PART ONE
The doors are heavier than I remember. My arms strain against them; they bar my passage, but I’ve already lost too much time. I put the weight of my body into the steel. They do not give. But neither do I.
I’ve gone round for round with death over the lives of my patients. I’ve put on gloves, duked it out, and come out on top almost every time. Cancer? Irradiated and excised. Abused woman? Lacerations stitched and police informed. Scared kid worried her parents will find out what happened between her and Tommy behind the school last Friday? Comfort, an STD test, and the knowledge that you always have options.
I don’t give up. And despite my already burning lungs, despite the aches in the muscles of my arms, legs, and back, all ganging up on me to remind me of the last month—a period of hell I’d like to forget—none of that matters. I’m better. I’m back. And I’m getting inside no matter how much that disease kicked my ass.
I can do this.
The doors open from the inside. Clara, a pretty young thing a year out of school, always dressed in nearly psychedelic scrubs, bounds through the opening and tackles me with a hug.
“Ahhh!” she exclaims as I struggle to breathe—
My chest is on fire. Every breath is agony. It feels like the air is made of razor blades. I’m choking on blood. No, it’s in my head. I don’t want to take another breath; it hurts too much. Make it stop. DO it. Take the breath. Gagging, I’m gagging on snot. I can’t breathe.
—under Clara’s grip. I’m not strong enough to push her away. It’s as if I’m being strangled, constricted, by love. She’s a sweet kid, and the warmth and affection are pleasant. I almost want to cry with relief at the welcome back, but if she doesn’t get off me, I’m going to die.
“Clara…” I gasp, and she loosens her grip.
Eyes wide, she looks up at me through those extra-long eyelashes, from behind a face of makeup she’ll give up on in a few more years when reality settles in, like I did. “Oh, sorry, Cynthia! I just missed you—this place really isn’t the same without you. Wait until I tell you what happened last week at the nurses’ station. Oh, and I’m pretty sure that doctor, you know the one you always talk into better diagnoses, is going to have a heart attack without you here to help. OMG, and we were so short-staffed while you were gone! It’s like you were three people running around filling holes we couldn’t even see and…”
Struggling to keep up with Clara, I wonder if I’m not going cross-eyed, because she stops, hugs me again—slightly more gently—and says, “Sorry, sorry. You’re probably pretty beat up. I bet it couldn’t have been easy.” She shifts side to side. “Like, we all asked Dr. Gray about you, and he said it was bad. He said you quarantined like back in the beginning—”
Alone. Days on days alone. It’s like the shadows are moving. It’s like the walls want to cave in but can’t. It’s the fever. The door is making fun of me. In on a joke. “Stay inside then, you can leave but you can’t too.” My reflection is mocking me when the show ends. Every time the show ends. It’s just my face on the screen. There’s sick on it. I start another show. An endless series of shows. Which world is real, the one I binged yesterday or today, or is it still yesterday?
Tom… I wish you could hold me.
Mikey… are you eating enough?
Cynthia… are you going to die?
“—and that he gave you Paxlovid, but you had rebound symptoms, like, really, really bad. Did you feel better at all after you took it? Sounds like it just made you worse,” Clara continues.
Before I was out the past six weeks with COVID, I’d wondered if this kid ever stopped to breathe when she spoke. Now I know for sure she doesn’t.
“Shhh, shhh,” I say and rest my finger on Clara’s lips to stop her talking. An inside joke for when she’s freaking out about a patient and has everything under control but just needs a moment to see it.
We both have a laugh.
Bang. Bang.
I jump, only to see Rhonda, another nurse I don’t know very well, through the glass. Her expression is one of concern; her eyes say help me and her lip says I don’t know what to do.
Rhonda, a stout woman in plain scrubs, presses the door open and, in a quiet yet serious voice meant to provoke alarm in Clara and me, but not anyone else in earshot, says, “We need some help in 204.”
Without waiting for a reply, Rhonda turns and leaves, presumably to help in 204, and before the door can shut and lock us out, I reach for it. But my arm is slow and dumb, uncoordinated, and instead pushes it closed.
