As I reflect over the past year and our battle with COVID-19. I am reminded of the first time I was faced with a potential COVID-19 case. This was back when COVID-19 was something that I was reading about in newspapers. It was in China and maybe there were some cases popping up in the US. I was still feeling good that we would be fine and that we would not get hit.
I was on a swing shift when a patient with a chief complaint of “intoxicated” popped up on our tracking board. I had caught up with the initial wave of patients and so I signed up to see the patient thinking that I could see him and wrap up the case before my shift ends. As I walked in he was disheveled and acting erratically. His answers to questions didn’t make complete sense and he seemed a little confused. After running through the critical differential for altered mental status it seemed like the most likely cause of his presentation was intoxication. I turned the lights off and continued to work through the patients in the department with the plan to reevaluate the patient in 2 hours.
When I circled back and he was still not acting right. I had the nurse revital the patient. He was afebrile with stable vital signs. Given that his mental status wasn’t improving the way I wanted it to, I decided to go down the rabbit hole of altered mental status. I ordered the usual battery of labs and imaging. Since he wasn’t following my directions we attempted to sedate him so that he could stay still enough for the ct scan. No matter how much sedative we gave him he continued to move too much for a ct scan.
We needed this imaging to ensure there wasn’t a brain bleed or some other emergent cause for his altered mental status the decision I made to sedate and intubate the patient. I get all my staff together and the equipment I need and we get ready to intubate. My colleague reaches across the bed and hands me a simple surgical mask so I put it on even though usually I don’t wear a mask.
It’s 2 hours after my shift by the time he gets his scan, which was negative. I sign him out to the oncoming doctor pending the results of his labs and a potential lumbar puncture to evaluate for meningitis/encephalitis.
It’s 12 am When I get home. I get a call from the chief of the department. Given how late it is, this can mean only one thing… That I messed something up.
Chief: “Did you intubate a patient?
Me: “Yup”
Chief: “Did you wear an N95?”
Me: “No but I did wear a surgical mask”
Chief: “A nursing supervisor is saying that this is a potential COVID patient because he was intubated. If you did not wear an N95 then you could have been exposed. You may need to quarantine for the next 2 weeks. I’ll get back to you.”
Me: “But this patient was intubated so that we could get a CT Scan there was no evidence of respiratory symptoms.”
Chief: “It doesn’t matter. The fire drill has been activated so we have to go through the necessary steps.”
I can’t help but think how crazy this is. Quarantine for two weeks? I have 3 days straight of shifts coming up. Also, back in the day when I was I resident at county we would intubate patients without any personal protective equipment. There was no time to wear a mask when someone needed an airway. We would just cowboy up. It was more important to save the patient than to protect ourselves. This was the mentality I had. I would intubate a patient and then get back a busted-ass x-ray with infiltrates everywhere and just kind of laugh and pray that I don’t get tuberculosis. Now after intubating a patient with a clean x-ray I am being threatened with quarantine. The situation starts to sink in; what do I do about my wife. I wouldn’t be able to live with myself if something happens to her because I got her infected.
The patient ends up testing positive for another virus. The ID team determined that the patient is extremely low risk for COVID and I am allowed out of COVID jail. Little did I know that this would be the start of one of the most challenging periods of my career.
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