The man sits comfortably on three liters of nasal canula as I peer into his ED room.
He laughs as I enter with a mask, a face shield, a gown and gloves: all standard protocol for “PUIs,” patients under investigation for COVID. He has good reason to laugh. I look ridiculous.
“You scared of me ol’ boy?” he states in the familiar rural twang of our region.
“Shoot, I ain’t scared. I believe I could whoop you without wrinkling my dress here!”
We both laugh. He can hear I grew up close by.
“They tested me for the COVID. You think I got it?”
I’d looked through his chart with my attending physician moments before. The ED note indicated he had sudden onset shortness of breath, pleuritic chest pain, oxygen saturations in the mid-eighties and was unvaccinated. His chest X-ray was clear. COVID test pending. It was more likely a pulmonary embolism (PE).
“Hard to say right now. We don’t think so, but COVID shows up all kinds of funny ways. The test is pending.”
We conversate a little more about his health history and what brought him in. He had a history of DVTs (Deep Vein Thrombosis, or blood clots), was a smoker and had taken a long trip in the car a day before. Suspicion for PE rose further. He changed topic.
“Brother, what do you make of this virus, this vaccine? Is it all a hoax or what?”
“This virus is real and the vaccine works.” I describe my own initial hesitancy to take COVID seriously and my rural family’s changing perception of it. Then I delve into my critical care rotation hijacked by COVID: phone calls to family members about deteriorating status; intubating folks in their fifties who die days later; telling an elderly man on BiPAP (a ventilator) this would be his last day. I tell him that all these people who died–my family members, the folks in their fifties, and the elderly man on BiPAP–were unvaccinated.
My voice breaks.
“It’s been tough. It’s been really tough.”
He responds, “Well listen, friend, I just hear all kinds of stuff on the news. I don’t know who to trust, but I trust you. I’ll get that vaccine.”
A CT angiogram hours later confirms a PE, and he is picked up by the medicine service, not sick enough for critical care. He is COVID negative.
A few days later, I see he is discharged. I read in the chart that the medicine service offered him the vaccine, and he refused it.
I don’t know who to trust.
Asheville, North Carolina