from the talk of the town section of the april 13th new yorker,
for ten years, i've been an attending emergency-medicine physician at brooklyn methodist hospital, in park slope. as e.r. doctors, we pride ourselves on being cool in a crisis. after years of practice and training, i have become desensitized to the blood, the urine, the feces, the vomit, and the screaming. it's rare that i ever feel stress, despite all the crazy things i've seen. things can get loud and out of control. if you demand silence, it completely changes the energy in the room. but this cool, it's a learned behavior. there's an adage from samuel shem's novel of hospital life, "the house of god," that your first procedure at a cardiac arrest is to check your own pulse. but now, in the time of pandemic, we may be finding ourselves tachycardic.
there are sixty-odd hospitals in the city, and all of us who work in them are approaching the point of being overwhelmed. somehow, my biggest fear now, with the covid-19, is that this learned ability to be cool and collected will get lost. i don't feel that way yet. but we're getting there.
as the pandemic ramps up, i'm working twelve-hour shifts, six days a week. i've picked up extra shifts to cover for doctors who are already sick. during a typical shift, you might intubate one patient who is critically ill. three would be a lot. on my last shift, we intubated ten. each day now, we're turning away hundreds of patients who definitely have the symptoms of covid-19. even when patients come in with an unrelated trauma that requires a chest x-ray, you incidentally find they've got it. the extent of community spread is unreal. you begin to realize that, without comprehensive testing, we are radically under-estimating the spread of this virus.
planning for disasters is part of emergency medicine. we run drills for events like a bomb in the subway or, yes, a pandemic respiratory illness. when they're over, all the participants invariably pat themselves on the back for how well they did. but, no matter how much you plan, reality is different. you think you're ready. then reality comes. and you're not.
during the ebola outbreak, we practiced "donning and doffing" --the art of putting on and taking off you p.p.e., personal protective equipment. you have to apply your gown, gloves, and mask in such a way that you are completely protected. while examining the patient, you become coated with viral particles. so, when you remove your p.p.e., you have to be careful not to contaminate yourself. it's not easy. now there is a national shortage of p.p.e. --but no shortage of infected patients--and some doctors and nurses are wearing a disposable mask and gown for an entire shift.
if our intensive-care units get overwhelmed, we're going to be faced with some difficult choices. and we aren't used to that in this country. traditionally, the american medical system is focused on aggressive healing at all costs, sometimes in the face of medical futility to the detriment of the patient's comfort. when i rotated through the i.c.u. as a resident, i had a patient with an overwhelming bacterial infection. she had been bed-bound, non-verbal, and ventilator-dependent for a decade. i tried to have a discussion with her daughter about end-of-life care. the daughter simply said, "my mother survived auschwitz. who am i to put an end to her life?" in this brave new world of covid-19 infections, a nursing -home patient like this is at particular risk. will we be forced to shift the emphasis of our bioethical values away from our "do everything" approach?
emergency rooms are the country's safety net. we work around the clock, and we're proud to take care of people no one else is taking care of. and yet, for the first time in my career, i feel truly appreciated by society. the mood at work has changed. before this, it was not uncommon to be cursed at by--understandably--angry, stressed people who are in pain and tired of waiting. i always joke that you want to be ignored in an emergency room. if everyone's ignoring you, then you're probably not sick enough to warrent immediate attention. if, instead, you see a lot of e.r. doctors getting really excited and paying a lot of attention to your case, then you should probably be a little nervous. the patients who now need me most can't speak. they're gasping for breath. or they're "altered"--they're out of it mentally, either from lack of oxygen or from direct viral infection of the brain.
there is something psychologically taxing about working a day shift at the e.r. no matter how hard you work, the day just keeps getting more and more intense--more patients, more illness--until you reach a crescendo of misery, and you walk out the door completely spent. on a night shift, you come into the e.r. at its busiest and most chaotic. people are screaming, someone is running naked through the department, all hell is breaking loose. but you take this chaotic landscape and transform it. things begin to taper off at midnight. patients get admitted. most have gone home. and, when the shift's over, you walk out into the morning light.
this morning, on my way home, i went into someplace to get a cup of coffee. a woman saw me in my scrubs and insisted on buying my coffee. after years of being abused in the e.r., it's amazing the appreciation people have shown. the e.r. is flooded with food that people are sending us: thai, turkish, regular pizza, fancy pizza. and, this being park slope, a nice kale salad, too. there's so much food around now that one of the residents said we're all going to gain the "covid-15."
by jessica van voorhees
for an earlier article from the
new yorker about the current situation (march 23rd) click
here.
dinner was ditalini with chicken broth, parsley, celery, garlic and parmesano.
