www.newstatesman.com/world/north-america/2020/04/how-long-will-we-hold-inside-new-york-s-struggle-against-coronavirus
“How long will we hold?” Inside New York’s struggle against coronavirus
The US city has become the epicentre of the Covid-19 outbreak. In this remarkable account, one senior doctor describes life on the frontline of an emergency department
There are tents outside our hospitals, and in our parks. Every time I see them, I stop, startled. Their drab and dirty flaps seem so out of place against the grand facades of world-class health facilities. But we are in utterly desperate times.
The last time I worked in a tent was in west Africa in 2014. There, I was providing medical care to patients suffering from Ebola. In those same tents, I saw agony, loneliness and death. I saw people dying alone. I never thought I would have to experience that again. I never wanted to; once was painful enough. But in New York we have no other option now but to erect medical tents; our ICUs are filling up too fast, and the city’s hospitals will soon be at breaking point, unable to bear the number of those infected with the coronavirus.
And
But it’s not the volume of patients that is hitting us; it’s the severity of the symptoms: respiratory arrest, respiratory arrest, respiratory arrest. Each critical patient requires six to eight professionals: nurses, respiratory technicians, ER doctors, anaesthesiologists. Each resuscitation takes an hour or more: starting medications, putting in breathing tubes, setting up ventilators, managing blood pressure. Back to back for 12-hour shifts, every day.
It’s not just the severity of cases either, and the hard, relentless hours. We are all being asked to do things that we have never done before, and to make decisions that were once unimaginable. Run a code as your goggles fog up and you can’t decipher the vital signals on the patient’s monitor. Try to predict which Covid-19 patient will crash if you send them home, and which won’t. Talk to palliative care. Talk to family members. Have long discussions about likely outcomes. Listen as family members sob. They aren’t physically present to say goodbye when they ask us to withdraw care from a patient; we FaceTime so they can say goodbye. We stop the drips. Turn off the ventilator. And wait. Your hands are upon theirs. You think of their family at home, and you think of your own. Someone starts saying a prayer. You can’t help but cry. You stand by. You wait. Time of death: 7:19pm
We have EasyJet crew signed up to man the Nightingale.