“What’s up?” Clara says, her eyes scanning my pained face for why I shut the door. She seems to have the impression that I wanted to say something rather than my hands being made of playdough.
“Nothing, I just didn’t want to get locked—
“You don’t have to lock the door.” Tom’s voice, through the door. I’m sobbing against it. “Go away,” I tell him, my voice little more than a whisper. He doesn’t hear me. I’m too weak to explain. “I can’t give this to you or Mikey. I can’t do this to you.”
“Cynthia, we love you. Let us take care of you,” he says back to my crying.
“Let me keep you safe,” I manage, screaming words that barely make it through the thin wood, past the soiled towels I’ve pressed into the opening at the bottom of the door, to minimize airflow into the hall. To minimize mixing my poisoned breath with Mikey’s as his little feet pitter-patter past.
“—out,” I finish, my words faltering for a moment against the onslaught of uninvited memories. I make a face as I get a whiff of acrid air.
“Oh, this door doesn’t lock,” Clara says with a smile and pulls it open, holding it for me while beaming with those pearly whites.
My eyes close and nearly roll out the back of my head.
Clara walks at a pace that makes my head spin. To say I know where I’m going is untrue. More like, my feet remember the way. I just follow along and try to keep moving. I hold onto walls, keep my eyes down to limit the sway of the world, and set my stomach before each turn.
“Cynthia,” Clara stops and says. I almost barge into her. Her face is a knot of real worry, real concern. My mouth is open, gulping air, and I’m sweating. “You okay?”
“Yeah, sure, kid. Just feeling it a little,” I say and give a reassuring smile I don’t feel. She goes in and out of focus as my head rushes. “Just need to get back in the swing of things.”
“Oooh, kay,” Clara says and knocks on 204.
We hurry to Room 204, where a young woman lies on the bed, sweating profusely. Her parents are arguing with Rhonda.
“She’s been here for too long,” the mother says, desperation and anger mixing with hope. “She’s in pain and no one is helping us.”
“Hello,” I say, stepping inside the room. “My name is Cynthia Little. I’m a nurse practitioner. Can you tell me what’s going on?”
Rhonda looks up, relieved. “She’s complaining of severe jaw pain, but I didn’t find anything wrong in her mouth. Dr. Gray will be here soon to check on her.”
“Okay,” I say, getting closer to examine the woman, who sits up holding her left jaw with one hand and rubbing the back of her neck with the other. She is soaked in sweat. The scent wafts off her. “What’s your name, hon?”
“Christine,” she says through soft sobs. I hand her a tissue to wipe her runny nose.
“Well, Christine, is it okay if I take a look inside your mouth and see if I can help?”
Christine nods as she wipes her nose, but even the movement of her arms seems to cause her more discomfort. I put on gloves and get to work.
“Okay, dear, open your mouth for me… there you go. Does it hurt more when you open, or the same?”
“Same.”
“That’s alright, you’re doing well.” I use my penlight to explore her mouth for anything that could explain the pain—signs of trauma, an abscess, a growth—but come up with nothing. “As far as I can tell, nothing here. Do we have films?”
The imaging of her jaw is clear.
God, she stinks—
I can’t stop shaking. I’m covered in blankets but still cold. It’s the fever. My muscles ache from head to toe. My bones hurt. My chest, oh god, the sweating and the chest pain, the jaw pain, the back pain. Am I having a heart attack? Am I so septic that I’m shutting down? I should be in the hospital, but I can’t risk it. I can’t leave this room and infect
my family.
Calm down, breathe, think. It’s the fever. Jaw pain, upper back pain, sweating—consistent with MI, yes, more common in women, yes, but you are just sick. Your knowledge is working against you.
You’re okay.
You can hold out longer. The Paxlovid will work.
—she’s drenched.
“How long ago was the game?” I ask.
“Not sure what that has to do with anything,” the mother snaps back, rolling her eyes at me.
