We begin our early day with rounds, where all members of the care team discuss the plan of care for each patient. We are all on edge. We are talking about a patient who is well enough to potentially take off the breathing machine so she can drink in precious, life giving oxygen on her own.
We are discussing percentages.
According to the Lancet, a recent retrospective cohort study showed that in a hospitalized population in Wuhan, 31 of 32 patients who are mechanically ventilated died. 96 is the percent of Covid-19 positive patients who died in the depicted population in Wuhan after being on a breathing machine.¹ Now, there are many other articles that are being written at this moment. There are other considerations. Our population is a very different population, and we are still gathering more data on the ratios in the US. These numbers may, and probably will, change tomorrow.
To put it into perspective, if there’s a 96% chance of rain, we assume it’s going to rain.
96% chance of failing, of getting placed back on a breathing machine, of the worst possible outcome.
All of us collectively hold our breath at this moment. We all know that the long and short of this means that when you fail, you are likely to get placed back on a breathing machine, and very unlikely to ever come off again. Even though I know these numbers, as I write this, my heart sinks to the bottom of my chest.
Successful removal of the breathing machine has happened once while I was on shift.
And it happened on Monday.
We couldn’t contain our joy. Even the most jaded among us were elated, faces bright, all attempts at our professional poker faces overcome by the upward corners of our eyes. We know the percentages, the risk. We’ve been through it all so many times-the removal, providers fully covered in layers upon layers of protection, shields covering our faces but not hiding the shielded expressions. Will this work. The quiet moment, only half a breath, then the removal of the mechanical tube from the mouth, viral droplets glistening in the air, the moment of hope followed by the gasping breaths signalling failure. Then terse calls to anaesthesia as looks shared by providers speak the grief already compacted into the narrow space of the room as the bed is laid flat, again. The patient is given medication to sleep, again. The tube is inserted, again. Then we exit solemnly, cry, and begin again. Day after day.
But this one was successful. We took out the tube and she was able to breathe in unadulterated air for the first time in weeks without gasping, entire body in an agonized fight, for breath.
Her face was wrinkled in confusion at first-what it must feel like to suddenly wake up from a long and dreamless sleep! Then to find yourself alone, in a cold unfamiliar place with sterile bleached smells that cannot completely overcome the smells of fear and death surrounding you, with harsh electric light uncovering each and every vulnerability, and strange hooded beings swarming around every corner of your person. Then, a voice, a hand emerges.
One shielded figure stayed to hold her hand, telling her it was going to be ok. The rest of us watched, through the transparent door. She looked questioningly into the shimmering glass window which separated us, and her face reflected her fear, her loneliness, her isolation. We began to smile and wave and then she began to wave back, a confused look on her face. Instantly we realized that with all of our protective gear and masks, we resembled hood clad space folk rather than humanity. Our protective gear was obstructing our smiles, our joy. We pulled our masks down, door completely shut to the negative pressure room, for less than a second. For only an instant, she could see our wide smiles. And when she smiled back I thought my heart would implode.
A flash of light.
An extubated COVID-19 patient facetimes her family
¹Zhou, F. You, T. & Ronghui, D. et. al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Table 2: Treatments and Outcomes. 395:10229, P1054-1062. Retrieved April 8, 2020 from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext#seccestitle150