I remember the first patient I had where the weight of the pandemic really hit home for me. He was a man in his 60s. We were asked to do chest and rib x-rays on him because he had a fall. He was to be done portably because he was in one of the isolation rooms when COVID-19 had only started it’s upward climb in numbers in Toronto and our community hospital was one of the hardest hit. Any patient that came through and had any symptom of COVID-19 (fever, cough, shortness of breath at the time when the symptoms list was short and limited) was put in our make-shift converted pediatrics wing of emergency in individual rooms or in one of 6 isolation rooms we had to use in the main emergency wing once reserved for flu or other droplet transmission patients. We were to use our standard droplet/contact precautions. Mask, visor, gown, and gloves. We were to work in pairs where one imaging technologist tried to remain “clean” and operated our portable x-ray machine while the other dealt with the patient and the imaging plate we had to position behind their chest for the exam. Today I was the “dirty tech”.
I had seen COVID-19 and was now familiar with the tell-tale often double pneumonia and lung consolidations usually only seen on end-of-life patients. What set it apart for us was that these people were on the outside, nowhere seemingly close to end-of-life. We as technologists were usually the first to identify potential COVID-19 patients because being the people to take the pictures, we were the first to see them. Our imaging was standard practice for admission into emergent care and our results (although mostly for advanced progression of the disease) came much quicker than the swab analysis. Based on this man’s clinical history we entered his room not expecting another COVID-19 case. We were cautious in practice but not expectant. This x-ray was to rule out a punctured lung from a fall. We were checking for rib fractures and a subsequent pneumothorax (where air gets into the space between your lungs and chest wall). He was under isolation precautions because he failed the COVID screening due to his shortness of breath. Something that at that moment was attributed to a potentially collapsed lung due to trauma. However, protocol meant he was to be isolated until the swab test came back.
I remember entering the tiny room through the sliding plexiglass partition. The man was Italian and was in mid-yelling conversation with his son over speaker phone. I asked for his name to confirm I was in the right room and he spoke back in Italian indicating he did not speak English. I then pointed to his phone and indicated for him to hold it up so I could speak to his son to confirm his identity and translate what we were doing. I asked what had happened to confirm which side of the ribs we were to investigate. His son said that he had found his father collapsed in his home and had called an ambulance to bring him to the hospital. His father who was normally a strong robust man needed his son to help lift him on the stretcher they brought him in. They thought he had fallen on his right side because that was the side he was complaining of discomfort. His son was left on speakerphone and the phone was placed to the side of the stretcher for the x-ray. Every so often we’d yell into the phone so his son could translate our directions and breathing instructions. Normally a guardian could come in with a family member for translation purposes but because of COVID-19 these practices were not allowed. We took our first of 3 planned x-rays. The standard chest picture to see the lungs and the gross anatomy of the heart. The image came up and immediately the dread sank in. His right lung which normally should have been black to indicate a chest full of air was solid white. His left lung already had hazy white patches and distinctive fluid lines filling the bottom half. This man had not simply fallen. His lungs were about to give up.
I looked back at the patient trying to mask my surprise with indifference. He was sitting up in his stretcher not without discomfort but otherwise healthy looking. At that point he yelled in Italian and motioned an invisible drinking glass to his masked lips. “Could he have water?”, his son asked over speakerphone, he hadn’t had anything to eat or drink since he got to the hospital that afternoon. It was 10pm now. I politely shook my head and explained to his son that we as technologists were not allowed to provide water in case there were any restrictions to his diet for upcoming procedures we were not informed of. He could ask his doctor or nurse if he was allowed after we had finished our test. In my head I knew that this man would soon be intubated. I tried to keep my voice calm and level to not give my suspicions away. Whilst I was talking my still “clean” colleague decided that looking at the ribs was a lost cause and walked over to the nursing desk to see if the ordering physician could come over to look at the x-ray off our machine. Within a few minutes the physician appeared, glanced at our imaging screen and then put down the chart he was carrying to don the appropriate PPE before walking into the patient’s room. As we were removing our equipment the beginning of the conversation was overheard. “Hello my name is Dr. X, I need to talk to you and your father about consenting to admission into our intensive care unit and performing an intubation.”
The next time I saw that man again was a few days later on our morning portable x-ray rounds through the ICU. He was put in an induced coma and intubated. I don’t know if after his son had found him collapsed in his home, that he ever saw him again. I don’t know if that day was the last time they were ever to speak again.
It still haunts me.
“Can my father have some water? He hasn’t had anything to eat or drink since this afternoon.”
When I think about COVID-19 and the pandemic it isn’t the disease that scares me, it’s the implications of treatment. I have taken more chest x-rays than I can count and have walked the war-like isolated halls of the COVID ward. As a technologist we often don’t have the luxury to chat with patients. We have a laundry list of exams that need to be done throughout the hospital and we have to get them done in a time sensitive manner. When we see COVID-19 patients there is a fear there. An expectant gaze acknowledging that we are amongst the smallest of human interactions that person has had during their day. An introduction, a hard plate behind their back, breath in, hold your breath, thank you and then out again. I am not scared of the physical burden of the disease, I’m scared of the emotional. I can’t imagine living out my final days isolated from my loved ones and them in turn isolated from me. I can’t imagine dying deprived of even basic human interaction. I don’t want the last time I see or hug my husband and family to be months away from my final dying days.
I remember at the beginning of the pandemic I was especially paranoid. I would come home at the end of every shift, strip naked in the doorway and immediately hop into the shower. I would keep a COVID box at our entryway where any item that went into the “outside world” would not be allowed further into our home. Every evening I would feel a tightening in my chest and throat from the anxiety of wearing PPE and inhaling cleaning fumes and pray that I wouldn’t find myself coughing and gasping for breath the next day.
I have had multiple breakdowns. I have felt like I’ve been spread thin like too little butter spread over too much toast. I’ve silently cursed any friend gathering over social media while I’ve maintained not physically seeing friends or family since Thanksgiving of last year (we went to a beach and sat on blankets 2m away from each other in a socially distanced picnic). It’s true, maybe if I didn’t see COVID x-rays on the regular, I would be more fatigued by the pandemic. Maybe if I didn’t have faces to put to those death count numbers that flash across the morning news every day, I would be more inclined to think it’s just not that bad. Admittedly I even have coworkers who work in other imaging areas question the validity of all the COVID precautions we go through. I remind them that I’ve seen it, often, and in the worst possible ways. I would not wish this sort of end on even my darkest enemies.
So if you’re tired of this pandemic I urge you to just keep going. Keep isolating. The insides of the hospital walls may seem like another world to you but the ticket on that rocket isn’t as unattainable as you may think. Our make-shift COVID section of emergency is now all of emergency. Our hospital had to convert an outpatient clinic into a space for the non-COVID symptom emergent patients. Many of our general wards are now COVID wards. Our ICU has been hastily renovated to accommodate the ever growing need for more negative pressure airborne isolation rooms to house our intubated aerosol-generating COVID patients. Every day it feels like we’re travelling to a new wing or an entirely new room as our numbers continue to grow. That foreign world is conquering and soon, will include someone you know and love. The knowledge of what we’re up against comes at great cost and I can assure you, it is as bad as they say. The grass on the other side of ignorance is certainly not greener.
And if you still think it is, then God help us all.
softshells. 