Names, locations, and some events described in the below story may have been changed for privacy and legal reasons. The premise of the story is based on a true event. This story is about the intubation of a Covid-19 patient. This content can be triggering. Reader discretion is advised.

At 23:00 (11pm) we had already been on shift for seventeen and a half hours. Six and a half hours to go before we were home free.

For the zillionth shift in a row we had not caught a break – hardly taking enough time to use the bathroom before clearing the hospital after turning over patient care. Covid-19 and the pandemic was still proving to be a challenge in our community. For the last two years our call volume continued to increase while staffing dwindled. Despite what the public might have assumed, healthcare workers were not immune to the effects of Covid. The mental toll Covid placed on us was often more draining than the symptoms we experienced – at least that was the case from where I stood.

Harley and I were en route to our posting location, praying the whole way that we would be able to catch a short nap once we arrived. We didn’t even go inside the stations anymore. It wasn’t worth the extra steps from the ambulance to the recliners inside. Instead, we had grown accustomed to lean the front seats back – the whole 1/8th of an inch they would recline – and use our jackets or blankets we brought from home to create makeshift pillows. If sleeping in the truck allowed us the 2 extra minutes of sleep that it would have taken to walk inside, the back pain was worth it.

Almost down to the second that Harley parked the ambulance in front of the station we heard the tones drop on the radio. We both held our breath. Our pager jingled that annoying tune that now gives me PTSD whenever I hear it play when I’m off shift in public.

“Medic 1, go available for urgent transfer.”

Harley and I groaned in unison. In the eye of the community, Harley and I had decided they would never see us moan and complain while attending to an emergency – no matter how trivial their complaint (the 3am toe pain that had been going on for weeks, for example). But in the comfort and privacy of our own rig we would shout and punch the air and curse until we would arrive on scene.

The dispatcher relayed that our patient was newly intubated, required a ventilator, and medication infusion for transport. The patient was to be transferred two hours south to an ICU for higher level of care. We copied the traffic. After being certain we had enough oxygen for the transport and obtained the travel ventilator we headed to the hospital.

Before I had transferred to my current location of employment, I had worked as an inter-facility EMT and paramedic. Inter-facility was primarily transferring patients from one health care facility to another. I had highly skilled medics who mentored me – my past medic partners, Scott and Brian – who I strongly credit with my development as a pre-hospital provider. The patients would be incredibly critical. I felt confident in my skills and my understanding of the vent and other critical care equipment.

The emergency room was as busy as ever. Nurses and techs swarmed in and around the halls carrying various medications, infusion pumps, and oxygen equipment. We made our way without delay to the critical care room and were greeted by a pretty nurse who was removing her PPE after exiting our patient’s room. She handed me a manila envelope containing a stack of paperwork and I checked to make sure everything I needed was included. Harley dressed himself in the appropriate PPE and entered the patient’s room to begin his assessment and report back to me with his findings while I obtained a hand-off report from the nurse.

She rattled off a swift but informative report – honestly, one of the best I’d received. She even explained that the sending physician had intended to fly the patient by helicopter, but was over the weight limit for the aircraft.

James had arrived in the emergency department by his own vehicle as a walk-in with a complaint of shortness of breath for three days. His oxygen saturation was reading as low as the 30%’s and otherwise didn’t have any other medical history. James was Covid positive and placed on high-flow oxygen followed by BiPap. The receiving hospital’s stipulation for acceptance was that the patient be intubated. The sending physician ordered the sedation, paralytic, and intubation to be completed. I assured her that, based on the information she provided, I would be able to handle the transport.

“He’s pretty big so you might need some help transferring him to your gurney,” she told me.

Out of the corner of my eye I saw Sammy, Dustin, and one of their new trainees cleaning their equipment after dropping off a patient. Sammy (who I call the love of my life) and Dustin offered their assistance to us without question and entered James’ room to help Harley.

As I donned my PPE and entered the room, the look on Harley’s face told me everything I needed to know.

“Holly,” he said in a low voice, “just in the few minutes I’ve assessed him, this guy looks even worse than when I came in.”

Turning my attention to the patient, I understood.