The following is a very long post from a current doctor at Bellevue in New York who I went to high school with. Much of it is over my head but I thought it was quite insightful:
hey everybody -
wishing you and your families lots of love in these strange times.
as many of you know, i work as a doctor in new york. i want to share my experience of what the past few weeks have been like at work w/ the hope that you may find it interesting, enlightening, or helpful. spoiler - it’s been crazy and this will be long.
i’m a hospitalist, which is a hospital-based internist. i work on the internal medicine floors, largely treating non-surgical patients whom the ER docs think are too sick to send home, but not sick enough for the ICU. my colleagues and i treat a variety of symptoms and illnesses, which notably include fever, cough, and shortness of breath. i work at bellevue, the flagship public hospital in NYC, and one of the primary training sites for NYU. it’s a chaotic environment in normal times. like many public institutions, we’re underfunded and understaffed. but we work hard, and we’re proud of what we do. i don’t hold any leadership positions or speak on behalf of anyone else, nor are my reflections representative of what’s happening at other hospitals in the city.
we began discussing covid preparations at our hospitalist staff meetings in january. protocols, volunteer teams, and call schedules were created, in our group and in other departments of the hospital. it was always a matter of when and to what degree - and never if - covid would come to bellevue. so at the time, i was apprehensive, but had confidence that our national public health system would spare us the turmoil we were seeing in china. i was out of the hospital for the second half of february, but i think work on the floors continued more or less as it always had.
i returned to work in early march, and the atmosphere in the hospital was palpably different. other countries fell like dominoes, and the failure of our national leadership and institutions was obvious and terrifying. the metaphorical storm loomed, from how far off we were uncertain, and the tension among staff increased daily. we mostly waited, reviewed plans and protocols, and hoped we were wrong about what seemed inevitable.
around march 9th bellevue’s internal medicine/hospitalist-led covid floor team went live, possibly responding to the first admitted patient with strong suspicion for the disease. i’m not sure when the first covid patients hit our ICU. our team was initially just staffed by one attending and a physician’s assistant (PA), employing an admission model that directed patients we suspected of having covid to this covid team, attempting to spare, for as long as possible, the care of these patients by the general medicine teams staffed by residents and students. over the next few days there was a steadily increasing trickle of patients admitted to this team with varying degrees of suspicion for covid. initial testing seemed haphazard. protocols were confusing and insufficient. but our leadership and the covid team responded admirably to a challenging situation that was changing daily. positive tests started returning for patients that had obviously been infected by way of community spread in new york.
covid presentation is variable. adults of all ages. including young people in their 20s and 30s without any previous health problems. by now you probably know that many people are asymptomatic and serve as unknowing reservoirs and transmitters of the virus. symptoms vary, and might - in isolation or combination - range from the sniffles, diarrhea, cold-like symptoms, flu-like illness, mild pneumonia, to severe pneumonia w/ complete respiratory failure. but the textbook case that our group began to recognize as most predictably covid positive was an adult with fevers and malaise at home for several days, often with a dry cough, sometimes with worsening shortness of breath that would ultimately prompt their ED visit. on admission, they might or might not have fevers and/or low oxygen levels in their blood. chest x-ray almost invariably shows a characteristic bilateral pneumonia, even in those without respiratory symptoms. labs often with normal or low white blood cell count w/ lymphopenia. some patients require oxygen immediately, others don’t at all. some are well enough go straight home from the ER w/ pending tests and instructions to self isolate, while others required immediate intubation and ICU care with mechanical ventilation. the patients in the middle came to our team on the internal medicine floors for ongoing evaluation and treatment. the luckiest are only in the hospital for a few days. others stay on our service for weeks, but eventually are well enough to go home. the least fortunate are ultimately transferred to the ICU.
our hospitalist/PA team caring for these patients on the floors began to see the same pattern described in other hospitals - those that would become the sickest would often take that turn after 7-9 days of symptoms. as their pneumonias worsened and massive inflammatory responses were triggered, their oxygen levels would continue to decrease to dangerously low values. often rapidly. the simplest and first-line method to deliver oxygen to patients is through a nasal cannula, a narrow tube that runs from the wall’s oxygen supply to your nostrils. generally, when treating low oxygen levels, if oxygen delivery by nasal cannula fails to improve a patient’s respiratory status, there are intermediate non-invasive modalities like high flow, CPAP, and BIPAP machines that are often used successfully and then eventually withdrawn when patients improve. intubation and mechanical ventilation isn’t usually necessary except in the most severe cases of pulmonary disease. but we’d learned from other hospitals around the world that these intermediate methods seemed to serve only as temporizing - and possibly dangerously delaying - measures in covid patients, while also increasing the risk of particle aerosolization, putting staff at increased risk of infection. once covid patients require more than 6 liters of oxygen by nasal cannula, with signs of ongoing respiratory decompensation, they get intubated and require ICU care. this is a huge deal and explains some of our national ventilator supply crisis - our typical second and third line oxygen delivery modalities are completely sidelined.
