On the night that UK Prime Minister Boris Johnson became the first world leader to be admitted into an Intensive Care Unit in St Thomas Hospital in London, viewers in the United Kingdom were given a rare glimpse of what life is like for doctors working at the frontline of the Covid-19 epidemic when cameras were allowed into the hospitalâs ICU. Tired doctors wearing, gowns, masks and plastic shields in front of their faces were milling around where patients were lined up close to each other. Most were lying on their fronts, sedated as mechanical ventilators kept their breathing going. It took five or six doctors just to turn one patient around. They looked harrowed, tired to the bone, worried about those into their care. And at that stage, they were given the unenviable task of trying to keep Britainâs No. 1 citizen, Boris Johnson alive as he struggled against the virus and was developing breathing problems. In some countries, doctors are gagged and not allowed to give their own account of what is going on in the wards where doctors are trying to stem the onslaught of the coronavirus; but many others have taken to social media to share their experiences. One of them is Craig Spencer, a New York doctor who survived the Ebola virus in 2014, who says he fears Covid-19. Spencer shared an audio clip of what he is experiencing and how it compared to the Ebola crisis on Twitter. The Wall Street Journal details more of what a day in the life of doctors in an ICU or Emergency Room looks like. It is not an easy read, but for South Africa that is nowhere near the crisis that is unfolding in the United States and Europe; it serves as a warning to heed lockdown restrictions before it gets this serious. As Dr Spencer says on his Twitter page; â We will BBQ in the park. We will have birthday parties on the river. Just not right now. Please. Stay Home. Save Lives. Still.â â Linda van Tilburg
The coronavirus crisis in doctorsâ own words: âA flood of death that I cannot manageâ
By Joe Palazzolo and Anthony DeRosa
(The Wall Street Journal) – As doctors, nurses and other health-care professionals face an unrelenting flow of patients through their hospitals, theyâve taken to social media to share their experiences. The raw emotions and visceral descriptions of what they are enduring comes through in countless posts on Twitter, Facebook, Instagram and other platforms.
___STEADY_PAYWALL___
Many call the fight against the new coronavirus unlike any other health crisis they have faced in their careers. In the words of one doctor, it is âunprecedented and dire.â Another wrote on Twitter, âI survived Ebola. I fear #Covid-19.â Amid the alarm, doctors and nurses have recounted extraordinary efforts among their colleagues to pull together and find creative ways to care for the sick under difficult circumstances.
Some medical professionals have also turned to the internet to voice frustrations with the government response to the pandemic, highlighting shortages of critical supplies and protective gear, and calling on policy makers to take speedier and more drastic action.
The Wall Street Journal is gathering and sharing some of those dispatches here, lightly edited for clarity, to show how U.S. health workers are directly addressing the public about the crisis.
Leora Horwitz
Director, Centrr for Healthcare Innovation and Delivery Science, NYU Langone, New York
After a week on #Covid-19 service, I have some non-clinical reflections for #hospitalists. This is NOT your regular ward time. Iâll be honest, it was a tough week. Iâll start with the tough stuff. But stick with me â ending with more positivity and some helpful hints.
The need for constant vigilance was exhausting. I felt pretty safe in patient rooms with gown, mask, gloves. But on unit, constantly reminding myself to open doors with a paper towel, wipe computer/phone with bleach before using, not touch face: v. tiring.
The frustration of knowing certain patients were going to deteriorate and not being able to do anything about it except watch it happen was very tough emotionally. Iâve been spoiled by modern medicine â in general, Iâm not used to feeling quite so helpless.
The emotional toll of seeing sick, terrified patients without any visitors was also high. Made it my top priority to get deteriorating patients to call/video chat family before too late. Sometimes this took hours and use of my own Skype account.
The visiting policy was very hard on families too. They were frantic trying to reach staff to find out what was going on. Our operators overwhelmed. Gave my personal cell to families of the sickest patients.
Also, everything took so much time. Assume donning+doffing takes 5 min per room entry â with 17 patients on unit thatâs 1.5 extra hours just to see everyone once, let alone more often if sick or to see new arrivals after old ones transferred. My days were much longer than usual.
