My six year old son hugs me tight. “Please don’t die,” he whispers. It’s something he now says nearly every time I leave to go to work.

My heart squeezes.

I’m a GP-anesthetist in Georgetown, Ontario. I work in a small community hospital, charming, old and in need of upgrades.

In the OR, I wipe my hands with hand sanitizer, cleaning the webs between my fingers, the bends, the folds, under my nails. I’m in scrubs. Wearing a blue hair bonnet. My phone, ID, and pen in a ziploc bag.

I slide on my N95 respirator. Out of all the protective gear, it’s vital to get this one right. Get a tight seal, ensuring that no aerosolized particles of the virus leak in and infect me. The bands and sides cut into my cheeks. The filter dries the air so it catches in my throat, making me cough. I swallow. 

A couple of emergency OR cases on the board today — a patient with a fracture. A patient with appendicitis. COVID19 status: unknown. So we’ll wear full protective equipment. Because of my job, I’m at high risk of catching COVID19.

Maybe I can keep the same N95 on for both cases? As long as it’s not soiled or damaged or difficult to breathe through, as long as I don’t take it off to eat or drink, I should be able to use my N95 for a long time. Maybe the whole day.

With the N95 tightly bound to my face, I put on the rest of my gear — goggles, face shields, gown, double gloves. 

And the accompanying worry: we don’t have enough. Not enough N95 respirators, surgical masks, gloves, gowns, face shields, goggles. None of us know from when or where the next shipment will come. Working in the community is worse — many doctors have a week’s supply left. The uncertainty is terrifying. 

The pandemic has already hit hospitals downtown, some are also at risk of running out.

“It’s a war zone,” a doctor downtown texted last week. 

These thin layers of protective equipment — it’s all that stands between us and COVID19.

The day wears on. Though I change everything else between patients, I keep my mask on. I’m thirsty. Hungry. Tired. Constantly on guard. 

My cell phone rings. It’s the hospitalist, consulting me for an intubation on the floor. An elderly man with COVID19 pneumonia. Poor lung function. Needing more and more oxygen. At risk of respiratory failure. My heart pounds. 

My team — a nurse, a respiratory therapist, and myself — gear up and review the plan. The patient is isolated in a negative pressure room. Once we go in, we stay in until we’re done. Each time we enter and exit, we risk spreading the virus. We gather the supplies we might need, preparing for all possibilities. Because sometimes you can’t intubate a patient. Sometimes you need to cut their neck and put a tube right into their trachea. Sometimes their blood pressure tanks. Sometimes they go into cardiac arrest and die. 

We go in. Late afternoon sunlight slants through the window. Cotton-ball clouds against a blue, blue sky. Mr. X’s face is turned towards the light. His hoarse breathing, the only sound in the room. He sits, shoulders slumped, huffing and puffing away. His white hair tangled. He looks small. Alone.

He turns towards me, his eyes hopeful. 

My heart sinks. With his age, his other complex illnesses, his frailty, his physical exam, Mr. X doesn’t look like an easy intubation. Worse, he faces a high risk of death on the ventilator.

There is no cure for COVID19. Even a ventilator is no cure for COVID19. At best, it buys a person time, but there is no guarantee they will live. 

Ten years doing this job: I’ve put people on life support as an anesthetist, I’ve helped people die a good death as a family doctor who does palliative care.

I want to make sure Mr. X knows exactly what he is choosing. 

He listens carefully. He is sharp as a tack. “Maybe I live, maybe I die.”

I nod. “With or without the ventilator.”

He closes his eyes. Looks back out the window. The silence stretches. “No tube.”

“You sure? It’s a difficult decision. I will be here no matter what you choose.”

“If I die, I don’t want to die on a machine. I want to die looking at the sky. Talking to my family.”

Seeing the tears in his eyes, mine well up too. I sit down. Reach over and hold his hand. I’m wearing two sets of gloves, so I can’t feel the warmth of his skin. In fact, my hands feel nothing. But I’m so sad. I hope he feels something more than plastic in his hands.

“I was careful. We did what we were told. All I did was go to the store one time. One time.”

We call his family on his cell phone. His wife weeps. She’s sick too and so afraid. 

“Please, can we see him?” She begs. His son begs.

And my heart breaks. “I’ll talk to his doctor,” I promise.

A tear rolls down my cheek. I can’t wipe it away. I can’t contaminate myself, my mask. So I let it fall. 

I stay with him. Sit with him. Hold his hand. And we keep watching that sky.

(First published in The Toronto Star in Rosie DiManno’s column on April 13, 2020.)