We finally got a new shipment of PPE. But it turns out that instead of N95 masks, which is what we really need, they sent gloves. Thousands and thousands of gloves. The guy who accepted the delivery is the chief of surgery and every resident I know is terrified of him because he is so intimidating, but today, I saw him break down and cry like a baby.
We have a new trick: proning. It’s tummy time, for adults. Its mortality benefit has been around in studies since 2013, but it’s never been used as much as it is now. We do it for hours, if the patient can take it. The way your lungs work, when you’re on your belly they have more room to expand and the blood flow and airflow are equilibrated enough to hold off intubation for a while. We’ve learned that patients can seem to tolerate a huge decrease in air exchange so now instead of only looking at the numbers for gas exchange, we look to see which patients are worn out from breathing, and they’re the ones who get intubated. That’s the good thing. The bad thing is that if someone decompensates, and needs intubation after a trial of no intubation, they will certainly die, because when lungs are already damaged by quick breathing, by the time they’re ventilated, it’s too late. We are basically playing Russian roulette with people’s lives.
One of the three patients of mine that died today was a nun. She wanted last rites and we couldn’t find a priest who was willing to come into the room and administer them.
Sorry if there are typos—I keep my phone in a Ziploc bag when I’m at the hospital. I’m wiping down the bills that come in the mail. A nurse told me she washed her broccoli with soap and hot water. I can’t remember the last time I ate a cooked meal.
I wish I knew for sure that this was getting through to you.
And I wish you’d answer back.
Dear Finn,
I wish I could tell you how badly I’m trying to reach you, although the fact that I can’t is sort of the point. Remember how we thought it would be so romantic to be shut away from the outside world? It doesn’t feel that way when I’m alone on the outside, banging to be let back in.
It makes for some pretty weird self-reflection. It’s like I am in some parallel universe where I am aware of other things going on, but I can’t respond or comment or even be affected by them. LOL, is the world even turning, if I’m not really a part of it?
The girl I told you about, she says that being here feels like moving backward. I know I should be grateful to be safe and healthy and in a gorgeous bucket list destination. I know this was the perfect time for this to happen, with my job in limbo and you stuck at the hospital. I also know that when you’re in the thick of living your life, you don’t often get to push pause and reflect on it. It’s just really hard to sit in the moment, and not worry if pause is going to turn into stop.
Jesus, I am bad at having downtime. I need to find a way to keep myself occupied.
Or I need to find a plane. A plane would be good, too.
Love, Diana
After I’ve been on the island for a little over a week, Abuela invites me to lunch.
I have not been inside her home before now. It is bright and cozy, with a tangle of plants on the windowsills and yellow walls and a crocheted afghan on the couch. There is a ceramic cross hanging over the television set, and the entire space smells delicious. On the stove is a pan; she walks to it and moves the contents around with a spatula before lifting the utensil and pointing at the kitchen table so I will sit down.
“Tigrillo,” she says a moment later, when she sets a plate down in front of me. Plantains, cheese, green pepper, onions, and eggs. She motions for me to take a bite, and I do—it’s delicious—and then with satisfaction, Abuela turns back to the stove and loads a second plate. I think she is going to join me, but instead she calls out, “Beatriz!”
Beatriz is here? I haven’t seen her for four days, not since we built the sandcastle together.
I wonder if she ran away from her dad’s farm again.
From behind a closed door on the other side of the living room comes a flurry of angry response I cannot understand. Abuela mutters something, setting the plate on the table and resting her hands on her hips in frustration.
“Let me try,” I say.
I pick up the plate and walk to the door; knock. The response is another muffled stream of Spanish. “Beatriz?” I say, leaning closer. “It’s Diana.”
When she doesn’t answer, I turn the knob. She is lying on a bed that’s covered by a plain white cotton blanket. She is staring up at the ceiling fan, while tears stream from the corners of her eyes into her hair. It is almost as if she doesn’t realize she is crying. Immediately I set the plate on a dresser and sit next to her. “Talk to me,” I beg. “Let me help you.”
She turns onto her side, presenting her back to me. “Just leave me alone,” she says, crying harder.
After a moment, I stand up and close the door behind me again. Abuela looks at me, her heart in her eyes. “I think she needs help,” I say softly, but Abuela just cocks her head, and my worry is lost in translation.