Third Week of March

N.Y.C. Covid-19 cases, March 15: 330

One of our E.R. doctors, who also works in the I.C.U., proposes an extreme case during a Zoom meeting: We know from China’s experience that once a patient is in cardiac arrest from ­Covid-19, the chance of survival is essentially zero.

His words hang in the air, but the question is clear: Should we try to resuscitate this patient, despite our equipment shortages and the risks to ourselves?

As this hypothetical situation plays out in my head, I immediately want to know the age of the patient. In practice, this decision comes sooner for me than I expect.

For now, it’s only a shadow of what my Italian counterparts are facing, but it forces the very real question of how to allocate resources, whether ventilators or beds — or those of us who work in the E.R.

纽约ICU医生日记|三|

A man in his late 80s is sent in from a nursing home with a fever, cough and diarrhea. He is my first patient who is most likely Covid-positive; I can’t know for sure, because tests are taking up to 24 hours to come back in our internal lab.

Although the man is designated D.N.R./D.N.I. — “do not resuscitate” and “do not intubate,” which instruct us notto pursue aggressive interventions like electric shocks and breathing tubes — his family, with death now looming, reverses his no-resuscitation order and decides, instead, that he should receive even the most extraordinary life saving maneuvers.

The man hasn’t walked in years; he has advanced dementia and was unable to talk even before this most recent illness. He can’t tell me what he wants, so under normal circumstances we are to follow the family’s orders. They are in the waiting room, unable to come in because of our new, strictly enforced no-visitor policy, to prevent virus transmission.

With the man’s breathing rapidly worsening, I don’t have time to call them. I am supposed to obey their wishes, which the doctor from the nursing home had, in his spare cursive handwriting, documented in a statement.

纽约告急！——现实更惨烈！

We are weeks away from the full impact of this outbreak, but we are already trying to conserve masks, gowns and face shields.

Because of how infectious the virus is and the country’s lack of preparation and equipment, the decision to intervene is a question not only of how to apportion tangible supplies, but also of how to best distribute risk among health care workers.

I want to do everything for my patients, as much as they and their families want, just as we have always done. But what do I owe future patients? What do I owe my colleagues?

As I look at my team of doctors and nurses and consider our next steps, I think of a recent Facebook post from one of my supervising physicians, who trained me during residency, William Binder, who is now in his 60s. “As an emergency physician, I understand anything can happen to anyone at any time, but I have never felt exposed nor susceptible,” he wrote. “ The coronavirus has stripped away my veneer of invincibility.”

待续：纽约ICU医生日记|四|

Forth Week of March

N.Y.C. Covid-19 cases, March 22: 1

纽约医院ICU病房的实景

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