33when she died. Being sick means you’re off your
game; that’s what’s been ingrained in us. But it’s also
understood that if someone steps out, you step in.
The same week my colleague was exposed and
went on quarantine, we had our fi rst positive case.
Since then, one of our colleagues tested positive.
And another doctor has had to step back. She’s
the caretaker for her mother, who has been ill
and is in very fragile health, and my colleague is
worried about exposing her. I understand deeply
that people must make personal choices, but I
am also very, very afraid of losing more doctors
while cases are rising so fast. Our facility now has
three confi rmed cases. And those numbers will
only continue to compound. About the time that
fi rst colleague was exposed, we think around the
weekend of March 11, the D.C. area had something
like 60 cases. Now we’re up to more than 1,600.
As each week, each day, brings a new surprise, it
has become very clear to us that we have to really
protect ourselves, because we don’t have enough
physicians to lose. We have N95 masks but not
an abundance of them, and we were recently told
to ration protective gear. We were already using
masks to go into rooms of people we thought were
suspected cases, but then we were told to wear a
surgical mask to go into every patient room. As
things have escalated, we have now been directed
to wear a mask all the time for the entire shift.
I think one of the other hardest parts for us
is the confl icting information from government
offi cials, saying there are enough tests for every-
body and everyone can be tested. That is not the
guidance we’ve been given, and it has caused
a problem with people demanding a test, and
they have to be turned away if they aren’t symp-
tomatic or have no exposure. I’ve had colleagues
who’ve been cursed out by patients who couldn’t
get tested. As a woman of color, I am used to
being second- guessed or having patients ask me,
‘‘When am I going to get to see a doctor?’’ When
I walk into a patient room, I automatically say,
‘‘Hi, I’m Dr. Adams.’’ But I get that people are
desperate and want answers and help, so I try
to bring in understanding. Our E.R. has only so
much capacity, and people use us for their pri-
mary care. So in the midst of all that’s going on,
we’re still treating people with everything from
sore throats to asthma, chest pains and strokes.
But these people are sort of commingled with
patients who might have Covid-19, as well as
those who are coming in wanting to get tested.
You often have only a thin curtain separating
our examining rooms. Our facility has only one
negative- pressure room, a separate facility where
the air doesn’t circulate around to other areas,
where you put somebody with a high-risk respi-
ratory disease. We thought the negative- pressure
room would be a place where we could separate
out people who were really high-risk, but with so
many potential cases and so many people, that is
not going to work out. So it has been hard to fi gure
out. How are we separating all these people sothat we’re not increasing their risk and we’re not
increasing our own health care providers’ risks? To
manage this problem with the testing, our facility
now has set up a tent outside the E.R. to prescreen
people before they come inside the doors.
The culture of the E.R. is that we don’t stop. That’s
part of the reason I went into emergency medicine.
I’m a hands-on person and fi nd that being on the
front line, the fi rst person to lay hands on a patient,
to get them stabilized — that’s what’s rewarding to
me. In my job, we don’t have designated breaks;
there’s no lunch. You do your work. You eat at your
desk as you’re seeing patients. You try to take your
water break, and if you’re really not slammed, you
hope to get to the bathroom. It’s the same but more
intense now, so that doesn’t really give me time for
paralyzing fear when I have a job to do.
My real fear and my main concern is my son.
I’m the sole caretaker of a 10-year-old child, and
his school just let out. School was my child care,
so I’ve had to scramble, especially because I fre-
quently have to travel between facilities. I have
two child care providers, and I don’t know what
I’d do if there is some kind of lockdown and they
couldn’t get to him. I also don’t want to endanger
him or his caregivers. Increasing evidence sug-
gests that they may have underestimated the risk
of younger people getting Covid-19. That means
that I have to balance family and work in a way
I’ve never had to before. It is a lot of stress. I
know I’m really putting myself out there, and I’ve
read about health care providers who have gotten
sick and died. So I try to do the best to protect
myself. I’m washing my hands like 5,000 times a
day, cleaning everything and wearing the mask.
But I also know what I signed up for.
AS TOLD TO LINDA VILLAROSAHOMELESS-OUTREACH WORKER
Nikki Grigalunas, 41, Chicago‘We’re not taking
anyone to lunch. We’re
not taking anyone
to the doctor. But we
want to make sure
that whatever basic
needs people have,
we help address them.’
I work for Thresholds in Chicago. My team scours
about two-thirds of the city. We identify people
who are living outside. We take people to the hos-
pital or to the Social Security Administration offi ce.
We take people to lunch. And over time, people
will begin to talk about their needs. If we feel that
somebody is homeless and experiencing mental
illness, we visit again.
Covid-19 makes the work diff erent. We’re stay-
ing six feet away from everyone. We’re not taking
anyone to lunch. We’re not taking anyone to the
doctor. But we want to make sure that whatever
basic needs people have, we help address them.
‘‘Hey, my sleeping bag is wet. Can I get another
one?’’ ‘‘I haven’t eaten in three days.’’ And for folks
on medication, we’re still out there monitoring
how their management of it is going. It really is
about survival.
We were out one morning recently. It was rain-
ing pretty hard. I spotted one man in his usual
spot, under an awning in a park. We were able
to meet his immediate need for food: McDon-
ald’s No. 9 combo meal. We talked to him a little
bit about the coronavirus. He typically practices
social isolation anyway, because of his mental-
health symptoms.
McDonald’s closed its seating areas. That has
really impacted our population. They can’t access
their regular fast-food restaurants to use the bath-
room, warm up, grab a glass of water or even
order food. We’re currently handing out bottles of
water because people can’t get water anywhere.
I would be lying to say I’m not worried about
exposure to Covid-19. But when I’m in the fi eld,
the fi rst thing I’m thinking about is helping our
people cope. We make sure that somebody sees
them. We hold hope. Seeing someone under-
neath a bridge for the fi rst time in fi ve or six days
might be the thing that carries them into the next
day. That’s the fi rst tenet of social work. We show
up. We show up. That’s it.
Left: From Dawn Adams. Right: By Sandy Oestmann. AS TOLD TO MATTHEW DESMOND