The waiting room is empty, and I take signout on five patients. The patients that typically line the hallways waiting for beds, for stress tests, for MRIs all stayed home. The familiar drunks still get their blister-packed turkey sandwiches. There’s a trickle of patients onto my side: a middle-aged woman who lost vision and a prematurely grey man clutching his distended belly that tightens like a drum as I lay my hands on him.  Meanwhile, I’ve never eaten better as I pile my plate with donated food from the break room as the TV continues its endless roll of the exasperated pleas of Manhattan doctors and images of Italian nurses crying in hallways.

They pulled him out of the COVID-19 tent: a slapdash field hospital grafted onto the ambulance bay where the worried well sit six feet apart while taking in the boilerplate guidance of a gowned and masked provider pacing in front of them while the never-ceasing ventilation fans drone on and on. He’s smartly dressed in a long coat as he walks down the hall toward the negative pressure room. A month ago, I couldn’t have imagined a world where this man would have an EMT toting an oxygen tank at his heels.

He’s tired. His wool coat hides pale and clammy skin and the all-to-obvious rise and fall of his chest. His X-ray reveals the reticulated spiderwebbing that I know will soon become commonplace.  I don’t need to listen to his lungs. I do it so I can hear the coarse rattle of his chest for myself and because it’s what he deserves. Constant through all of this is the steady of the beep of the pulse oximeter as the monitor begs us to recognize the 89 percent flashing on its screen. The 4 liters of oxygen I run through his nasal cannula gives him palpable relief, but it’s not enough. I call the ICU.

Outside the negative pressure room, I don as many layers of plastic, latex, and nylon as our dwindling supply will allow. I get to work as he sits upright in bed with his phone never separated from his clammy hands. It’s all rote. Talk ventilator settings with the respiratory therapist. The pharmacist draws up meds for sedation and paralysis. Gather equipment. Prepare for the worst. I run my checklist again and again and wonder if this man has read about ventilator shortages and if he’s absorbed my practiced speech about intubation. “We need to use a breathing machine to let you rest. Your lungs need time to heal. You will be asleep, and we will keep you safe.”

Soon it’s quiet except for the gentle hiss of the suction canister. He’s stopped texting. With a sudden attack of guilt, my eyes find his LCD screen.

“Papa, what’s going on?”

In the intimacy of this moment, moments before the inherent violence of the procedure we all know is coming; my stomach churns with this violation. I squat at his bedside, and my eyes meet his through my goggles and face shield. Somehow he’s aged in the last 30 minutes, sweat beads near his faintly greying temples. His thumbs tap out a response which he deletes. Then another. As he deletes the third message, I finally speak.

“Do you want to call her?”

He shakes his head, “no.” There are no tears in his wide, brown eyes as he finally settles on a response.

The doctor will call you and tell you.

He hands me his phone and looks straight ahead. Absent is the usual crowd of onlookers. The extension tubing from his lines run out the door where the pharmacist mans the pump, and a team of nurses stands behind the sliding door to watch the first drops of the coming storm land against the glass windows. I’m alone with the RT and the nurse, conferring with the attending and fellow through a cell phone sealed in a plastic bag. The tube is in within a few seconds. The room fills again. The intensivist is a familiar face, even behind her N95. She asks for a central line, and I throw the drape over the man lying paralyzed in front of me. I need to cover his face. His vessels bounce under the needle. His skin is taut and smooth. Before long, I’m stripping layers of gown off of my sweat-soaked scrubs that cling to my chest and back.

The waiting room still sits mostly empty at the end of the hall. The stroke patient got tPA, and the bowel obstruction has been whisked off to the OR. I run my uncharacteristically short list of patients while the gowned and hooded docs outside burn through patients in the ambulance bay. The last minutes of the shift end uneventfully, and I sign out a record-low number of patients to my relief.

What’s going to happen? What’s going on? I wish someone could tell me.

Matt McCauley is an emergency medicine resident.

Image credit: Shutterstock.com