Six months in, it is clear that mortality is not the only outcome that matters.
By Daniela J. Lamas, M.D.
I scan through my patient’s record, four months of life distilled into a series of progress notes, lab values and radiology, until I find what I am looking for — a chest X-ray from May. It is a striking image, the kind of X-ray that should not have been compatible with life.
Yet here I am, preparing to see the patient in our critical illness recovery clinic. Though we started this clinic long before the pandemic, it now offers us an opportunity to see our sickest coronavirus patients after they leave the hospital and return home. Understanding that many of them might not otherwise have access to the subspecialty and psychiatric care that will help them recover, we screen for common post-intensive care issues and check labs and lung function to better understand the course of recovery after coronavirus.
But this clinic serves another purpose as well. Here in Boston, months past the peak of the pandemic, we are in a strange sort of limbo. Time dilates. I read through old patient notes and autopsy reports, replay decisions, wonder what we would do differently if — and when — this happens again. No matter how much I try, I might never be able to make sense of it all. But perhaps seeing my patients again on different terms can help me begin to understand the long shadow of the pandemic, and to move forward.
I enter the small clinic room. My patient is sitting on the exam table with his teenage son by his side. As we greet each other from across the room, I cannot help but marvel for a moment at the simple fact that we are all here. That he is alive and walking and talking and breathing under his own power. I meet his son’s eyes and wonder if he too is thinking about that day in May.
It was about a week before the chest X-ray. We were on rounds when the nurses called us to his room, yelling through the closed door. From outside the room I took in the bright red blood in the vent tubing and suction canister, oxygen saturation wavering. We moved quickly to stabilize him while one of the resident doctors called his family to come in. It would be the first time they had seen him in person in a month, as the rules at the time said that family members could only enter if a loved one might be dying.
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