As Covid-19 has developed over the course of the past months, weeks, and days, our plans have changed and so have our lives. And it appears this will be the norm for a while. In this series (duration: a few weeks to…not sure?), we’ll share the stories of people who have confronted the unexpected in interesting ways. Today, we have a New York City-based ER doctor, who is staying in an apartment a few blocks away from his wife and child, to protect them from exposure to the virus he’s working around the clock to treat. —Mallory
I’m an ER doctor in New York City, so on a typical day I take care of all sorts of problems. One moment, I could be treating someone with a heart attack or stroke, and the next minute I could be helping someone figure out whether they’re pregnant or helping someone who’s fractured their arm and needs a splint. The day kind of goes like that—from true emergencies to more mundane or benign complaints. It’s part of what makes our jobs as ER doctors interesting and exciting.
I noticed things were starting to change while working a specific overnight shift about a week and a half ago. I realized there were no other cases in the emergency room. I was no longer seeing that variety of complaints. Everybody had the same symptoms—a fever, a cough, body aches, chills, severe fatigue, and weakness. It’s gotten to the point where it seems like every single person is coming in with the exact same malady, and there’s very little variability now in the care I provide. It’s really quite stunning, because part of what we love as emergency doctors is the unknown, and now these symptoms are part of our daily routine.
Once I realized that the coronavirus was probably everywhere, and every patient and really any interaction outside the house was a possible exposure, my wife and I talked about what we can do to protect each other and our son. Overall, I would say we’re still in the lower-risk category—we definitely see a lot of young people get sick from coronavirus, but those cases are less common than the 70-year-old with multiple medical conditions. That said, we want to make sure we’re not getting sick at the same time. Taking care of a toddler when we’re sicker than we probably have ever been in our lives is not something we can feasibly do.
I’ve talked to a lot of families where both parents are sick, and they’ve said that taking care of their children is the hardest part of all this. So, in order to not take any chances and to not be patient zero in my household, we rented an Airbnb apartment a few blocks away where I’ve been staying for about two-and-a-half weeks now. I just extended it for another couple weeks so we have a safe place for me to stay. I think I was one of the first doctors or nurses to do this. But as the weeks have progressed, I now know of at least half a dozen to a dozen colleagues who are in the same boat. They’ve either sent their kids away or have rented apartments. Now our hospital is providing some limited housing, and there are also hotels opening up rooms at discounted rates for hospital workers.
To keep in touch, we do a lot of Zoom. Last night, we played Taboo with a group of friends, which was an interesting experience, but it worked. I also keep in contact with my work colleagues this way. We have Zoom meetings to keep ourselves grounded and talk about how things are going across the country. There are also text message threads and FaceTiming. I’m probably communicating with my friends outside of work a lot more than I would on a normal basis.
Usually, when I’m at home, I’m woken up by my toddler kicking me or crying at 6 or 7 in the morning. You’d think I’d actually be getting better sleep when I’m sleeping at an Airbnb on my own. But I find that I’m waking up in the middle of the night, almost every night, around 2 or 3 a.m., feeling very anxious, worried about what the day is going to hold. I don’t remember ever feeling these feelings of doom. I don’t go to work afraid —I go to work thinking I have a job to do, and it’s my responsibility to take care of these patients, which is what I signed up for. It sounds cliche, but we’re taught to run toward danger as emergency doctors. We put our heads down, but we’re shocked, consistently, on a daily basis, about how bad things are getting or can get.
If you look at the recent maps that have come out depicting the impact by borough and by neighborhood, they show that the virus is disproportionately affecting the poorer communities in the Bronx and Queens. I think the [numbers are going up for lower-income people] because as people get poorer, they live in larger family households. We know from China that much of the transmission, early on especially, was happening in households. Another component is whether low-income communities are getting the right messaging. Do they have access to the same experts telling them to stay home? They also often have to work hourly jobs to survive, so many of them are doing work like delivery or construction with much more frequency. And then finally, there’s usually less access to care in those communities, so you could have a 40-year-old with uncontrolled diabetes because they don’t get to see a doctor with the same regularity as someone who lives on the Upper West Side or the East Village. The inequality is pretty stark.
Our hospital has been very progressive in terms of how they’re protecting us. We’ve been wearing masks and goggles at all times in all clinical areas for the past three weeks. We clean our goggles after every patient interaction and we try to exchange our masks as often as we can, especially if they get wet or visibly soiled. Many of us are wearing N95 masks the entire time we’re on-shift and then covering those with regular procedure masks—that way we can keep one N95 the whole shift and then just exchange the procedure mask that covers it. We also wear gowns for every patient interaction, and we exchange those gowns between patients. Even if I’m sitting at my computer, I’m still wearing goggles and a face mask at all times. We wash our hands excessively. My hands are raw. I have skin breakdown on the entirety of my left and right hands and wrists, just from scrubbing and washing my hands so frequently. We have indentations on our faces from wearing the masks 12 hours a day. Despite that, we are still getting sick sometimes. We’re human. Sometimes people will take off their goggles and forget and maybe rub their eye with their hand.
I think one problem that the public may not be aware of is that we’re focused on New York City right now—pouring in resources, talking about ventilators, staff coming from across the country to help us. Those things are very important, but I think in the next week or two we’re going to realize that it’s not just New York that needs help. There are cases in New Orleans that are hitting the news, Philadelphia, Detroit. You can always isolate New York State and New York City and pull resources and get ventilators and staff here, but what happens to those areas that are not yet at the same level of pandemic as we are? What happens when we have not one or two cities that are seeing a tremendous spike in cases and it’s now a national issue?
The other thing that I think is helpful to pass on is that the tracking of cases is valuable in some ways, but it’s also quite misleading. The more you test, the more cases you’re going to find. New York has a lot of cases because we tested people for two weeks—we set up outpatient testing centers, we did drive-through testing centers, urgent cares were testing. But now you’re not going to get a test unless you’re sick enough to be admitted to the hospital. I turn down probably 80% of the people I see in my ER for testing because they’re not sick enough to be admitted. So the case number is going to seem like it’s dropping but what’s more important to follow is the number of people who are dying each day. That’s more indicative of the severity, and it’s also indicative of how many people are getting truly infected. We have to remember that the people who are sick now were infected seven to nine to 10 days ago. So those numbers lag even further. We’re not out of the woods yet.
If you want to do something to support medical workers today, continue to stay at home. 15 days is not a magic bullet. It’s not going to be enough, most likely. This is going to require a longer-term self-isolation and social isolation to make sure we combat this. I still go to Central Park or the East River promenade and see kids playing together. The Great Lawn [in Central Park] is packed with people on a sunny day, listening to music and playing sports. Unless we really make a true commitment, we will continue to see deaths at a level that we’ve never been accustomed to. We are not through this yet, and we, as a younger generation, are not exempt. There are many, many people in their 20s and 30s who are getting critically ill from this disease. I would urge people to take action—before they learn the hard way, when someone they know gets sick.
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Graphics by Lorenza Centi. Images via Getty.
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