Two emergency physicians, based at two different hospitals in the New York metropolitan area, are logging their days for Slate. At the end of each shift, they write a response to three questions: What was today like? How did it compare with yesterday? And how do you feel? We have offered them anonymity so that they can write freely about their experiences. Dr. Kelly Keene and Dr. Lauren Serino are pseudonyms.
Dr. Keene, March 25
When I arrived at work, I stopped by the administrative assistant’s desk to sign a logbook and receive my PPE allowance: one N95 mask for the week and one surgical mask for the day. Our hospital has been running out of supplies. Our personal protective equipment is being rationed right now. I’m told we are getting a new shipment of N95 masks this week.
It is COVID central in the emergency department. Not even two hours into the shift, the bridge of my nose is already in pain from the pinching of the N95 mask. The safety glasses keep slipping and are weighing heavy on my ears. I’ve never worn glasses in my regular life.
Boluses of patients come in, and we attempt to push through. One patient was there for a possible ectopic pregnancy and another for a severe allergic reaction. I sincerely hope they don’t catch COVID while being treated in the ER. Almost everyone I see these days is a potential COVID patient.
Day by day, the numbers seem to be increasing. More and more COVID patients. Almost half of the patients I saw today were “bounce backs,” meaning they were seen for flu-like symptoms a few days ago and returned, as instructed, because their breathing status worsened. Some are fairly young, with little to no comorbidities.
Some of my feelings tonight are familiar. I’m scared about the possibility of having to ration health care. I’m scared of getting sick and then getting others sick. I’m angry that the government didn’t take it seriously sooner, that we don’t have PPE. But the new feeling tonight is helplessness. I feel helpless that I can only treat so many people, helpless that the patients on vents are not improving, helpless that many are still not taking a quarantine seriously. Feeling helpless—for me, it’s a very foreign feeling.
Dr. Serino, March 26
Today was a test of patience. Patients are still coming with minor complaints. Our frequent flyers—patients who oftentimes have nowhere else to go and whom we see almost daily—are still coming around. But it’s a viral miasma. They can’t be here. It’s dangerous for them. I trade being kind and compassionate with being efficient and compassionate. It’s not the warm and fuzzy side of myself, but there’s no space for that now. Kindness is going to look very different in the months ahead.
My focus keeps getting narrower. Every day there are more cases, and every day I see less “normal” pathology. Where is the appendicitis? The upper GI bleed? The broken leg? Even patients with symptoms that suggest they have one of these diagnoses end up having an X-ray or a CAT scan consistent with COVID. Everything is COVID now. It’s almost like you can hear it—that roar before the wave crashes.
I feel so much uncertainty: in my personal protective equipment that I’ve self-supplied, in the stability of the patients I’ve sent home, in the future of my city. The only thing I’m certain of is that this is going to be terrible, which isn’t my usual outlook. The problem is I don’t know what ways it’s going to be terrible. Maybe I’ll have to decide who gets a ventilator and who doesn’t. Maybe I’ll be on one. I don’t know. I don’t know.
Dr. Serino, March 27
I have the weekend off from clinical duties, so I spent it working on logistics. There’s a gross lack of scientific guidance that, coupled with a dearth of PPE, means I have to do my own risk analysis, and then my own purchasing, fitting, and testing. (If the Occupational Safety and Health Administration was hiring, every ER doc in the country would be ready to report for duty.) Just trying to find equipment is a second full-time job right now. I’ve spent last month’s salary trying to get supplies for myself and my team. In a month or so I hope that the production ramp-ups will make this process moot for many other parts of the country. But we’re in it in New York now, and every day the cases grow, and the risk grows.
Today I’m also working on coordinating donations and purchases of PPE for doctors and hospitals in need, which is everyone. I was able to get a box of masks dropped off for my residents today. That felt good. But it also felt dystopian. An ICU doc I’m friends with expressed it best: “I’m happy to have the masks, but I didn’t get into medicine so I could do back-alley handshake deals for basic protections.” Some docs are having to fight their administration to wear their own PPE. They find it, pay for it, and then are told they’re not allowed to actually wear it. That isn’t a fight I have had to have myself. If it’s a fight our chair has had, we’ve been shielded from it.
