By Kar-Ming Lo MD, FCCP
My friend, Michael, asked me to write some of my thoughts for the INFINIT community about my recent NYC experience.
Two weeks ago the Cleveland Clinic sent out a memo asking us if we wanted to volunteer to travel to either Detroit or New York City to assist the healthcare providers on the ground who had been overwhelmed by the surge. This request gave me comfort as a confirmation of what we the numbers were starting to bear out in Ohio. . . that is, we were not going to get the SURGE. As long as my family (including my 81 year old mom) practiced good social distancing and personal hygiene, they’d likely be spared this first go around.
Knowing that my family was probably going to be okay left me torn. I wanted to go help yet I also wanted to stay home. Why risk it? It was a fierce back and forth internal debate. Will they have enough equipment for us? Are there really people in the hallways dying? What kind of shit show that I’m walking into? Will I get sick? Why don’t I just stay at home? How can I stay at home?
As I waffled back and forward, my wife was all for it. In fact she wanted to go but she’s an outpatient nurse practitioner not a critical care MD or RN. She cries when there is suffering in the world, whether it is animals or people. “Honey, I’d go in a second but you have to choose for yourself.” I can say for absolute certainty that her strength of conviction to put herself in the thick of things (despite not really having the ideal training) helped to shore up my resolve to go. I volunteered to go to Detroit but received an email Wednesday morning informing me that they didn’t need us but that NYC still needed doctors. “Oh shit! I don’t want to go to NYC. That’s the epicenter. I’m absolutely going to get COVID.” So I sent an email and said no. I’m not proud. I volunteered and they don’t need me. I’ve done my obligation. I can now sleep at night knowing I tried to do the right thing. For those of us who are endurance junkies, you will understand intimately what I’m going to say. I choose to compete in Ironman races because I want to find out who I am. When that point comes late in a race to fold or to carry on, what do I do? After I sent the “no” reply, I knew and didn’t like what I saw. This was that same point but now it was at that point in my medical career. I knew that 20 years from now I would regret being able to help and choosing not to do so. Ten minutes after I said no, I resent another email. This has led to one of the most fulfilling experiences of my life.
My best friend that I have known since we were 5 years old is an Ohio State Trooper. I never knew how he chose to put himself in harm’s way every day. Now I have a tiny inkling. You choose because you might make a difference. That’s it. This is nothing like that but it did give me insight into him and all those like him.
We arrived at Hopkins Airport where 10 docs and 25 nurses have volunteered for this trip. It was quite the scene. Lots of cameras and media. I’m not sure it would be fun to be a rockstar. I later found out when the story was posted that there were some naysayers accusing us of doing this for the money. Those comments just simply reflect more about the values of the person that made those comments than they do about me. I did make extra money on this trip but it’s unclear why they paid us. I will make $300 for the week. Woohoo!! This comes out to about $25/day or $2.08/hr after taxes (as we worked 12-hour shifts). So yeah, I’m a money-grubbing doctor.
As we boarded the plane the skybridge was loaded with airport workers, police and firefighters clapping for us. Weird and cool at the same time.
Shout out to United Airlines. The pilots and crew volunteered their time to fly us out. We had the best time flying out as they entertained us the entire time.
We arrived in Newark to a repeat of our departure. Clapping and thank you from the staff lining the skybridge. I wondered about the why. Why do they clap? We were only 35 people and couldn’t even begin to make a dent in what was happening. I think it is about hope and optimism. About not suffering alone and about knowing that the world cares about them.
After we check in we head over to NY-Presbyterian Queens hospital. As we tour the hospital it’s an eerie feeling. Although the air is cleared continuously I can’t help but feel that I am walking through an imaginary cloud of COVID particles. I can imagine myself as Arnold in "The Terminator" with the CPU processing data along my visual field. When I walk down the hallways in the ICU I imagine that my Heads up display flashing violently red. COVID threat risk - HIGH. Risk of Infection: Moderate to High. I can't shake the sense that the virus is everywhere.
