COVID ICU

PART ONE

CHAPTER ONE

Karly

Morning, Mon., May 3, 2021

I linger in that place between sleep and awake, dreaming of the sun on my face, and laughter of the children playing in the park across the street.

Suddenly, I hear Pink’s raspy voice:

“It ain’t easy—growing up in World War III. Never knowing what love could be...”

I roll over with a groan, eyes closed, and reach for my alarm clock with my hand. My arm is uncoordinated since I’m woozy, and I hit the wrong switch. Pink’s voice morphs into shrill pulsing. My hand gropes around until it silences the annoying beeping.

I sit up, rubbing my eyes, as everything comes flooding back to me. The nightmare we’ve all been living in for the last twelve months. It might not be a literal World War III, but the worldwide pandemic has completely transformed our lives. We’re no longer living in a temporary global “emergency situation”; it’s just the way life is now, and how we can expect it to be for a long time to come.

I slide out of bed and check my closet for an outfit for the day. I pull out a light-weight shirt and pants, suitable to wear underneath my hospital garb. Today I’m doing a 15.5 hour cross-cover shift at the hospital, so I’m aiming for comfort. I toss the outfit onto my bed and walk into the bathroom.

The hot water streams down over me, and the steam clears my sinuses. One of life’s basic necessities now stands out like never before, and I’m reminded of it every day. The ability to breathe. It is no longer taken for granted by those of us who provide medical care, since we see people in respiratory distress every day. Every breath for them is a struggle. I inhale deeply then exhale as I step out of my shower and start rubbing moisturizer into my wet skin.

After my shower, I grab a breakfast bar to eat while I’m getting my things together for the day. I put on a warm jacket, comfortable shoes, and my mask, lock my apartment, and hit the elevator button with my elbow. I get out at the ground floor, and call an Uber.

We arrive at the hospital, and I clip my ID badge to my collar as I take off my seatbelt. “Thank you.” I reach for the door handle.

The driver nods back at me. He speaks through his mask, his kind eyes reflected in the dash mirror. “We all appreciate what you are doing. Stay safe." I nod back and smile with my eyes. It’s not the first time a stranger has thrown some encouragement my way. On some days, those words are the only thing that give me the strength to keep going.

At the entrance of the hospital, I go through the normal “screening”. Security scans me, checking my temperature, heart rate, blood pressure, and level of oxygenation in my blood. I’m asked the routine questions while being scanned. “Have you had any symptoms—fever, cough, difficulty breathing, loss of taste or smell?”

“No, I’m good.”

“Any contact with anyone who’s been out of the country?”

“Nope. I’m in isolation at home except for essentials.” Security looks at the readings, nods, acknowledging my ID badge, and lets me pass.

I walk to Diagnostics and am fast-tracked to take the mandatory test for the virus for health-care workers. The rapid virus test should come back within 10-15 minutes. I walk back outside after nodding to the security guy, and have a seat on a bench to wait. I pull out my phone, and check the latest updates on the news.

The breeze is chilly today and the metal bench feels cold through my pants, but the sun will soon start to warm up the day. A shiver runs down my spine, but it’s not due to the weather. I feel nervous and excited, since I’m no longer a med student. As of today, I’m an intern, and will be taking on more responsibilities than I’ve carried in the past.

The last year has been intense, going through the new accelerated program. It was designed to put med students out on the front lines as quickly as possible as new doctors, where they are needed most. Given the lower risk category we are in, and the amount of new energy we bring to medical teams, we’re a vital part of the strategy to help patients in their recovery from COVID-19.

I browse the usual news sites to get a glimpse of what’s happening today in the world, and to check the status of the coronavirus spread. I’ve been placed at a hospital in the hotspot of Ontario where there have been constant outbreaks. The hospital is in the final stages of preparation to quickly expand the Intensive Care Unit. The demand for beds is rising and we’re about to see a surge.

In less than ten minutes I get a call from Diagnostics, giving me the “all clear”. I walk back inside, through the lobby of Credit Valley Hospital. Instead of waiting for the elevator, I automatically take the stairs. Otherwise I’ll be waiting forever. Social distancing has been ingrained in me, and I’m not one to take health risks. I jog up two flights of stairs to the second floor.

“Hey, wait up!” I hear a male voice at the entrance to the stairwell, and can tell someone is rapidly taking the stairs two-by-two. I’m about to exit, but I hesitate, realizing I’m the only other person in the stairwell. The voice seems somewhat familiar. I look backwards, and see a guy on the next landing down a flight of stairs from me, hands on his knees and facing down, panting from his race up the stairs.

A quote from an old movie pops into my head. “Who is that masked man, anyway?”

