Ann took over, “One of the patients in the medical ICU is a thirty-one-year-old at twenty weeks who developed fever, cough and difficulty breathing over the last twenty-four hours. So far, she hasn’t responded to any of our medicines. Her influenza A and B were negative, her strep screen is negative, and we’ll know about coronavirus tomorrow.”
Peggy asked, “Haley, what’s our coronavirus update?”
“Well, we didn’t have any cases in New Mexico until ten days ago, but now we’ve had more than a hundred positive tests. The Albuquerque schools are closed, the University has gone to cyber-classes, all the sports events, concerts, and tours are canceled, the mall is closed, and Governor Michelle Lujan Grisham has closed indoor dining at restaurants. Most of the senior living facilities have stopped allowing visitors. People have exhausted the stores of bottled water and toilet paper. We’ve self-isolated any first responders and emergency room workers who are waiting for test results. We’re now down to twenty-four hours for test results, and our University lab has started analyzing them.”
It became an open forum. “But this will be more deadly,” Faith said. “I read there are more deaths per case of COVID than influenza.”
Ann said, “COVID transmits more easily. It looks like it’s all through respiratory droplets, like with influenza, but nobody is sure about surfaces and body fluids.”
“In our modern medical environment,” Josh said, “we can isolate better. This should not explode into the influenza outbreak of 1918 to 1920.”
“I don’t know about that,” Haley said, “this is getting scary. It’s us who will have to deal with all the pregnant ones.”
Peggy said, “Let’s be careful, isolate suspected patients, wash our hands, don’t touch our eyes, nose and mouth, cover our face when we cough, yada yada.”
“This might become a big deal,” Ricky said. “There are a lot of deaths, more than you would expect from influenza assuming we know the number of infections—”
“Which we don’t.” Haley said.
“— and there are long ICU stays. There is concern about whether the health system can manage this.”
“Which it can’t.”
“Shut up Haley.”
“Well,” she said, “the east coast is already becoming overrun with ventilator cases and they are scrambling to build temporary hospitals and mobilize the navy’s hospital ships. That means we may be in the same situation in a month.”
“We can manage. They are,” Ann said.
Haley said, “No, they aren’t. They are trying to figure out where to put all those critically ill patients.”
Peggy wanted to stir the pot. “ICU occupancy is about ninety percent all the time. No hospital can afford to have empty ICU beds on a continuous basis. So, there isn’t much space available for something like this. We might have to stop doing elective surgeries that require ICU beds to accommodate the epidemic, then resume when things settle down.”
“That would throw a wrench in the works for patients who need heart surgery or big cancer surgery. How do we deal with that?” It was Ricky. “We figure out which ones can wait, like surgery for weight loss and joint replacements, but there are a whole lot of people who need intensive care when they need it.”
“You wouldn’t be able to delay transplants,” Haley said. “When you have the donor, you have the donor. And auto accidents.”
“Out here, we won’t have as much transmission because of our low population density,” Ricky said. “You’ll see.”
“Shut up, Ricky.” She put her phone to her ear and listened. “Yes.” She ended the call. “Our patient in ICU is positive for coronavirus. That’s our first pregnant patient.”
“OK,” Peggy said, “it’s going to get real now.”
After rounds had ended, Faith and Josh suited up and entered the coronavirus patient’s room. “Good morning Reyenne,” Faith greeted her.
“Good morning,” the wheezy subject answered. Her eyes were sunken, she was straining to breath.
“This is Josh, one of the other doctors here. His last name is Menkowicz, but Josh is easier.”
Josh looked at the pulse ox reading, ninety-three percent. He looked at the blood pressure, slightly elevated. He noted the elevation of respiratory rate. “Have you been coughing?”
“Yes, I just had a fit of coughing. Sometimes I cough so hard I throw up.”
“We understand,” Faith said. “Do you have some family here?”
“No. They were told to stay away. We talked for a few minutes by Facetime, but I fell asleep.”
“Your coronavirus test is positive.”
“They told me.”
“You know we’ll take the best care of you we know how,” Faith said.
“I know.” She paused to take a few breaths. “Am I going to die?”
“Not if we can help it,” Faith said. “We will do everything we can to prevent that.”
“What about my baby?”
“We don’t know everything there is to know about this virus, so we are playing it by ear, but we have not heard that it is bad for the baby. Just for you.” Faith, in gloves, held Reyenne’s hand.
“Why won’t they let my mom come in?” she whined.
“We don’t want her to get infected. We need to contain this as best we can. Neither your family nor other patients in this hospital need this disease.”
“I hate that, though,” Reyenne said. “I wish someone could sit with me.”
“I understand,” Faith said. “I would feel the same way. But for now, we need to be careful.”
“Please come back and see me,” Reyenne said.
“I will,” Faith promised.
The two wandered out of the room as the patient started to doze. In the hall, “Reyenne really doesn’t look good to me,” Josh said.
“Nor to me,” Faith said. “What disturbs me the most is how fast she is getting worse.”
“I wonder what that means,” Josh said. “I wish we knew more about this disease. What the prognostic signs are, which medicines work, which medicines don’t work, what lab tests should we watch.”
“I agree.”
They wandered toward the elevators on their way back to the Labor and Delivery charting station. On arriving, Ann was at the desk.
“Reyenne looks terrible,” Josh said. “I wish there was more we could do for her.”
“Me too,” Ann said. “What did you tell her?”
Faith’s voice quivered, “We told her we would take care of her the best we could.”
“That’s enough. That works.”
When work had calmed down, Faith and Josh went back to talk to Reyenne. “Do you have a husband?”
“Not anymore. He left when we found out I was pregnant. He didn’t believe the baby was his. He said some doctor told him he couldn’t ever have children.”
“I’m sorry. Are you excited about the baby?”
“I was. Then my husband left. That hurt me, but now I’m slowly getting excited about it again.”
“Have you thought about whether you want a boy or a girl?”
“Dr Ann thinks it’s a girl and showed me on the ultrasound. I already have two boys. I want to dress her up and take her out. I like to sew, so it would be fun to make her things to wear.” Her voice was thin and tinny, her eyes moved slowly to Faith and then Josh. “My mom says it is just as fun to make clothes for a boy, dress him up and take him out, but I like pink and lace and fluff.” She closed her eyes long enough that Josh thought she might have fallen asleep. When she opened them, “Do you have children, Dr Faith?”
“No. Someday I would like to.” More information was not appropriate.
The patient drifted off again, but Faith sat and held her hand. “Go do what you need to do, Josh. I’m going to sit here for a while.”