Yale-New Haven Hospital
New Haven, CT
This is part of our series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
A few weeks into “Code Disaster,” I was redeployed to be a drone-strike operator in the medicine wards.
That’s awfully militaristic, but so is the patois that’s evolved between medical jargon and common language. I put my uniform on. We fight the virus. Front-line defenders get discounts. At this point, I’m not sure anymore whether I was drafted or volunteered.
One plan, to reduce exposure and preserve the always-precious supplies, was to split us up. Attending docs to go in and see the patients, talk to them mask-to-mask. The platoon units, a motley crew of residents, physician assistants, and nurse practitioners like me stayed back in work-rooms. Sometimes we were nearby, but sometimes not even on the hospital grounds. These faded fluorescent rooms were where we did our fighting, a carefully distanced place away from the trenches.
For six weeks, I never saw a patient. I saw labs, countless labs. Assessed, ranked, filtered, and reported to a doc who could go in and look and touch from behind nitrile and mylar. I made these maps, the landscapes of the patient, blindly. Here, signs of inflammation; Here, numbers for factors we aren’t sure about yet. In the morning, I radioed my maps into the attending doctor. By noon they had changed.
I didn’t see his fever, the confusion and chills and sweating; I saw numbers crawl down, spike up, and then go down for good. I saw ‘4 LPM NRB prone’; the attending docs saw a woman who had to lay herself awkwardly, both face-down and propped up enough to let the oxygen mask still do its job.
Sometimes I took action: a pew-pew-pew of orders typed out and clicked into existence, a scan to look for a suspected enemy combatant, like a clot lurking in the lungs and terrorizing the surroundings. Pharmacy, I call out. I see signs that the opponent is closing in. May I have permission to release the immunomodulator? Once I stood in the hallway, reporting numbers to the rapid-response team, standing outside the door with my N95 on.
We work alone, but not alone, both amongst ourselves and within our patients’ bodies. For us, well, we get to learn new things every day. This is both sustaining and draining. There are some cool hits of dopamine from experts all coming together, but it’s all so damn new. HQ rewrites the protocols every few days, and we trust the art of the hunch in between. Each of us works in ways we don’t know, against a villain we don’t understand. Is it working the patient’s own cells against her? Did it mobilize disaffected cytokines? I can only hope the virus is a terrible team player.
I go home. I scrub, I sleep, and I do it again and again, until I can come home to my familiar base. The trenches we dug and the craters left are going to be visible for years to come. How will we remember this field?
Jen Picagli is a nurse practitioner in vascular neurology at Yale-New Haven Hospital, who previously trained in archaeology, anthropology, and blood gas analysis. She can be found drawing diagrams on her patients’ whiteboards during the day and writing alternative history fiction at night.