RFC Essay Contest 2020: 2nd Place, Resident Category
A Breath of Air
by Michael Chiou MD
Due to the overwhelming surge of COVID-19 cases, resident physicians in physical medicine and rehabilitation at Mount Sinai Hospital in New York were redeployed to COVID-19 units.
I hold the N95 mask cupped to my face with my left hand while my right dexterously slips the rubber straps behind my head. I check the seal. No leak.
I am ready.
I open the door to the COVID-19 unit and take a deep breath as I step from the green zone into the yellow zone. I smell mint and I am reminded of the Colgate Total Advanced Whitening toothpaste that I used just hours before. I glance down at my list, a single sheet of computer paper lightly creased across the middle that holds the names of my patients.
How many will survive?
Two from the bottom is a frail 81-year-old woman struggling with high flow nasal cannula, unable to tolerate bi-level positive airway pressure. It is difficult to communicate — the wall of air proves to be more of a barrier than my broken Spanish and her rudimentary English. She has received antibiotics and other medications thought to treat her disease, though we are uncertain if the treatments will work. She does not qualify for any clinical trials. She prones but not often enough. It is an uncomfortable position for her.
“Please save my mother.” Her daughter’s voice echoes in my mind, the same plea each day when I call to give an update to the family. I cannot put a face to the name. I have not met her daughter because the hospital does not allow visitors. No exceptions.
She is alone.
We step from the yellow zone into the red zone. The creatures that enter look inhuman — gaudy yellow gowns cover the body, white masks where mouths should be, plastic shields covering the face. Only tired eyes are visible.
Somehow, this frail 81-year-old woman looks even more feeble. A cursory glance at the monitor indicates her oxygenation has dipped below 90% yet again. There is little more we can do. I gentle nudge her awake. She is so very tired. For the past week, we have worked to prolong this woman’s life; today, we decide to ease her passage. We arrange a FaceTime video call for her and her daughter.
There must be more we can do.
As the nurse slips out of the room, doffing her PPE, my patient’s weary eyes peer back at me through the crack of the closing door. I return to the green zone and remove my N95 mask in the usual fashion, a ritual previously rehearsed with infection control so we get it right. The taste of the air is salty and stale, like a New York City subway car at the end of a long workday. I take in fresh breath of air, what feels like the first of the day, and pick up the phone.
After a brief exchange with the nursing manager on call, security, and the patient’s daughter, I arrange a visit. It feels like a clandestine operation because the hospital is devoid of visitors, but her daughter will be allowed to come, escorted by security from the front door of the hospital to the unit and back. I reach out the chaplain to be present. It is an emotional moment — a daughter and mother saying goodbye, recounting a lifetime of memories, treasuring their final moment.
That night, she takes her final breath.
I lose another patient.
COVID-19 continues to be a challenging disease for modern medicine. At the time of this writing, there are more than 5.31 million confirmed cases with more than 168 thousand mortalities in the United States of America. Each patient journey is different. As physicians, we tried to ease the passage. We must always try to ease the passage.
To my co-residents, our fellows, attendings, and nurses, it has been the most humbling experience serving beside you. Thank you to all our healthcare heroes for your service and sacrifice, to the people of New York City for your generosity, to my friends and family, and to my wife for always being by my side.
Michael Chiou, MD is a current PGY-4 at Mount Sinai Medical Center, New York.