Tony Scott - Along Came COVID - Love and Loss in the 2020 Pandemic

“I need to call her mom. I’m not sure what I’m gonna say.”

“Tell it like it is. You have a son, and she has a grandson.” Peggy answered, making it sound simple. Not.

Justin pulled out his cell phone, punched buttons, and put it to his ear.

“Mum, it’s Justin.” He choked up.

Peggy heard “No, no, no,” on the other end. There was no more conversation. Peggy just stood still, her presence more important than her words. When the call ended, he accompanied Justin back to the waiting room to join his parents. No words were needed to convey what had happened. Two grandparents’ faces relayed surprise when they were told baby had been saved.

Washing his hands and face in the bathroom near the ICU, Peggy looked in the mirror. Ricky barged in the bathroom, sweat rolling off his face, bright red PPE marks across his cheeks, chin, and nose. “I can’t believe what I just did.”

“A true cesarean,” Peggy finished. “Congratulations? Or maybe it should be my sympathy?”

“I’m sorry.”

“I understand. Nobody wants to have to do one. But what you did was save the life of a little boy. You did a great job.”

“But I killed a woman.”

“No, you didn’t. The virus killed the woman. You prevented the virus from also killing the baby. Be sure to focus on the bright side.”

“That’s hard.” The rest of the conversation flowed by eye contact through the mirror.

“I don’t think I want to do this,” Brian said, situating himself in front of Peggy on a rolling chair.

“What don’t you want to do?” Peggy asked.

Brian took a deep breath. “I don’t want to do anything. I don’t want to stop my opiates, I want my nightly weed, I don’t want to take this medicine, and I don’t want to work here.”

“That sounds like a step backwards.”

“But the expectation of me is insurmountable.”

“Hmm.”

“I don’t know if it’s worth it.”

“What choice do you have?”

“Just keep going the way I am.”

“Until JD and Emily terminate you? Until you fail another board exam? Until you alienate more friends and coworkers? Where does that end?”

“I don’t know. Just let it run where it runs.”

“Let’s go back to lymphoma and cancer of the pancreas.”

“Why does it have to be lymphoma and cancer of the pancreas?”

“Because you have about the same chance of dying. We know patients that are not treated are more likely to die.”

“How do you know all this stuff?”

“I read. I didn’t know any of it a month ago. Anything I don’t think I know enough about, I read.” Peggy reached for a few sheets of paper stapled together. “Here. This is what I found out about depression and substance abuse. The article is mostly about opiates. It was eye-opening for me. I didn’t know the prognosis was this grim.”

“I don’t see the similarity. How does this kill me?”

“Suicide or overdose.”

“I have never thought about suicide, I don’t know how I would do it, and I don’t think I could.”

“That’s a good thing. But it’s possible to do it by accident.”

“So, why’s this threatening?”

“Because so many opiate dependent patients do it, and most of them do it either impulsively or accidentally. It seems that families and caregivers rarely see it coming.”

“Is that what this says?” Brian flipped one of the pages of the little bundle.

“Yes, but maybe not in so many words. Just that the prognosis is surprisingly poorer than one would imagine, recurrence is common, and that death is unexpected. Like cancer of the pancreas.”

“I came to tell you that my Pain Management doctor gave me another medicine.”

“Suboxone?”

“Yes.”

“You told me. Something that prevents you from getting the high, the euphoria, of the opiates. It also makes it a little harder to overdose. Did you start it yet?”

“No. I am still taking some Percocet.”

“When did they tell you to start it?”

“When I have been Percocet free for a week.”

“OK. What else is going on?”

“Nothing.”

“You know about Elizabeth Kubler-Ross’s five steps of death and dying, right?”

“Yes, sort of. Denial, anger, bargaining, depression, acceptance. There, I guess I did remember.”

“Congratulations. Where do you think you are?”

“I am not dead or dying.”

“What does that tell you?”

Brian didn’t answer.

“Denial?”

“But I am denying something I am not sure is facing me.”

“What if this was lymphoma or cancer of the pancreas? Wouldn’t you wonder if they had interpreted the biopsy right? Wouldn’t you wonder if they had mislabeled the specimen and that the cancer was someone else’s?”

“Yes. I don’t think what they told me is correct.”

“So, you have some soul searching to do.”

“Between you and my Pain Management crew, I am about to go nuts.”

“You realize that is half the battle, right? Once you honestly, in your deepest soul, are convinced that this is a problem, you can tackle it with vigor. Only you can enter and follow the treatment. Only you can allow yourself to be treated. Only you can climb this mountain.”

“But then what?”

“Take up life and enjoy it. Dive into your career.”

Brian didn’t say anything, visions of mountains, treatments, trials, and tribulations swirling in his head. How would this end? When would he be free of it? Brian stood. “Thanks.” With no more than that, he left the room.

The window didn’t rattle.

Peggy was relaxing in the call room when her phone displayed Ann as the caller. “Peggy, the patient that Faith brought up from the Emergency Department, Melanie Forsythe, has become extremely difficult to ventilate as well as oxygenate. We’re using insanely high peak inspiratory pressures, insanely high PEEP, and one hundred percent oxygen. With that we only have about eighty percent pulse ox, and a blood gas shows a carbon dioxide too high for pregnancy. I’m about out of options.”

“Yes, Ann,” he replied.

“She has an insanely elevated d-dimer and almost no white blood cells, both terrible predictors. I’m meeting with the family in the main lobby. Do you think you could join us?”

“Absolutely. I’ll be right there. Are you insanely OK?”

“No.”

Sunny skies in the lobby atrium belied the gravity of the immediate problem. Two trips to this place for the same reason in four days was repugnant.

Ann introduced Peggy, “This is Greg Houston, father of the baby, Frank and Brenda Forsythe, Melanie’s parents.” The faces were grim. Brenda was seated with the others standing. Ann had masks on all of them.

Ann addressed the family, “Dr Valdez can help me.”

“What do we know so far?” Peggy opened the discussion.

Frank, the patient’s father, said, “Dr McCauley told us that her lungs have rapidly deteriorated, and that she might not survive.” Tears were running down his cheeks. “No one should outlive their child.” This yanked hard on Peggy’s heartstrings, as she thought of her wife, niece, and her extended family in Crystal Springs.

“Yes, no one should outlive their child. Coronavirus causes swelling and fluid in the tiniest airways in the lung. In her case it’s bad enough to occlude them. This prevents moving air in and out and keeps oxygen from getting into the blood.”

“Dr McCauley told my wife, Brenda, that there was nothing else to do.” He struggled with the rest of the thought, “If her heart stops, they won’t do anything because even if she restarts, it will stop again and again.”