How could we forget?
2021; Elsevier BV; Volume: 9; Issue: 4 Linguagem: Inglês
10.1016/s2213-2600(21)00041-2
ISSN2213-2619
Autores Tópico(s)Family and Patient Care in Intensive Care Units
ResumoMy mother-in-law walked in a rush into my room at 3:13 am and shook me awake. “Your mom is trying to reach you. Derek is worried that Natalie is exhibiting symptoms of COVID.” Even in the early blush of sleep—sleep had not come easy that night—I felt the cold rush of fear in my veins. I reached for the phone, over my now awake husband, and made a rushed call to my brother-in-law. “What's happening?”, I asked. He explained clearly and deliberately that my sister had woken up in the middle of night with acute shortness of breath and chest tightness. I could hear her in the background saying tightly, “I can't breathe”, panic in her voice. What started out as mild concern grew to fear, as she pointed out her chest tightness was increasing and she couldn't breathe. We deliberated, the three of us—911 or the car? We wanted her to go to the academic hospital (a revered institution), not the local emergency department (ED), and we worried about the risks of ambulance transfer. “I'll jog to the car. Be back in 10 minutes.” Their toddler (3 years old) was asleep soundly in the bedroom next door. “Let me pack Sam's things”. My sister's voice was becoming more thready and more urgent: “I can't breathe.” “Don't leave. Please don't leave me”, she pleaded with her husband. Derek gently rationalised with her: “Your sister will stay on the phone with you. It will be okay.” Through her fear, she acquiesced and allowed me to stay with her. “You will be ok”, I kept reassuring her, but inside, I didn't know. COVID is still so new, so uncharted. She finally told me, gently, to shut up. A few minutes—maybe an eternity—later, Derek was back and ready to go. It became clear at that point that even putting on pants was a difficult problem and maybe a car transfer was not doable. My sister agreed to 911, and losing control. It was 3:45 am. 9 min later the ambulance came along with gentle but kind folks (it seemed, I was on the phone). They did an assessment and brought her into the ambulance. Her pain and shortness of breath continued to increase and I heard her vomiting. My first thought was, “Oh good, only a viral gastroenteritis.” Her O2 saturation was 100% and she had people taking care of her. Her husband and son were at home. We couldn't join her. She was alone in the ambulance with only me on the phone. We were in the era of COVID. No-one there to share her fear. Just me on the phone, trying desperately to understand what was going on. I heard her gagging and vomiting, and I felt helpless knowing that she was not being attended to. I think they got some vitals, but then she was so alone again. I knew the protocols. I did it every day when I walked into the cancer clinics as an oncologist. N95 first, gloves, then gown. Face shield, too, just to be careful. I heard the muttering of the ambulance heading into the emergency room, and the sounds of the nurse triaging my sister. “O2 100%.” It was 4:20 am. We took a small breath of relief. She was sent to an isolation room and left alone with just me on the phone. “Jennifer, the chest pain is getting worse”, she said, “but the breathing is better”. Gastro-oesophageal reflux disease, oesophageal spasm, I thought. “Just be calm, it will be okay—try to sleep.” “Okay”, she said. I felt reassured myself—she was safe and well cared for. But 8 min passed and she called my phone again. “Jennifer, its bad. The pain is now a 7.” My alarm spiked again. I asked her to try and get a nurse's attention. I heard them say, “There's a lot going on in the ED. You will have to wait.” More minutes passed as I heard my sister become more and more agitated. “Jennifer, it's worse”, she said. “It's in my back now.” Suddenly, I knew: a dissection, a heart attack. It couldn't be. I begged her, “Get out of bed! Get the nurse!” She fell. The nurse came into the room and told her, “Get back into bed.” My sister tried, but couldn't. Finally, I heard a doctor's voice. 5:40 am. “Let's get an EKG, chest x-ray”. Suddenly I heard a piercing alarm—a code. The phone fell silent. It was 5:55 am. The call came at 7. Derek was crying. “Natalie had a massive heart attack. She's in critical care. They are not sure she's going to make it.” I don't even remember what I answered. How could we forget? My sister, a 39-year-old mom, with no cardiac history is now in the cardiac care unit at our very well known and well respected academic hospital. She had a complete occlusion of her proximal left anterior descending artery and went into ventricular tachycardia and became pulseless for over 45 min. She is on extracorporeal membrane oxygenation and dialysis. We are taking it day by day. Her voice still rings in my ear. I remember telling her to be calm, take shallow breaths, she was safe, there were people there who knew what to do, knew how to take care of her. And we forgot. In the midst of COVID, we forgot to do a differential, to make an assessment, or get an electrocardiogram. More than that…we forgot to care and to be present. How could we forget? In the days following, people continue to send me messages, about unsettling heart problems associated with COVID. My sister is COVID-negative. She had a normal massive heart attack. But COVID probably affected her outcomes dramatically. It has changed the way we practice medicine, the way we touch, and care, and think. It has changed our process, instilled fear instead of logic, and made us forget that we are so much more than this horrible virus. I declare no competing interests.
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