Vassar
Vassar on the Front Lines

Voices from a Pandemic

Seiji Hayashi ’91

Dr. Seiji Hayashi is the Chief Transformation Officer and Medical Director at Mary’s Center, a community health center that provides primary health care, family literacy and social services to anyone regardless of their ability to pay. He is an experienced leader in primary care, quality improvement and health policy at the local and national levels. Dr. Hayashi has been chronicling his experience as a primary care physician in Washington, DC on his personal Facebook page.

While he continues his work on the front lines of the current pandemic, he is also sharing his knowledge to help the next generation of Vassar students be ready for the unexpected challenges that they may face. Learn more about his virtual presentation on July 22.

Report from the Field #1 “Please stay home.”

March 21— In our clinics at Mary’s Center, we started separating anyone with respiratory symptoms (fever, cough, difficulty breathing) from the rest of our patients. We also created a special waiting room for vulnerable patients (>60 yo, chronic conditions, immunosuppressed). Most importantly, we are now doing three quarters of our visits virtually by phone or video. We knew this, but it’s amazing to experience how much we can do virtually.

The poor and underserved patient populations we serve need us to make care access easier because these are the same people losing their jobs and struggling to keep their families intact.

This wasn’t the circumstance in which we wanted health care transformation to really take off, but this pandemic has forced and enabled us to be more efficient and smart about how we provide care. This is especially important for our patients at community health centers across the U.S. The poor and underserved patient populations we serve need us to make care access easier because these are the same people losing their jobs and struggling to keep their families intact.

I worry about my health care colleagues on the front lines. If we go down, we all go down. It may be too dramatic a sentiment, but we need help to protect ourselves. We are devising plans to go bare bones and rotate staffing every 3 weeks (e.g., one week with in-person care; two weeks virtual). Many of our staff are anxious about their own health and of their families, but they have all stepped up. It’s amazing to see the dedication and commitment to do whatever they can despite the chaos of creating new workflows and improvising solutions while still needing to do their regular jobs.

In order to protect my own family, I come home through the garage and into my basement, take a shower, and throw my clothes in the wash before I see anyone ([Hayashi’s spouse] Joan E Myles’ great idea). I’m especially worried when I come home after conducting the COVID-19 test on a patient with classic symptoms. We have not had any positive tests yet, but I believe it’s a matter of time.

Please stay home.

Report from the Field #2 The Impact of Delayed Testing

March 28— Our clinic finally got access to testing for COVID-19 on March 18. We immediately started testing people according to the CDC guidelines. The first patient I saw that morning was a young 30-something-year-old man. He was sitting hunched over coughing. He has had fever, cough, and difficulty breathing for over a week. I listened to his lungs and he had fine crackling sounds in the lower half of both lungs. He has pneumonia in both lungs. His oxygenation was 96%, lower than normal, but not dangerous.

This was my first PUI (Person Under Investigation) with classic symptoms. I consulted our infectious disease specialist and the director of our internal medicine team. We knew that the emergency rooms were turning people like this away, so we decided to give him antibiotics and follow him closely.

I called him every day. On the third day, he sounded awful. I asked him to get on FaceTime, and I saw his face in a dark room. He was coughing so hard that he couldn’t catch his breath. I told him to call 911 and go to the hospital immediately. He agreed, but he said his wife and two kids were also sick but not as bad.

A couple of hours later, I called him, and he was in the emergency room. The phone disconnected before I could ask him which hospital he was in. I looked in our Health Information Exchange portal, and his case had not been reported yet.

I tried calling his cell unsuccessfully for three more days, but on the fourth day, he answered. He sounded well, and he told me he was in the hospital and was diagnosed with coronavirus. He said his family was doing better. I got his hospital and room number and called the unit nurse. She confirmed the diagnosis and that his pneumonia was improving.

I keep thinking, “If only we had the tests earlier… If only we started isolating people sooner…”

This was seven days after we had tested him, and the results of the COVID test we did have not yet returned (the average delay is now 7-10 days). Despite the delay in our commercial lab, I was thankful that I had the information. I immediately called our Chief Medical Officer to let him know that we have our first confirmed case, and how lucky we were that we had set up a separate sick clinic and had put a mask on him outside the clinic.

