My initial thought: “What did I get myself into?”
Reflections of a volunteer doctor at a New York City hospital
The first time I walk into the ER, I stop for a second to collet myself. The room is jam-packed with patients whose faces are covered with masks blowing air into their lungs. They lie stiff and uncomfortable on stretchers, two to a bay that is designed to fit only one.
My initial thought: “What did I get myself into?”
The first patient that I see is an elderly woman lying almost invisibly in the corner of a room. I ask about her breathing and she mouthes “it’s okay.” I can barely hear her over the oxygen mask she is wearing. I ask her if she would want a breathing tube if her condition were to worsen. She mumbles. I cannot hear her over the surround-sound cacophony of alarms and CPAP machines. I kneel and lean in and repeat the same question. She says “no, I don’t want no tube.” Then, I suddenly realize that my face is only inches away from hers. I jerk back. I think to myself, “this N95 better fucking work.” I feel a pang of guilt.
Day after day, it is the same thing. Low oxygen level requiring oxygen support. X-ray with bilateral interstitial infiltrates. Elevated inflammatory markers. On my last day, I tell half jokingly and half exasperatedly to my team during the morning rounds, “yea, we don’t need to look at the x-ray. I’m tired of looking at the x-ray. They all look at the same. It’s all COVID.”
A nurse calls me to a patient’s room because one of my patients is struggling to breathe despite being on the maximal oxygen support short of intubation. It’s the elderly woman that I saw in the ER. I get to the room and call my resident, “hey can you come over here? Ms. X is not doing well.” His response, “umm, I can’t. I am running a rapid response on another patient.”
Later that day I call my friends from residency and try to describe what it’s like here. “Do you remember your worst day of residency where patients after patients decompensate all day? Yea, it’s like that here, but every single day.”
Initially I am taken aback by the scene of congregated bodies in white bunny suits near a patient’s room. It almost always means something bad is happening. A patient’s breathing is worsening quickly, they are coding (i.e. being resuscitated), or getting intubated. In some sense, there is little difference between the three. The chances are, that they will all die sooner or later.
After a couple of days, I see multiple of these groups on the same floor at the same time, and it barely slows my pace.
On a slightly different note, every health care worker is covered head to toe with PPEs. From top to bottom: a hairnet, goggles or a face shield, a surgical mask over an N95, a gown over a bunny suit, gloves, and shoe covers. It’s great that everyone’s well protected. The downside: I still don’t know what some of my colleagues look like; I probably won’t recognize them if I ran into them on the street a couple of years from now.
That elderly patient who did not want to be intubated die later that day. With one hand I hold her hand. With the other, I hold my phone next to her face so that her brother can talk to her as she takes her last breath. I can barely hear the brother repeating “I’m so sorry I can’t be there, I’m so sorry” over his cracked wailing voice. Tears drip down from the eyes of my lifeless patient who has been unconscious for a while now. There is no way her brain has been getting enough oxygen for her to know what’s happening. But I can’t help but think that she knows that she is dying and she hears her brother’s voice. This shakes me, hard.
To be fair, it’s not all death and gloom. Some patients get better and go home. The eldest patient I discharge from the hospital is 90 something years. I remember seeing on the internet that in some hospitals staff line up, clap, sing, and dance as patients leave the hospital. No one claps for my patients when they leave the hospital, but I wish we did.
On my last day, I stop myself for the second time when walking into the ER. There is only one stretcher per bay. Some of the stretchers are empty. It’s eerily quiet and civil in the ER. I talk to an ER attending who says “yea it’s been getting better everyday. Hopefully it will stay this way and this is it.”
This makes me feel less guilty about having to go back to California. On my flight back to San Francisco, I browse through the comedy section and pick the dumbest movie I can find. I press start and put my earphones in.