After our tour I went out for a quick jog. Times Square, Grand Central Station, Fifth Avenue - all empty. It's all silent. This virus is a game-changer.
Queens was hit hard. NYC is the epicenter of COVID-19 in the USA and Queens is the epicenter of NYC. It is the county with the most cases and deaths in the entire USA. For Queens, NYP-Queens Hospital is a beacon in the night.
The staff were warriors in scrubs who showed up day after day and worked tirelessly. They fought and fought. Some died but many more survived. As the head of surgery told us, ““we have no choice, it’s what we have to do.” And so they did. They created beds anywhere and everywhere. Their engineers worked overtime to make any and all available space into COVID units. When we toured they had just begun flattening their numbers and were able to close their cafeteria which had been turned into a field COVID unit as it was a bigger open space. Their CAFETERIA!! Holy crap!! Even though the numbers have begun to flatten in NYC there are still a ton of sick people in the hospital. Their ICUs remained full to capacity as patients continue to deteriorate and require higher levels of care. During our time at NYP-Queens we began to see a change in patient case-mix. We saw a trickling back of the patients presenting with non-COVID illnesses. Though it is still early things seem to be returning back to normal.
There were 5 of us assigned to NYP-Queens. Four of us were critical care physicians that were assigned to the ICUs with another internist who was assigned to the floors.
I have been a pulmonary & critical care physician since 2002 and have seen much death and dying. I’ve seen sick people and I’ve seen SICK people. This past week was universally the sickest cohort of patients that I’ve ever taken care of at the same time. The doctors who had been working tirelessly for the past 3 weeks when the shit was really hitting the fan were amazing and so willing to share the knowledge that they had gained at such a high cost. My entire week consisted of waking up at 6 am (exhausted), catching a Lyft to the hospital where I’d work a 12 hour shift then heading back to the hotel. Rinse and repeat. I won’t go into the gory details of what I saw or did except in one thing did stand out to me. I've seen it in Cleveland but it really didn't sink in until now. Since COVID-19 has struck, hospitals have been closed to visitors. This is true everywhere. Cleveland. New York. San Francisco. Small cities and big ones. It’s to protect everyone. As a result, people die alone. Death is always a solo journey but that does not mean that it is a solitary journey. Many of us are blessed to be with our loved ones at the time of their death and in the years to come will have our families be with us when we die. This shitty virus robs us of that last dignity.
Thank God I was not alone this week. In the evenings, I was able to decompress with my
fellow critical care doctors as well as the other doctors and nurses that went to the other hospitals. We shared stories learned about each other's lives and laughed. It felt natural. Most importantly I never felt that I was shouldering the mental load alone. Thank you Chirag, Pravin, and Abhijit. I didn’t know you well before but you are now my brothers-in-arms.
I am not sure that I made all that much of a difference in the lives of the patients as they are so sick. Many of those I took care of will die. Some will live. We can only hope that we helped them a bit. It was very heartening to hear from the critical care fellows and attending physicians how much they appreciated us being there as it allowed them to have some time off to decompress and come back to work rejuvenated.
On my last day in NYC, I finally got a run in. It was a 10 mile loop through Central Park. Granted, it was lightly drizzling but I think I saw less than 10 runners during the entire time.
What's more, no sirens, horns were heard. Just the light pitter-patter of raindrops.
I've felt this need to write down my experience to decompress myself and maybe to let others have a sense of what it's like. This experience reaffirms my belief in the goodness of my fellow man/woman that exists in the world. That we are not alone in our journey as long as we allow others to be with us. That we may bicker and disagree but when the chips are down, we put those things aside and do what we can for those who need it most.
I am back in Cleveland living in a hotel for the next week in quarantine so that my family will worry less. Heroes and lepers. That was the phrase I saw somewhere a few weeks back in the media. It's so fitting. I've visited my family for a very brief time just to see them and hear the noise of the house. They joke but there is a subtle sense of nervousness when I'm around.
I can't wait to go home.
Be safe, hug your family but maintain social distancing.
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