Later that day, I got a text message from our infectious disease specialist, “I think I saw him …” I was initially confused, but then panic struck me. I quickly looked into his medical records, and he indeed was seen at our clinic days before for “cold-like symptoms.” I felt my heart in my mouth. We looked into the time logs to see who registered him, which medical assistant took vitals, and how long he had been in the waiting room. He was in the waiting room for about 20 minutes …

I keep thinking, “If only we had the tests earlier … If only we started isolating people sooner…”

There are thousands of people in our community with mild or no symptoms.

Please stay home.

Report from the Field #3 Who do you live with?

March 31— Since the first case of confirmed COVID-19 in the U.S. was reported on January 20, we have now exceeded 160,000 cases. The Trump Administration now projects that up to 240,000 people may die even with mitigation.

It’s hard to imagine 240,000 people dying. Quickly googling cities larger than 200,000, I see that’s more than the population of Boise (228,790) or Baton Rouge (216,853), and way more than Providence, RI (179,335). My city of Hyattsville only has 18,000 people.

As the number of cases grew rapidly over the last few weeks, it was hard to picture how the virus was being spread. Within the immigrant and minority communities we serve at Mary’s Center, I now have a pretty good idea.

Today, I saw a middle-aged Latina who had fever, cough, and difficulty breathing. I sent her to the emergency room because her oxygenation was 91% and I could hear fluid in her right lung. She came with her husband who also had a cough, but he was well enough to have driven her to the clinic. I asked the husband, “Who do you live with? Who else is sick?” He said they live with their daughter and granddaughter, and neither have any symptoms.

A physician at another community health center told me that a patient with COVID-19 had passed away. This patient had six family members living in the same house. The doctor was trying to figure out how to get the family members tested.

I then called a patient whose test result came back positive for COVID-19. He was fortunately getting better, but now his wife’s cough was getting worse. I asked him who else he lives with, and he said, “My parents and my wife’s brother.” He said his parents are in their 60s, but do not have any symptoms. They have been holed up in their bedroom, rarely coming out. I asked him how many bathrooms they have and he said one.

In the afternoon, I saw a 60-year-old man who was having chest pain with his cough. Three days ago, his wife was admitted to Washington Hospital Center and diagnosed with COVID-19. He said he was scared that he was going to end up in the hospital too. He was mildly relieved when I told him his lungs were clear. He has four other people living with him.

A physician at another community health center told me that a patient with COVID-19 had passed away. This patient had six family members living in the same house. The doctor was trying to figure out how to get the family members tested.

I have the luxury of secluding myself in my basement to keep my family safe. Most of my patients don’t have the ability or means to do this. How can we stop the spread when social distancing is not possible?

The goal has to be preventing a single person in a household from getting it…

Report from the Field #4 “Nail Polish Lady”

April 15— In my third post, I mentioned the “middle-aged Latina” who I sent to the emergency room. She died yesterday. She was 45 years old.

A few of us have been keeping track of her condition while she was in the nearby University Hospital. We endearingly referred to her as the “Nail Polish Lady.” We used this nickname for privacy reasons but also to let the care team know who we were talking about.

She came to our clinic on the last day of March. The nurse told me that her oxygenation was very low, but she couldn’t be sure because the pulse oximeter was not reading very well. Her oxygenation was jumping anywhere from the high 80s (dangerous) to mid 90s (not good, but not so bad). We thought that her nail polish was interfering with the readings. She had a glossy light pink nail polish with some details in the middle. We tried to remove the nail polish with wipes and alcohol pads because we ran out of acetone in the clinic. No luck. I tried scraping it, but it was done very well. I briefly wondered if this was professionally done or if it was one of her daughters that put this on so well. We tried a pediatric probe on her ear without luck. We finally got a consistent reading on her toes. Although she had the same nail polish there too, her little toe nail didn’t obstruct the probe. It was 91%, not the number I wanted to see. Together with fluid in her lungs, I asked her husband to take her to the emergency room right away.