Today it felt good to not be encased in PPE. But the anxiety is always there. It lives in my stomach. I haven’t had a day without a stomachache. My face and neck really hurt. I have lines on my forehead, cheeks, and chin from 13 hours in goggles and masks that won’t fade, and now there’s some skin ulceration. So I guess that’s it for my modeling career.
Dr. Keene, March 28
One patient is back for his third visit with worsening symptoms. I learn his sister had just died the prior day from COVID. Another patient is presenting with shortness of breath, and his son is in the next room intubated because of COVID. Yet another grandfatherly gentleman is there with obvious viral pneumonia, telling me through gasping breaths about his loving son who had been visiting him weekly, but who had some mild flu-like symptoms when he came last week. One after another, the presentations are similar. First mild fever, body aches. Then worsening cough and shortness of breath. Finally they show up with some degree of respiratory distress.
As I approached my station in the ED, I witnessed my colleagues expertly placing a chest tube and intubating a patient. It was déjà vu. This scene seems to keep recurring. When I looked on the board at the list of patients, it’s the same—another day filled with respiratory distress patients, likely COVID-related.
Leadership at our hospital has been trying their best to keep up with the volume. We have already expanded “COVID units” to multiple floors and increased our bed capacity by an impressive percentage. We were running low on ventilators, but then we received another shipment.
In the midst of all this, I hear some good news: Two patients were successfully taken off the ventilator. As I gown up to enter another patient’s room, ready to intubate, two nurses swing by and place a smoothie on my desk. There are cookies and pizza and other food being brought to the break room. I pause and look around—and realize I feel proud. Proud to have the honor of working with such a wonderful team. Yes, multiple physicians and nurses are already out sick—many of them are close friends, even family. But even as shifts open up, more and more staff physicians volunteer to step up and work extra hours. I feel grateful for every single human being I have the privilege of working with.
Dr. Serino, March 28
Today I woke up to the doorbell ringing. It was FedEx. A few days ago, I had found out that the one and only HEPA filter I have for my 3M PAPR—a hooded air-purifying system I need for high-risk aerosolizing procedures—had been recalled. It had taken two weeks and accepting a ton of price gouging to acquire the one I had, and now I learned it wouldn’t work. And filters are now back-ordered for two months. I panicked, because having a working filter system might literally be the difference between life and death given the amount of viral load I am exposed to during intubation or other invasive procedures on COVID patients. So I’d called 3M repeatedly and had finally been connected with one of the heads of supply. I told him what happened. He couldn’t promise, but said he’d try to find a way to help. When I opened the FedEx box, there was a filter. Overnighted. Amazing.
Later in the day, 40 N95 masks showed up. I was able to split them up amongst teams at four different hospitals. More packages showed up with donations. More calls are made to find out what we need to do to keep each other going.
I let myself forget how crazy it is to be excited about basic protections today, and I feel bolstered. The pandemic won’t wait for things to be fair, and we can’t go back in time to be better prepared on a countrywide level. Talking about how things went wrong won’t make things right this time around. But we need to make sure everyone is aware of what we’re doing so that it doesn’t happen again. In the meantime, all we can do is try to take care of each other.
I feel intensely loved. I have a little clan of people who have truly rallied around one another. When they’re unwell, I check on their temperatures and their symptoms. Now, they check on my mental health and my PPE supply. Friends are getting donations for me and solving problems in creative ways. One is 3D-printing masks for our team. Another, a hairdresser, sent gloves and processing masks to use as hair covers, which would have never dawned on me. Another has sourced N95s for us, one of which I wore on my shift the other day. Another has raised $4,000 in a GoFundMe, all of which is going to purchasing masks for ERs and ICUs around the city. Many have done this while they’re not well themselves.
I have been tearing up all day. I see so much loss already. I’m heartbroken and scared. But then there are these people. I can’t name them here, but they know who they are. They’re my family. I always suspected I was lucky. Now I know it.
Dr. Keene, March 30
This is my fourth shift in a row, and it’s all starting to blur together. But today I am working in a non-COVID area of the emergency department. I’ve almost forgotten what it’s like to see nonrespiratory complaint patients.
