Ballad of the hospital bed allocator

Pandemic Diaries is a series of personal essays by Canadian writers and artists reflecting on their experiences during COVID-19.

"If you don't get that patient a bed, he will die," I was told by my coworker on my first solo shift as a bed allocator at the city hospital. "Ok, enjoy your night."

Truly, there is nothing to prepare you for that job. I was on the 11pm to 8am shift, so there were no ward nurses to ask to break protocol, no surgical beds left, and I couldn't put a surgical patient on a medicine floor because there weren't surgical nurses there. If this reminds you of a game of chess, it felt more like pulling people from a burning building.

A bed allocator is the person in charge of all the movements of bodies, alive or dead, in the hospital. One cannot just put a patient anywhere — it depends on infection level, type of stay, and whether they have insurance coverage. As people are told they are staying overnight, the shuffle begins again in the allocator's office.

I rotated between being an emergency room clerk and a bed allocator, sometimes in the same shift, since it was all in the same area. The clerk is the most accessible person in the ER because we have the least power to change anything. I've had all sorts of things flung at me: body matter, words, weapons, and panic, so much panic. No one comes to the hospital when they're feeling good.

When you tell someone you work in an emergency room, their response is usually to complain about the time they waited for six, eight, ten hours. How it made no sense; there were doctors, so why didn't they do their job? (This is a good time to ask who they voted for in the last election.) These stories make me feel as if we are both sinking into a swamp, and if I open my mouth to say anything, it will suckle me into some bottomless deluge of trying to explain how these decisions are made.

Last night I had a nightmare that I was still doing bed allocations, except I didn't know how to work the computer system and there was some sort of stinking mass filling up my office and I could hear the cries of people from every room in the hospital, and the eyes, the eyes, always the eyes.

In actuality, there were eyeballs on my desk most days — floating in fluid, waiting for transport, keeping me company. Some would have belonged to people who checked in with me only days before. I wrote their names down in the death book and dealt with funeral parlors. I didn't cry. I've been accustomed to hospitals ever since I was a child waiting for my mom to finish her shift. I loved entertaining the nurses, who never made fun of my lateral lisp. The business of dying is sometimes best handled by those who have been born into these roles.

I remember the moment I shifted, when my grasp of life and death became less based in the heart and more based in the brain. It's what made me leave healthcare to pursue a career in the arts. It's also what made me realize that pain is in direct balance with joy. I funnel new ways of thinking about humanity through humour; I try to foster hilarity in grief; I don't get angry at things I cannot change. I know that someday I'll be a breathing body defined only by infection level and medical, surgical, palliative, or ICU, and I'll enter that hospital knowing I chased my joy when I could.

The event that solidified this happened on a night shift. It was day three of a patient being in emerg, fighting for their life with a level 2 infection. This is a droplet transferrable infection, not an airborne one, which is a level 3 and has its own ward we can easily transfer patients to. To accommodate this level 2 patient, the hospital would have to close off a double room.

Someone else's death would be the only way I could shut down a double room and save this man's life. I knew he was not getting sleep; there was a guy who had been screaming for the past 30 hours and keeping us all on edge. I moved a few other people out of emerg that night, always keeping in mind that enough moves like this might mean he would never leave the ward. Near the end of my shift, around 6am, a nurse called.

"Calling down a death; they passed at 1:14 am."

My body reacted first — a surge of adrenaline because I knew I'd done three chess moves since then, and that might have been my opportunity to perhaps save this man's life. I asked why she waited, why a dead body sat there. But we both knew why. Getting a body out and a bed ready is a lot of work, and some nights, you just can't do it.

I looked into the eyeballs on my desk and I felt it; that moment I became a dealer of bodies. I stopped feeling I could change something, that I could expect to be alive despite all odds. Survivors of disaster, of war, of (once) terminal illness get this. The gallows humour of it all, the audacity of life. We are just beds and bodies.

Today I am thinking of the plight of bed allocators in Italy, in New York, in offices I used to sit in. There are so many factors that keep a person from being able to get a bed, to clear that bed for the next person who has been waiting for six hours just to be seen by a doctor. Healthcare workers get your worst days, your panic, your anger, grief, and violence. But they want what you want: for you to be seen quickly, for you to to recover, for you to get a bed when you need one. And during this pandemic, when prevention is in the hands of the public, we need to be in this fight together.

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