We got a message from the emergency room doctor that our patient was admitted to the hospital but was stable. I happily reported to the team that the Nail Polish Lady was safely in the hospital and our work made a difference. A couple of days later, I received a call from the attending physician at the hospital asking if I knew the patient’s COVID-19 status. After getting over the shock that the hospital didn’t know, I told him that we just received the result and it was positive. The attending physician then told me that the patient took a turn for the worse and she was requiring 100% oxygen. She may need to be intubated and placed on a ventilator.

I told him how serious it was, and he asked me if she was going to be okay. I told him I didn’t know.

The next day, the original ER doc messaged us that she had indeed been intubated. She wrote, “Intubated, but stable numbers for the most part. Labs look okay other than leukocytosis and PO2 low on ABG.” I sent another note to the team, “Nail polish lady intubated, but stable…”

I received a call from the husband on Monday. He and his children had recovered and he needed a note to go back to work. He told me that the hospital had called him, but he didn’t understand what was going on (his daughter was trying to translate in Spanish with the ICU). He asked me why he can’t go visit her. I told him I would call the hospital and call him right back.

I was able to get hold of the ICU doctor taking care of our patient. He stated that the CT (cardiothoracic) team was working to start ECMO (Extracorporeal Membrane Oxygenation). The ECMO machine pulls blood from the patient, adds oxygen, and then pumps it back into the body when the heart and lungs can’t do it anymore. This is a last resort effort.

I hung up the phone with the ICU and tried to collect my thoughts before calling the husband back. I told the husband what they were doing. I told him how serious it was, and he asked me if she was going to be okay. I told him I didn’t know. He asked again if he could go see her. When I said no, he asked me if I can go, and if I could even send a photo of her. I imagined a photo with his comatose wife with tubes coming out everywhere. I didn’t think it was a good idea, but I called the ICU again. The nurse was assisting the CT team and starting ECMO. I was somewhat relieved that I didn’t have to ask for a photo.

Early the next morning, I received a message from a colleague (who was not on the care team) stating that the patient had died. She knew because the patient was a cousin of one of our staff. I quickly called the ICU, and the nurse confirmed what had happened. She said the room was already “empty and clean” when she started her shift at 7 a.m.

I cried for a few minutes in my office thinking about the husband’s request to see his wife. I had 25 patients on my schedule waiting for me to test them for COVID-19, so I collected myself and walked into the Respiratory Clinic.

Report from the Field #5 “They make me take care of the dead people.”

April 16 — I walked into the respiratory clinic and heard a woman sobbing behind the makeshift curtains. She was trying to explain something to the nurse. I couldn’t hear what she was saying, but the sobbing went on for several minutes while I was seeing another patient.

As I headed towards the exam stall where I heard the sobbing, the nurse stopped me and told me that she’s having a lot of anxiety. She also has fever and cough.

As I walked in, I saw a woman with a red cardigan sitting in a chair clutching onto her bag with both arms in front of her. Above the surgical mask she’s wearing, I could see her red eyes still welling with tears. I knelt next to her and told her my name. I gently asked her, “Are you okay? What’s the matter?”

She blurted, “The dead bodies! I’m so scared! My friend now has coronavirus. I don’t know what to do! I can’t do this anymore.”

I said, “It’s okay,” and gestured to slow down. “Can I ask you some questions?” She nods.

I asked, “Where are the dead bodies?” She said, “In the hospital. I work there, and I need to take them to the basement. They all had coronavirus.” She begins to sob again, “They make me take care of the dead people.”

My eyebrows go up. “OMG … She’s the hospital worker that takes people to the morgue after they die.”

I take a deep breath to catch myself and realize that I’m re-traumatizing her. I tell her that I understand the situation enough and that she doesn’t need to say anything more. I ask her if I can reach out to a therapist to help her through this, and she nods twice in agreement.

I quickly click open our IBH (integrated behavioral health) schedule on my laptop and look for a therapist that speaks Spanish. I message the therapist asking if she is available to do a virtual warm hand-off, and fortunately, she is. I walk the patient to a private room down the hall and call the therapist from the room. I introduce the two and leave as they start their session.

My eyebrows go up. “OMG… she’s the hospital worker that takes people to the morgue after they die.”