“Two hours,” Christine says through clenched teeth. Two hours off the field and this kid is sweating like she’s mid-marathon.
“Hey, Rhonda, do we have telemetry for her?”
“Ah, no. Dr. Gray thought it was probably gallstones because of the upper back pain,” Rhonda says, shifting uncomfortably, her head going where mine already is once I asked the question.
“Gallstones typically over the right shoulder.” I turn to her, half-expecting her to run off and get the telemetry unit. When she doesn’t, I give her a little push. “Jaw and upper back pain are consistent with MI in women, along with profuse sweating.”
“I’ll get the unit,” Rhonda says.
“Thanks, we better rule it out. Clara, can you go with her?”
Clara and Rhonda head off to find a telemetry unit. We’re understaffed and underfunded. Sometimes our unit makes its way off our floor and needs to be located. Sending both of them together lets them know I’m worried without worrying the patient and their family.
“What’s going on?” the mother asks.
“Well, the doctor thinks her pain might be a digestive organ issue, and it might be just that, but I want to check her heart out just in case,” I say while taking Christine’s pulse and other vitals.
“Why would her heart be a problem?” the dad says, finally deciding it’s time to join the conversation. “She’s twenty-two and a soccer player. Bet she’s got the strongest damn heart in the building. Her chest doesn’t even hurt.”
I nod along with him. “It’s rare, but sometimes, even when we’re young, we can get a clot that blocks the blood going to our heart. And in women, the pain isn’t always chest pain. In fact, a heart attack presenting as jaw or back pain tends to have a worse outcome because diagnosis is delayed.” Seeing the man go from confrontational to gradual and acute worry, I add, “So, just in case, we best rule it out.”
The ECG arrives moments later, thankfully. As we strap the electrodes to Christine and start to get readings, I notice the fatigue creeping back in. The adrenaline is wearing off.
But then I get the readings. ST elevation.
At the same time, Dr. Gray, an older man with hair to match the name, a keen smile, and a long history of being the best damn doctor I’ve ever known, walks in. He comes up to me and the ECG and reads it.
“She’s having a heart attack,” I say.
Eyebrows raised in concern, Dr. Gray responds, “Indeed she is.”
“tPA?”
“tPA.”
“Wait, what, is that why this hurts? How am I having a heart attack?” Christine is crying now, her previous sobs giving way to uncontrollable shaking, which makes her groan and clutch at her face harder.
While Dr. Gray reviews Christine’s chart and asks her parents questions to make sure tPA (a really strong blood thinner) is safe, I tend to Christine.
“Hey,” I say but don’t get past the wall of tears. “Hey!”
She looks at me, her face in her hands and her hands in mine. A smile creeps across the concern on my face and I soften my eyes. “Sometimes, even when we’re young, we can have a little clot pop up. Okay?”
“Am I going to die?” she asks.
“No, hon, you’re not going to die. We’re going to give you a strong medication, alright?” She nods as I talk. “And that medication is going to eat that clot right up. Okay?”
“Okay,” she squeaks out.
As Clara prepares the tPA for administration, I prep the area. Dr. Gray leans into me and says, “Good catch. Glad you’re back, Cynthia. I might have missed that.”
***
It feels good to be back at work. And to come back and nail a notoriously hard-to-pin-down presentation in an atypical population, well, it’s like coming back home from war and standing at the front of the parade.
Being out of the house, moving around, and breathing in the air, even if it reeks of sanitizer, is a welcome relief from those days locked in my bedroom. A bedroom I still have trouble sleeping in. Too many memories.
I can still remember all of it as if it’s happening again, now, in this moment. The pain in my lungs, which is better now but not gone. My skin seems coated in grime. I can’t wash it off. I can still smell myself.
And I remember the what-ifs… They play games with you, you know that? Creepy little gremlins talking in your voice, right in your own head, using your own imagination to scare you. Messing with the past, the future. Let me tell you about my big what-if, the one I played over and over again in my mind as the disease had its way with me.
