The fire department had three of their men in full gowns when we arrived. The patient was up on the fourth floor, unable to walk, they said. They weren’t certain what was wrong with him -- he wasn't answering questions--but he had been shaking and vomiting all morning, and he had just gotten out of the hospital, according to his family.
My partner and I put on our full PPE. For me that means an N95 mask with a surgical mask over it, a face shield, a body gown and gloves. When this COVID thing started, a patient had to have been in China for us to gown up, now it was nearly becoming an every patient thing. People didn't even have to leave their houses to be infected. One of the fire guys helped me tie my gown on as this brand of gown you can only tie in the back and the paper ties can easily break when you pull them. Carrying the stair chair up the narrow, dirty and dark staircase was hard. My face mask fogged up up and it was hard enough to see in dark stairwell where on each small landing there were objects in the way – a broken vacuum cleaner, shoes, a vase with glass balls in it. With the N95 mask on and a surgical mask over it, I was starting to feel short of breath myself, walking up all those stairs, carrying the bulky chair. This was going to be a bitch of a carry down with no room to properly turn on the landings. I pictured what a carry down like this would like on a sweltering day in August, and us still having to be fully gowned up because the experts are now saying COVID isn't going anywhere for a longtime.
On the 4th floor, there must have been fifteen people in the apartment, from babies and toddlers and tattooed bare-chested toughs, to middle-aged and elderly, including an old man smoking a cigarette next to an old woman in a wheelchair. I was trying to figure out who the patient was and where they were. I was led to the bathroom, which had three more people in it, all standing around the bathtub where I found the patient--a man in his early twenties--naked in the curled in a fetal position in two inches of water. He wouldn’t talk to me other than saying he couldn’t leave the water. I asked him what was wrong and he said was sick and too weak to get up. I felt his pulse at a steady eighty-eight and saw he was breathing okay. "What did they say was wrong with you at the hospital?"
"Nothing," he said. "They didn't tell me anything."
"Let me help you up," I said. I offered my hand, but he wouldn't even look at me.
We finally had to lean over the tub and pull him out and get him sitting on the toilet, where we had his family try to dry him off with a towel as he lay slumped there. When they tried to put on his pants, he suddenly kicked at them and said those weren’t the ones he wanted. He got up then and walked into his bedroom and came back with the right pair. He sat back down on the toilet and let them dress him. My partner and I exchanged looks with the firefighters. One of the firefighters folded up the stair chair and carried it back downstairs.
The patient, after going back into the bedroom to get his cellphone, was able to walk down the stairs now, accompanied by four EMS professionals in full PPE. Once we got outside we found two neighbors filming us on their I-phones. The man did a near swoon, but I was able to catch him as his knees weakened and get him safely on our stretcher.
On the way to the hospital, while I put in an IV and gave him zofran for his nausea, I slowly managed to pry out more of the story. He told me he had been at the hospital earlier, but he had left because they wouldn’t give him a room with a shower. I made him say that again to make certain I understood what he said. It was exactly as he said it. This time he had requested the other hospital across town. And no, he had no cough or fever or shortness of breath, just nausea and anxiety, he said, and yes, he had chest pain too. By the time we reached that hospital, I had taken off my face shield, pulled off my PPE gown, and shoved it in the garbage pail. I kept my N95 and my gloves on. You never know who has COVID, but this patient wasn't going to be put in an isolation room--at least not a respiratory isolation room.
On the radio, I patched in the call to the ED. Vomiting, but not in my presence. Normal vitals, good 12-lead, zofran for the nausea, history of anxiety. No to all COVID questions.
In the hospital ED, we put him in the bed they assigned him.
“What? Oh, no, oh no," he said. "Where’s my shower? You don’t understand, I need a room with a shower!"
He got up off the bed and walked out of the room, then did a swoon in the hallway. He lay there on the ground like he was dead. We had to pick him back up and put him in a wheel chair and wheel him back to his bed. “I need a room with a shower!” he said again. “Why don’t you listen to me!”
When we came back to the hospital later with a depressed patient who we brought to the behavioral ward, we saw our old patient. He was in the ward, too, now. He stood by the sink, running water over his hands.
