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This House is on Fire
2. Closer to Terminal?

for Adrian Cotarelo, MD [ October 2, 2021 ]

In January, I rolled up for my first shot, thought: It’s real! What a relief. A turning point. 
Then came my argument with a patient’s husband. Ailing, oxygen levels low, 
she didn’t yet need intubation but could at any moment. I recommended she stay,
given her condition and positive COVID test.
We don’t know if that’s true, said the husband. So she’s not going to stay.
Hold on, I said, I’m asking your wife.
She’s not going to stay.
Listen, it’s not prison, you can leave. But we’ve seen thousands of people die. It’s not a good plan.
Finally, the wife spoke: Could you let us talk?


They called me back in: Okay, she wants to stay. But if she has COVID, do I have COVID?
Maybe, I said. And then seeing how little the literal worked, I wanted to tell him—
This house is on fire, and I’m showing you the way out—wanted to show him the nonsense 
of him insisting—This house is not on fire!


Terminal Extubation
Maybe they’re braindead—we got used to saying this. 
Many left on a trach and died when their hearts gave out.
Some shifts: back-to-back cardiac arrests. 


One woman, late 50s, whose heart stopped multiple times, whose pulse we lost, found, 
lost again, four or five times, no longer intubated but not waking up, 
her teenaged kid asked—Hey, if we send you her reading glasses would you put them on her face? 
Maybe she won’t wake up because she doesn’t have her reading glasses? 
Nonsensical, but I did it anyway. 


I’d go in and speak to sedated patients—Good morning, I’m Dr. Cotarelo. 
I talked to your family and they love you. Most never woke up.
But one day, a voice said back—Oh, hello. 
Oh my God, hi! Reading glasses woman, one of the few patients I spoke with.


Usually I just talked with the family, like the wife who said—You have to save him 
You have to save him You have to save him I’ll pay you You have to save him! 
(I could not save him.)

Because I speak Spanish, more calls fell to me, like the FaceTime
end-of-life discussion, little kids in the background crying, saying—
Daddy, wake up, wake up and play!


Terminal extubation—the opposite of intubation—marks medical end of care, 
when sitting with them and waiting is all I can do. I removed the tubes from a few people: 
One guy with no contacts, a Russian man so alone, I sat with him until he died. 


Is this where it ends? Will we know when it ends?
Like I said before,
I’m trying really hard to hold on
to the ones who made it through.


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