“Give me a minute,” he pants. “I ran all the way from Diagnostics." I wait as he pauses to catch his breath. After about twenty seconds, he raises his head. “Whew! That was quite the workout.” Then he stands up, flips open his mask so I can see his face, and looks up at me with a lop-sided grin. My eyes widen as I inhale sharply. I recognize him from med school.

“Clay?” My heart rate starts accelerating. He’s only the most drool-worthy bachelor, sought out by women left and right.

He loops his mask back over one ear. “Yup, that’s me—and you’re Karly.” He flashes a big smile that reaches his beautiful blue eyes, as he reaffixes his mask. I stand stunned, floored that he even knows my name. And how does he even recognize me with my mask on?

I try to make my voice sound casual, even though my heart rate is elevated. “Uh, that’s right. Sooo...what are you doing here, Clay?” I’m curious, but also feeling a bit anxious at the same time. Visitation of patients is disallowed, since we're on the cusp of the third wave of the virus, so he wouldn’t be at the hospital to visit a patient. I start to get an inkling of why he’s there. The same reason I’m here. I wonder what department he’s been assigned to.

“I’m an intern here. I’m assuming that’s why you’re here as well?” I can’t break away from those mesmerizing eyes.

Suddenly, I realize I’m just standing there, looking like a dork. I manage a weak laugh. “Oh right, me. My placement is here, too.”

“You’re in the ICU?” Clay gestures to the doorknob my gloved hand is resting on. The sign on the door lists the Intensive Care Unit as one of the destinations.

“Yes. Staffing is really low and we're about to enter the third wave of the pandemic, so I applied to be placed at a local hospital. What about you?”

“Same here—ICU. Looks like we both decided to fight this thing where it’s causing the most critical devastation.” I detect the seriousness in Clay’s voice, and can see that his eyes are now reflecting determination.

I feel a bit stunned that both Clay and I are in the same hospital, in the same department. How did this happen? Clay covers the last flight of stairs two-by-two. I am in the middle of opening the heavy door, when Clay easily reaches over my shoulder and pushes it open the rest of the way. “After you.” He holds the door for me.

“Thank you.” My heart flutters a bit, then settles. I’m surprised he even knows who I am or even recognized me. We never really talked when we were in school together. Inside I’m shaking my head in disbelief. But really now. He knows who I am?

As he holds the door for me, I can smell his fresh, clean, masculine scent. I inhale the wonderful aroma before stepping through the door. His heady scent causes my mind to spin and land elsewhere.

I remember the first day of classes, three years ago, when I saw Clay for the first time at the St. George Campus.

“So, Karly, have you had a chance to check out the guys in our class yet?” My best friend Violet and I walk down to the Med Sciences cafeteria.

I reply truthfully, feeling a bit embarrassed at my admission. “I’ve been too focused on not getting lost, and on making it to classes on time.”

Violet sounds wistful. “So you haven’t noticed Clay Aldridge yet? Every girl in the class has eyes for him.”

The name sounds familiar. “Honestly, I haven’t taken notice of much else today other than planning out my semester.” With three years of undergrad already behind me, I already know the importance of starting off the year running. I also know what the fallout being distracted by a man exacts. Been there, done that.

We walk into the cafeteria, and get in line. I watch as a group of girls is about to sit down together. Oh, and one gorgeous guy, who is looking straight at me. “Speaking of…" My voice trails off. "That wouldn’t happen to be him, would it?” He seems familiar. I think we had some undergrad courses together. I was too busy being distracted by another man back then to pay much attention.

Violet looks in the direction I'm looking. She squeaks. “That’s him! And he’s looking straight this way!” Clay stands there, looking at me, as the girls around him sit down. He has dark brown hair, piercing blue eyes, and this endearing lop-sided grin on his face. I smile demurely at him, and he nods at me. One of the girls tugs on his shirt, and the spell is broken as he glances down at her, then slowly sits with the group.

Violet pokes me. “Karly? Earth to Karly?” I turn and look at her, then at the gap in front of me in the line up, and quickly walk ahead.

“Don’t worry. Clay seems to have an effect like that on all the girls. He should be labeled an illegal distraction.” Violet giggles. I watch Clay laugh and chat with the popular girls, and he doesn't look my way once. I wonder if I imagined the whole thing. He’s already forgotten about me—if he really even noticed me in the first place.

I snap back to reality and the present, step through the door, and walk briskly to the ICU. Clay easily keeps stride with me. He asks me about the remainder of my med school training. “So you stayed with the accelerated program, too?" Clay has that serious look in his eyes again.

“Yes, I wanted to be as useful as I could, as soon as possible.”

