The New Yorker - 13.04.2020

12 THENEWYORKER, APRIL 13, 2020

IN THE E.R.

RAMPINGUP

F

or ten years, I’ve been an attending

emergency-medicine physician at

Brooklyn Methodist Hospital, in Park

Slope. As E.R. doctors, we pride our-

selves on being cool in a crisis. After

years of practice and training, I have

become desensitized to the blood, the

urine, the feces, the vomit, and the

screaming. It’s rare that I ever feel stress,

despite all the crazy things I’ve seen.

Things can get loud and out of control.

If you demand silence, it completely

changes the energy in the room. But

this cool, it’s a learned behavior. There’s

an adage from Samuel Shem’s novel of

hospital life, “The House of God,” that

your first procedure at a cardiac arrest

is to check your own pulse. But now, in

the time of pandemic, we may be find-

ing ourselves tachycardic.

There are sixty-odd hospitals in the

city, and all of us who work in them are

approaching the point of being over-

whelmed. Somehow, my biggest fear

now, with Covid-19, is that this learned

ability to be cool and collected will get

lost. I don’t feel that way yet. But we’re

getting there.

As the pandemic ramps up, I’m work-

ing twelve-hour shifts, six days a week.

I’ve picked up extra shifts to cover for

doctors who are already sick. During a

typical shift, you might intubate one pa-

tient who is critically ill. Three would

be a lot. On my last shift, we intubated

ten. Each day now, we’re turning away

hundreds of patients who definitely have

the symptoms of COVID-19. Even when

patients come in with an unrelated

trauma that requires a chest X-ray, you

incidentally find they’ve got it. The ex-

tent of community spread is unreal. You

begin to realize that, without compre-

hensive testing, we are radically under-

estimating the spread of this virus.

Planning for disasters is part of emer-

gency medicine. We run drills for events

like a bomb in the subway or, yes, a pan-

demic respiratory illness. When they’re

over, all the participants invariably pat

themselves on the back for how well they

did. But, no matter how much you plan,

reality is different. You think you’re ready.

Then reality comes. And you’re not.

During the Ebola outbreak, we prac-

ticed “donning and doffing”––the art of

putting on and taking off your P.P.E.,

personal protective equipment. You have

to apply your gown, gloves, and mask

in such a way that you are completely

protected. While examining the patient,

you become coated with viral particles.

So, when you remove your P.P.E., you

have to be careful not to contaminate

yourself. It’s not easy. Now there is a na-

tional shortage of P.P.E.—but no short-

age of infected patients—and some doc-

tors and nurses are wearing a disposable

mask and gown for an entire shift.

If our intensive-care units get over-

whelmed, we’re going to be faced with

some difficult choices. And we aren’t used

to that in this country. Traditionally, the

American medical system is focussed on

aggressive healing at all costs, sometimes

in the face of medical futility to the det-

riment of the patient’s comfort. When I

rotated through the I.C.U. as a resident, I

had a patient with an overwhelming bac-

terial infection. She had been bed-bound,

nonverbal, and ventilator-dependent for

a decade. I tried to have a discussion with

her daughter about end-of-life care. The

daughter simply said, “My mother sur-

vived Auschwitz. Who am I to put an

end to her life?” In this brave new world

of COVID-19 infections, a nursing-home

patient like this is at particular risk. Will

we be forced to shift the emphasis of our

bioethical values away from our “do ev-

erything” approach?

Emergency rooms are the country’s

safety net. We work around the clock,

and we’re proud to take care of people

Anthony Fauci, who must spend nearly

as much mental energy trying to finesse

the ignorance and the ego of his Com-

mander-in-Chief as he does in assess-

ing the course of the novel coronavirus.

We’re cheering researchers in labs all

over the world who are at work on an-

tivirals and potential vaccines. We’re

cheering everyone who makes it possi-

ble for the city to avoid the myriad con-

ceivable shortfalls and collapses: gro-

cery clerks and ambulance drivers;

sanitation workers; pharmacists and

mail carriers; truckers, cops, and fire-

men; the deliveryman who shrugs off

the straps of his knapsack and jabs the

intercom buzzer with a gloved finger;

the community of artists, dancers, d.j.s,

musicians, and actors who have lost pay-

checks and jobs but are posting paint-

ings on Instagram, FaceTiming solilo-

quies, singing into iPhones. And we’re

thanking those who are providing

straight information, lobbying Wash-

ington for medical supplies, looking out

for the most vulnerable among us, and

making critical decisions based on the

scientific evidence, no matter how un-

forgiving. We know the limits of this

release—there is a feeling of helpless-

ness reflected in it, too––but it’s what

we have in a dark time.

And there is no question of the dark-

ness. Last Tuesday, President Trump

presided over a two-hour news confer-

ence at which he fleetingly appeared to

bow before realities that he had airily

dismissed for so long and at our collec-

tive peril––the most chilling fact being

that, even with effective strategies of so-

cial distancing, perhaps one or two hun-

dred thousand Americans could die in

this pandemic. “As sobering a number

as that is, we should be prepared for it,”

Fauci said, as the President stood nearby,

seeming, for once in his life, humbled.

These next weeks and months will

be demanding in ways that are hard to

fathom. If New Yorkers are in hiding,

the virus has shown a knack for seek-

ing. But, with time, life will return to

the city. Our city and your city. The

doors will open and we will leave our

homes. We will meet again. We will

greet our friends, face to face, at long-

delayed Easter services and Passover

Seders. Children will attend class with

their teachers. Sidewalks and stores and

theatres will fill. Remnants of the cri-

sis—a box of nitrile gloves, a bag of

makeshift masks; containers of drying

Clorox wipes—will be tucked away, out

of sight and out of mind. We’ll forget

a lot about our city’s suspended life. But

we will remember what, and who, we

lost. We’ll remember the cost of time

squandered. And we will remember the

sound of seven o’clock.

—David Remnick