Provider Practice Essentials registered nurse continuing education

Thoughts from the Pandemic PA

The time is Early COVID eruption. The place is New York City. The center of this Pandemic. My name is David. Bear with me as I try to put this emotional experience into words. If you haven’t read my previous article, it will set the stage to what NYC was like in the start of this Pandemic.

                My first day and my first patient…

After the debriefing. I gowned up in my shoe covers, surgical gown and gloves. Entering this sealed room felt like stepping over a barrier. A barrier once crossed could not be Uncrossed. It was risk and knowing combined. Knowing and acceptance that in spite of the fear I must press on. Mrs. Chin (patients name and other identifiers have been changed to protect her confidentiality and to abide by HIPPA) sat on a hospital bed. The room had a total of 4 people in it. Three African Americans and Mrs. Chin my patient. My first COVID patient. She was on the far side by the window. She was looking out at the city. I’ll never forget the look on her face as I entered. She was scared, and she was my age maybe in her forties. She only spoke broken English.  I was able to ascertain she worked in a local shop where a relative had become ill. She had a fever of 103. She presented with a dry cough, fever, and shortness of breath. Her O2 sats were in the 70’s on room air. But on oxygen they were holding around 94%, thank goodness. We were initiating a mixture of hydroxychloroquine and antibiotics. In combination with oxygen it had been proven to help. She seemed in good spirits. After leaving the room I jotted a few notes. Often times there wasn’t enough O2 monitors for each patient to have one, so purchasing a portable one to check each patients’ vitals was helpful then cleaning every square centimeter of it before putting it in your pocket. Going back to chart on the patient before making rounds with the Doctor, I would sit in the Patient waiting room with a portable wheeled computer. It offered the best vista, a panoramic view of the City. Its massive skyscrapers. The empire state building, breathtaking sunsets.

                No less than 10 minutes into my note ALARMS… ALARMS…CODE BLUE….

Everyone was rushing to floor 14… To my room…. To Mrs. Chin …. She was crashing… O2 sats had dropped into the 30’s… just like that. One minute she was fine, talking and the next, not able to breathe. The residents had to intubate and start critical care… quickly she was rushed up to ICU where another team would manage her care. There were 5 other codes that day. It seemed like an endless string of intubations. People suddenly crashing. Mrs. Chin crashed 2 more times in ICU. and returned to my care 2 weeks later. After being extubated, then intubated again before starting on a trial drug. Managing Hypernatremia, managing metabolite irregularities, then her kidneys shut down.  Then Hyperglycemia. Slowly we treated her, step by tedious step, getting her back to baseline. When I noticed a turn for the better was after the second dose of trial drug.  It was an Interleukin-6 inhibiter. It helped prevent inflammation and it worked. These drugs two in the class have since been approved by the FDA for treatment of COVID-19 systemic inflammation and hypoxic respiratory failure on a trial basis. Sarilumab, and Siltuximab. Originally intended as a rheumatoid arthritis treatment. IL-6 inhibitors would block the cytokine inflammatory pathway. This trial drug was being administer in a double-blind study. How do I know she got the drug, let’s just say I had a theory. She was immediately better.  Maybe it was a combination of her care and fighting the virus. The months of critical care. Maybe it was the drug, I’m not one to speculate but after so much invested it was nice to see her recover. Daily I would call her family. We developed a relationship. I knew her husband, and he knew me. I held her hand. I talked to her. I relayed messages, every day. I was there when Mrs. Chin left the hospital. She was wheeled down in a wheelchair to the front lobby. A parade of hospital workers applauding. Doctors, Nurses, Nurse techs, Cleaning people, Security, and Secretaries all who were paramount in her recovery. As she was helped into the front seat of her minivan, accompanied by her two small children, I couldn’t help but feel like a success. Like we had won. One small step.

If you enjoyed this article on NYC, please stay tuned there is more to come…

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