Still, it is shocking how few non-COVID patients there are. The volume is much lower than I am used to seeing in the ER. Where did they all go? I guess they are actually taking heed of the quarantine and attempting to stay away from the hospital—wise choice. At this point, over 75 percent of the inpatients in the hospital either have or are suspected of having COVID. However, it also worries me that patients are attempting to stay away from seeing doctors, and it is particularly concerning that a lot of outpatient clinics are closed. I worry that because patients are delaying care, their presentations may eventually be more severe and further into their disease progress.
There are fewer and fewer beds available. We are all feeling the strain. Friends in EMS tell me of the surge in their call volume, from normally 4,000 per day to now 7,000 per day. But some help might be on the way: The USNS Comfort docked today and will be taking non-COVID patients soon. A temporary field hospital has been set up in Central Park, with 68 beds and 10 makeshift ICU beds. The Javits Center has been converted to a temporary hospital. The Billie Jean King National Tennis Center will be converted next.
So far, there have been more than 38,000 diagnosed cases of COVID in New York. I feel tired, and constantly fluctuate between being numb and being sad. All of a sudden, I hear a growing noise outside my window. It is 7 p.m., and New Yorkers are leaning out their windows and flooding their balconies, applauding and cheering on the front-line health care workers. Tears well up at this show of appreciation. Yes, this is my city, and I am honored to be able to help those in need.
Dr. Serino, March 29
Today was about preparation for tomorrow. Every day “off” is. If I can focus on my mental flow sheets, my contingency plans, my developing understanding of how the virus works, I can focus on things other than my stomachache. I spoke to infectious disease colleagues in another state today about a drug trial, and I gave them updates about what is and isn’t working for us here. Even as we learn, we can help other communities that aren’t yet hard-hit to prepare. I enjoy the collaboration. It feels like we are all in this together.
The rest of the time, I’m studying. Every day we learn more about how COVID-19 behaves. And the more we learn, the stranger it gets. Loss of taste and smell, but also myocarditis, but wait, maybe it causes a cytokine storm or maybe it doesn’t, and what is actually happening with the drug trials? Why isn’t anything really working? What will? I hold on to stories of extubated patients being discharged home as my lifeline to optimism.
Dr. Serino, March 30
I don’t have words for today.
I woke up for my shift at 5 a.m., and I’m heading to bed now at midnight. Everything hurts.
I feel like I can’t talk about this until tomorrow.
Dr. Serino, March 31
This morning I woke up thinking about yesterday. I slept a little. No nightmares this time—I was too tired, which was a relief. Yesterday the ER was packed. There’s no room on the medicine floors, so patients who are admitted are shoulder to shoulder with new patients. Every spare bit of square footage is packed with people. People on chairs. People on beds. People standing. Five people surrounding one IV pole so that everyone’s bags of fluids and medication can be hung. Everyone coughing and coughing and coughing. There are no hot zones anymore. Everything is a hot zone. Everyone is positive. Because there are no visitors, everyone is scared.
We’re scared, too. Supplies are scarce. I’m not just talking about protective equipment. Every available oxygen wall outlet was used. Every available O2 tank was used. But the patients keep coming anyway. For a half-hour, not a single additional oxygen supply was available, but there were three patients with extremely low saturations who all needed access to one. I saw the real challenge of our future in that moment. Not just caring for the thousands sick, but figuring out who could take a break from oxygen, how we could share it, who would have first priority access to the available noninvasive ventilator.
Outside, there is a refrigerated morgue truck. Patients come in, some die, and that’s where they go. Bodies are cremated because of infection risk. Families never get to see their loved one again. My colleague had to deliver a death notification by phone, something we are trained to never do. I’ve taught classes on how to deliver bad news. This isn’t the way. But now, in some cases, it’s the only way. I haven’t had to yet, but I’m sure it’s only a shift away.
We’ll lose colleagues to this virus. Both to illness and possibly to moral injury later. I worry about everyone’s mental health. It feels odd to say it, but it’s almost a relief now that I can see the wave about to crash. The anxiety of waiting is so much worse than the anxiety of action.
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