Thread by @TheRealDoctorT

I turn off the lights.

These bulbs are old, not the newer LEDs. There is a lingering glow as the hot tungsten filaments gradually cool.

I watch them as the room slowly goes dark.

A lingering glow... and then nothing.

I am exhausted, but I can’t sleep.

A monster awaits. 1/

Morning comes far sooner than it has any right to, and before I know it I’m back in the hospital.

It’s almost like my time away from this place was the dream, and the hospital is my waking reality.

N95 on, surgical mask over it.

Face shield for when it’s time.

Armor up. 2/

You don’t face the monster without armor. Even if it’s in short supply, you reuse what you have, and you find a way to make it work.

And you don’t face the monster alone.

The intensivist sits with me in the dictation room.

She is a seasoned veteran.

She leads naturally. 3/

I’ve known her for five years now. She is kind, with a smile that brightens the room. Like when she shows me photos of her son’s graduation, or a funny meme.

But beneath the kind smile is a steely resolve.

And above the mask her green eyes are twin pools of calm strength. 4/

Something is different today.

Something in the air, quite literally.

The monster is on the prowl.

The intensivist is more stressed than I can remember her being. Her smile is thin.

“Tubed several so far. Floor people decompensating. ER is packed.”

Short, staccato updates. 5/

We are in the dictation room together. A sort of fishbowl in the middle of the ICU, with large glass windows.

A nurse comes up and opens the door, her voice terse. “Doc, we need you out here.”

“Coming.” She gets up quickly, grabbing her stethoscope.

I follow, to see. 6/

The COVID rooms are sealed, negative pressure rooms, constantly keeping air flowing inwards.

Outside the doors are sets of IV pumps, so they can be adjusted without going inside.

Face shields hang on makeshift hooks when not in use, names written on them in Sharpie. 7/

One of the patients is not yet intubated, but experiencing that rapid decline that is the hallmark of the monster attacking aggressively.

The breathing is becoming shallow, labored, despite multiple interventions.

The ICU team prepares for another intubation.

Armor up. 8/

I am a nephrologist by training, but I am also board-certified in internal medicine, and I spend a fair amount of my time practicing critical care medicine.

I sit down at the table outside the room. Backup, just in case things go sideways.

The team preps rapidly, smoothly. 9/

To enter the monster’s lair and perform an “aerosolizing procedure” requires special precautions.

The team (the doc, a respiratory therapist, and an ICU nurse) wears PAPR hoods.

PAPR - Powered Air-Purifying Respirator, running on batteries.

They put them on in silence. 10/

Once the PAPR is active you can’t hear much while wearing it. The whirring of the fan drowns out a lot of sound.

To make sure they can hear each other, the team dials in to a special number, and tapes their headphones to their ears so they won’t dislodge accidentally. 11/

Sitting outside the room, I dial into the line on my phone, and I can hear them too.

They enter the room, the door sliding open slightly with a hiss.

Now they are in the monster’s lair.

“You got everything?”
“Yup.”
“I’m going to move fast.”
“Ready to position.”
“On it.” 12/

They talk to each other with the calm efficiency of a cohesive team of professionals, at the peak of their expertise.

I can hear the patient through their mics. She’s gasping with each labored breath.

“Ohgodohgodohgodohgodohgod-“

Her voice is growing quieter.

Ominous. 13/

Sometimes when people sound quieter and calmer during a respiratory issue it’s a sign of impending doom.

You can’t make noise if you can’t breathe.

The team moves rapidly.

“Etomidate.”
“Yes.”
“Succs.”
“In.”

The intensivist’s eyes are keenly focused as she intubates. 14/

She is a mother, and just a few weeks ago she was proudly showing me her son’s socially distanced graduation photos.

As I watch her team save a life, I wonder how I could make people see.

The risks that some have to take because of the simple steps that others wouldn’t. 15/

Afterwards we are back sitting in the dictation room. She reviews the chest x-ray to confirm the placement of the breathing tube.

“Looks good.”

She exhales deeply, rubbing her eyes. Then she looks up.

“You ok Sayed? Did you eat something?”

Her empathy is her strength. 16/

Before either of us can grab a bite to eat, another emergency page.

Another patient beginning to succumb.

The monster is raging like a wildfire.

She opens a small packet of gummy bears, and pops a handful in her mouth.

The sugar will help.

Time to go.

Armor up. 17/

The day passes in this way, and turns to night.

Not every life has been saved. People have died today.

My fatigue is the kind that makes my soul feel shallower.

I am hollow.

The work isn’t done, but it isn’t ours anymore. Backup arrives in the form of the on-call team. 18/

Before we leave for the day, I tell the intensivist I’m going to write about her.

She is exhausted, her face marked with the indentations of her PPE, but she smiles.

“Aw really? Be sure to tell your readers to wear their masks.”

I nod. “You got it.”

Time to go home. 19/

On the elevator to the garage, I run into the patient’s respiratory therapist.

I tell her I’m going to write about the day.

I ask her if she has any messages.

She nods, and her smile is faint.

“Wear your f***ing masks. Distance. None of this had to happen. None of it.” 20/

As I drive home I pass a restaurant less than a few blocks from the hospital.

It’s packed, and I can see only a few masks as I drive by.

The thought occurs to me.

The monster isn’t just in those hospital rooms.

Everywhere.

People risking other people’s lives. 21/

I finally get home.

Get ready for bed.

I turn off the lights.

These bulbs are old, not the newer LEDs. There is a lingering glow as the hot tungsten filaments gradually cool.

I watch them as the room slowly goes dark.

A lingering glow... and then nothing.

A monster awaits.