October 2019:
I entered the exam room like any other; an unmasked smile, a handshake and hello. It was the same performance I'd given patient after patient for over a decade in emergency medicine. I began my initial assessment: She was in her early thirties, maybe younger, non-toxic appearance and in no respiratory distress. Looking at the chart, her vital signs were completely normal. Chief Complaint: Cough. I had seen it thousands of times.
This time would change everything.
As she gave me the history of present illness, I noticed her tense body language and odd expression. Any seasoned provider can tell you that certain diseases have 'a face.' Myocardial infarction, Influenza, Cancer – they all have a distinct physical appearance that you can spot from across the room. That young woman had a face I had never seen before, but one I would never forget.
The face of COVID-19.
“It’s been almost two weeks and I just...don't feel right,” she said, shaking her head.
As a provider, those words and that look gave me pause. It was confusion mixed with anxiety and desperation, like a sign of early oxygen starvation. Even though she was afebrile and her oxygen level was normal, my first thought was pneumonia so I ordered a chest x-ray. What I saw I will never forget.
Bilateral ground glass infiltrates.
It would be several months before this became a radiologist's default description of COVID-19 pneumonia.
I treated her with antibiotics like I would any other pneumonia patient, but something about the case was unusual enough that I told my wife, a nurse, about it later that night. Then I saw a similar patient a few weeks later, another anxious young girl who had come in very sick the week prior. Her first provider noted a dangerous combination of vital signs in the chart; fever, tachycardia, and low oxygen; but explained a lack of aggressive treatment on the pneumonia appearing viral on x-ray.
I was as appalled. Aggressive treatment of patients with any pneumonia, particularly those meeting sepsis criteria, is basic medicine. Fortunately, the girl was a bit better when I saw her, but she still had a low-grade fever and shortness of breath so I prescribed her the standard of care; antibiotics, an albuterol inhaler, and steroids. I then decided that particular medical group was not for me and promptly resigned.
It was the first sign of what was to come.
***
Shortly after I saw those unusual pneumonia patients I took a trip to San Diego. Standing on Pacific Beach, my favorite stretch of California coast, I received a call from a friend that his parents were found shot to death in their home. It looked like a murder-suicide. A dark and trembling chill settled into my chest.
They were like my adopted parents. I'd spent more time with them since the age of twenty than my own family. The father knew what was coming and the New World Order was the foundation of their entire existence; finance nothing, buy reliable used vehicles, and build small, off-grid homes to survive sustainably. Minimalism and mobility were fundamental.
After months of either severe depression or early dementia, police reports indicated that he likely shot his wife then turned the gun on himself. What exactly happened and why nobody will ever know. But several days later, as the two boys and I stood in that primitive kitchen, the scene of the incident, we settled on not letting their father's obsession with privacy and solitude take us to that same dark place.
Based on that conviction, I sold my own off-grid cabin in the mountains above Reno, Nevada. Inspired by their lifestyle, I’d purchased ten acres of raw land and built the place myself as soon as I became a physician assistant. But my daughter would be born in May of 2020 and I figured the resources would be better allocated elsewhere. I thought we had more time. How could I have known it was all coming so soon?
The sale closed two weeks before 15 Days to Slow The Spread.
***
New Year’s Eve 2019:
My resignation from the urgent care was an easy decision. I had already begun the hiring process for a new free-standing emergency room under the same corporate banner and the start date lined up perfectly. The facility had just been built, and I will admit that we were warned things could be a little rocky as we got up and running. But in the hunt for profit, corporate rolled us out right in the middle of flu season.
It was New Year’s Eve and our tiny emergency room was swamped. Typical. After only a handful of shifts in the new facility, I saw an elderly man with the same bilateral, patchy pneumonia. He was septic, very sick, with critically low potassium levels on initial bloodwork. Our on-site lab was giving unreliable results so we had to resend samples to the actual hospital. I couldn’t treat him until I knew for sure, and the transfer would take hours. My patient was already a ticking time bomb. If I mismanaged his care, he could die.
The attending physician coming on for the night shift introduced herself and asked how I liked the job so far. I explained the situation and admitted that I wasn't sure I felt comfortable practicing in that environment. She said that if I felt that way, she didn't want me there. I was a bit taken aback, so much so that I called the medical director. The conversation did not go well and we decided that my resignation would be complete at the end of the shift, no strings attached. I did not pick up any more patients, and when the real potassium levels came back normal I finalized the transfer of my pneumonia patient to the main hospital ICU.
I had nothing else lined up but I didn't care. When it comes to medicine, I do not fuck around. The traveling nurses recruited to staff that facility agreed with me about the safety issues. At the stroke of midnight, as I pressed the button on the wall to open the ambulance bay doors, I looked back at them and said, “2020 will be my year, I can feel it.”
I would not practice medicine again for another 19 months.
Stay tuned for Part Two of Medimorphosis and thank you for reading.
You are a heck of a writer Cody! When the world stops burning, we will need you in the rebuilding process. Keep the faith!
#TeamReality is sharing this on Twitter. Looking forward to more.