So the episodes play out like this:
Like most other ER docs, my shifts in the last few weeks have had a fair amount of Covid patients. Yesterday and today were no exception to that. What did stand out was that both days I had a patient come back to the ER that I had seen several days ago with Covid and sent home at the time. The decision on whether to keep a patient in the hospital with Covid or send them home can have multiple variables involved, but, in general most of the time it comes down to one variable- their oxygenation status. If they are above 90% on room air they go home, if they are below, they stay.
Both of these guys when I first saw them (on different days, they were not together) were in the mid 90s on their oxygen saturation. Both of these guys were in their mid to late 40s and one had hypertension and the other had no medical history other than being about 25 lbs overweight. I distinctly remember both of these guys because they were loud and obnoxious about not being vaccinated and loudly proclaimed how proud they were about that decision and each one stated to the effect that they are so tough they won't get really sick and they'd rather die than get vaccinated. Also, as the story always goes, the only reason they came to the ER is because a family member or friend had forced them to come and get checked out. For some reason it seems really important to them that they repeatedly state that.
They each seemed a little surprised when I stopped their vaccination proclamation mid sentence and told them verbatim, "I don't give a shit whether you are vaccinated or not, it does not affect me or my family." I then tried to clue them in that they are the only ones rambling on about vaccination stuff. I tell them what they need to know and that they are OK to go home to which, of course, they revert back to saying they were "forced" to come to the ER.
Fast forward about 4-5 days and that brings us up to yesterday and today. Dude #1 came back yesterday brought in by ambulance at the very beginning of my shift. He was in moderate respiratory distress and his oxygen saturation when the medics picked him up was about 78-80% on room air. In the ER he was on high flow oxygen via nasal cannula with an oxygen sat of 90%. He was still working moderately hard to breathe at that time. I told him I needed to know what his wishes were with regard to being intubated and put on a ventilator if his O2 sats continued to drop. To this he burst out in tears and is literally yelling/crying with just about the same decibel level as his earlier obnoxious proclamations 4 or 5 days ago. He also asks if it's too late to get the vaccination. Ummm yep, it is. He of course states he wants "absolutely everything done", despite his tough guy statement to the contrary a mere few days ago. He also asks if he can be transferred to, "Stanford or somewhere like that." Ummm, nope.
I admit him to the hospitalist and he gets a bed about an hour later upstairs in the step down unit. A couple hours later I get an update from the hospitalist that the guy has gotten worse and is now on 100% oxygen face mask and is sedated and prone in the bed. Hours later, less than 30 minutes before the end of my shift, I hear an overhead code being called in the step down unit and of course it is this guy. Unsurprisingly, the guy does not make it through the code and had no response to code resuscitation. On my way back down to the ER, I had this sudden realization that I had not eaten all day and I was starving. I diverted to the cafeteria and ate a big sammich which was surprisingly good.
Today, same scenario plays out with dude #2 who comes back in respiratory distress but not by ambulance. I won't bore you with all the details but his loud crying and his clinical course was very similar although by the time I had left the hospital this afternoon around 4pm, he had not coded yet but he was sedated and intubated. Just prior to writing all this about 30 minutes ago, I got a text from the hospitalist that the dude was dead.
Disclaimers:
1. I don't give a fuck if you are vaccinated or not. In my friends group/mountain bike group/shooting group, we have people who are and are not vaccinated. The only time this comes up is when we are jokingly fucking with each other and making fun of people who grandstand about their status.
2. With regard to vaccination, probably the only thing I really do give a fuck about is making sure people have a choice and can make that decision for themselves. That being said, you need to accept and live with the consequences of your choices and not be fucking loudmouths before the consequences or during like the two little bitches above.
3. I have been an ER doc for over 20 years, I don't give a fuck what you think you know about medical issues.
Cheers!!
Like most other ER docs, my shifts in the last few weeks have had a fair amount of Covid patients. Yesterday and today were no exception to that. What did stand out was that both days I had a patient come back to the ER that I had seen several days ago with Covid and sent home at the time. The decision on whether to keep a patient in the hospital with Covid or send them home can have multiple variables involved, but, in general most of the time it comes down to one variable- their oxygenation status. If they are above 90% on room air they go home, if they are below, they stay.
Both of these guys when I first saw them (on different days, they were not together) were in the mid 90s on their oxygen saturation. Both of these guys were in their mid to late 40s and one had hypertension and the other had no medical history other than being about 25 lbs overweight. I distinctly remember both of these guys because they were loud and obnoxious about not being vaccinated and loudly proclaimed how proud they were about that decision and each one stated to the effect that they are so tough they won't get really sick and they'd rather die than get vaccinated. Also, as the story always goes, the only reason they came to the ER is because a family member or friend had forced them to come and get checked out. For some reason it seems really important to them that they repeatedly state that.
They each seemed a little surprised when I stopped their vaccination proclamation mid sentence and told them verbatim, "I don't give a shit whether you are vaccinated or not, it does not affect me or my family." I then tried to clue them in that they are the only ones rambling on about vaccination stuff. I tell them what they need to know and that they are OK to go home to which, of course, they revert back to saying they were "forced" to come to the ER.
Fast forward about 4-5 days and that brings us up to yesterday and today. Dude #1 came back yesterday brought in by ambulance at the very beginning of my shift. He was in moderate respiratory distress and his oxygen saturation when the medics picked him up was about 78-80% on room air. In the ER he was on high flow oxygen via nasal cannula with an oxygen sat of 90%. He was still working moderately hard to breathe at that time. I told him I needed to know what his wishes were with regard to being intubated and put on a ventilator if his O2 sats continued to drop. To this he burst out in tears and is literally yelling/crying with just about the same decibel level as his earlier obnoxious proclamations 4 or 5 days ago. He also asks if it's too late to get the vaccination. Ummm yep, it is. He of course states he wants "absolutely everything done", despite his tough guy statement to the contrary a mere few days ago. He also asks if he can be transferred to, "Stanford or somewhere like that." Ummm, nope.
I admit him to the hospitalist and he gets a bed about an hour later upstairs in the step down unit. A couple hours later I get an update from the hospitalist that the guy has gotten worse and is now on 100% oxygen face mask and is sedated and prone in the bed. Hours later, less than 30 minutes before the end of my shift, I hear an overhead code being called in the step down unit and of course it is this guy. Unsurprisingly, the guy does not make it through the code and had no response to code resuscitation. On my way back down to the ER, I had this sudden realization that I had not eaten all day and I was starving. I diverted to the cafeteria and ate a big sammich which was surprisingly good.
Today, same scenario plays out with dude #2 who comes back in respiratory distress but not by ambulance. I won't bore you with all the details but his loud crying and his clinical course was very similar although by the time I had left the hospital this afternoon around 4pm, he had not coded yet but he was sedated and intubated. Just prior to writing all this about 30 minutes ago, I got a text from the hospitalist that the dude was dead.
Disclaimers:
1. I don't give a fuck if you are vaccinated or not. In my friends group/mountain bike group/shooting group, we have people who are and are not vaccinated. The only time this comes up is when we are jokingly fucking with each other and making fun of people who grandstand about their status.
2. With regard to vaccination, probably the only thing I really do give a fuck about is making sure people have a choice and can make that decision for themselves. That being said, you need to accept and live with the consequences of your choices and not be fucking loudmouths before the consequences or during like the two little bitches above.
3. I have been an ER doc for over 20 years, I don't give a fuck what you think you know about medical issues.
Cheers!!