Every morning, Jim would knock on the door and ask if today was the day. If freedom had finally found me. Had the snot fled my nose and allowed me to breathe in that sweet air.
And I’d shoo him away, because it hadn’t. The snot had me.
But what if I didn’t answer?
Knock, knock. “Hey, hun.”
No reply.
Knock, knock.
“Hun, you want some breakfast? I can do eggs or cereal.” Knock, knock. “Maybe just some coffee if you’re having that much trouble getting moving?”
Knock, knock.
Knock, knock.
And then he’d open the door. Come right on in. Move towards the bundle of blankets on the bed. Damp. Sweated through. See the stains on the side of the bed where I vomited.
Mikey would, of course, be at the door. Peering inside. He’d see the whole thing, every terrible second of it.
Jim would come on over. Say something sweet, make a joke, and then put his hand on me to shake me.
I’m not sure what he’d notice first. Maybe how cold I felt. The blankets, they’d be cold too. But that might not be it. Maybe he’d put his hand on my shoulder or arm and shake me awake like he’s done every year on my birthday because he’s so excited to give me breakfast in bed he can’t help himself. And he’d feel that rigidness. But he wouldn’t know what it was, not yet. He’d instead start asking me questions, calling me a sleepyhead, peeling the blankets off my body until, until… until he knew.
“Oh, honey!” I almost fall out of my chair at the nursing station. I’d dazed off, lost in the recollection of my recollection. It takes me a moment to get my bearings, remember where I am, what’s going on, and realize the fire in my chest had gone out before and the pain I’m feeling now is just its afterglow.
Little old Miss Margaret wanders out of her room, smiling and waving at me. I can never be more sure which is true, that she pushes her walker or that it carries her with it.
She’s a lady who is entirely non-compliant with her kidney failure diet. This lands her on my floor pretty often. She is stubbornly resistant to education on the matter, but she’s sweet as anything. “I was wondering whatever happened to you.”
A big smile crawls across my face. It’s like I’m being greeted by family I haven’t seen in a long while. Kind of like that first hug Jim gave me when I left the room, all smelly, tired, and worn away. And he didn’t give a damn. Scooped me right up. Made me pancakes.
“Well, Miss Margaret, even those in healthcare can get sick. Guess we’re as vulnerable as anyone else.”
“No, dear, you have to take care of yourself,” little old Margaret chuckles. “Else who’s going to take care of me? I don’t know any of this medical stuff… someone has to explain it to me. Otherwise, I’m helpless.”
“No worries, Miss Margaret. I’ll take care of you.”
“Oh, thanks, love. People say so much stuff about everything, I don’t know what to believe.” I lead Margaret back to her room while she talks, arm in arm. Two reasons. First, she’s a pretty big fall risk. Secondly, well, I’m rather partial to her. “How do you know any of this will work? It’s just what you’re taught in school, is it?”
I laugh. “Well, everything changes. Evolving. We’re learning as we go.”
“Shouldn’t you just, know, what to do? You’re a doctor,” Margaret says.
“Well, I’m a nurse practitioner, not a doctor. The training is a bit different, but we all follow the scientific process.”
“Oh nonsense, science hasn’t ever done anything good.”
I skip the part where I point out science is the only reason she is alive. People don’t hear the truth when their beliefs don’t line up with it. “Well, it’s a pretty good approach to test stuff out and see what works and what doesn’t. Otherwise, we can even trick ourselves into thinking we’re helping when we’re not.”
Margaret looks spaced out, uninterested, so I drop it.
As Margaret and I enter her room, a pretty typical hospital room designed for functionality over decoration, though we’ve kicked around the idea of making special “suites” for frequent fliers like Margaret, I can’t help but think—you know? She’s right. It takes a crazy amount of education to get this stuff right, this medical stuff. And Margaret would have left this world more than once if me, or someone like me, hadn’t been there for her. Sometimes it’s easy to take it for granted. Some of this stuff is so well understood, etched in stone, that I don’t think I use a single brain cell saving a life that, years ago, would have been a slow, steady death. And I’m really thankful I get to do that.
