Wyoming Medical Center's first experience with a severe coronavirus patient came through a panicked phone call.
The doctor on the line was from another hospital in Wyoming. They were frantic. A patient in their 20s had come in that day. On paper, in theory, such a young patient should've responded well to a respiratory virus that is most dangerous to the elderly. But in short order, the patient's condition deteriorated rapidly; they grew ill, seriously ill. Their oxygen levels plunged.
As the doctor spoke to WMC's Dr. Tola Akiode, staff were "bagging" the patient — using a device to pump oxygen into the lungs like bellows into a fire.
Bagging wasn't working. The patient was going to die.
"I have this patient here, and they're not breathing, their oxygen saturation is like in the 60s, and we’re bagging them," Akiode, who works at WMC's intensive care unit, says the doctor told her. Normal oxygen saturation is in the mid 90s.
"It’s like, 'Gosh, how do I get my hands across?'" she says, stretching her arm out in front of her, as if she could touch the patient herself. "'How do I get my eyes there?'
"You could hear the panic in their voice because the patient was about to die," she continues. "(The patient) came in that day, and it was like a boom." Akiode snaps her fingers.
"That was my first encounter."
It would not be her last. Fortunately, the 20-something patient managed to survive. But all told, seven coronavirus patients have died in Wyoming since it first wormed its way into the state nearly two months ago. Nearly 500 people in the state have been infected, and over 150 more likely have had the disease.
"I wish I could say it’s the kind of thing that I went through my life without experiencing because it’s just — in terms of all the death," Dr. Tara Taylor, who runs the hospital's intensive care unit, says. The impact on patients is unlike anything she's seen. "The worst influenza seasons I’ve ever had, I've never had this. Never."
Still, Wyoming's caseload — and deaths — is a fraction of the devastation that's ravaged New York, Seattle and New Orleans. There is, then, a temptation to downplay the disease here. That temptation has only been magnified as Natrona County and the rest of the state begin to loosen restrictions placed on businesses and everyday life, strictures intended to slow the progression of the virus.
But Akiode and the intensive care team at WMC are not relaxing, and they did not view the coronavirus's spread up until this point as acceptable. Three of their patients have died. The disease is a particularly cruel one in that it does not allow a patient to have their loved ones at their side when they go. Families are kept away, for their own safety. The doctors have to lean more heavily on the go-betweens already inherent in health care.
"Families are just besides themselves, they can't go and visit their loved one," Taylor says. She's spent more time on the phone, delivering long-distance updates to families who can't enter the unit.
She says that the wife of one of the hospital's critical patients was upset that her husband couldn't get remdesivir, the drug that's shown promise in fighting the virus. Akiode says the hospital has only been able to use the drug on one patient because of its limited availability.
"She was upset, and that was very — because I had to take a deep breath and just say to myself, 'This is her husband, this is someone she loves, someone she’d has Christmases with, children with," Taylor says.
The wife told Taylor that "all you have to do is call this company, you could get it, doctor, you could get it if you wanted to."
"I felt awful," the doctor says. Her hair is a dark red, with gray emerging at the roots. "I was almost in tears. A doctor wants to be — we’re trained to do good and do the best we can, to exhaust every avenue to try to get somebody well."
That moment — created by a pandemic that separated husband from wife and exacerbated by a disease with no clear treatment options — taught Taylor to have more patience, to "dig down deep in your soul and be very patient and do the best you can."
"Because you're not only taking care of that patient; you're taking care of the patient's family as well," she said. "That’s true with all different diseases, but during this pandemic, that extra piece where they can't go and visit or hold their loved one's hands or kiss them — the human touch element has been taken out of the equation."
In the run-up to the disease's advance into Wyoming, there were apocalyptic reports and videos streaming out of New York and Italian hospitals. The doctors here watched them.
Akiode says she'd stay up late and wake early, scrolling through her phone. "COVID, COVID, COVID" was all she consumed. Her fellow intensivists, Taylor and Dr. Mark Mc Ginley, obsessively read up on the virus, studying it as much as they could.
The virus was scary, Taylor says, because it was "faceless and invisible." In a past life, she'd been deployed to Iraq and served on a team that transported wounded soldiers to a hospital in Germany. The enemy in Iraq was identifiable, tangible, understandable in its way.
That experience had been the most intense part of her medical career, up until this pandemic. So much remained — and remains — unknown about the virus. It was a giant unknown, hurtling toward Wyoming.
"I was scared, man," Akiode says. She's a Nigerian native and speaks with an accent. She has an Eiffel Tower pin attached to her name badge. She worried about taking the disease home with her, to her 67-year-old husband.
"Was I going to get this disease and die?" Mc Ginley adds. He's Irish and also speaks with a soft accent. He had come straight from the ICU to sit for an interview, so he's in blue scrubs. A flash of blurry handwriting is visible on his left palm.
The doctors' fear was not misplaced. Health care workers across the country — and several in Wyoming — were getting sick. Many were dying. Akiode, Mc Ginley and Taylor became evangelical sanitizers. Before she left after each shift, Akiode would change out of her scrubs. She'd wipe down her hands, her face, her neck, her cellphone, her purse. Then she'd wash her hands again, then once more after she'd pushed out of the hospital doors.
Taylor would change out of her street clothes at the hospital, sanitize thoroughly and put her scrubs in a plastic bag. Before she touched anything in her house, she'd take a shower.
As the disease spread, researchers' understanding of it changed, too, not only in how the virus moved but in how doctors could treat it. The hospital adapted with the daily developments. Proning patients — the process of rolling someone onto their abdomen to help their lungs — used to be a "performance," the doctors say. Now nurses can do it with little fanfare.
Initially, Mc Ginley says, the hospital was giving its seriously ill coronavirus patients hydroxychloroquine, the anti-malaria drug that drew international attention after a small European study suggested it could be used to treat the virus, a study seized upon by President Donald Trump.
The hospital doesn't do that anymore, Mc Ginley says, because the drug seems to do more harm to a patient's heart than it does good in fighting the virus. Now, he says, the hospital is closely following national guidelines on treatment options.
The doctors all say the hospital and the county were "on top of this early on in the game." The ICU at WMC can accommodate 14 people, but an old nursery was prepared so the hospital could double its intensive capabilities. Protective equipment — face masks, face shields, gowns — were preserved. Infection control measures were implemented quickly.
The hospital hasn't run out of protective gear, as many had feared. It hasn't needed to use the nursery. The providers — both in the hospital and at outlying clinics — have worked as a team to fight back against the disease, the doctors says. Taylor feels more confident now, her purpose as a doctor reinforced.
"It’s made me a stronger person because I was very anxious at the beginning," she says. "That whole thing I talked about, about this invisible, horrible, extremely contagious disease, what if I get it and go home and die — it's made me a stronger person as I work through that. Then in terms of building that strength, I remembered when I raised my hand and took an oath to do this very thing, to take care of patients who were extremely ill."
Yes, she says, the virus hasn't taken the horrid toll it's taken elsewhere. But that hasn't lessened its impact on the state, on the hospital where the sickest have been sent, on the providers who've fought to keep them alive. Nor should it lull Wyomingites into a false sense of security. Taylor says she expects the disease to spike again in the coming months.
"We anticipate that we may still have a surge, but later," she says. "If not with some of the loosening of the restrictions out there in the community, or with there being a resurgence later this year. So in the back of my mind, I'm still standing at the ready. That’s probably the little bit of anxiety: It hasn’t happened yet, but will it? I don’t take comfort in that."
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