When you have cared for hundreds or thousands of patients during residency, there are names you will never forget. They are structural beams in the blueprint of a physician, a piece of your humanity preserved in amber that your fingers idly skim across years later.
Guadalupe Fuentes. Was this during the first surge, or the second surge? To Elise, it has been all the same, a single monstrous swell rising and rising towards an infinite height. Seven months ago, Elise was the overnight MICU resident when Lupe was transferred from the floor. 63-year-old woman with diabetes, contracted COVID from her 87-year-old father who was briefly hospitalized for a few days and had already made a complete recovery. She’d initially required 4 liters of supplemental oxygen on the floor and had been started on Dexamethasone and Remdesivir, but that night, her oxygen requirements suddenly increased. Rosy apple cheeks and impeccably arched tattoo eyebrows, Lupe was always awake when the night team passed by her room, flashing a thumbs-up through the window as the high-flow nasal cannula obscured part of her face.
Her final night is imprinted upon Elise in pieces.
The alarm of the bedside monitor ringing, the blue numbers never rising past the 80s, shallow fluttering breaths as the respiratory rate climbs to the 30s, then 40s.
Martha Fuentes, holding it together just long enough to say goodbye to her mother over Facetime, her voice cracking before a trickle becomes a rush of sobs, begging Elise to take care of her mother. Theo, the MICU fellow, calling out the orders for rocuronium and etomidate from the head of the bed as he wields the blade of the GlideScope in his hand. Elise, foolishly placated by the calm that follows a smooth and uneventful intubation. Foolishly lulled by the back-to-back success of her flawless placement of a central line catheter and arterial line, with Theo remarking that Elise was ready to do the procedures solo.
Fool, fool, fool, fool, she has told herself a thousand times since.
The phone rings while Elise is signing out overnight events to the day team. Her intern announces that Bed 40 is coding. Dread strikes like electricity shooting from the roots of her hair, through her scalp. Theo is already gowned up in the room when Elise gets there, calling out orders for one amp of sodium bicarbonate, one milligram of epinephrine. Elise jumps in to perform the next set of chest compressions, the sweat dripping down her neck under the gown as she feels the ribs rolling under the clammy skin beneath her gloved palms. They achieve ROSC after one cycle of CPR, but then the oxygen saturations drop and they are coding her again, three more cycles of CPR. Finally, they call it. Time of Death, 7:04 AM.
She remembers how Fortino spared her from having to call Martha, telling her to go home, that he would take care of everything. But as soon as she was alone in the call room, Elise could no longer move, body dull as lead as the last gasp of adrenaline abandoned her. She sat on the bed in a daze for what felt like hours, until Rigo entered the room. It’s funny now, when she remembers how awkward things were between them back then. Neither knew how to behave around each other after what happened in Vegas. Trapped together as the night float residents for their respective MICU teams, she couldn’t look him in the eye as he stood in the doorway.
Hey, are you okay?
How many times had she been asked that question before and answered with a lie? Before she could even get the words out, the tension in her facial muscles gave him the answer by letting go.
This was the last time Elise cried for one of her COVID patients. How many others has she lost since then? Ten? Twenty? Fifty? The story repeats itself, one by one, the bodies in her mental graveyard lining up in rows. Dexamethasone, full-dose heparin drip, Nimbex drip, Vancomycin, Cefepime. Nothing works. They slip through her fingers one by one like sand.
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