Listen: On the Front Lines at a New York Hospital

New York has become the epicenter of the coronavirus pandemic in the United States, as hospitals in the state face surging numbers of patients and deaths. On this episode of Social Distance, Dr. James Hamblin and Katherine Wells talk with one doctor about preparing for the worst at her hospital in New York City.

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An edited and condensed transcript of the conversation follows:

Katherine Wells: Can you tell us how you would like us to identify you? You can introduce yourself with whatever level of detail you feel comfortable with.

Angelica: Sure. So my name’s Angelica. I am a third-year resident in an internal-medicine program in a large hospital in New York City.

James Hamblin: Right. So tell us what you’re experiencing. What was the lead up, and where are we now?

Angelica: Things are really heating up. As of today, we have 81 people admitted in our hospital with COVID-19. That’s just people admitted, meaning hospitalized. My hospital is part of a big system. In our entire system, as of today, the number I got this morning was 424 people admitted, and about 20 percent of the people are admitted in the ICU right now. So at our facility, we have 18 of our 81 admitted patients in the ICU. And, of those 18, 17 of those are on ventilators, meaning hooked up to breathing machines. Three of those patients are requiring ECMO, which is a means of oxygenating someone’s blood in a very high-tech way.

Hamblin: Do you remember when you got your first case?

Angelica: Yeah. So it was actually Super Tuesday. We had the first patient in New York City.

Hamblin: So about two weeks ago?

Angelica: Two weeks ago. So that was on the [March] 3^rd. I’ve been keeping a calendar myself. We’ve had about three or four last Saturday. And then by Tuesday of this week, we had 16 hospitalized patients with COVID-19. And then by Wednesday, we had 33. By Thursday, we had 37. Yesterday we had 59. And then today we have 81—just to show you what’s happening within 24 hours. It’s just really rapidly evolving.

Hamblin: And where are you in terms of PPE supplies?

Angelica: Things are really dire.

Hamblin: Maybe I should explain, sorry, just to set the scene. If you’re a doctor or health-care worker or nurse, someone who’s taking blood, someone who’s going into a room at all with someone who has an infectious disease like this, you’re supposed to wear an N95 mask and a gown. And does this include eye covering as well?

Angelica: Yeah. No, no, that’s exactly correct. I think it’s important for the public to know that we use this equipment for other patients. This is not a new thing. You know, we take care of many patients every day who require personal protective equipment. So this is in addition to our regular burden. And yes, right now, our hospital is having a very critical shortage of masks, specifically things that can cover our eyes. The virus mostly transmits through particles. If they land on things they can go into your eyes and go into your mouth, so covering your eyes is really important. And we are lacking face shields. We’re lacking masks, both just the regular surgical mask as well as N95s, which we are currently only using for procedures where there’s highly aerosolized particles [...] originally they were saying ‘N95s for every single patient with coronavirus,’ and because of data coming out and also just because of the shortage, we’re now only using them when patients are requiring intubation with a breathing machine, putting a tube down their throat, or when they’re on specific kinds of oxygen deliveries that create aerosolized particles.

Hamblin: So there are essentially two kinds of masks. And what you see mostly around town and on subways are surgical masks, the kind you can just buy at any drugstore. And those are a little bit effective at blocking some particles, but they don’t fully keep the virus out.  But then there are N95s, which allow you to get really close near the face of someone who is actively coughing and sneezing as a physician. And it should protect you. Anyway, so you started off with a directive that you would wear in N95 masks, the really protective ones, every time you went to see a patient with the virus. But now it is such that you’ll put on a lesser mask unless you’re getting really close to that patient, or doing a procedure where you’re putting a tube down their throat and are just inches away from their nasal pharynx. So already you’re doing rationing based on supplies.

Angelica: Right. And there’s a lot of reuse right now, to be honest. We’re not supposed to be reusing when you’re seeing a patient who has known coronavirus, but with kind of everyone else we are reusing masks, which is not hygienic and it’s not safe for us, because if you think about it, you know, right now our emergency room doctors, for example, are wearing goggles and a face mask at all times. But if you touch that face mask, once you touch your goggles, once you touch your computer, unless you’re getting a new mask or you're cleaning your goggles religiously around the clock, you are kind of defeating the entire purpose of containing this. Things are not good in the hospital right now, I’ll just say.

Hamblin: What is the mood of the health-care workers? Your co-residents, nurses, and everyone else—are people getting worried for their own health?

