COVID-19, Prison Visits, and the Value of a Cup of Coffee
Authors: Thomas J. Doyle
Journal: Annals of Internal Medicine (2020)

On Being a Doctor2 June 2020COVID-19, Prison Visits, and the Value of a Cup of CoffeeFREEThomas J. Doyle, MDThomas J. Doyle, MDSouthcoast Health/Charlton Memorial Hospital, Fall River, Massachusetts (T.J.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-3073 Audio Reading - “COVID-19, Prison Visits, and the Value of a Cup of Coffee” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “COVID-19, Prison Visits, and the Value of a Cup of Coffee” by Thomas J. Doyle, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail B.R., who works stocking shelves at a local big-box store, is sick for a week before he comes in to our ER in mid-April with fever and cough.He feels as if he has been run over by a truck. His constellation of low oxygen levels, chest pain, and laboratory and imaging findings strongly points toward COVID-19. A coronavirus swab is sent, and he is admitted to our COVID-19 ward.I take over his care the next morning when, suited up in full PPE, I open the windowless door to his room and encounter a heavyset, unshaven man in his mid-50s slumped in bed, ashen-faced, scared, and isolated. His shallow respirations are twice normal, and he requires 3 to 4 L of continuous oxygen through nasal tubing.“I have all the symptoms of coronavirus,” B.R. tells me weakly. He had looked up his symptoms on Google and tried to ride out his fever at home for a week before coming in. B.R. is taciturn and seems quite stoic, increasing my anxiety that he is even sicker than he appears.As I talk to B.R. and gingerly examine him, I think, “So this is COVID-19.” He is my first patient with this disease.He is in day eight of his overall illness, when many patients turn a slow corner and start to improve. Others, I know, take a different path.Our ward is a purgatory of sorts between the relative heaven of home discharge and the potential hell of ICU treatment.My colleagues and I have been fortunate that COVID-19's arrival into southeastern Massachusetts seems to have been slower than in other places. During the weeks and days before my rotation through our COVID-19 ward, I educated myself by trying to drink from the firehose of COVID-19 information that has taken over the medical and popular press.As I get to know B.R., I focus on his chest pain and how to treat it. I encourage him to try shifting his position in bed from side to side and to spend hours prone on his stomach if possible.B.R. has a hard time changing position at all, and he is unable to lie on his stomach. After discussing the lack of clear evidence for or against hydroxychloroquine in his situation, the infectious disease consultant and I elect to treat B.R. with it. He fortunately has no cardiac or other complications from the drug. We have no idea whether it is actually helping. What helps—given his dismal appetite and ongoing chest pain—are oxygen, IV fluids, and morphine.On day three of his hospitalization, I stand in the room in my PPE talking to B.R. through my N95 mask and face shield. We have gotten to know each other a bit, and he starts to improve ever so slightly. He is now able to have a normal conversation, whereas before he could only manage five words before taking a breath.He tells me that his wife has a cough and fever and that his son, who lives separately and whom I talk with each day, is anxiously checking on both of his parents several times daily.I lose track of time a bit while talking with him. Suddenly, I note a patch of fog forming on the lower half of the goggles I wear under my face shield. I know that the fog suggests possible failure of the protective seal of my N95 mask, and I change my speech so that my cheeks move less.In the back of my mind, I calculate how long I have been in the room. I flash to various suggestions in the literature about correlation between increased exposure time to the air around COVID-19–positive patients and the risk for contracting the virus. The fog passes. I decide to wrap up.“There is one more thing,” B.R. says, somewhat awkwardly.Morphine has slowed his bowels. The remedies he has received—Colace, laxatives, Milk of Magnesia—haven't helped.I ask him what he would try at home. Prune juice? Or maybe coffee?“I'd love a good cup of coffee, but I hate the coffee here,” he says acidly.The sudden edge in his voice startles me but feels completely understandable.An hour later while on my circuit through the cafeteria—empty of the usual bustle of visitors—I pour a tall cup of the specialty coffee and realize that I forgot to ask B.R. how he likes it.I call his cell phone, which rings on his bed two floors above me.