© Scott Weinstein

 

Washington, DC
May 17, 2020

 

Hello readers,

I thought I’d share with you a few stories from the COVID ICUs.

Just after receiving Montréal Serai’s email in March asking for this submission, I admitted Mr. Jasper* into my ICU, an elderly African American man who had just come into the ER. As my fellow nurses were settling him in, I went to the conference/break/lunch room, away from the crowded scene, to get the ER nurse’s report. She told me several times that Mr. Jasper was her favourite patient ever, and described how chatty and nice he was despite having been sick for a few weeks and possibly suffering from a lack of care in the nursing home he came from. His oxygen had gone down in the ER, and they’d had to put him on a ventilator.

After our 10-minute briefing, we walked back to his room and noticed Mr. Jasper’s blood pressure and heart rate dropping. I grabbed a jet-fuel drug, and the last thing the ER nurse saw before she had to head back to the ER was me kneeling over this poor man’s bed, doing chest compressions. He survived our CPR, but the ER nurse didn’t know that.

I wondered how she felt ending her shift with such a shitty experience.

For me, the same kind of attachment to a patient occurred in a brief encounter seven weeks ago that lasted less than two minutes. I went into the room of Karina, a young-looking Latina woman in her forties, to borrow some equipment.

Karina was breathing through a facemask on 100% oxygen, lying prone on her stomach – a technique to help oxygenation. I asked her in my simple Spanish how she was doing, and she replied, “Bien gracias.” I asked her how her breathing was, and Karina smiled at me and cheerily replied, “Bien.” I left thinking she sounded too good to be in the ICU, unlike our other patients struggling to breathe. I cannot explain why I bonded with a patient after such a short visit, but it happens.

You know how they keep saying, “We’re all in this together?” We’re not. In this city that is now majority white thanks to relentless gentrification, our expanding COVID ICU beds are filled with blacks and Latinos, many of them in medically-induced comas on ventilators. While white workers are staying at home by themselves or in couples and telecommuting, it is the blacks and Latinos who comprise most of the essential workers, working in jobs with little protection and living in homes shared by many.

Four hours later, they were intubating Karina for the ventilator. The day after, she was transferred to the cardiac ICU to be placed on ECMO (extracorporeal membrane oxygenation) using a high-tech blood bypass machine, because her lungs were shot. A week later when I went to visit Karina, I was happy to see she had survived ECMO… most adult COVID patients do not. Yet she needed dialysis, as her kidneys had failed. Karina was still prone and sedated by our drugs. More than my other patients, her tragic fate really got to me. It finally made me realize that COVID-19 doesn’t play.

Karina ended up returning to a medical ICU, ventilated and in our drug-induced coma. She developed “COVID toes” that were turning gangrenous. But by last week, Karina had recovered enough to sit up in bed, was off most of the sedatives, and managed to weakly wave to me when I waved to her. I have visited her often, but I can’t tell if she remembers me. She now has a tracheostomy and looks rough to say the least – but what a force of nature she is, to survive this hell! So far.

Karina left the ICU a few days later. With a lot more luck, she will be able to rejoin her family and community.

PPE selfie © Scott Weinstein

And you know, through all of this the patients’ families are not allowed to visit except if their loved one is about to die. This is a very cruel disease exacerbated by our efficiency-driven health care.

We don’t have much to offer in the way of cures, yet we certainly are inflicting pain on families through our medical isolation protocols to prevent the spread of the virus. The marriage vow of sticking together till death do us part, and the bonds that make a family a family might be a natural result of our social DNA. Now hospitals and nursing homes are tearing it all asunder.

But tonight, nothing could break up the McBrides,* an elderly husband and wife team who were patients in the same room on a medical unit. At 17:29, Mr. McBride’s heart stopped due to oxygen starvation, and in rushed the code team to do advanced cardiac resuscitation.

The McBrides come from a home where their two children and Mrs. McBride’s mother also contracted COVID but recovered. For more than an hour, Mrs. McBride stayed in the room with her husband as he was worked on by the anonymous, gowned and masked code nurses, a respiratory therapist and doctors, who aggressively did CPR on him, shocked him, injected him with drugs and stuck tubes and needles into him to keep his heart from stopping, as it repeatedly did.

The code was successful in the most purely technical terms, as Mr. McBride somehow managed to get transferred to me in the ICU, with a beating heart on too much jet-fuel drugs. But clearly not long for this world.

How does Mrs. McBride feel seeing her husband’s repeated death and revival under the hands of a code team that swoops in performing our high-tech voodoo? It must be tragic and terribly frightening.

But I hope it’s not awful. I hope Mrs. McBride saw that we were fighting for Mr. McBride’s life when it mattered, honouring his wishes. That we cared. That we were present.

 

*Names have been changed to protect the patients’ identities.