After 20 minutes, the patient comes back and she seems calm. I finish the exam and the nurse swabs her nose for the COVID-19 test. I give my usual precautions on worsening symptoms and when to call us or 911. I see that she already has a follow up appointment with the therapist in two days and I tell her that I’ll call her when I get the results back.

That evening, I tell my wife, also a family physician, what happened that day. She says, “There’s going to be a lot of PTSD because of this.” I’m thinking I’m going to be one of them, as we have our 21st consecutive dinner on FaceTime.

There are so many unsung heroes in this pandemic. The hospital workers like this patient that do the unthinkable but necessary work. The housekeeping staff that clean up after each COVID patient. The cafeteria workers that prepare and deliver the food. The therapists that take care of us. The social workers that make sure that each patient has a safe place to go. So many more…

Report from the Field #6 “Please don’t send me to the hospital. I’ll die there.”

April 19 — I was not supposed to be in the respiratory clinic, but I was there again. I had asked a patient to come in because he was having severe cough and difficulty breathing, and the nurse practitioner in the clinic that day was swamped.

When I walked into the clinic, my patient had not yet arrived, but I noticed an oxygen tank set up in one stall. I followed the clear plastic tube with my eyes and then peered behind the curtain. The oxygen tube led to a woman sitting in a “tripod” position (hunched forward with hands on both knees and chin forward). This is a classic sign of respiratory distress.

I quickly turned to the care team and asked about the patient. They said the patient came in with 10 days of fever and worsening cough. They were debating whether to call the ambulance or try giving her medicines and see how she responds at home. The pulse oximeter read 96% and the oxygen regulator indicated that it was putting out 3 liters per minute. I asked, “What’s her stat on room air?” The nurse responded that she came in at 90%. I muttered to myself, “There’s no way she’s going to be okay at home…”

The risk was too high, and the team decided to call EMS. As the nurse dialed 911, I realized that no one had discussed the plan with the patient. Making decisions for the patient without the patient is one of the things we are trying to stop in health care, but we did it again.

The nurse practitioner caring for the patient did not speak Spanish, so I went in to talk with her. I introduced myself to the patient and asked her how she was doing. She said she was not able to get enough air. I said we want to send her to the hospital and that we had called an ambulance.

The patient suddenly stood up and cupped her hands in front of her mouth. Her voice quivering, she said, “No, no, no … I can’t go.”

Startled, I said, “Why not?”

With furrowed eyebrows she pleaded, “I can’t go. Why can’t I go home? Please don’t send me to the hospital. I’ll die there.”

I have heard patients say this several times over the years, but this got burned into my psyche when I heard a doctor from Physicians for Human Rights (PHR) speak when I was in medical school. PHR had been working in Kosovo in the 90s during the Balkan wars, and he spoke about how Kosovo Albanians avoided going to the Serbian hospitals because they thought they would be murdered there. This resulted in the Albanians avoiding care until they were seriously ill, so when they did go to the hospital, many died.

There is ample evidence in the U.S. that people of color delay seeking care and have worse outcomes because of it. Reasons include cost, language barriers, distrust in the health care system, and many others, including the Trump Administration’s Public Charge Rule that jeopardizes gaining U.S. citizenship if immigrants use public services.

In this pandemic, we know that minority populations, especially African Americans and Latinos, are dying at double and triple the rate of European Americans. Data from New York City also show that the mortality rate among those who are hospitalized is very high, and if placed on a ventilator, 80% will not make it. I am not sure why this patient feared going to the hospital, but television images of refrigerated trucks outside New York hospitals should make anyone worry.

With furrowed eyebrows she pleaded, “I can’t go. Why can’t I go home? Please don’t send me to the hospital. I’ll die there.”

I was very frank with our patient. I told her that she will probably get worse at home (I was thinking about a patient from another clinic in town that refused to go the hospital and died at home). She said her husband will take care of her, so I picked up my cell phone and called her husband. On speaker, I explained the situation to the husband. I reassured both that the hospital was the best place to be, and the patient finally agreed.

As she was wheeled away by the EMTs, I reflexively said, “You’re going to be okay.” However hopeful, I regretted saying that because I worried she would not be.