“I like it tan, whole milk. Not too tan, though … .”I deliver the coffee back to the ward and give it to B.R.'s nurse, who then carries it to him a few minutes later along with another dose of morphine.The simple act of being able to walk downstairs and buy coffee crystalizes a feeling I have had during my days on the COVID-19 ward. Our patients are prisoners of a sort, isolated in closed rooms and with limited contact with the outside world, hoping for freedom. I also think of the plight of actual prisoners, who face the anxiety of COVID-19 in a locked room.As these thoughts swirl in my mind in the slightly sleep-deprived state that doesn't leave me during the week I am on the ward, I realize that I feel like a guard. “A prison guard?” I wonder. That doesn't fit.I settle on an idea that I am more like a bodyguard—trying to do the right thing for patients while protecting myself.At least three patients among the many I care for ask me point-blank, “Doc, am I going to die from this? I mean, am I going to make it?” COVID-19 places us all on uncertain ground. However, I always answer, “Yes, you're going to make it!” because I know that positivity can help. Besides, what other answer is there?A unique camaraderie develops among us bodyguards, whether we are nurses, aides, phlebotomists, custodial staff, doctors, transporters, or secretaries.We share COVID-19 hacks: We encase our cell phones in plastic wrap before going to work so that, on arrival home, we can peel it off (and maybe wipe the phone down again—can't hurt). The nurses show me how to use a skin protectant similar to moleskin on the bridge of my nose to reduce abrasion and breakouts caused by hours of pressure from my N95 mask.I can't wear my hospital ID on the exterior of our single-use yellow isolation gowns, so I use a black Sharpie to write “Dr. Doyle” in large block letters across the top of my reusable welder-style face shield. I have to periodically refresh the letters, because they continually fade under the effect of the meticulous antiviral wiping I perform on the shield multiple times a day.The next morning, B.R. has good news when I call him on his cell phone at the bedside. Problem solved: The coffee did the trick. When I gown up and see him later that day, I arrive with a cup of coffee in hand. During the last 3 days he is in the hospital, this becomes a welcome routine.After 7 days, B.R. leaves us and goes home. It is a celebration for both of us, and it feels good to liberate him from the hospital. He is eager to donate plasma in the weeks ahead, with its promise of antibodies to coronavirus and potential treatment for COVID-19. His wife is better.At the end of my first week taking care of COVID-19 patients, my anxiety has diminished. I let my obsessive–compulsive side run wild. I wash my hands until they are raw. I don and doff my PPE the same way every time without fail. I leave a pair of shoes in the hospital. I spend hours on the phone with the friends and family of my patients, and many conversations end with profound expressions of gratitude.The COVID-19 ward grows on me, even though it still feels like prison, purgatory, and a safe place—often all at once. Comments 0 Comments Sign In to Submit A Comment Dr. Louis VerardoRenaissance School of Medicine at Stony Brook10 June 2020 Comment about your article. Dr. Doyle, you are a good doctor; we should all be so fortunate as to be under your care when we are in need of help. Keep up the great work and stay safe. Basim AyoubAtrium Health9 June 2020 Great much needed bedside manners I must say I'm impressed MapungManifesco Cafe22 July 2021 Dr Doyle I wish you in health and all under your care get well soon. Impresive writing, you should be a novelist too Author, Article, and Disclosure InformationAuthors: Thomas J. Doyle, MDAffiliations: Southcoast Health/Charlton Memorial Hospital, Fall River, Massachusetts (T.J.D.)Corresponding Author: Thomas J. Doyle, MD, Hospital Medicine Service, Southcoast Health, Charlton Memorial Hospital, 363 Highland Avenue, Fall River, MA 02720; e-mail, tjdoyle@fastmail.com.This article was published at Annals.org on 2 June 2020. PreviousarticleNextarticle Advertisement Audio Reading - “COVID-19, Prison Visits, and the Value of a Cup of Coffee” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “COVID-19, Prison Visits, and the Value of a Cup of Coffee” by Thomas J. Doyle, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byMental health status among prison officers in the process of enforcing the law during COVID-19epidemic: a cross-sectional survey from ChinaCOVID-19 Risk Management and Screening in the Penitentiary Facilities of the Salerno Province in Southern Italy 20 October 2020Volume 173, Issue 8 Page: 666-667 Keywords Anxiety Coffee COVID-19 Fevers Ischemia Milk Morphine Oxygen Personal protective equipment Stomach ePublished: 2 June 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...