 

 

“Let your plans be dark and impenetrable as night, and when you move, fall like a thunderbolt.”
― Sun Tzu, The Art of War

 

This morning I wake up early with worries. In bed, cuddling my main squeeze, loud rock music and static invades our bedroom. Some asshole outside is testing a sound system. It’s 9:30 am, Sunday.

We live in a weird spot, squeezed by inner city traffic on one side and green space on the other. We occasionally get pelted with noise from events, but dammit, it’s 9:30 am on God’s fuckin’ day of rest!

Immediately, the political brain springs into action. Some would call it, “How to right a wrong.”

  • Call the police and make a noise complaint? But it’s the police, and an organized event probably has a noise permit.
  • Get my neighbours to rally naked against the beast? I don’t think I’m that persuasive.
  • Unpack my trusty rocket-launcher? Where’s the target?

So I grab Liza, my 9-kg Lhasa Apso terrier mix, and dash out to take on The Man! I’m in such rage that I must remind myself not to drag poor Liza while she tries to pee.

“If your enemy is secure at all points, be prepared for him. If he is in superior strength, evade him. Attack him where he is unprepared, appear where you are not expected.”
― Sun Tzu, The Art of War

The sound tech is weaponizing Classic Rock against me – “Start Me Up” by the Stones, “Light My Fire,” by The Doors. But where’s the source? Acoustics in this zone are disorienting, deflecting off buildings, roads and hills. Nothing by the volleyball courts. Nothing by the tam-tams statue. It must be from the pre-game tailgate party by the stadium.

Liza and I cross Avenue du Parc. I conduct my first security assessment. Some rent-a-guards doing traffic patrol on the feeder road. Don’t appear armed. The field seems unsecured.

History teaches valuable lessons. Many decades ago at The Forum, the opening band, Sha Na Na, suddenly went silent while performing its second rousing encore. I noticed that Leslie West, the corpulent leader of the heavy rock marquee band Mountain, had ripped out the sound cables from the amps with his meaty hands. A brilliantly simple solution to Mountain’s fury at this dorky ’50s imitation band stealing their time.

“The whole secret lies in confusing the enemy, so that he cannot fathom our real intent.”
― Sun Tzu, The Art of War

Liza’s recent haircut distracts people who notice her. « C’est tellement cute ! » We arouse no suspicion. I scan and assess as we advance. The tailgate party is more organized than I expected – food trucks, benches, inflatable water slides, and a dozen or so dark-clad men gathered around a food tent and the noise source. My first doubts about my plan… With sound cables in one hand and Liza Minelli’s retractable leash in the other, I would be defenseless as they beat the shit out of me.

I must think of optional attack scenarios and quickly, as we approach the target. Stunned, I realize they have no loud sound system!

It has to be… Molson Stadium, just beyond. Standing in its shadow, looming high above me, I can only glance at a segment of its outside barrier walls. Massive. A coliseum.

Through the gates, I spot empty interior top-row seating. Early in the day? Possibly. But the Alouettes are 3 and 10 in a depressingly lousy season. I also spy loudspeakers and distinctly hear the directional sound.

We are 30 meters away from the entrance. Liza hunches over and shits. Fuck you! Despite poop bags hidden in my pocket, I’m not picking it up!

“The spot where we intend to fight must not be made known; for then the enemy will have to prepare against a possible attack at several different points;”
― Sun Tzu, The Art of War

We stride towards the entrance. Inside lies the hidden target – the Sound Engineer and the Control Panel. Around me, linked gate barriers control access and evasion. Two choices: Entrée avec billets and Billeterie. The narrow Entrée is heavily patrolled. I eye them. They eye me and Liza. They’re not smiling.

I choose the unguarded Billeterie. Once I commit, I face the sobering realization that I will not be able to directly penetrate the stadium.

It gets very quiet. The sound stops.

The Billeterie is closed but a door is ajar. Inside, underpaid workers working for a depressing corporate team that traded away top draft picks for Johnny Manziel, a wasted NFL quarterback notorious for his self-destructive partying and on-field antics. (A touching fact – Manziel revealed later he is bipolar and struggling to be healthy.)

“The opportunity of defeating the enemy is provided by the enemy himself.”
― Sun Tzu, The Art of War

Inside, a man of authority. I attack. « Hey, j’habite ici et le bruit du système de son avant 10 h un dimanche, un jour de repos, c’est dégueulasse ! »

He strikes back. « Oui, je suis désolé. Je vais adresser votre plainte. »

I counter « Oui mais calice, c’est dimanche ! Ce n’est pas une excuse ! »

My foe digs in. « Oui monsieur. Il y a un match aujourd’hui. »

I’m not fooled. « À 13 h ! Il est 10 h maintenant ! »

«Vous avez raison. Je vais transmettre votre demande. »

His fuckin’ active listening is killing me. The illusion of addressing the consumer’s complaint. The deflating reminder that bureaucracy has no beating heart. At 1 pm, Air Force jets scream over our homes for the national anthem.

Next time I‘m packing the rocket launcher.

I’ve seen the speakers.

P.S. The Alouettes lost.