Small victories on the night shift

COVID-19 brought fear and anxiety, but also humanity and hope.

The 101 freeway was unusually deserted at 5 p.m. as I drove to my night shift one spring evening. The typical cacophony of car horns and the angry looks from speeding drivers eager to be someplace else were absent.

It felt odd not seeing the smiling face of the toll booth lady as I whizzed past Dumbarton Bridge. For a creature of routine, the drive to the hospital was unnerving tonight, more so as I knew exposure to SARS-CoV-2 was a distinct possibility.

Image courtesy of Dr Mehta
Image courtesy of Dr. Mehta

With each red light, I prayed a silent prayer, thankful for the few extra seconds of safety it bestowed upon me. For the first time in five years of working as a hospitalist, I didn't have any trouble finding a parking spot as I rolled into the desolate hospital parking lot.

I walked through the hospital's double doors and was greeted by a woman with kind eyes. She was probably smiling beneath her N95 mask as she took my temperature, briefly glanced at my ID, and gave a slight nod. I was cleared.

I walked toward the call room, getting more anxious with every breath. Fear is a dominant feeling in this terrible time for all frontline health care workers, and I was no exception.

Around 7:30 p.m., I got a call from the emergency department. Eric, a seasoned ED physician assistant, greeted me with the usual pleasantries, paused, and then said, “Are you ready? I have a 40-year-old, very nice young lady, coming in with fever and a dry cough. She just got off a plane from Los Angeles yesterday. We suspect COVID.”

At times like these, “fight or flight” is the sympathetic response that starts your heart racing. No one truly prepares you for a pandemic in medical school, but along the way you acquire the tools needed to fight: science, resilience, and empathy. The oath we took in medicine absolutely removes the option of flight, so fight it is. For every patient. Against every disease.

I walked toward the patient's room on the medical floor, taking my usual detour to the nurse station to meet the night crew. I handed the telemetry technician some homemade brownies for the team. My eyes lit up when I saw the unit charge nurse, Olga. Over the years, we had shared stories about her time in Russia and mine in New Delhi while we sipped hospital coffee in the break room and munched the donuts that were often dropped off by a grateful family or discharged patient.

Olga knew this patient with COVID-19-like symptoms was now on her floor. Taking care of the patient and protecting her crew was all on her shoulders tonight, and I could see her worry as she downed her remaining coffee quickly and nodded her thanks for my brownies. We shared a look of mutual understanding, fear, and respect as I headed to room 501, where my patient, “Ms. Daisy,” was waiting for me, possibly already infected and contagious.

I donned my PPE with great deliberation, mentally going over every detailed hospital webinar and CDC recommendation on precautions. Just before I opened the door to the patient's room, Olga scurried over and mouthed, “Stop,” raising her hand and gesturing that I should follow her. Intrigued and puzzled, I did, wondering for a minute if something was wrong with my brownies.

She ushered me into a tiny nurses' storage room, which had two specially marked drawers for PPE. I felt like a client following a bootlegger to the back of her van in a dark alley to buy some pirated DVDs or handbags. She said, “Dr. Mehta, would you like to use this PAPR shield in addition to what you are wearing? I know I would.” I took the shield, thanked her profusely, and walked over to room 501.

I knocked and entered to find before me a sweet and visibly scared woman about my age. I introduced myself and started with my usual 20 questions, or as we call it, “history taking.” I realized within 60 seconds that she was more consumed by fear of COVID-19 than I was. Not being able to have her family at the bedside due to visitor restrictions made the experience even more terrifying, as did the clinicians coming in one by one wearing what looked like astronaut suits and mumbling words to her through their N95 masks.

I sat down next to her bed and acknowledged her fear and anxiety. Then I asked her two questions that I ask all my patients but that were especially critical tonight: what worried her most and what mattered most to her about this hospitalization. I saw her tight shoulders fall a little and her eyes connect with mine despite the impersonal garb I wore.

As she opened up in between fits of coughing, she shared that she worked in the hotel industry and her job required frequent business travel. Her husband had been recently laid off, and she was the sole breadwinner at home, with two elderly parents and a seven-year-old son. She said that her biggest worries were her family's well-being and her ability to keep her job. Her worry for her health, surprisingly, seemed last on her list of priorities. I asked if they had food and essentials at home, and she nodded, “Yes, my sister is helping out.” I reassured her I was there all night if she needed anything and went over the plan of care. As I took my leave, I couldn't help but say, “Stay strong, Ms. Daisy. Our entire team is with you!”

Back in the call room, the familiar monotonous clicking of the keyboard as I typed in lab orders offered me some semblance of comfort. I checked on my family briefly and saw video of my two toddlers sleeping blissfully. I let out a sigh of relief. My family was safe, and Olga and the nurses all had my back. Our patient Ms. Daisy was resting comfortably after a long phone conversation with her family. I was hopeful she would fare well and go home to them soon. While fear was pervasive in the hospital tonight, I felt humanity and hope had triumphed.

Each day health care workers are going to the front lines of a war. Tonight, my dear friend and colleague Olga gave me her armor to wear in the fight. Tonight, I formed a formidable bond with my patient to fight hand in hand as soldiers. I felt stronger and safer than I had at the start of my shift, and I was empowered to continue the good fight.

As I counted my blessings, I was called back into action: the emergency department with my next admission. I knew that a long night was ahead of me, but for now, the score was humanity, one, COVID, zero.