July 7, 2020

The Threshold

A narrative writing piece about seeing a patient in the hospital with COVID-19

By Carrie Tamarelli, PGY3 psychiatry resident

I suit up. Hand sanitizer, gown. Hand sanitizer, mask and goggles. Hand sanitizer, adjust the goggles that have steamed up from the mask. Hand sanitizer, gloves.

Through the door of the ICU, I see my patient, staring off towards the windows, and his hand grasps at the air. I lean forcefully to drag open the suctioned sliding door. I enter the room and introduce myself. “I’m Doctor Tamarelli with psychiatry! Your doctors asked us to check in with you!”

I recently learned of the concept of a “thin place”: a Celtic term for those rare situations where the distance between heaven and earth collapses, or where a threshold appears as entry to a new world. I hope to find these places with each of my patients, but it is not easy in the times of COVID-19.

Carrie Tamarelli, M.D.

When I introduce myself, I speak loudly because I am under water. My voice is muffled. Already my armpits are steaming up. The air surely is too viscous to be therapeutic. This place is a thick place.

My patient’s head bobs back and forth, and I see that his forehead is shiny with sweat. He looks at me, but his eyes do not register mine. His voice is gone because the ventilator is pushing breaths down the hole in his throat. He mouths words at me. I apologize that I do not understand what he communicates. I continue to speak too loudly, and I am irritated by the grating tone and volume of my own voice. He nods and shakes his head to my questions, but sometimes he tries to talk to me. I guess aloud what he says, and he shakes his head no, no, no. His hands are too weak to grasp the marker that I offer. Finally, he gives up, closing his eyes. A drop of sweat slips from his brow.

“This stinks,” I say. “You must be so frustrated with me and all these other idiots who cannot understand you.”

He smiles.

I do not ask any more questions about anxiety, hallucinations or suicide. I start to talk with him about what has happened to him so far in the intensive care unit. His eyes are vacant. I tell him he is recovering from the coronavirus. He does not know this illness. He also cannot choose his own name from a list of multiple choices I give him. He is very delirious.

So, instead, I get close and hold his hand. Suddenly this is not such a thick place after all. I feel the warmth of his body, and he squeezes, just a little.


Original article on Pulse - Voices from the Heart of Medicine website.