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I don’t know what it’s like on the other side of the mask.
Not the cloth mask, which I now wear every day, as habitually as my socks. I mean the plastic bipap mask, which provides the highest level of ventilation COVID patients can receive, short of intubation.
“After eighty-five years of life, I still don’t know what death is,” said Lonnie, as I sat beside her bed in the nursing home. “I just know it scares the heck out of me.”
Despite decades as a hospice social worker, I don’t know what death is either; but I’ve spent much time with patients exploring the question together.
“What scares you?” I asked.
For months, as I’ve visited Evan as his hospice social worker, he’s been praying to die. In his early nineties, he has been dealing with colorectal cancer for more than four years, and he’s flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.
Gearing up for my night shift in the COVID-19 intensive-care unit, I don my personal protective equipment (PPE)–a white plastic air-purifying respirator (PAPR) hood. The hood connects via a tube to a large battery pack that I strap onto my waist over my scrubs. I turn on the battery and shiver when the rush of cool air blows past my ears. I walk into a bright white antechamber where a safety officer inspects me.
As a pulmonary and critical-care medicine fellow, I care for patients with a broad variety of respiratory ailments. But little did I know, as I examined my patient Mr. Smith in the outpatient pulmonary clinic this past winter, that I’d see him again only months later as my first patient with COVID-19.
Mr. Smith was tough as nails. A stoic retired steelworker and former smoker, he suffered from significant emphysema, but was inclined–by nature and
It’s winter of 1993. A cold, snowy day. Windy. A blizzard. The phone rings.
I’m not on call for my patients today–except for one. Daisy has been in my care since the early 1970s, and given the risk that she may suffer a serious downturn, I’ve instructed her nursing home to call me whenever necessary.
The day began in Mom’s room with a 10:00 am conference at Upper Valley Medical Center, west of Columbus, Ohio. In attendance were my ninety-three-year-old mother Joanne (now in her third week of hospitalization), her palliative-care nurse Richard, her Episcopal priest Mother Nancy and myself.
“Deeper compressions! Deeper! Make sure you get that recoil!”
I push harder and lift off higher. I’m starting to sweat. My stethoscope is banging around my neck. I should have taken it off, I think. My hair is flying around my face. I should have tied it up. I’m on tiptoe; my legs are cramping. I should have stood on a step stool.
“All right, she’s getting tired. Next!”
Bobak Akhavan ~