Ariane Jan Runolfsson

DR: Mrs. Runolfsson? I am Dr. Okafor, the physician who will be looking after you on this unit. I know the gown and the face shield make this feel strange — can you hear me all right through all of this?
PT: Yes. You look like... an astronaut.
DR: I get that a lot this winter. And you must be family?
FAMILY: Teresa, her daughter. They let me gown up to help get her settled. She gets so short of breath that I did not want her telling the whole story alone.
DR: I am very glad you are here, Teresa. Mrs. Runolfsson, tell me what you can in your own words, short sentences are fine, and your daughter can fill in the gaps. When did this start?
PT: Five days. Maybe six. A cough first. Dry. Then the fever came... and stayed.
FAMILY: It was right after the holiday she started coughing. By New Year's Eve she was feverish and stopped eating properly, and this morning she could not get from the bed to the bathroom without stopping twice to breathe. The swab they did at the urgent care came back positive for the coronavirus. They said isolate and watch her, and we watched, and it kept getting worse.
DR: You did exactly the right thing bringing her in. We repeated the swab here in the emergency department and it is positive as well, so the diagnosis is confirmed. Mrs. Runolfsson, any chest pain or pressure? You have had a heart attack before — do you remember that feeling?
PT: I remember it. This is not that. No pain. Just tight. Like the air is... thin.
DR: Any coughing up blood? Leg swelling?
PT: No. No.
DR: Confusion, falls, fainting?
FAMILY: No falls. She seemed a little foggy this morning, but as you can hear, she is still herself.
PT: Foggy and sharp. Both at once.
DR: Clearly sharp. Let me make sure the chart I have is right, because I want to know exactly who I am treating. I have high blood pressure, the heart attack we mentioned — an ST-elevation heart attack some years back — high cholesterol, metabolic syndrome, prediabetes, osteoporosis, obesity on the problem list, and scoliosis from adolescence. Anything missing?
FAMILY: That is her. And the allergy — tree nuts. Please make sure the kitchen knows. She swelled up badly once from a walnut brownie.
DR: Tree nut allergy, flagging it for dietary right now, and it is on her armband. Medications — I have aspirin eighty-one milligrams daily, atenolol fifty, rosuvastatin forty, and lisinopril twenty. Is that current, nothing added or stopped?
FAMILY: That is exactly her pillbox. She never misses.
PT: Sixty years of... discipline.
DR: It shows. Now let me tell you what we found and what we are doing. When you arrived, your oxygen level was about eighty-seven percent — we like it above the low nineties. Your temperature was thirty-eight and a half, your heart rate was in the fifties, blood pressure one-oh-five over fifty-three. The chest x-ray we took shows pneumonia — the virus has inflamed the lungs themselves. That combination is why you are being admitted, and because of the virus it has to be an isolation room.
PT: Isolation. So Teresa... cannot stay.
DR: I am afraid not, and I am sorry. Once you are settled, visitors cannot come into the room. The nurses will help you two video call every day, and Teresa, I will call you personally with updates — we will pick a time that works.
FAMILY: Evenings are best. Doctor, be honest with me. How bad is this?
DR: Honest answer: this is serious, and I am worried enough to watch her very closely. She is eighty-one, and the heart history, blood pressure, and blood sugar issues all make this virus harder. Her latest reading a few minutes ago actually dipped further — her oxygen dropped to about seventy-six percent lying flat, her fever is climbing toward thirty-nine, and her heart rate has come up to the high eighties. So we are not waiting.
NURSE: Sorry to interrupt — mask is ready. Mrs. Runolfsson, I am going to slip this oxygen mask over your nose and mouth. It blows air a bit forcefully, like holding your face out a car window. Breathe normally.
PT: Cold... but better. Yes. Better.
NURSE: Good. Sats are already coming up on the monitor. I will stay to recheck in a few minutes.
DR: Thank you. So, the treatment plan, and I will explain each piece. First, oxygen by mask, continuously, and we adjust the flow to keep your levels safe. Second — and this one sounds odd — we are going to have you spend a good part of each day lying on your stomach. It is called prone positioning. Your lungs have more tissue toward your back, and lying face-down lets the healthier parts do more of the work. It genuinely helps with this disease.
PT: On my stomach. With my back? The scoliosis...
DR: A fair concern. The nurses do this many times a day and will pad and position you so your spine and hips are comfortable — pillows under the chest and pelvis, arms in a swimmer position, and we rotate on a schedule rather than leaving you any one way for too long. If a position hurts, you tell them and they adjust. It will be part of every day while you are here.
FAMILY: How many hours a day, roughly?
DR: As many as she comfortably tolerates each day — we will build it into the daily routine along with her nursing care, meals, and rest. Third piece: blood work, every morning. A blood count, a chemistry panel, and on a regular schedule some extras — a heart enzyme called troponin, because of her cardiac history, clotting tests, because this virus makes blood sticky, and iron studies. One needle stick a day, everything drawn together whenever we can manage it.
PT: Every day. My poor arms.
NURSE: We will rotate sites, and I will send our gentlest phlebotomist. Recheck here — you are holding in the low nineties on the mask. Much happier with that.
DR: So am I. A few things from today's first labs, so you both have the full picture. Her white blood cell count is a little low — we see that with this virus. Her platelets are on the lower side as well, which we will follow. And her kidney numbers are the thing I most want to watch: the creatinine is elevated at two point seven, and the filtration estimate is quite low. Between the fever, poor intake, and the illness itself, the kidneys are under strain. The daily chemistry panel tracks exactly that, and we will be careful and deliberate with her blood pressure medicines while the kidneys recover — we will adjust based on what each morning's labs show.
FAMILY: She barely drank anything for two days. I kept trying.
DR: That fits with what we see, and it is fixable. Gentle fluids, monitoring, and time. Her potassium is also running slightly high, which goes along with the kidney strain — again, the daily labs guide us. Now, what should you watch for, Mrs. Runolfsson? If breathing gets harder, if the mask feels like it is not enough, if you feel chest pain or your heart racing — press the call button immediately. Do not be polite about it.
PT: I am always polite.
DR: Be impolite for once. That is a medical order. Teresa, questions before we move her up to the unit?
FAMILY: The heart — could this set off another heart attack? That is my nightmare.
DR: It is a real risk with severe infections, which is exactly why we are checking the troponin regularly and keeping her on her aspirin and heart medicines as long as the labs allow. If anything shifts, we will know quickly and act quickly. Anything else?
FAMILY: No. Just — take care of her. She is tougher than she looks, but still.
PT: I am... exactly as tough as I look.
DR: I believe that completely. Here is the plan once more, simply: isolation room upstairs, oxygen by mask around the clock, tummy-lying sessions every day, blood tests every morning, the kitchen knows about the tree nuts, and I call Teresa every evening. We take this one day at a time, together.
PT: One day at a time. Thank you, doctor.
FAMILY: Thank you. I will wait for your call tonight.
DR: You will have it. Let us get you comfortable upstairs, Mrs. Runolfsson.