Report from the Field #7 The EMT

April 22 — Dr. G asked me to come to the Respiratory Clinic to consult on a sick patient. I grabbed my stethoscope and walked into the room. I immediately saw the pulse oximeter blinking 88%, 90%, 89% (not good). The patient could not speak a whole sentence without stopping to catch her breath, and she was fatigued. I quickly ran to the nurse and asked her to bring the oxygen tank and call 911. While the nurse spoke with the EMS dispatcher, I listened to the patient’s chest and I could hear fluid in both lungs.

A few minutes later, two EMTs in full PPE walked in. I gave a brief report to the EMTs and they measured her blood pressure and listened to her lungs. By this time, the patient was receiving 7 liters of oxygen through a mask, which equates to about 50% inhaled oxygen. She is looking more calm and her pulse oximeter is reading 96%. One of the EMTs looked at me and said, “She doesn’t seem to be having difficulty breathing. She should go home.”

I felt the blood filling the vessels in my face, and I sternly said to the EMT, “She’s on 7 liters of oxygen and she came in at 88%. What do you mean she should go home? She’s feeling better because she’s on oxygen. And, by the way, what did you hear on the lungs?” He responded, “It sounded clear to me.” I jumped on it and said, “She’s got crackles up and down her chest. She’s got pneumonia in both lungs. She’s going to die at home.” The EMT backed up and said, “Oh, okay. I didn’t mean… Yeah, we can take her.” I must have given him that look that I reserve only for my teenage daughters. I turned around and saw Dr. G shaking her head with her eyes wide open full of disdain towards the EMT.

Calling 911 was a rare occasion before COVID-19. We used to have 300 people coming through the clinic every day and we called 911 about once a month. Now, we see 20 people in the Respiratory Clinic, and we are calling our friends at EMS every day.

A couple of weeks ago, I called 911 for a similar patient. The paramedic said, “They told us don’t take them unless they’re dying… and to bring people like this to the clinics.” They explained that every time they put a COVID-19 patient into their rig, they need to air it out and clean it. This puts the ambulance out of commission for 2 to 3 hours and they can’t afford that with the overwhelming number of calls they get. That was 2 weeks ago, and I’m sure they are not waiting 2 hours to air out their rigs now.

I felt the blood filling the vessels in my face, and I sternly said to the EMT, “She’s on 7 liters of oxygen and she came in at 88%. What do you mean she should go home? She’s feeling better because she’s on oxygen. And, by the way, what did you hear on the lungs?” He responded, “It sounded clear to me.” I jumped on it and said, “She’s got crackles up and down her chest. She’s got pneumonia in both lungs. She’s going to die at home.”

Realizing I was a little harsh, I apologized to the EMT. He seemed embarrassed. I remembered being an EMT in college and having no clue what a “sick” person looked like. I made my own mistakes. I once picked up in our ambulance an elderly woman who was not feeling well. Halfway to the ER, I noticed that something was wrong, but I couldn’t recognize what. Before we left the emergency room, the ER doctor came out and told me the patient had a massive stroke. He said that when the patient came in, she had agonal breathing, a gasping rhythmic breathing you see in cardiac arrests and severe strokes. I was embarrassed. But, it’s now burned in my mind’s eye, and I’ll never forget it.

After they left, I realized I should have gone over the lung sounds with that EMT. That would have helped him and his patients in the future. We’re all part of the same system, and we need to help each part of it improve. We’re all in this together.

Report from the Field #8 “If something happens to the both of us…take our kids.”

April 25 — It was a particularly hard week emotionally, and I found myself agitated with staff. We sent multiple patients to the hospital and we tested 20 staff members for high risk exposure or symptoms of COVID-19. I’ve been counseling and advising several employees and friends whose family members have died or are in the hospital. Nursing leadership is reporting, “we are running out of medical assistants.” Everyone knows someone close to them who is sick. Fear is palpable.

Staff are afraid of working in the Respiratory Clinic. I’ve been asked multiple times, “Why do we need more staff in the respiratory clinic?” When I requested additional cleanings to be done in the respiratory clinic, one response was “You have five people (doctors, nurses, and medical assistants). They should clean their own spaces. If they don’t have time, then perhaps you should see fewer patients.” It took everything to keep me from losing it.

