Wake up at 6.30am. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks, too. It’s all closed. On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it’s early. Regardless, that’s good.
Walk in for your 8am shift: Struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.
You take sign-out from the previous team, but nearly every patient is the same, young and old: cough, shortness of breath, fever. The staff is really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast.
You immediately assess this patient. It’s clear what this is and what needs to happen. You have a long and honest discussion with the patient, and with her family over the phone. It’s best to put her on life support now, before things get much worse. You’re getting set up for that when you’re notified of another really sick patient coming in.
You rush over. He’s also extremely sick, vomiting. He needs to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10am.
We were too late to stop this virus. Full stop. But we can slow its spread. The virus can’t infect those it never meets. Stay inside. Social distancing is the only thing that will save us now.
For the rest of your 12-hour shift, nearly every hour, you get paged. Stat notification: Very sick patient, short of breath, fever. Oxygen 88 per cent. Stat notification: Low blood pressure, short of breath, low oxygen. Stat notification: Low oxygen, can’t breathe. Fever. All day ...
Sometime in the afternoon, you recognise you haven’t had any water. You’re afraid to take off the mask. It’s the only thing that protects you. Surely you can last a little longer — in West Africa during Ebola, you spent hours in a hot suit without water. One more patient ...
By late afternoon, you need to eat. The restaurant across the street is closed. Right, everything is closed. But thankfully the hospital cafeteria is open. You grab something, wash your hands (twice), cautiously take off your mask and eat as fast as you can. Go back. Mask up. Walk in.
Nearly everyone you see today is the same. We assume everyone is infected. We wear gowns, goggles and masks at every encounter. All day. It’s the only way to be safe. Where did all the heart attacks and appendicitis patients go? It’s all COVID-19, the disease caused by the novel coronavirus.
Hospitals running out of ventilators
When your shift ends, you sign out to the oncoming team. It’s all COVID-19. Over the past week, we’ve all learned the signs — low oxygen, abnormally low lymphocytes, elevated protein fragments known as D-dimer. You trade messages with doctor friends throughout the city without PPE, personal protective equipment. Hospitals running out of ventilators.
Before you leave, you wipe everything down. Your phone. Your badge. Your wallet. Your coffee mug. All of it. Drown it in bleach. Everything in a bag. Take no chances. Still, you aren’t sure you got it all. Wipe it down again. Can’t be too careful.
You walk out and take off your mask. You feel naked and exposed. It’s still raining, but you want to walk home. It feels safer than the subway or bus, plus you need to decompress. The streets are empty. This feels nothing like what is happening inside. Maybe people don’t know?
You might hear people saying it isn’t real. It is. You might hear people saying it isn’t bad. It is. Do your part. Stay home. Stay safe. And every day, I’ll come to work for you.
You get home. You strip in the hallway. (It’s OK, your neighbours know what you do.) Everything in a bag. Your wife tries to keep your toddler away, but she hasn’t seen you in days, so it’s really hard. Run to the shower. Rinse it all away. Never happier.
Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don’t stop. Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be “stat” notifications. More will be put on a ventilator.
We were too late to stop this virus. Full stop. But we can slow its spread. The virus can’t infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don’t care as much about the economic impact as I do about our ability to save lives.
You might hear people saying it isn’t real. It is. You might hear people saying it isn’t bad. It is. Do your part. Stay home. Stay safe. And every day, I’ll come to work for you.
— Craig Spencer is director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Centre.