âMade it my top priority to get deteriorating patients to call/video chat family before too late. Sometimes this took hours and use of my own Skype account.â
I rented an apartment for the week as I live far from hospital and also wanted to keep my family safe. This was lonely and I missed my kids/husband.
On the plus side: this is a great stint for those of you (like me) who are medical minimalists and #ChoosingWisely fans. On my 58 patients I ordered: 0 CTs, 0 echos, 0 ultrasounds. Turns out, you donât really need them and minimises iatrogenic spread [transmission of a pathogen through medical treatment] and staff exposures.
Also, the goals of minimising room entry and maximising situational awareness prompted an outburst of creativity. Partway through the week some nurses had the bright idea of writing the info we most cared about right on the doors: oxygenation.
Some tips: ditch the rings, the watch, the white coat, the necklaces, the dangly earrings. First time in 18 years I havenât worn my wedding ring. Weird feeling. But made donning/doffing much safer & easier. I got to pretend #ILookLikeASurgeon!
More tips: A snack bag size ziplock is perfect size for an iPhone. Put it in a clean one every morning. Touchscreen, microphone work just fine through it. Wipe it down with bleach wipes periodically. Discard bag at night to have clean phone in home. (Explains blurry pics.)
Final tip: Hack the EHR. Make a dedicated Covid note template (history/plans monotonously similar). Reconfigure patient list to add crucial info like oxygenation and Covid test result. (Adding O2 was game changer for helping me track sickest patients.) Use Covid order sets.
Lastly, lean on your colleagues. Such amazing support here by hospitalist director @KHochmanMD and the rest of our non-twitter hospitalists; heroic ICU group incl @StermanDaniel @SamParniaMDPhD (& many nontwitter peeps) plus @PaulTestaMD and terrific MCIT team
â Posted on Twitter March 30
Colleen Farrell
Internal medicine resident, NYU Langone and Bellevue Hospital, New York
I started caring for coronavirus patients two days ago at Bellevue Hospital in NYC. If any place could tackle a new pandemic, it is Bellevue. The oldest public hospital in the country, it has tackled tuberculosis, the AIDS epidemic, 9/11, Hurricane Sandy, and Ebola. Our most senior clinicians are saying what is obvious to anyone on the front lines right now: Covid-19 is unprecedented and dire.
My first coronavirus patient was in his 50s, some chronic but not major medical problems, feeling lousy for a few days. Then his oxygen levels started dropping. The fear in his eyes will be forever seared into me. Not long after he was admitted to the hospital, we had to move him to the ICU where he was intubated. I called his family to tell them. They were also coming down with symptoms. They will not be able to visit him. Only time will tell if they will ever see each other again.
He stood out to me because he was the first. But others just like him have been pouring through our hospital doors at ever increasing rates. I know our hospital leadership is brilliant, innovative, and dedicated to the most vulnerable patients in New York. They are rapidly deploying creative solutions. But time is not on our side.
I feel grateful that I am able to put my training to public service. I donât do well being cooped up at home. I became a doctor to do this work. But I would be lying if I said I wasnât scared. I am calm and committed, but also deeply, deeply terrified.
Most people in todayâs America donât know what death looks like. Whats the difference between 10, 100, 1000 deaths? Numbers are so sterile and removed. Death itself is hidden in hospitals and nursing homes.
As doctors, we know what death looks like. During normal times, when family members fall into our arms over their lost loved ones, it pains us. We try to debrief each death. We spend time with each family. We call chaplains and palliative care doctors. We ask for bereavement services. We help families call funeral homes.
I am bracing myself for a flood of death that I cannot manage. Phone calls to family members who never got to say goodbye. Young people (60 is young in my book, for the record, and this is affecting people much younger than that too) living their lives and then snatched away. Bodies of patients I never got to know because they were one more case of Covid and it was too dangerous for me to go to their bedside, hold their hand, and learn about their life.
Never in my life have I experienced anything like this, at all. It feels like what I imagine war to be like. In a very real sense, my life is at risk. I work with doctors and nurses and other providers much older than myself with chronic medical problems whose lives are in real danger as they work tirelessly to save others.
