Forth Week of March

N.Y.C. Covid-19 cases, March 26: 23,112

I am scheduled to be off from work for several days. The evening before I’m due to return to the hospital, a colleague messages our group to say that a 49-year-old Covid patient of hers, who was waiting in the E.R. for an inpatient bed, was found blue and dead in a chair. Nobody even knows if he gasped before he died.

On my way to work, I hear on the radio that a 48-year-old nurse from another New York City hospital has died from coronavirus. Someone else tells me that an anesthesiologist at our hospital is on a ventilator. A surgeon and an E.R. doctor across town are in similar states.

纽约ICU医生日记|五|

When I walk through the hospital doors, the E.R. is a place I no longer recognize. Intubated patients, of every age, are on ventilators everywhere. It feels simultaneously electrifying and oppressive. But it’s also eerily quiet. Family members and friends haven’t been allowed into the E.R. for more than a week; most of the patients are too sick to talk; the few without breathing tubes who are able to cough are muffled by their masks. Oxygen hisses in the background.

A couple of hours into my shift, one of the nurses comes to me. She falls apart, tears streaming down her inflamed, marked cheeks. She sobs out words of anger and frustration and sadness. The morning, on top of the last several days, has crushed her. I want to hug her, but I can’t.

Soon after that, someone asks, “Doctor, is it OK to take the patient to the morgue?” The other physician on duty and I look at each other. The morgue? Who just died? Apparently, a patient who was waiting for an inpatient bed, whose family had decided against extreme resuscitative measures, had died, without us even knowing.

Several days ago, only a few patients had Covid, but suddenly it seems we have become, like facilities in Italy, a Covid hospital. Every patient seems to test positive for it. I am shocked by the one or two negative results I receive during a shift. We have to function as if everyone is infected.

PPE告急！听天由命吧！

A co-worker tells me he used three masks during the course of his shift. Three masks?! I respond. That’s crazy! Then I realize I am the absurd one.

The masks are meant for single use, one per patient encounter; my colleague had used three masks over a 12-hour shift, most likely having seen upward of 30 patients who potentially have Covid. It’s idiotic that I was shocked by his using three masks, especially when many of our co-workers in the city have fallen ill.

Patients who test positive for the virus are unintentionally roomed with those who test negative or whose tests are still pending, because the E.R. is bursting. Even if we are exposed to a patient without proper personal protective equipment, we are expected to return to work if we don’t have symptoms.

In Italy, where 61 doctors have already died from Covid (a number that will grow past 100 in the next couple of weeks), health care workers believe that they themselves expedited the spread of the virus. There, the doctors are routinely tested for any exposures, even if they are asymptomatic.

I have to shut down thoughts about my own risks and mortality. I recall the words of my old mentor, but I don’t think I can do this job unless I force myself to believe in my own invincibility. Otherwise, with every violation of the protective barrier, every instance of less-than-ideal protection, which is almost every time, I would be paralyzed by thoughts of having infected myself. I see a patient around my age intubated, hear about a hospital colleague getting critically ill.

A co-worker texts that her classmate from residency is now intubated. I read an article about how health care workers seem to suffer more from serious Covid infections, even if they’re young, possibly as a result of being exposed to higher initial doses of the virus. I’m not even sure this is true anymore — I’ve seen plenty of critically ill patients in their 30s and 40s. I push these thoughts away, immediately.

Better to be lucky than to be good, I remind myself. It’s the only thing that provides some reassurance. If I feel like it’s not totally in my control, then I won’t completely lose my mind over every mistake I make donning and removing my P.P.E. and recycling single-use equipment.

I look in the mirror for the first time when I get home one night. My eyes are bloodshot. Deep horizontal creases run across my cheeks. A faint abrasion has already settled into the bridge of my nose. I just want to fall into my bed, but I force myself to shower. When I turn my phone back on, a nurse in Bergamo, Stefania Cornelli, has texted me that she crashed her car. The vehicle was totaled, but she wasn’t seriously hurt. It had been about one month into this crisis for her.

“We are so tired, tired of a tiredness that no sleep can relieve,” she writes. “ I think I really need to ask help to a psychologist .”

待续：纽约ICU医生日记|六|

Forth Week of March

N.Y.C. Covid-19 cases, March 28

疫情系列日记——朗读（点击链接）

|医生日记|纽约抗疫前线ICU医生（四）

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