“You really had that COVID, huh?” Margaret asks me. Margaret plants herself in her recliner (and this one really is hers, it’s the softest one in the hospital and we’ve actually written “Margaret’s BFF” under the tag but we’ll never tell her that) and covers herself with the blanket already placed there. Before she can ask, I’m already unwrapping another blanket and placing it on top of her.
She gets cold, you know? Every time. Margaret’s got to have two blankets, you understand? Hospital rules.
“I sure did. I was made of snot for weeks.”
“I had some friends die of that,” she says, nonchalantly, like she was talking about breakfast. “Man on the news says it’s not real though. Not sure how my friends die of something that’s not real.”
I frown. Margaret’s memory isn’t the best. That’s part of why she’s so non-compliant with her kidney diet. Though I’d say it’s more stubbornness than forgetfulness on that front. But the thing is, Margaret and her friends were here right before I got sick. They’d all had COVID then.
Sure, I could have gotten sick from any number of places, but, well, it was probably from Margaret and her friends. I may have been just a little lax in my PPE a few times working with them. It’s like the ones you like can’t hurt you; you forget yourself with them.
As I tuck Margaret in and she smiles, I feel a pang of guilt in my chest. See, she and her friends came in at about the same time, but Margaret’s the only one who left again. They all got the same treatment. We might play favorites with recliners but not with medicine.
“I know you lost some people. That must be hard.” It had been a fresh mutation. The vaccines were not ready for it.
We. I. Did the best I could for them.
“You know I think I had it too.” Little Miss Margaret bundles herself up in blankets and searches for the remote that’s right in her lap. I hand it to her. “Memory’s going, though. Tell you what, getting old ain’t for sissies.”
“No, ma’am.”
Margaret flips on some cable news and I wave goodbye, but I don’t think she sees me. Or notices that I left. Pretty typical for her once the television’s on. The real world just melts away.
Margaret is one of the good ones. Now, don’t give me that. I care about all of my patients; of course, I do. But it gets a little rough around the edges when you hear the same excuses, the same complaints, the same non-compliance that even Margaret has for treatments. She’s only human. But she’s so sweet. One time she brought me chocolates. Not really. She’d bought them from the vending machine and forgotten where she got them from and decided that since I was so good at taking care of her, she must have bought them. So we shared. And I left another candy bar for her when she was asleep, imagining she’d think she had a secret admirer or a guardian angel.
And, I suppose she does.
Because she’s the only one of her friend group of four we treated that didn’t go blue. That didn’t need to be intubated. That didn’t end up on ice with family crying all around her. Which I guess she wouldn’t have had, because there’s no one left for her anymore, or at least no one she remembers or no one that visits.
But
I would have cried.
That’s why I did what I did.
It was late at night, and two of Margaret’s friends had already passed. The third was on his way to be intubated—I made that call myself—and, well, I was more than torn up. I liked them all. But Margaret was my favorite. She wasn’t as sick as the others were, but her vitals and rate of deterioration told me she would be, but I wasn’t going to let her go down that path. Not down to the morgue, on ice, with no one to cry about her beside me on my lunch break, if I even got a lunch break.
So I gave her ivermectin.
What was the harm? Yeah sure, the FDA didn’t approve it, and the CDC says it doesn’t work. But we’d already given her everything else. And I didn’t want to see her crash like the others did. I’m a nurse; I want to help, I have to help. It’s like a compulsion for me. So I gave Miss Margaret a little something extra, in addition to the normal care.
And you know what? She’s still here.
So, a couple weeks ago, locked away in my own quarantine room to protect my husband Jim and my little boy Mike, I thought about her. I’d called the hospital to check in, found out Margaret was the only one of her friends to live, and was close to discharging, and there I was, basically dead to the world on my back, in the dark, alone.
And so I gave myself a little extra too.
And I’m still here, just like Margaret. Maybe with a new secret weapon too.
It’s hard to argue with results, isn’t it?
