5th in a series of emails from a physician treating COVID-19 patients near the Tyson processing plant.
Day 5: N = 10
Significant for so many reasons. First, we have the patient volume to show HBOT is working. Second, the volume of COVID-19 here is astonishing. Over the past week, averaging 70 positive test results each day. Today, total cases = 164. COVID-19 is not going away anytime soon. Third, great lengths are being taken to get patients to the HBOT center – the word is out and we are being told about patients.
Leaving last night, I got a call at 11:30 PM. Patient in the ER, sick. I am not as young as I used to be, so I asked if he could wait until this morning… yes, great. But I forgot his name. This morning I went to the telemetry unit, how is the new admission? Stable, good. I will start the scheduled morning treatment before I see this new patient. No sooner had we gotten the scheduled patient to pressure, I got simultaneous messages – a text on the hospital app, a text through my cell phone and a call on the unit landline. The patent in the ICU was getting worse and when was I coming to see him? (My goal before I leave here is also to have someone on the wards at all times, talking to all the floors so I can be ahead of the curve everyday instead of behind!)
My incredible 13 year old son is helping develop our protocol. He read an article about proning patients. He called and said, “Mom, you know you really should have your patients on their stomachs in the chamber.” While we are not going to do prone positioning during HBOT, I started to have patients prone for an hour (if possible) before coming to HBOT. There seems to be a “honeymoon” with proning, and that is a great time for a potentially dangerous transport.
I Can’t Stop Smiling
So, I went to see the patient in the ICU. Incredible 70+ year old man, still working every day. But he was on 30% face mask oxygen and 15 liters of oxygen through a nasal cannula, and was still desaturating. Heart rate 140s.
So I had them prone him. He needs HBOT, but he was on a Cardizem drip and Amniodarone for his new onset atrial fibrillation and high heart rate. Fortunately, his niece is one of the Hospitalists and was in the unit. She was instrumental in getting the first patient enrolled, and she saw how well that patient did. We can’t run drips in our chamber. I told his physician niece, “If we can turn off his drips and he doesn’t get worse, this is our window. If we do not treat him with HBOT soon, I am concerned we will miss our window, but turning off drips in a 70 year old man is a risk by itself.” She said, “I want HBOT for him.”
He was too weak for a wheelchair, but the back hall we use, a stretcher can’t make the turn, but we got permission to go through the Wound Clinic, making sure to call ahead so all patients would be out of the hall and not exposed to COVID-19… so I took the HBOT stretcher to the ICU. (They really need a new stretcher! The lock doesn’t work and it doesn’t steer well and I am a bad enough driver as it is!) We put a very weak, tired, man on the stretcher. We took off all of his monitors except the portable pulse ox, and took him to the HBOT unit. He wanted to talk to his family but despite his face mask and nasal cannula, his sats dropped to the mid- to low-80s.
We started his treatment, we had a wonderful NP translate for him and is family. He started perking up. He started talking, he opened his eyes completely and regained facial expression… then he realized we did not put a gown on him (he had sheets and blankets), and he got irritated at us because he was hot but he didn’t want to take his blankets off. He had a foley and he moved around and dislodged it from the urinal we had it in, so rightfully so, he was really irritated about that. His final complaint was how soon could he eat? Like the “best rant ever” on Tuesday night, I almost started laughing. Not laughing AT him, but laughing because I was beyond excited that a dying man was mad he didn’t have a hospital gown on and asking for food (after not eating for 3 days) when he had previously been so weak he couldn’t open his eyes! Patients dying from COVID-19 don’t complain, because they can’t talk! It’s a good thing I wear a mask because when they complain after HBOT, I can’t stop smiling. He was returned to the ICU, sitting up in a wheelchair, chattering away, with his eyes wide open!
We decided to treat him again later, so as I was swinging by the unit I went in to see how he was doing and let him know about what time we’d come get him. When I told him he was getting HBOT again, he got that pre-rant look and said “No! I don’t…..OK.” Before he could finish his “no”, he decided to make it “yes”. His second treatment, he talked the whole time and touched everything. To take a patient off of medication drips, travel over a bridge across the street with no monitoring except pulse oximetry, and have everyone in complete agreement that it is worth the risk because the alternative of NOT providing HBOT seems more risky… it’s unbelievable that’s where we are. I have enormous respect for the hospital CMO and the Chief of Staff who are supporting this and made this happen.
HBOT is Saving Lives
Two patients were admitted with COVID-19 last night, one to the ICU and another to the telemetry unit. We treated the ICU patient with COVID-19 and just after we finished, the patient in the telemetry unit had a cardiac arrest and died. When I went to the telemetry unit, “the cart” was in the hall. “The cart” is designed so that not everyone knows what it is, but it carries a beloved person whose life ended. People are dying from this horrible disease, but HBOT is, thus far, saving lives. I just wish we could do more, and faster, and in more places, to save lives all across America.
We are trying to make lists. Lists of things to prevent everyone from re-inventing the same wheel, but more importantly, list of our fumbles and recoveries, so others don’t fumble like we did. (We make sure every oxygen bottle is completely full before transport!! All those nights of being on call as a resident are paying off 30 years later. We didn’t fumble that one but these patients desaturate when we unhook from the walk and have someone standing right there with the canister).
I seem to have already developed a routine: hotel after midnight, overdue shower, sanitize everything that crosses the line in my hotel room, get a cold bottle of water, and then brag to everyone about how much fun I am having! So many clinicians all levels say COVID-19 has taken a mental toll on them. I am spared from that. With HBOT, what I get to see are patients coughing so hard that they can’t catch their breath – with the look of pure exhaustion in their eyes – STOP coughing, take deeper breaths, slow their rate of breathing down and then relax and go to sleep.
Tweaking the HBOT Protocol
Most patients stop coughing before they are even at 1.5 ATA. We are treating at 2 ATA (atmospheres absolute, CF). We all want to know the right hyperbaric treatment protocol. I can’t say that I know the right protocol yet – I’m still tweaking it. Overall, longer hyperbaric treatments seem better for them because the patients need the rest. Also, I think we are going to find that proning prior to HBOT is a great combination… just takes coordination and the ability to plan and think ahead.
I continue to be amazed at what an opportunity this is, that I have been allowed to participate. Transporting these sick patients is giving me a cardiac stress test on an almost hourly basis. But the environment is very supportive and recognizing how incredible HBOT is for COVID-19. The alternative of NOT treating them is not acceptable.
What an incredible 5 days it has been! Confirmed cases have more than doubled, and we are gaining respect for this terrible disease. But, our Fumble Prevention list working and we keep going. I sincerely appreciate all the support I have from everyone.