surfacing to try to get relief — but his breaths were never deep enough to provide it.
The care he was getting was not always comforting. A nurse came in at some point to take his blood pressure and temperature, but his voice was fearful. “Turn your face away,” he told Cai. He placed a thermometer on the tray and told him to use it himself.
But his main anxiety was that his condition would deteriorate — that his lungs eventually would be so compromised that his oxygen levels would drop to a degree that endangered his life. The mechanism is both complicated and simple: If not enough oxygen reaches the organs, the intricate gears and motors of the human body start to fail. He frequently texted Huang. He was scared, he told him. He asked for reassurances that his friend would not let him die there. Of course not, Huang replied. Huang hoped he was telling the truth.
Cai’s world was reduced to the size and reach of his phone. To pass the time, he watched videos of his daughter over and over and stared at a picture of her in his arms. He would have yearned to video-chat with her but was afraid that it would be too upsetting for her — and maybe for him. They could never explain to a young toddler where he was and why he couldn’t come home, and so he and his wife decided not to tell her anything. He knew she had to be confused and suffering, and the thought of that was bound up with his own confusion and suffering.
The evening of Saturday, March 7, Cai was afraid to go to sleep. He was barely able to talk without collapsing into coughing fits. Earlier that day, he started receiving oxygen from a tank through
a nasal cannula, a flexible tube that sits just inside the nostrils. But as he monitored his oxygen levels from his bed, he could see they were dropping. Even with the extra oxygen, his saturation level was as low as 88 while lying down, suggesting his lung functioning was weakening. He started to worry about acute respiratory distress syndrome. From there, he knew intubation could follow, a procedure that involves putting a tube down a patient’s throat and connecting the lungs to a ventilator. Cai knew that the I.C.U., where the ventilators were kept, was on a different floor; if he started to crash — if his vitals indicated that his organs were in imminent danger of starting to shut down — how were doctors going to intubate him and transport him to the ventilator in time to save his life? He’d seen patients die from respiratory failure in less than 10 minutes.
Cai’s family and friends were continuing to communicate with doctors in China and passing on their advice and suggestions. It was common practice during the Covid-19 outbreak there to give patients a second CT scan to provide a clearer view of the progression of lung damage; the so-called ground-glass opacities on the lungs common with Covid-19 could easily be missed on an X-ray or mistaken for something else.
Earlier that morning, Cai told the infectious-disease doctor on call that weekend that he wanted a second CT scan, a suggestion made by top doctors in China, who thought they could help his doctors in New Jersey understand the progression of the illness. The doctor seemed disinclined. They would determine treatment based on oxygen levels, which they were keeping an eye on . Simply moving Cai to the scanner
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