Friday, April 3, 2020

Guest Post: A Pandemic Tale

     [The following comes our way from Historian, the worthy proprietor of Views From Liberty Hollow. It will not leave you dry-eyed. Read at your peril.]

     I work at a hospital. Not as a doctor, to the well-concealed disappointment of my late mother (and the well-concealed satisfaction of my late father, who loathed doctors,) nor a nurse or a medical technician; my job is to ensure that the facility itself is capable of supporting the demands of those who use it. I'm a construction project manager for a mid-sized non-profit hospital in one of the mid-Atlantic United States, and I'm good at what I do.

     Generally, this hospital is well run, well organized, and well staffed with high quality people, ranking among the top US hospitals, part of a larger system also well ranked. If friends or family were to need care, I'd take them to my hospital, which I consider one of the two best in the system and the area, one reason I accepted an offer to work there.

     Over the years, I've overseen a large number of projects for this organization ranging from small cosmetic renovations to large multi-million dollar additions and renovations.

     The Facilities department saw this pandemic coming, and unlike a number of other facilities in the Mid-Atlantic now scrambling to get long-neglected systems functional, (which I hear about through my contractors but which will remain forever un-named), all of our HVAC (Heating, Ventilation, and Air Conditioning) systems and all our negative pressure rooms (of which we have an unusually large number) were checked well ahead of time to ensure that they were fully functional and had received full Preventative Maintenance well ahead of this pandemic, along with most everything else. By early March we had all of our existing systems confirmed to be in excellent order, as did all of the other facilities system-wide; some needed more work than we did, but all were brought to good condition.

     Regrettably, in hindsight, system leadership was hesitant to expend funds or cut revenues prior to the onset of the pandemic outside China.

     Perhaps understandably, they were reluctant to commit significant funds for facility modifications or to take occupied rooms out of service for any length of time, so we waited and watched as case numbers overseas and here in these united States began to grow. We made more suggestions about contingency planning as the cases continued to increase. We started seeing cases in the area. And still we waited.

     We started seeing cases in our hospital, and finally we were directed to convert existing patient rooms to negative pressure rooms.

     For the uninitiated, this is a non-trivial modification. A negative pressure room or isolation room, has to exhaust ALL of the air coming out of the room directly to the outside. Standards are for 12 air changes per hour, and the room must meet certain negative pressure standards. That means that the entire volume of the room gets replaced every 5 minutes. Our facility policy is to filter all of that exhaust to ensure that we are not placing passers-by at risk of infection, further complicating matters. Normal air conditioning, even in many areas of a hospital, recycles most of the air to reduce energy costs, so when you throw that air away, as you must do for an isolation room, you significantly increase the load on the air conditioning system. It is a BIG change.

     I'll spare you, gentle Reader, the details, but in 3 days last week we went from about 10% isolation rooms in our hospital to 15%, i.e., a 50% increase in isolation rooms by dint of much effort by a number of contractors, vendors, and hospital staff. Those rooms were virtually empty last week, and hospital volumes were WAY down. It was rather eerie. After that success, I was directed to convert another 12% of our rooms to negative pressure, and we are working that now.

     This is now much more difficult as seriously ill patients are starting to swamp the hospital, and the rooms which were empty a week ago are all now filled or rapidly filling with patients on O2 or intubated, most of whom had been seen a week or two ago, evaluated as not seriously ill, and sent home with instructions to come back if they started to feel worse, not better. Well, they DID get worse, and they are coming back.

     In significant numbers, and this is just the beginning.

     This is compounded by the fact that contractors willing to work in a Covid19 ward with infected patients in the NON isolation rooms right down the hall are hard to find, and willing contractors are finding it hard to persuade their staff to work there, regardless of PPE, pay or anything else. I have been feeling more than a little bitter about the time thrown away, about having to deal with trying to modify patient rooms that are filling faster than I can get needed materials and equipment (which every half-decent hospital in North America now wants,) to modify them. I've now seen first hand room after room with sedated intubated patients, and I've seen the security staff bringing the bodies of those who've died to the morgue. And I know it is likely that if I catch this bug and get a severe case, I'll make that trip to the morgue in a body bag myself, because I'm old, with several risk factors.

     This bug scares me, and I have been weighing my duty to my family against my duty to my employer and my coworkers. I've been setting the example to my contractors and my staff by walking the work areas in Covid19 units, inspecting completed work several times a day. I never ask anyone to do anything I won't but lately I have been questioning the wisdom of doing that and thinking about finding something else to do rather than risking my life shoveling against an overwhelming incoming tide.

     And then this morning, while I was trouble-shooting a pressurization problem with one of the converted rooms, in a ward filled with Covid19 patients, I saw something I did not expect. In a ward now inhabited by unconscious patients, and nurses and doctors in scrubs, there was a man all in black, with a white collar, talking to our chaplain. It took a moment (and hearing the man called 'Father'!) for me to realize that I was seeing a Catholic priest in a Covid19 unit. While I wrestled with my pressurization problem, I also wondered why this priest, who I have never seen before, was here, in this unit.

     A few minutes later, when I saw him next, he was awkwardly donning, with the help of a senior nurse and our chaplain, the PPE required to enter a room with an intubated patient on a vent- cap, splash guard, respirator, gown, gloves, the whole setup. I overheard the chaplain say, "Father, are you sure you want to do this?" and he nodded. I realized that this man, who obviously had never been fit tested in his life and had no idea of how to properly don or doff his PPE, who was having to be helped by nurses to wear this stuff, was going into a room occupied by a dying unconscious Catholic patient, to get right up next to the head of that dying patient who was breathing out aerosolized infection, and administer Last Rites. That priest was walking into a room where any mistakes on his part, and he was virtually certain to make at least one, would mean he was breathing in serious illness, or death, and that dying man would never know it, yet in he went. Why? I'll never know for sure, but my guess is that he saw that as his duty, to himself, to his fellow Catholic, but most of all, to his faith, and he had to be true to that.

     Having seen the pressure issue dissipate (although we did not get to the root cause until later on,) I returned to my office, but I was mightily moved by what I had seen. How could I walk away, having seen that? How could I abandon my job, allowing some unknown, but likely less competent and less experienced person tackle one of the greatest personal and professional challenges I have ever faced, during the worst pandemic in living memory? Yes, leadership has made some stupid mistakes and they need to own them, but how could I leave my friends and colleagues, all the good people I know there, when I can help?

     I can't. As long as I can help, I'm going to help. I'm going to do my best not to get infected, but I'm going to stay and help as long as I can. Fear is not sufficient cause to leave. Failure of material support would be, but so far we have that.

     A few after-notes:

     Normalcy bias is real, and it has bitten a lot of people. You who survive this need to remember that.

     Refusal to believe reality will kill people. As Rand put it, "You can ignore reality, but you cannot ignore the consequences of having ignored reality."

     If you still truly think that this virus is "not as bad as the flu", I invite you to visit the nearest hospital and spend some time in the ICU with the intubated Covid patients. Of course, the only way you can do that is if you yourself are seriously ill and have to be intubated, and about 3/4 of those folks that sick die. If you survive the experience I'll bet you'll sing a different tune.

     This bug killed over a thousand people yesterday. If the death rate continues to increase, in three weeks we'll be losing the average annual flu deaths in a day.

     Lastly, it is better to have it and not need it, than to need it and not have it. True for food, toilet paper, ammo and N95s among many other things. I mention these because family, friends and co-workers, none of them stupid, needed my help to acquire same.

With regard to all who serve the Light,

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