The heat of battle

By : Alberto Palacios
Jefe del Departamento de Inmunología y Reumatología del Hospital de los Angeles Pedregal en CDMX

05 November, 2020

"Eloise, Specialist in Critical Medicine, lives the pandemic from a hospital, cries in silence for those who have left and fights for the ones that come to her service, doctors or patients, hold on."

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In the neighborhood the contagions rage and the rumors of death cross the streets. Eloise overcomes exhaustion and the accumulated tension in order to get under the shower. Before this, she looks at her well-formed body in the mirror, although she has lost some muscle tone with these frightening shifts.  

She lets the warm water wake her up a bit. She has no energy to sing like she used to before the pandemic. Her scrubs are folded in the chair waiting for her as a strict order that she just cannot avoid.  

She braids her hair and gets dressed – violet scrubs today – to go to the hospital before dawn. Once again, her apartment is a mess; the Intensive Care Unit has been her home for a semester.  

When she finished her Critical Medicine specialty with honors, she was the only woman in her generation that had ventured into that path of monitors, prolonged silences and distress. Her friends, - many of them dermatologists, the occasional pediatrician or ENT, two internal medicine specialists and an endocrinologist – warned her that she would not see the light of day and that this professional demand will cost her losing her precocious marriage. 

Said prophecy was fulfilled last year, when her husband, an engineer that was starting to stand out economically speaking, abandoned her for calmer waves, the cynic.    

She got over him son, devoted in body and soul to tending to her ill patients that were being attacked by the new microscopic enemy. The truth is that it took her team by surprise.  

When the first cases arrived in March with those who were affected by that silent hypoxia that killed them in hours, the information was limited, and the resources were scarce.   

Only those who were in charge of the daily contact received vinyl suits, double gloves and discontinuous shifts. Still, Eloise saw three nurses and an anesthesiologist that was courting her fall with an atypical pneumonia that annihilated them in a few days, despite all the measures and efforts taken to help them.  

As the chief of service, she cried for them in silence and dedicated numerous praises in front of her team with stoic attitude to scare off the discouragement that surrounded her before every death.  

Today she walks by the semi-deserted streets of the capital, another Latin American city that barely survives under fear and darkness. People around her walk downcast, not all wearing masks, trying to win make a living as well as they can. 

In Europe they were able to lift their heads soon – she thinks – because they don’t drag centuries of poverty that strangle them. This virus swept through all the marginal communities here like an uncontrollable, murderous plague.  

She knows it well, she has seen the eldest, poorest, those with a hollow stare, hungry for oxygen, showing a deep incomprehension in the face of their fate, succumbing.   

By the end of May the statistics were a sum of disappointments, and the few patients that managed to recover did so more by chance than by the use of convalescent serum, steroids or Tocilizumab. The first ray of hope came when on two patients that were drifting into that dry death and someone suggested taking thrombosis markers test.   

It was either because of serendipity or because one of the most curious residents found an isolated article that documented perialveolar endothelitis. Be that as it may, the D-Dimer results sparked general awareness and they started to use low-molecular-weight heparin on a piece-rate basis. After all those weeks of failures, the more acute patients started to respond; the oxygen finally seemed to be flowing without setbacks and the cardiopulmonary function curves were restored. 

It’s not like they won the battle, Eloise would think while she drove her small Toyota, but they were able to find a bit of a twilight at the end of the tunnel.  

Upon her arrival at the hospital, the head nurse is waiting for her under the drizzle. She is wearing a gray anorak that hides her features, especially since the mouthpiece only leaves her languid and anxious eyes free. Eloise gets out of the car and greets her with modesty.  

- What is wrong Lola? You look concerned.  

- Dr. Rojas, we ran out of anticoagulant. I don’t know what we are going to do. I am desperately looking for supplies at other hospitals. 

Surprised by her maternal reaction, she who has not yet conceived more than her tireless spirit, takes her by the hand and leads her towards the side entrance. 

-Don’t be alarmed -, she tells her in a friendly voice – we will survive worse skirmishes. 

Her presence in the Therapy instills calm; they will use aspirin, clopidogrel, warfarin, or whatever is necessary, but they will not allow death to flood their sanctuary. 

Somewhere in that city, subdued by the plague, Eloise and her team serve themselves a comforting coffee and get ready to check the details of the ending guard. Outside, the famine, like in so many other metropolis of this wounded America, keeps piercing homes where there is barely enough to make do for the day.  


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