âThose already living in poverty, incarcerated or homeless have limited means to keep themselves safe. Injustice has a way of compounding during epidemics.â
I want to end this missive with something useful and hopeful. Obviously, wash your hands, donât touch your face, and STAY HOME FOR THE LOVE OF GOD. But beyond that.
I return to my guiding principles in medicine and in life: love and justice. We cannot know who amongst us we will lose in the coming months. Even if life itself is not lost, so much of what gives life joy and stability have already been disrupted. My advice is to reach out to those you love, even just to say âIâm thinking of you.â
This crisis will not harm all people equally. Those already living in poverty, incarcerated, or homeless have limited means to keep themselves safe. Injustice has a way of compounding during epidemics. Use your voice and whatever privilege you have to fight for those who most need help right now. Here in New York, we desperately need housing solutions for our homeless patients. We need folks released from Rikers where coronavirus is already spreading. [Editorâs note: The first inmate died from Covid-19 on Sunday at the jail complex, where officials have moved to reduce the population amid mounting infections.] Poor families need cash help. Other folks can chime in with suggestions for advocacy.
These are tragic times, thereâs no doubt about that. But out of tragedy can come opportunities for connection, solidarity, love and justice that we never before imagined.
sending love to you all,
Colleen
â Posted on Facebook March 20
Craig Spencer
Director of global health in emergency medicine, New York-Presbyterian/Columbia University Medical Centre, New York
A Day in the Life of an ER Doc – A Brief Dispatch from the #Covid-19 Frontline:
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. Itâs all closed.
On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or itâs early. Regardless, thatâs good.
Walk in for your 8am shift: Immediately struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyoneâs protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.
You take signout from the previous team, but nearly every patient is the same, young & old:
Cough, shortness of breath, fever.
They are 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. Itâs clear what this is, and what needs to happen. You have a long and honest discussion with the patient and family over the phone. Itâs best to put her on life support now, before things get much worse. Youâre getting set up for that, butâŚ
Youâre notified of another really sick patient coming in. You rush over. Theyâre also extremely sick, vomiting. They need 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. Itâs not even 10am yet
For the rest of your shift, nearly every hour, you get paged:
Stat notification: Very sick patient, short of breath, fever. Oxygen 88%.
Stat notification: Low blood pressure, short of breath, low oxygen.
Stat notification: Low oxygen, canât breath. Fever.
Sometime in the afternoon you recognize you havenât drank any water. Youâre afraid to take off the mask. Itâs 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 patientâŚ
By late afternoon, you need to eat. 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, & eat as fast as you can. Go back. Mask up. Walk in.
Nearly everyone you see today is the same. We assume everyone is #Covid-19. We wear gowns, goggles, and masks at every encounter. All day. Itâs the only way to be safe. Where did all the heart attacks and appendicitis patients go? Its all Covid.
When your shift ends, you sign out to the oncoming team. Itâs all #Covid-19. Over the past week, weâve all learned the signs – low oxygen, lymphopenia, elevated D-dimer.
You share concerns of friends throughout the city without PPE. 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.
Sure you got it all??? Wipe is down again. Canât be too careful.
You walk out and take off your mask. You feel naked and exposed. Itâs still raining, but you want to walk home. 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 donât know???
âYou might hear people saying it isnât bad. It is. You might hear people saying it canât take you down. It can. I survived Ebola. I fear Covid-19.â
You get home. You strip in the hallway (itâs ok, your neighbours know what you do). Everything in a bag. Your wife tries to keep your toddler away, but she hasnât seen you in days, so itâs really hard. Run to the shower. Rinse it all away. Never happier. Time for family.
You reflect on the fact that itâs really hard to understand how bad this is – and how bad its going to be – if all you see are empty streets.
Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens donât 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 itâs spread. The virus canât infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I donât care as much about the economic impact as I do about our ability to save lives
You might hear people saying it isnât bad. It is.
You might hear people saying it canât take you down. It can.
I survived Ebola. I fear #Covid-19.
Do your part. Stay home. Stay safe.
