The experience that struck me most involved the first death of a COVID-19 patient I personally witnessed. Even though I had taken care of very ill COVID-19 patients for the past month in my emergency department in Hartford, Connecticut, none had died prior to transfer to the intensive care unit. I was on duty for my first evening shift in the Kayenta emergency department when a patient who had previously tested positive for the novel coronavirus and was short of breath was being brought back in a wheelchair. I saw on the tracking board that she was 28 years old. One of the other physicians started donning his PPE in anticipation of treating her when she suddenly slid out of the wheelchair and collapsed on the floor in front of the nurse’s station.

The physician who was in his PPE and several Team Rubicon volunteers who were not jumped in to assess her, found she was apneic and pulseless, and began CPR. I quickly donned my PPE, and we were able to lift her to a stretcher and move her to the trauma room to continue the resuscitation with the Kayenta staff and Team Rubicon volunteers working as a team. She had copious secretions from her mouth and needed an airway. My colleague attempted twice without success and handed me the laryngoscope. I was able to secure her airway with direct laryngoscopy. I learned quickly how resource-limited the Kayenta facility was, with limited equipment (no adequate video laryngoscope), personnel (no respiratory therapist), and supplies, including medications.

Our team continued the resuscitation for more than two hours. She would intermittently regain pulses and then lose them. The air medical transport team was called in anticipation of transfer to a medical center, but they had delays getting out of Gallup, New Mexico. As I looked around the room during the code, I observed a mix of emotions on the faces of the nurses and technicians. There was determination in saving such a young life as well as despair as her condition did not improve. There was also concern and likely fear about exposure to COVID-19, especially those who jumped in to help at the beginning.

Eventually, when it was obvious the resuscitation would not be successful, her significant other was brought into the room to be with her. That is when I learned that he had been infected first with COVID-19, likely from his job in a prison, and that the patient and the couple’s infant child only recently tested positive. The baby was being cared for by the woman’s family while she stayed home to care for him while he was ill. A moment of silence was held, and the grief of witnessing the death of such a young individual was apparent.

What I didn’t notice was that staff who were Navajo shied away from the room after her death. Later one of the nurses explained the Navajo’s belief and fear of the spirit of the dead that lingers around the body. My physician colleague and I only had a short period to debrief the staff before ambulances brought in several trauma patients needing our care. Later I learned more about the life of the young woman, a former Miss Navajo, from multiple news stories celebrating her life. Although I have witnessed innumerable deaths during my career, including those of young people and children, the cultural aspects and fear of exposure during a pandemic made this experience different. I developed a new respect for how devastating the effects of COVID-19 can be.

Dr. Chartoff is assistant professor of emergency medicine at the University of Connecticut School of Medicine in Hartford, an emergency physician at the University of Connecticut–Hartford Hospital, and medical director of Team Rubicon Northeast Territory.