Angelica: I would say things are pretty tense right now in the hospital. I think in general, most Americans, most New Yorkers are pretty anxious right now. And I’d say health-care workers have that baseline anxiety, plus the addition of their own safety and also just the regular work anxiety that we already have. We work 27-hour shifts. We work 14-to-18-hour shifts; we’re already kind of stressed as it is. So, yes, things are pretty tense right now. I’d say that there’s a lot of concern about what’s coming. I think that right now things are manageable. Our job is, yeah, maybe a little bit more tense than usual, but it’s still manageable. But I think that we all are seeing that it’s going to become unmanageable very soon. It kind of feels like we’re all just watching a car crash happen really slowly, and you just can’t stop it.

Hamblin: What is going to run out first? Is it the ventilators or the masks or [...] If people don’t feel protected and you start running low on masks or rationing them in ways that the staff feel uncomfortable, or if the staff get sick, you could simply run out of people to operate ventilators versus actually running out of ventilators. I don’t mean to pose these terrible scenarios. I just, you know, am trying to plan out what can possibly be done to prevent this situation.

Angelica: Right. The masks and the other PPE are running out right now. I think that’s the most urgent issue. And we are working on getting more. I’ve kind of taken it upon myself, at least in my program, to be kind of this mask collector. Literally, today I drove around New York City and picked up random donations from different people, which is how I’m spending my days off.

Wells: Where are you getting donations? Like, who has masks?

Angelica: So starting a couple days ago, I have just started calling and emailing random businesses that I can think of. I’ve gotten some donations from veterinary clinics. I’m reaching out to different departments like research labs. On my list is dental clinics. I actually just got some donations from an art department, from their ceramics department. I also recently posted things on social media, and I’ve gotten a lot of responses from people who just, like, have two extra boxes at home, and they want to send them or drop them off.

Katherine Wells: If listeners have supplies that they want to donate, do you have any suggestions on how they could figure out where to donate it? Just call your local hospital?

Angelica: I have talked to some people who were planning on just, like, dropping them off at the emergency room, and I will say that is a bad idea. Do not just show up in an emergency room, even if you have donations, just because the emergency rooms right now are a hotbed of coronavirus. We appreciate your donations, but please try to reach out to somebody who can actually help you and get them safely.

Hamblin: Have there been discussions about how decisions will be made as to who is getting ICU beds, who’s getting admitted?

Angelica: As far as I know, so far, we’re not at a point where we’re not able to provide our regular care. If someone is requiring ICU-level care, they are getting that at this moment. We’re not at the point where we’re like Italy, for example. The stories coming out of Italy are really terrifying to me, especially as a provider. We’re used to seeing these things. We’re used to seeing people dying. We’re used to breaking bad news to family. None of this is that new. But the part that is new is the idea of not being able to provide the appropriate care to people who need it or, like, having to choose between patients; that’s a very scary prospect for me, at least.

Hamblin: You won’t have the capacity for that sort of call and shouldn’t have to have that weighing on you as well right now. So you’re a resident. You’re in training, and you’re putting yourself at risk by going to work right now. Is there a point at which you wouldn’t go?

Angelica: For me, I think no, unless I’m actually sick. I feel grateful. I’m young, and I’m not immunocompromised. Although, right now we’re seeing 20-year-olds in the ICU with coronavirus who are otherwise healthy. So there is a risk. I think initially it was really being sold to us as something that was just going to affect older people or immunocompromised people. We’re seeing 20- and 30-year-olds in ICU. I’m really aware that there is a risk. But for me, I will probably be working unless I’m actively ill, in which case I will stay home, both for my own safety as well as the safety of others. I do think that it is something to think about for other providers. Both my parents work in hospitals, for example. My parents are in their 60s and 70s. And honestly, right now I’m trying to beg my mom to quit her job. My mom has baseline respiratory illness, and I know that she wants to help out right now, but for me, I selfishly really want her to worry about her own health and have younger, more able-bodied nurses take control at this point. Maybe if one day they really need her, she could try to consider helping. But I’m begging her to quit her job.

Wells: How is she responding?

Angelica: She’s thinking about it, I think. But this is really hard for people who have been trained to help others, and really want to rise to the occasion and do their part. But it is hard when you’re trying to balance that with your own safety and your own health.

Hamblin: I want to underscore the bravery in what you’re saying and doing. Some people will assume, well, this is your job. So you have to go. But you’re not yet to the point where it is your job to run the ICU until you can no longer. There’s some intermediary steps where people are in training and will be asked to step up.

Katherine Wells: I think what Jim is trying to say is “Thank you.”

Jim Hamblin: Yeah. That’s all I mean to say.  

Angelica: You’re welcome. I mean, thank you to everyone. I’m amazed with my colleagues, the nurses, the techs, the janitors, there are so many people that are involved to help make a hospital run right now. The lab techs, everyone, it’s really incredible. And as someone right now who is soliciting donations for the PPE, for example, it’s really amazing to see how many people have been emailing me and reaching out and wanting to do something from their home while they’re waiting this thing out. Thank you to everyone.