The phone rang. “Dr Valdez, this is Ricky.” Peggy brushed shards of deep sleep away. She had to orient herself. She was at home, in her own bed. Ricky. Ricky. Blue lights from the nightstand said 4:30 am.
“Ricky. What’s up?”
“We thought we should tell you that our patient had a cardiac arrest. She died about two hours ago.”
“What? She died?” Peggy tried to push through a thick shroud of dream fragments. “Ricky.” She wondered why Ricky was calling her at home, but didn’t pursue the issue.
“Yes, Dr Valdez, Ricky.”
“Where are you?”
“At the charting station in ICU. I was trying to finish up the death certificate, which I’ve never done before. I’m making slow progress. When I think I’ve finished it, the computer rejects it.”
They discussed the diagnosis until they came to an agreement on how to describe the asthma and COVID which the computer finally accepted. “Yes ma’am, it worked. Sorry to have awakened you.”
A few hours later, Haley opened rounds. “Good morning everybody,” she said to grim faces. “Our coronavirus patient died in the night. This is bad.”
Faith, not having been in the hospital overnight, wrestled to get words out, “Why did she die? What killed her?”
“They couldn’t oxygenate her, and then she arrested. In other words, lung failure.” Ann answered.
“I talked to her the day before yesterday, and I sat and held her hand. I did her admission chart work and told her we would take care of her!” Faith’s voice trembled and cracked. “Then I saw her yesterday, when she looked terrible. I guess I shouldn’t be shocked, but I am.”
“We did take care of her,” Peggy said. “But her disease was bad and progressed rapidly. OK, what do we have here?”
“That sounded crass, Peggy,” Ann said. “But I know what you mean.”
Josh said, “Well, as you can imagine, we’ve got a lot of patients with minor issues we need to clear out of here. There are non-COVID colds, there’s a patient with contractions that isn’t in preterm labor, and a urinary tract infection that needs to be sent home. We don’t have anyone with anything serious.”
“This is a little annoying,” Haley said.
Peggy missed the point. “What’s annoying, Haley?”
“That we’ve got so many patients with minor issues that were not taken care of during the night. They should all be out of here already. It’s always like this, considering.”
Peggy still didn’t get it. “Considering what?”
“Our nighttime attending.”
“Who was it?”
“Yankton.”
“OK, what did he say about our death?”
“They couldn’t find him,” Haley said. “We aren’t sure he knows. Ann finally called Dr Beacham, and Ricky called you. Can’t you get fired for that?”
“You don’t talk to me about each patient,” Peggy said. “Why couldn’t you send them home? And if you couldn’t find him, why didn’t you send them home anyway?”
“He insists we talk to him about each one,” Josh said. “No other attending makes us do that.”
“We can get them out of here shortly,” Faith said, still staring at the floor. “We need to keep our unit clear so we can accommodate people who really need us.”
Peggy nodded. “Have we got ICU patients?”
Ann said, “Yes, both are in Medical ICU. We’re waiting on coronavirus detection tests on both.”
“Here we go,” Peggy said. She thought about the plagues in Europe in the Middle Ages.
Haley, Faith and Ann looked at each other.
“What?” Peggy asked, clueless again.
“I’m not at all comfortable with this,” Ricky boldly stated. “We may be about to enter our most critical time with our flat-out weakest attending!”
“Stop,” Peggy snapped. “Let’s take this conversation somewhere else.”
Like Keystone Cops, they made for the little conference room, shed the medical students, and shed their PPE.
Ricky took command again. “I don’t like this. We’re concerned we could have another death in the ICU today or tonight.”
“Should we talk to Dr Beacham?” Haley asked. “Ann, you’re our leader. Can you take us to Dr Beacham to talk?”
Josh next, “I second that.”
“I’m good with that,” Ricky said. “We need to have this conversation today.”
Peggy didn’t notice that Ann was on a call. “We need to talk to you. We’re concerned about a situation that is immediately upon us, and we need to have direction. Could the five of us — no, six of us — come talk to you? Or can you come to us?” There was a pause. “We’re in the little conference room in the hospital. We can come to you if you need us to.” There was another pause. “Yes, ma’am.” Another pause. “That should be fine. I’ll make that happen.” Ann glanced at each of them. “Yes, thank you. See you then.”
“OK!” Haley said. “Spill it!”
“We’re meeting at noon in the office building conference room. Be sure you’re there, Peggy.”
Peggy was still bewildered, “Is this situation that bad?”
Ricky said, “Oh, yeah, that bad.”
There was discussion of other patients and issues, followed by scattering to work they all wanted to have finished up before noon.
The impact of the previous night darkened Peggy’s vision and thickened the shadow over this morning. With a plodding gait, she made her way to his fellows’ closet desk. She slumped into her chair, opened a Diet Mountain Dew, logged onto her computer, and organized the tasks she needed to accomplish.
Faith entered, the frosted window acknowledging her soft spirit by emitting no sound. Josh followed, the two sitting in chairs halfway across the room, far exceeding the recommended six feet.
“We’re pregnant,” she announced.
“Congratulations. I assume this is your baby, Josh?”
“Yes. We think it’s a girl and we’re thinking her name is Cori.”
“That’s a nice name,” Peggy responded. “I’m glad it’s not Corona.”
“It’s not,” Faith said. “I had thought of this name before the pandemic, and it turns out my parents considered that name for my sister Natalie. I was only eleven years old at the time, so I don’t remember the discussion, but maybe that’s where it came from.”
Josh said, “We might tease some people about Corona, though. Like Haley.”
“She deserves it,” Peggy said.
“That’s what I said,” Faith agreed.
“So, how’s it going?” Peggy asked.
“Good so far,” she answered. “I haven’t felt her move yet, but I’m only fifteen weeks.”
“Yes. Glad to hear it. What do you think, Josh?”
“I’m so excited,” he said. “On one hand I am proud and excited, and on the other I know parenting is a life’s work. And to top that off, we’re bringing her into a world of COVID.”
Faith said, “We haven’t been telling anyone, except our parents. I met his parents on Facetime. He has a lawyer sister who helped me with my divorce. We’ve talked to my parents and sister several times. They met him when they came to help me move.”
Peggy changed the subject. “You have been learning amazing things that you discuss in rounds. I’m proud of you. Both of you.”
“I’ve been reading everything I can,” Faith said. “This pregnancy doesn’t help, though. Reading makes me so sleepy.”
“I’m completely familiar with that. At night, sometimes, I can hardly stay awake long enough to find where I left off the night before. It’s getting worse as I get older.”
“I’m trying to keep up,” Faith affirmed. “I want to become you, Ann, or Emily. I want to have that knowledge and judgment.”
“You’re on your way. Just keep going,” Peggy said.
“Can you believe Reyenne died?,” Josh said. “How does that happen?”