. I go from the room of the immunocompromised patient with a liver transplant who received two doses of the vaccine early on and had just received his third dose when developing symptoms who did everything he could to avoid infection to the room of someone who ignored vaccine science and the opinions of epidemiologists, physicians, and researchers.

I look at the distressed face of my transplant patient and I feel deep sorrow, compassion, and empathy that he is here. He should not be. I move next door, to the room of the young man who chose a story of personal freedom above the one that prioritizes community, collaboration, and the ways we belong to one another. Unlike waves prior to the vaccine, our anti-vaccinated patients are here of their own volition. I feel the drip, drip, drip of his vent tube on my bare skin and I feel rage and a sense of hollow detachment as I interrogate the internal jugular, the subclavian, and the brachial vessels as I have for hundreds of patients before him. I wonder, as I search for the signs of clot, if in his state of unconsciousness he can feel my weariness and bewilderment. Toward the end of my exam, the moisture accumulates until the sleeve of my protective gown is wet enough that it sticks to my skin as I balance on one foot over his ravaged body. I perform the best exam possible despite the insidious supposition that, if our roles were reversed, he may not do the same.