A Case in Point Part 1: A Story of Song

For some, singing is a hobby, a profession, a stress release. It has launched careers. It has united people, it has helped people identify with one another. This is a story of song. 

Three days ago, I had one of those classic eye opening COVID-19 cases that we sometimes read about. A 70 something male, let’s call him Artie, arrived at the Emergency Department, brought in by his wife and son. He looked ok, at best, but had profoundly low oxygen levels. Normally, oxygen for a healthy person is generally 98-100%. Artie was sitting around 66% on room air with a lovely bluish-purple hue. He was nice and slightly altered in a very pleasant way. His wife and son were not permitted back into the ED, given the ongoing pandemic in Arizona where we have a no visitor policy. They painted the picture of an exceptionally nice guy, in mediocre health who was well loved and had only been sick for a day or two. Does this sound familiar? I feel like it describes almost all of our grandparents.

Artie’s ED stay was mostly uneventful, other than the opera singing. Every few moments we would hear him belt some pretty perfectly pitched notes from behind his closed, isolation door. The entire ED staff smiled and laughed. It was a refreshing change from the stressful grind we had been experiencing for a number of weeks. Every now and then, he would take his oxygen tubing off to sing better and we would have to go replace it in order to correct his quickly declining oxygen levels. On any other day, the staff would often be annoyed at having to gown back up into their PPE over and over again just to replace his nasal cannula, however we liked Artie. He was great. He was nice, respectful and a hell of a singer. I think by now you can guess which direction this is going. If you picked ominous foreshadowing, good on you.

“ Every few moments we would hear him belt some pretty perfectly pitched notes from behind his closed, isolation door. The entire ED staff smiled and laughed. It was a refreshing change...”

Artie’s work up was actually significantly better than most suspected COVID-19 with that low of an oxygen level. His inflammatory markers were not significantly elevated. His CT scan of his chest wasn’t that bad. He was stable on just simple nasal cannula oxygen. Things, at least for the time, were looking better than many in his age group afflicted with the virus. But things turned quickly. 

I remember one of the nurses remarking that they hadn’t heard Artie singing his opera for some time. At this point, he was already admitted to the hospital, but was still held in the ED while awaiting his bed on the inpatient side. He was still in my emergency department, but was not necessarily my job to continue checking in on him as I was taking care of the numerous other likely COVID-19 cases currently active in the ED. We looked at the monitor and saw his oxygen levels were now in the low 90s, a departure from where they were, at 96+% most of his stay. This, however, was not nearly anything to raise an eyebrow at, given what we had seen during this pandemic. Several minutes later, his nurse called for me to come to the room quickly. Upon arrival, Artie was cyanotic (BLUE). He wasn’t breathing. He had lost his pulse. In a matter of minutes he had died.

His code (or the cpr, medications and procedures that go into resuscitating a pulseless person) lasted around 15 minutes. He was intubated. He wasn’t following any commands, or doing anything of purpose for that matter, but was alive. He was transferred to the ICU where he was terminally extubated the following day and passed quickly. His positive test for COVID-19 returned hours later. He never sang again.

While this is far more of an abrupt ending than most elderly patients afflicted with COVID-19 it is a great reminder of just how dangerous it is to the at risk patients. These are our parents, grandparents, those with chronic medical conditions, young people with immune system compromising illnesses. These are our neighbors and our friends. When deciding whether or not the COVID-19 pandemic will affect you personally, remember the other people in your lives, or even those in bubbles adjacent to you. Do you really want to be the person who bagged Artie’s groceries, came to his home to fix his air conditioning, or simply shook his hand as you walked past him and accidentally infected him? Whether you are young and healthy, old and infirm or somewhere in between, just take it seriously. The harder we work at ending the pandemic, the quicker we will be back to normalcy and the more people like Artie live to sing again.

I am Brandon Lawrence, MD. I am an Emergency Medicine physician in Phoenix, Arizona. I am passionate about jump starting our society in as safe a way as possible in light of the ongoing pandemic. This is achieved by ongoing discussion, research and trying to reach as many people as possible.  I enjoy creative writing, endurance athletics and spending time with my awesome family.  Just getting started with the 21st century, follow me on twitter at @Lawre237.