I sanitized, gowned, tied the billowing fabric around my waist and neck. Then: blue gloves over cuffs, face shield over N95, breath cocooned in layers of synthetic fibers.

Out of habit I knocked on the glass door, though I knew the oxygen Mr. Abraham needed for each breath was so loud it masked the hollow sound.

Breath. It sustains life but now it will take your life, too. The very act of breathing allowed you to draw Covid into your body, through the welcoming portals of your nose, mouth, eyes. The tiny virus particles, covered in a knobby crown of proteins, attached themselves to cell receptors like wild blackberries in a child’s cupped hands. The virus spun frantically in your nasal cells, buzzing, bouncing, multiplying. It traveled up the nerve fibers in your nose, a beetle infestation in a tree, and stole your ability to smell. Maybe you had a runny nose then an irritated throat, a dry cough, itchy eyes. Then your immune system released trickles of cytokines. Those little messengers told your hypothalamus, the brain’s thermostat, to turn up the heat and you spiked a fever. Some of your immune cells attacked the virus directly and some swept away the infected cells. If you’re lucky, this is where it ends.

You weren’t lucky, Mr. Abraham, I thought.

I opened the door. Mr. Abraham lay in bed, strapped into a tight-fitting clear plastic mask. His pressurized oxygen murmured a song with no notes, just rhythm pulsing through the plastic corrugated tubes: whisper in, rest, whisper out, rest, whisper in, rest, whisper out. I let my own breath fall into the shape of his mechanical inhalations and exhalations, so different from the undulations of natural breathing. My shoulders tensed until I let my breath roll freely through my lungs again.

Mr. Abraham had been drawing in those unyielding breaths for too long. The muscles in his rib cage and abdomen tired from the effort. His kidneys were shutting down rather than filtering his blood. He was rarely awake enough to talk. Mr. Abraham’s family asked over and over why we couldn’t do more to save him. Over and over I apologized for the virus, told them that Covid had made our usual treatments futile.

I put a yellow plastic stethoscope in my ears and placed the diaphragm on Mr. Abraham’s chest. The gesture was symbolic. All I heard was the rumble of his oxygen. I rested my gloved hand on his for a moment, the blue vinyl bright against his skin.

Mr. Abraham, I’m trying to help you, I’m doing everything I can. I’m trying to make sure you don’t have pain.

I thought I spoke the words, but could barely hear them through my layers.

The virus overflowed your upper respiratory tract and traveled deeper into your body. Replicating over and over, it slid through the tubes in your airways, which look like upside down trees, or perhaps right-side-up tree roots, in the center of your chest. This is where the storm started. The fast wave of cytokines told your immune system to destroy the virus. But the harder those immune cells worked to save your lung cells the more damage they caused. The lining of your lungs tore, leaking fluid into the lung tissue. Eventually debris accumulated in the fluid, forming labyrinths of ropy fibers, stiffening your lungs. Your oxygen was mired in this mess.

At that moment I didn’t know the detail I would remember most about him was the wail his wife made when I told her he had passed away. It was the same wail my mother made when, sixteen years ago, my father’s doctor told her that my dad had died.

Standing near the door I pulled off my gown and gloves, stepped out of the room, sanitized my hands and face shield. Then, the whole thing in reverse: gown, tie the billowing fabric around my waist and neck, blue gloves over cuffs, face shield over N95, breath cocooned in layers of synthetic fibers. Knock.

Ms. Christie was awake and ready to talk. Before I even introduced myself, she started a rush of words: she wouldn’t even be here if her husband hadn’t been sick and though she was helping she didn’t know that she would get sick too and if he hadn’t decided to get surgery during the middle of a pandemic maybe he wouldn’t have gotten Covid and now here she was — she was panting by this point.

Ms. Christie, I said, watching her chest retract and release, retract and release, I’m so sorry that you and your husband have Covid. I don’t want you to tire out, so why don’t you take a break while I examine you. You’re on high flow oxygen, 60 liters and 70% oxygen. Regular air is 21% oxygen. The high flow forces air through those thick prongs in your nose. It reduces the dead space in your lungs, that ominously named place where there is no exchange of oxygen and carbon dioxide.

Ms. Christie looked comfortable enough while she was quiet. Her age and her frail body, which belied her sharp words, were not on her side though. Her gradually stiffening lungs were not on her side. I stared at the numbers on the monitor above her head, though I didn’t need it to tell me anything. I bit the inside of my lip under my mask, felt my fists balled up at my side. Maybe she would be different. Maybe her spunk would save her.