What bothers me most is this question I’ve gotten multiple times: “What’s the goal of the respiratory clinic? Why are we doing it?” It’s code for “why are we risking our lives?” I can hear the anxiety in their voices. I say it’s to make sure we do everything possible to keep our patients safe and out of the overwhelmed ERs and hospitals. We are part of the public health system. Furthermore, the ER is the worst place for most of our patients, because they will wait for hours and will surely get COVID if they don’t already have it. We can also care for their diabetes, asthma, heart disease, and other chronic conditions so that they will be less likely to suffer severe complications.

One clinician pointed out, “But we’re not equipped to handle patients with COVID.” I responded, “You think the ERs and ICUs are equipped to handle COVID?” The biggest difference between us and the ERs is that we can close our doors if we want to, but they cannot. If we’re not here, patients will go to the ERs. We are vital to flattening the curve.

I try to remind staff that the people who work in the ERs and hospitals are also parents, children, brothers and sisters. I went to medical school in New York, so many of my former classmates are still there. One of my best friends from med school is an ER doc in Manhattan and Queens, the epicenter of the pandemic. He texted me photos of him in full PPE and the refrigerated trucks (mobile morgues) outside the hospital. What we do in the clinics seems almost normal in comparison to what they are doing. Every situation is different, however, and I don’t minimize our staff’s fears and anxiety.

“I talked to James tonight and said that if something happens to both of us, it has to be Seiji and Joan E who take the kids.”

My sister and her family also live in NYC. My sister is an internist and her husband is a pulmonary critical care specialist in the ICU. They have three children under 9 and live in an apartment in Manhattan’s east side. They have to juggle child care and homeschooling like everyone else on top of the additional risk to their family. Although their hospital is offering apartments and hotel rooms for staff, they are weighing the pros and cons of leaving one parent at home with three young children.

A few weeks ago, I received an email from my sister with the subject line: “A makeshift will.” In it, she describes her fears and concerns about contracting COVID-19 and the impact on her family. The email culminates with the line,

“I talked to James tonight and said that if something happens to both of us, it has to be Seiji and Joan E who take the kids.”

I think about this line every day as I try to keep people out of the ER.

Sending love to all the front line workers and everyone who is suffering. In solidarity.

Report from the Field #9 The Death Certificate

May 9 — I’m sitting next to my daughter on the couch helping her with Spanish homework. After six weeks of self-imposed quarantine, I’m happy that I can finally spend time with her, but I was weighed down by having to notify my team that four of our patients had died in the last 72 hours. Two died of COVID-19, one died of liver cancer, and the fourth passed away due to end-stage kidney disease. Before COVID-19, I sent these notices once every other month.

Confronting the death of a patient is a rite of passage for any doctor, but it’s never easy. We all have our ways of coping with it. I often think about how challenging it must be for my colleagues in the emergency rooms and critical care units right now. Sometimes our choice of specialty is determined by whether we can cope with this or not. For example, I would not make it as a pediatric oncologist.

The doctor-patient relationship is a professional one, but we often develop deep connections with our patients and their families. We are privileged to the most intimate facts about a person and participate in their happiest and saddest moments. This is what makes a career in medicine fulfilling, but it takes something out of us each time a patient dies.

An important task that comes with accompanying a patient who dies is filling out their death certificate. We all learn to complete this official government document early in our careers. The form asks for the “Cause of Death.” Determining this isn’t as easy as one may think. Right now, there are interns in the hospital struggling with this, “Well, the patient died because they stopped breathing. Is the cause of death cardiopulmonary arrest? Or, is the cause of death the hypoxia from the pneumonia that caused the lungs to fail and the heart to stop? Or, is the cause of death COVID-19 that caused the pneumonia?”

As I reviewed the medical record of the patient with kidney disease, I realized that it was the same doctor who cared for the patient that died of COVID-19 two days prior. I also see that the patient had many visits with the doctor over the last year. I now remember this patient because we had discussed his case. The doctor had spent many hours talking with the patient and his family about starting dialysis, but the patient refused despite pleas from his family. When I messaged the doctor about the passing of her patient, she wrote back, “… my heart is heavy.”

