I’ve had hard conversations this week. “Look me in the eye,” I said to my neighbor Karen, who was spiraling to a dark place in her mind. “I make this personal promise to you — I will not let your children die from this disease.” I swallowed back a lump in my throat. Just the image of one of our kids attached to a tube was jarring. Two weeks ago our kids were having a pizza party and watching cartoons together, running back and forth between our apartments. This was before #socialdistancing was trending. Statistically, I still feel good about my promise to Karen because children do not seem to be dying from Covid-19. There are others to whom I cannot make similar promises.
A few days later, I got a text from another friend. She has asthma. “I’m just saying this because I need to say it to someone,” she wrote. She asked that if she gets sick and has a poor prognosis, to play recordings of the voice of Josie, her daughter. “I think it would bring me back,” she said. Josie is my 4-year-old’s best friend.
Today, at the hospital where I work, one of the largest in New York City, Covid-19 cases continue to climb, and there’s movement to redeploy as many health care workers as possible to the E.R.s, new “fever clinics” and I.C.U.s. It’s becoming an all-healthy-hands-on-deck scenario.
The sky is falling. I’m not afraid to say it. A few weeks from now you may call me an alarmist; and I can live with that. Actually, I will keel over with happiness if I’m proven wrong.
Alarmist is not a word anyone has ever used to describe me before. I’m a board-certified surgeon and critical care specialist who spent much of my training attending to traumas in the emergency room and doing the rounds at Harvard hospitals’ intensive care units. I’m now in my last four months of training as a pediatric surgeon in New York City. Part of my job entails waking in the middle of the night to rush to the children’s hospital to put babies on a form of life support called ECMO, a service required when a child’s lungs are failing even with maximum ventilator support. Scenarios that mimic end-stage Covid-19 are part of my job. Panic is not in my vocabulary; the emotion has been drilled out of me in nine years of training. This is different.
We are living in a global public health crisis moving at a speed and scale never witnessed by living generations. The cracks in our medical and financial systems are being splayed open like a gashing wound. No matter how this plays out, life will forever look a little different for all of us.
On the front lines, patients are lining up outside of our emergency rooms and clinics looking to us for answers — but we have few. Only on Friday did corona virus testing become more readily available in New York, and the tests are still extremely limited. Right next to my office in the hospital, a lab is being re-purposed with hopes of a capability to run 1,000 tests a day. But today, and likely tomorrow, even M.D.s do not have straightforward access to testing across the country. Furthermore, the guidelines and criteria for testing are changing almost daily. Our health care system is mired in situational uncertainty. The leadership of our hospital is working tirelessly — but doctors on the ground are pessimistic about our surge capacity.
Making my rounds at the children’s hospital earlier this week, I saw that the boxes of gloves and other personal protective equipment were dwindling. This is a crisis for our vulnerable patients and health care workers alike. Protective equipment is only one of the places where supplies are falling short. At our large, 4,000-bed New York City hospital, we have 500 ventilators and 250 on backup reserve. If we are on track to match the scale of Covid-19 infections in Italy, then we are likely to run out of ventilators in New York. The anti-viral “treatments” we have for Covid-19 are experimental and many of them are hard to even get approved. Let me repeat. The sky is falling.
I say this not to panic anyone but to mobilize you. We need more equipment and we need it now. Specifically gloves, masks, eye protection and more ventilators. We need our technology friends to be making and testing prototypes to rig the ventilators that we do have to support more than one patient at a time. We need our labs channeling all of their efforts into combating this bug — that means vaccine research and antiviral treatment research, quickly.
We need hospitals to figure out how to nimbly and flexibly modify our existing practices to adapt to this virus and do it fast. Doctors across the globe are sharing information, protocols and strategies through social media, because our common publishing channels are too slow. Physician and surgeon mothers are coming together on Facebook groups to publish advice to parents and the public, to amplify our outrage, and to underscore the fear we feel for our most vulnerable patient populations, as well as ourselves and our families.
Please flatten the curve and stay at home, but please do not go into couch mode. Like everyone, I have moments where imagining the worst possible Covid-19 scenario steals my breath. But cowering in the dark places of our minds doesn’t help. Rather than private panic, we need public-spirited action. Those of us walking into the rooms of Covid-19-positive patients every day need you and your minds, your networks, your creative solutions, and your voices to be fighting for us. We might be the exhausted masked face trying to resuscitate you when you show up on the doorstep of our hospital. And when you do, I promise not to panic. I’ll use every ounce of my expertise to keep you alive. Please, do the same for us.
Reference: The New York Times