Several days later my colleague texted me that she passed away, her husband at her side. I was off that week. Every day, as if in a never-ending nightmare, I sat alone at home checking the medical record to see which of my patients had died. At least with Ms. Christie, my colleague and I shared our grief.

For that moment in her room though, I turned away from the monitor. I put my blue-gloved hand on hers, told her I would check on her husband down the hall later in the day.

Standing near the door I pulled off my gown and gloves, stepped out of the room, sanitized my hands and face shield. Then, the whole thing in reverse: gown, tie the billowing fabric around my waist and neck, blue gloves over cuffs, face shield over N95, breath cocooned in layers of synthetic fibers. Knock.

I entered Ms. Colon’s room with a video interpreter. Ms. Colon, too, was on high flow, 60 liters and 100% oxygen. She had an additional mask strapped lightly to her face. There’s no science to this oxygen on top of oxygen. It is a desperate measure to save you, something we wouldn’t do before Covid because how can you breathe more than 100% oxygen? I already know what’s going to happen, though. As your lungs, stretched like deflating balloons by years of smoking, ache for more oxygen they’re getting stiffer and weaker. Fluid pools inside. Your chances of surviving this are slim.

The interpreter could barely hear my voice, muffled by my mask and face shield, through the tablet speaker. Ms. Colon’s words were lost in the loud tangle of her oxygen tubes. Somehow, though, we had a conversation. At that moment she was determined to undo her failing lungs. She was convinced that the oxygen, the steroids to reduce Covid’s inflammation, the antiviral medication to kill the virus, would all work. Similar treatments had treated her underlying lung disease many times. She wanted to keep trying.

Are you sure, Ms. Colon?

¿Está segura Señora Colon?

Later I got permission to bring her daughter in to talk more about her prognosis and her wishes. Ms. Colon was determined to beat the virus, even though every morning I saw her pulling the oxygen off her face in frustration. We cried together, my blue-gloved hand on her right hand, her daughter’s on her left. I handed Ms. Colon tissues though the oxygen seemed to blow her nose dry.

Each day it became harder for her to speak, and then to stay awake for the conversations. But that day, while she was still awake, I knew that she didn’t have much longer to live with Covid permeating her sagging lung tissue. I wonder if she knew, too.

Standing near the door I wanted to yell in frustration. I considered it, wondering if anyone would even hear me through my layers of protection. But I pulled off my gown and gloves, stepped out of the room, sanitized my hands and face shield.

Instead of donning my gear, knocking on the next door, and entering Mr. Jackson’s room, I walked to the end of the long hall. A window overlooked a parking garage and bare trees. Eight years ago I was a patient on this same floor. I had just been diagnosed with colon cancer and had a long operation to remove my entire large intestine. The day after the surgery I didn’t have the strength to walk the length of this hall. All of my energy went to breastfeeding my infant twins during their daily visits. Which was worse, I wondered, colon cancer as a new mother or failing so many sick and dying patients? I healed from my cancer. Covid traveled on waves of breath, though, stealing air from person after person. Some healed, but too many did not.

The day before Mr. Jackson told me he wanted to go home. I paused when he said this. He, too, had been on the same forceful nasal oxygen for days, and hardly had the energy for speech. But when he did talk he always had a joke or stories about his family. Most of the time I stood with him in silence, feeling the faint movement of his chest through my blue-gloved hand on his shoulder. There was no way he could make the journey home.

What do you mean by home? I asked him.

He shrugged.

Do you mean home like your house or home like… my voice trailed off. I pointed at the gray sky out his picture window.

I would like to go to my home, he whispered, but I know I ain’t going to make it. What I mean is home, he said lifting his index finger to the ceiling.


*Note: All names and identifying details of the patients have been changed


Image: Photo by Masaaki Komori on Unsplash.

Rohini Harvey
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  1. Thank you for this lovely and painful piece about the cost of Covid on patients and their providers. The beautiful and poetic descriptions of the physiological way the virus works make it very understandable. I especially like the repetition of your sterile ritual before each room- just as repetitive as our breath, and the description of walking by the room of Mr Jackson – still called the room of Mr. Jackson- although he has gone “home”- leaving something of himself behind like all of our patients do.


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