And every day Iâll come to work for you
â Posted on Twitter March 24
Stephanie Haimowitz
Emergency medicine physician, Jacobi Medical Centre, Bronx, NY.
Dear Rabbi Rothwachs,
I hope this email find you well and that you and your family are feeling good. I would firstly like to thank you and the entire RCBC for your bulletin to the Bergen County Jewish community regarding social distancing and the closing of the shuls [synagogues]. I know it was not a decision that was made lightly.
As an Emergency Medicine Physician, I am on the âfront linesâ of this pandemic, and quite frankly I am scared by what I am seeing. Over the past 10 days, I have witnessed first hand how quickly this pandemic has evolved. We in the medical community are in agreement the worst is yet to come. We anticipate that over the next 30-45 days we will see an even more massive influx of patients with the disease ranging from the worried well to the critically ill who will require intubation and ventilatory support in our intensive care unit. As it stands, we do not have the resources to support this, which is why I am reaching out to you to ask you for your help.
Pesach [the Jewish holiday of Passover] is swiftly approaching and with it comes travel and family time. Many people have plans to host their elderly parents and/or their children and grandchildren. I cannot stress enough how dangerous this is. With every passing day we learn how varying the presentation of illness can be and there are asymptomatic carriers who can transmit the virus. It is getting increasingly more difficult to say with any real degree of certainty who has the virus and who does not in the absence of widespread testing. We therefore cannot conclude that it is fine for families to get together provided no one has any symptoms or a fever.
In fact, the medical community itself has not come to a consensus as to what they consider true symptoms and how to distinguish Covid-19 from any other condition based solely on clinical presentation. As an example, I recently had a patient whose only symptoms were diarrhoea and a fever. He is Covid+ and currently in our ICU. When we first discussed the case with infectious disease on call for our hospital, he was declined for testing due to his lack of respiratory complaints despite a CT scan of his lungs that appeared to be consistent with Covid-19. After much arguing and a repeat phone call he was accepted for testing. This patient presented 6 days ago. In just 6 days, we have changed the way we think about this virus and are learning that it can present with anything.
And to the people who will say âbut this is a disease of the elderly or those with pre-existing conditionsâ I have some very sobering information. While the overwhelming majority will likely be okay, we are seeing more and more cases every day of young and otherwise healthy people who are requiring ventilators and ICU admissions. The man in the example above is 45 years old with no other medical problems.
There is another patient in his early 30âs in our ICU. I know of cases in Brooklyn, Seattle, Westchester, and other Bronx hospitals with intubated patients in their 20âs, 30âs, and 40âs who have no other medical problems. The good news is that most of the data coming out of other countries and Seattle (they were a few weeks ahead of us) is that most of these young patients ultimately survive. But ventilators and ICU beds are not unlimited. We can and will run out at this rate.
âThere is no class in medical school on how to tell a family that their son or daughter is less deserving than someone elseâs family member, or that grandma has had a good run.â
My friend at one Bronx hospital had to intubate (put on a ventilator) 10 patients over a 48 hour period. My hospital has the capacity for approximately 35 intubated patients. I give you these numbers to help you understand how rapidly our resources are being depleted. When we run out, my colleagues and I will have to start making impossible decisions. We will be forced to decide who will receive these potentially life saving interventions.
There is no training for these kinds of decisions. There is no class in medical school on how to tell a family that their son or daughter is less deserving than someone elseâs family member, or that grandma has had a good run and so letâs give someone else a shot at a long life. I pray it does not come to this.
But without your help, this nightmare will become my reality. And so I urge you to speak with the members of the RCBC to help us flatten the curve. This is not business as usual. Members of the Bergen County Jewish Community need to understand that this virus is everywhere and if we do not continue with our social distancing we will be faced with more heartbreaking situations than a lonely Pesach Seder.
I understand that for many, logistically, this will be a tremendous burden. But our community is strong and together we can lessen the load. Perhaps we can speak with restaurants and caterers about providing affordable kosher for Pesach packages to the elderly or families whose plans are being changed at the last minute. We can create message boards for people making Pesach for the first time to post questions or recipes. We can still be connected without physically being together. It will just require some creative ideas and out of the box thinking. Maybe we can explore how we can use technology to create a sense of togetherness while still remaining faithful to Halacha [Jewish religious law] and our traditions.