We enter the ICU together. “Karly, Clay.” Dr. Romara, the intensivist who heads up the unit, acknowledges us with a nod as we arrive at the ICU specifically reserved for patients with COVID-19. “Really glad you’re here. We’ve been short-staffed.” Dr. Romara glides quickly past us, as she continues with her pre-round patient evaluations.

I pick up a tablet and start reviewing the patient list, both to get a general knowledge of each case, and to carefully analyze for any change in day-to-day trends, regarding measurements and conditions. Understanding the general patterns in each patient’s chart helps highlight deviations from the norm, which could be early warning signs of more serious health issues.

When it’s time for rounds, Clay and I wash up and put on our first set of Personal Protective Equipment: N95 masks, gloves, face shields, gowns, and head and foot coverings. I’m certain I’ll feel like a boiled chicken by the end of my shift.

We begin rounds together as a team, going over the observations, needs, and progress of each patient. Each patient’s treatment plan is discussed, any changes in their vitals or condition are clarified by the nurse, and goals and clarifications are given by the specialists on the team. The pharmacist adjusts medication calculations as needed. We also do physical exams of each patient.

In the first room, the team prepares Mrs. Johnson to be turned onto her front. A nurse repositions all the wires and tubes while we prepare the bed, position pillows, and ready Mrs. Johnson herself, who is sedated. By the time we’re finished, she looks like a burrito.

The Respiratory Therapist directs us. “On three." She does the count, and we turn Mrs. Johnson carefully to her side. The ventilator tubing is adjusted, and we do the final turn. Clay adjusts Mrs. Johnson to relieve pressure points while I document the procedure and the other team members check tubing and devices. I can see how gentle and caring Clay is with the patient, and I smile to myself.

The entire process of turning the patient, between disinfecting, donning and doffing our protective equipment, and the actual turning, has taken 30 minutes. We continue with rounds, and finish four hours later. Clay says he’ll grab me something to eat after meeting with his resident supervisor and will put it in the break room fridge for me.

Clay uses a mock formal voice, and pretends to pull out a pen and paper. “Can I take your order, Ma’am?”

I giggle. “A deli sandwich would hit the spot."

Clay speaks in his normal voice. “Any specific type?”

I give him a smile. “Surprise me.”

Clay has a glint in his eyes. “So you like surprises?”

“Love them! They keep life interesting."

As Clay leaves for his meeting, I head over to mine. I became reacquainted with Dr. Jamar during orientation. I was full of trepidation at first, starting with a new supervisor, but I found him to be disarming, and he encouraged me to voice my opinions. I admired his thoroughness as well as his compassion for his patients as I observed his approach to patient care. I’m really happy with my assignment, as I highly respect him. I am sure I can develop and improve my skills under his supervision.

“So what were your thoughts today?” Dr. Jamar asks me regarding one of the patients I’ve been assigned to. We work through the list of patients on the tablet, while he continues to jot down notes on paper. I like the way he is open to my comments and suggestions without patronizing me or shutting me down. I feel like a colleague rather than like the student I had been up until recently. It’s a new feeling that will take me some time to get used to.

Voicing my opinion has been difficult in the past, and I’m still pretty sensitive to other people’s responses. Unfortunately, once you’ve been belittled, there’s a tendency to clam up or just plain freeze. Although in my head I understand my opinions have value, I know it’s a long road to actually feeling like my contributions are valuable. I’m still struggling with this, but can already see potential for personal growth in this area with Dr. Jamar.

Once we’ve reviewed the patient list, we walk over to the nurse stationed outside my first patient’s room, where she can clearly see and monitor him. She has light brown hair swept back off her face in a ponytail holder. Curls that have fallen out of the elastic stray around her ears. She is very attentive, monitoring her patient.

“Hi there, I’m Karly. We met briefly on rounds earlier. How’s Mr. Vaughn doing? Any concerns?”

“Maggie." She nods and smiles in greeting. "Nothing new. Jaime seems to be responding well to the convalescent plasma and antiviral meds. He’s showing some initial signs that indicate he is fighting the virus.” The nurse smiles. “It’s encouraging when someone is having a good day, especially when it’s someone so young.”

I can only imagine what her experience has been like this last year. The initial survival rate from COVID-19 was 50% in this ICU, but has now increased dramatically by placing the patients in prone position and through various treatments. Some seem to be responding well to the plasma of survivors with antibodies that can fight the virus, others not so much. Newer anti-inflammatory drugs have also been very helpful in increasing the survival rate from this terrible disease.

Although most younger people don’t become critically ill with the virus, there are those who do. My patient in Room 5 is only 24 years old; he’s the same age as me. It’s good that he may be on the road to recovery. I truly hope he won’t experience lung damage or damage to his other systems. That’s always a possibility with this disease. For those sick enough to warrant a bed in the ICU, the probability that the disease has invaded other systems of the body is high.