The Patient Escaped Isolation

 A typical hospital scenario: a 74-year old patient with an active Covid-19 infection wishes to leave the hospital for a short time to visit well-wishers. You see the patient dressed in no protective gear except for a black cloth mask walk down hallway. As a nurse, you know that he has had two episodes of low blood oxygen saturation, and that can cause confusion.

The patient is also on Dexamethasone—a steroid that typically reduces the immune system, but also that increases, in many cases, the patient’s sense of well-being. Steroid use got Lance Armstrong in serious trouble; it both built his lean muscle and gave him energy he wouldn’t otherwise have had. You think about ‘‘roid rage,” and reflect that it’s steroids, not the Android operating system, that give the phenomenon its name.

Fortunately, you think fast on your feet. You explain to the patient that though he is very rich and very powerful—in fact, the president of the United States—he is actively putting everybody’s health at risk. You redirect him to his room. You get help stat. And you might even call Dr. Leana Wen. Here’s what she would do (according to a tweet last night):

“If @realDonaldTrump were my patient, in unstable condition + contagious illness, & he suddenly left the hospital to go for a car ride that endangers himself & others: I'd call security to restrain him then perform a psychiatric evaluation to examine his decision-making capacity,” the ER physician tweeted on late Sunday.

Dr. Wen is a CNN medical correspondent and visiting professor at George Washington University.

What was anybody at Walter Reed Hospital thinking?

Sure the president was feeling great—he was pumped full of steroids. But what would have happened if the president’s oxygen level plummeted? If he had had a heart attack—due to the steroids, perhaps, hitting an already stressed cardiovascular system—what would they have done?

And what if Trump, who tends anyway to be impulsive, had changed his mind? What if he had said, “Hey listen, boys, just swing by the White House. I want to kiss Melania goodnight!” And then once back in the White House, he turned on the television and watched as utter pandemonium ensued. “Maybe I’ll come back,” he tweets to the doctors and the world.

What if he had ripped off his mask and gotten out of the car to greet his followers?

Impossible, you say? Not with a guy on steroids with a rapidly decreasing oxygen saturation level.

If everybody from the nursing assistants to the Chief of Staff failed the president—and the country—well, what about the Secret Service? Their job is to protect the president, even if it means a tantrum from the chief executive. Most presidents know this: they grudgingly give over their personal freedom for the good of the country. There are unspoken norms. The Secret Service will not rub their authority in; the president will play by the rules. 

And speaking of yet another norm that we apparently now have to spell out into a rule: what about the idea that a patient can determine his fitness for work, not the medical team? True—a president can be perfectly capable of guiding the ship of state after he has had minor surgery. But even a minor procedure can often produce pain: should anyone be working who is on Percocet? Dilaudid? And what happens when the clinical picture changes rapidly, and the president has an adverse reaction to a drug? As we saw—or rather, didn’t see—last Friday, the president’s condition can change on a dime. Sorry, Mr. President—if you’re sick enough to be in a hospital, you’re not working today.

Lastly, there are people who take care of a politician’s image. We’re getting up towards a quarter of a million people who have died of Covid-19 in this country. Some, perhaps many, died alone. Nurses are arranging Zoom calls so that husbands and wives can say farewell. Children are staring at parents through plate glass windows. My husband’s family has not been able to bury their father, nor see their mother in a nursing home for over half a year. Trump’s joyride was not funny.

He got away with it, you may say.

Maybe.

But to go back to Dr. Wen, on whose ward I will happily be a patient: “I'd call security to restrain him (and) then perform a psychiatric evaluation to examine his decision-making capacity.”

Shouldn’t we have done that four years ago?