The doctor had spent many hours talking with the patient and his family about starting dialysis, but the patient refused despite pleas from his family. When I messaged the doctor about the passing of her patient, she wrote back, “… my heart is heavy.”

The medical record indicated that the patient with kidney disease died at home. I hope that the patient died peacefully surrounded by family. I started to worry, however, about all the logistics that need to happen for the family in this time of COVID-19. Is there a mortuary able to assist this family? How will the body be transported? And, who will sign the death certificate?

The physician of record is tasked with filling out the death certificate. When the death occurs in the hospital, this is usually very clear, but when it occurs outside the hospital, signing this document often falls to the primary care physician. Signing the death certificate is an important and urgent task especially because the body cannot be released for burial or cremation without it.

Due to systems issues at the health department, I am currently the only physician at Mary’s Center able to sign a death certificate online, so I will probably receive a message shortly. I’m happy to do this for our patients because the family should not have to worry about government forms while grieving. It’s one of the last acts of kindness I can do for this patient.

Report from the Field #10 “Chills like a breeze from Alaska.”

May 23 — I received a message from our nurse manager that she needed help getting one of our staff tested for COVID-19. Both of our testing sites were overflowing with patients and it was going to be a challenge squeezing him in at 4 p.m. on a Friday. I asked who it was, and she responded, “Rolando.”

Rolando is one of our medical assistants working in the Respiratory Clinic. No one was surprised when he volunteered to work there. He would have worked in the high-risk clinic every day if we let him. Rolando was born in Tuscaloosa, AL, but grew up in Venezuela where he earned degrees in both public health and nursing while serving in the Venezuelan army. He has large tattooed arms as big as my legs.

The Respiratory Clinic staff squeezed him in and tested him for COVID-19. His oxygenation was 95%, and his lungs were clear. The physician assistant (PA) in charge of employee health and I agreed to check in with him over the weekend.

When I called him the next morning, he wasn’t any better, so I delivered a pulse oximeter to his apartment. It took him over 5 minutes to walk from his apartment to the front door. He looked exhausted. From 10 feet away on the sidewalk, I asked him to check his oxygenation. It was 95% and went up to 98% with deep breathing. Reassured, I told him to get some rest. Just a few hours later, however, I got a text from employee health stating that Rolando’s O2 sat was down to 92% and that she was sending him to the ER.

He insisted that he could drive to the ER rather than call the ambulance, but he regretted that decision afterwards. It took him 10 minutes to walk from the hospital parking garage to the ER less than 50 yards away. Rolando didn’t need hospitalization, but the ER doctor cautioned him, “Your body may feel like every fiber is ripping. Come back even in an hour if you think you are worse.” Fortunately, he slowly recovered over the following week.

I asked him what was going through his mind during the time he was sick. He said he knew he had COVID-19 from the beginning, but since he is young and fit, he thought he would be fine. By day 5, he started thinking about the “Nail Polish Lady,” one of our first patients that we saw together that had died (see post #4). He then said, “The fact that you came to my house to check on me, that really got me worried. I thought I was in big trouble and was going to die.”

We laughed about it, but I was worried too. Rolando had every single symptom associated with COVID-19. He recounted, “I was feeling awful. I couldn’t roll over in bed without excruciating pain and dizziness. I thought my chest would collapse. I felt chills like a breeze from Alaska.”

When asked why he volunteered to be in the Respiratory Clinic, he said, “I didn’t want anyone else to be exposed. I wanted to protect my team. Everyone else has kids and babies, with large families. I was a better fit for the job.” This was typical Rolando.

He then said, “The fact that you came to my house to check on me, that really got me worried. I thought I was in big trouble and was going to die.”

He was always looking out for his team in the clinic or elsewhere. When he was waiting to be seen in the ER, he heard a patient yelling at the receptionist asking why it was taking so long. Although he was very sick himself, he confronted the man and said, “Hey, you don’t know what’s going on in there. There are a lot of people like us with COVID. The doctors and nurses are doing their best. Sit down.”

He explained to me, “Now as a patient, I appreciate all the front line workers even more. I never felt alone. You all are my family.”

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DC Primary Care Association – DCPCA
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