This House is on Fire
1. First Wave
for Adrian Cotarelo, MD [ October 2, 2021 ]
I waved away the signs. Tired—isn’t an ER resident always tired?
But another resident checked me out anyway, before my month’s work in ICU,
and when the thermometer beeped like crazy, everyone turned my way.
104 fever and heart rate way up, I followed protocol, stayed away for 10 days.
When I resurfaced, I tuned in to fellow residents chattering about how to fill out
their MOLST forms—how to answer: If you’re near death, do you choose intubation?
The world changed while I slept, the first wave rose, three patient screening tents
bloomed outside the ER, four overflow ICUs grew a sea of people arranged in tight lines:
bed-ventilator-bed-ventilator-bed. Whole rooms of negative pressure, contaminated air
sucked out to contain as much as we could. What rattled me: people we don’t normally see.
First on the list: age 22. We ventilated so many in their 30s. We climbed a steep
March peak, up and up, until the air was almost too thin and rare to breathe.
His brother, the daily point of contact, fed me tidbits by phone: he so loves the opera—
do you think he’ll go back? I know you can’t possibly know, but oh!
He's one of the smartest people, 84 and still such a brain.
I never knew him—saw him sedated from the start, full gray beard, longish hair,
tan complexion from Italian roots. (Eye color, who knows, with eyes always closed?)
No wife, no kids, just his brother, who I had to tell after a week—
we stopped his sedation but he’s not waking up.
When he left for the trach floor, I saw in his cards not opera but life in long-term care,
a death by pneumonia. One day a month later, there he was in the hall, wheeling toward
me, toward a scan, fully awake, talking through a speaking valve on the trach tube.
I’d never heard his voice! I’d come to love this patient without ever meeting him.
I told him: I took care of you a long time! What are you doing here? He said: I want solid food,
pizza, and they’re humoring me. I wanted to cry, asked the ER nurse: what are the chances?
Has he been to the opera? I hope so.
I’m trying really hard to hold on
to the ones who made it through.
What I couldn’t know was how I would cry and cry when the thought came: he will die
and I will have to tell his fiancée with their one-year-old in her arms. Police detective,
first-responder: 9/11 left him with an insult to the lungs, then cancer weakened
his lung lining more. I never met him awake, but he was only 38, in good shape.
A few days after we ventilated him, just as we were getting ready to insert a trach,
a massive stroke hit every part of his brain, arrested blood flow. I rushed him
to CAT scan, saw blood on the screen, leaned into the wall and sobbed.
When I called the fiancée, I needed another resident to stand with me. Where are you?
I asked her. Are you with people? She looped her sister into the call, then fell apart—
I can’t do this I can’t do this I can’t do this I can’t do this. Protocol said: No one in the ICU
until the patient is dying and even then, one-person limit, with limited time.
To arrive at the end took 24 hours, and when she came in, we gowned her up,
put on PPE, set her bedside and stopped the meds keeping his blood pressure up.
I offered her water, coffee from the back, stayed until he died, an hour or so.
I mourned throughout the day, and when I left at seven, I wondered—
why is the sun still out, making a big show of shine on the Hudson?
Then the sun and breeze hit my face and—oh—did I appreciate that touch.
I never did fill out a MOLST for myself, didn’t want to consider any question that began:
If you’re near death...
After my month in ICU, the final day, I don’t think anyone died. That was a good day.