I will lead by example. My husband and I will be spending this Pesach just the two of us. My grandmother will be staying home alone in her house in New Jersey. My parents will be sitting at a big empty table come Leil Pesach. But if we act now then the hope is that next year my parentâs table will once again be crowded with their children and grandchildren bumping elbows and spilling wine and making matzoh crumbs while belting out off key tunes to our favorite Pesach seder songs.
Please help me in ensuring the safety of the people and community I love. I may possess the medical knowledge but without your leadership echoing my words they will fall on deaf ears.
May we be zocheh [worthy] to live long and healthy lives and may our community continue to be a source of strength to anyone who needs it during these most trying times.
Respectfully,
Stephanie Haimowitz, MD
Attending Physician
â Posted on Facebook March 20 by user Larry Rothwachs
Nurse practitioner
San Francisco
Thanks for the well wishes and love from friends and family, I am on the mend! A lot of you have been asking me about my signs and symptoms so I thought I would share my experience and what helped:
Day -2: Symptomatic patient coughed in my mouth during an exam without PPE
Day 1: of symptoms I work up very tired, uncharacteristically slept 10 hours, felt like I was âcoming down with somethingâ. Was able to go to see patients (used social distancing and PPE) for a few hours but started feeling like I was floating, my throat started hurting and started taking Dayquil/Nyquil.
Day 2-5: was basically bedbound in my room, very tired with body aches and fatigue (worst flu I have ever had). I had an intermittent low grade fever (we were unable to get a thermometer but I could tell by some sweats and chills). I only had energy to get up to the bathroom and make basic food. At this point I took Dayquil/Nyquil and Mucinex, I slept 12 hours a night.
Day 3: I demanded a Covid test from Kaiser and did drive through testing.
Day 6: Feeling better, got the news that my test was ânegativeâ even though I had textbook symptoms for someone my age. Was able to go for a walk around the lake, social distancing.
Day 12: was able to breathe without pain, now using a short and long-inhaler, mucinex, dayquil/nyquil and an antihistamine called CHLORPHENIRAMINE MALEATE or Wal-finate ( Walgreens brand).
Today is day 13 and although I donât have much energy I think the worst is behind me. If I had to do it again I would have taken Mucinex religiously from onset of symptoms, to clear out mucus so hopefully it does not get in your lungs. Some experts have recommended even gargling with mouthwash to try and kill the virus in your throat nightly when sick.
Covid-19 starts in your throat and after initial symptoms and fever goes to your lungs, cough is a LATER symptom.
I would have already had a thermometer, and I would have a PULSE OXIMETER and vaporizer already at home. When I was having trouble breathing it would have been nice to know that my capillary oxygen was high.
I am a 33 year old healthy person who exercises regularly (swimming, hiking, running) and who does not smoke anything with regularity, and I can say with confidence that Covid rocked me and made me the sickest I have been in my adult life.
The main takeaway is that even though my test was ânegativeâ, I actually had it. So everyone that has any symptoms of Covid should self isolate for 14 days and assume that they have it.
â Messages shared in a private text-chat March 22
Anne Podalanczuk
Attending physician, New York-Presbyterian/Columbia University Medical Centre, New York
Today I told a 28 year old that he needs intubation. He was scared. Couldnât breathe. I told the wife of a 47 year old that he is dying over FaceTime. I bronched [performed a bronchoscopy on] a #Covid-19 patient who mucus plugged. It saved his life. Risked mine.
I walked through the ED as the ambulances kept rolling in, bringing more patients with sats in the 60s. I worked with an amazing team of residents, fellows, nurses and respiratory therapists. Iâm completely humbled by their heroic effort and teamwork.
I returned home on empty streets past shuttered store fronts. In time to have dinner with my family for the first time this week. Hoping that I wonât make them sick. This is our new normal. #NYC we will get through this.
â Posted on Twitter March 28
Write to Joe Palazzolo at [email protected]
