!Third covid winter --- agk's diary 7 December 2021 @ 00:28 --- written on Pinebook Pro while Evy and the baby are at the library --- Loretta puked in the trashcan in the smoker's shack outside the staff entrance. 24 years old in black scrubs, ID badge clipped to collar, hair in two plaits dyed grey. I pulled my mask off to emote. "You ok?" "Oh, I'm fine, Anna," she said. She lurched over the trashcan again. "I've gotten good at just throwing up and popping back into work. It's actually no big." "You pregnant?" Kneeling on the concrete with the trashcan, she looked up. "No---GOD, no! (laugh) I--it's just, ever since I got COVID in September I've had this digestive thing. They've done a lot of tests, maybe it's IBS or some- thing, but---it's honestly no big deal. I just run out here like six times a shift to puke or whatever. It doesn't hurt or anything." - - - The 19-year old was rail thin---still fashionably underweight, not skeletal yet. Consumed with anxiety, her nose and mouth were capped with the highest-flow Venturi oxygen mask. The head of her hospital bed was raised 30°. Her mom woke in the recliner. I only heard breath sounds in the upper part of her upper lobes. She was frail. Her and her mom were pushing her to the top of her class in a fashion design major and leadership positions in multiple student clubs when she collapsed. She wasn't moving much, so antibiotics or no, her pneumonia wasn't going anywhere. I sat her up with another nurse (a registered one), took off her mask, and instructed her to inhale through her incentive spirometer. She couldn't hold her breath for ten seconds, only 2 or 3. She couldn't inhale in a controlled way, just little gulps. She was embarrassed, out-of-breath apologetic, scared. Her lung capacity seemed the volume of a grapefruit or less. She couldn't do ten reps. We stopped after three. In under a minute of her mask being off her O2 sats had dropped into the 70s. The respiratory therapist switched her to high-flow oxygen. She had three negative COVID rapid tests. The RT ordered a PCR test. Her mom explained to anyone who would listen they didn't get vaccinated for religious reasons. The X-ray showed "ground glass" lungs and nipple barbells. The RT, in the nurse's station, laughed angrily, indicated the radio-opaque piercings. "I guess she didn't have a religious exception to *these*." The cat scan showed lungs without airspaces. Her condition steadily, rapidly declined under her over- bearing mother's suffocating gaze. "No wonder she can't breathe," I said. The girl wasn't a progress- ive case anymore. We prepped to send her to the ICU. A resident ordered COVID precautions (N95 etc) going forward, just in case. My shift ended. She was still on our floor. I guess they were prepping a negative pressure room for her? I've never worked in the ICU. I don't know how it works. - - - "Numbers are up," I tell Evy. "That checks out," she says. "We have five in over- flow again."