we’re using medications you’ve heard about in the news. the combination of hydroxychloroquine and azithromycin is of very unclear benefit, and patients i started on this combo early in their at-first seemingly mild presentations later required intubation and eventually died. it’s no panacea and disinformation is dangerous.
my second week back at work in march, the surge in patients still hadn’t arrived, but we seemed on track to follow the epi curve seen in italy. all internal medicine teams began expediting discharges of our other patients. the ED stopped admitting patients that lacked an absolute indication for hospitalization. we were effectively clearing out the hospital. elective surgeries and procedures were cancelled. bellevue’s outpatient clinics began planning to stop most in-person visits and prepared for a predominately telehealth model. normal hospital business drastically changed, and non-covid patients are certainly suffering from the relative absence of routine medical care.
a mobile covid testing tent was set up in the courtyard. med students were dismissed from all clinical rotations, including on our floor teams, of which they’re vital members. an ICU-lite unit downstairs was turned into a covid respiratory unit, with crit care nursing staff walking around in futuristic air purifying helmets called CAPRs. most of our ED space was taken over by presumptive covid patients. dozens of residents were out sick, some of whom had already been confirmed as testing positive. yet still, on the internal medicine floors upstairs, most clinicians just waited in our half-empty hospital with a resigned sense of doom, continuing to care for the few non-covid patients still there. it was eerily calm, but the undercurrent of helplessness and dread was everywhere.
as that week went on, the trickle of covid-likely patients admitted to our service turned into a steady stream, and more attendings, PAs, and now also volunteer residents were added to our covid floor team to care for the growing patient load. likewise, the ICU was admitting patients for mechanical ventilation at a frightening pace. i left my normal inpatient team overseeing residents caring for non-covid patients on march 19th and joined the covid team. the night before, i said goodbye to new york friends i knew i probably wouldn’t see for a while. a day later, our makeshift dam broke, and we began transferring our low-acuity covid patients onto the resident staffed teams, as our covid team could no longer handle the growing patient volume alone. now a river, they just kept coming. and keep coming. from the ED. from other hospitals. for now, by the dozens.
at the beginning of last week, our leadership implemented what seems appropriate to call a war-time staffing model. all internal medicine teams would now treat the increasing number of covid patients. new inpatient teams were created. all of our internal medicine residents were re-allocated to our three hospitals (which include NYU-Tisch-Langone and the Manhattan VA) working in rotating 12 hour shifts on the floors and in the ICUs. many outpatient internists are joining the hospital medicine/covid teams, as are attendings and fellows from internal medicine subspecialities like GI, endocrine, and rheumatology services. our tenth floor normally houses distinct medical, surgical, cardiac, and neurosurgical ICUs. the entire floor is now a medical ICU predominately filled with covid patients on ventilators. areas of the hospital that were used for other services are being converted to covid medicine units on what seems like a daily basis. medical schools across the city petitioned the state to graduate fourth year students early in order to staff the hospitals. retired MDs are coming back to work. surgical attendings, fellows, and residents may soon join us on the medical covid floors.
our hospital’s efforts at coordinating an organized response has been absolutely awesome, but we were in no way prepared to handle all of the nuance required for a crisis of this scale. for example, from the start, hospital-wide messaging about appropriate PPE has seemed all over the place, leading to confusion and distrust across the hospital. a few weeks ago, internal medicine leadership adopted WHO and CDC guidelines regarding appropriate PPE for covid patients. although we were trained in january to use n95s and other more aggressive PPE, the new policy advised using a less protective surgical mask, along with eye protection, and basic gowns and gloves when interacting with patients during general encounters. n95s were only to be used during aerosolizing procedures, such as intubation, suctioning, and nebulizer treatments. this change was supposedly backed by some scientific evidence of its validity, but it was hard to ignore that it was implemented in light of the expected PPE shortages. smart people disagree about this, but i believe the data’s too limited as to be conclusive regarding what’s really necessary to protect providers. to some extent, internal medicine MDs and PAs on the covid team were expected to model the more liberal PPE practices for the rest of the staff at the hospital, so as not to contribute to panic and irresponsible use, considering the anticipated shortages of n95s and other supplies. seeing ancillary staff walking the halls in n95s while we were going into the rooms of sick coughing patients armed w/ simple surgical masks was frustrating, if not disturbing. there’s been substantial and heated internal discussions regarding how to balance our own protection with the need to preserve PPE for an epidemic with no end in sight. the truth is that if we had unlimited n95s, we would almost certainly be using them. but that isn’t the reality, and so most of us knowingly assume some unknown degree of risk in using surgical masks, hoping they’re sufficient for the majority of patient care. not ideal.
regarding our PPE supply - there are pictures online of staff at other hospitals in the city using garbage bags as gowns. bellevue isn’t there yet. but last week, the shortage of gowns and masks with face shields was noticeable. they are being rationed in a disorganized way and sometimes have required hunting around the wards to find them. it’s exhausting and demoralizing. towards the end of last week, staff members were issued goggles to be kept and reused, as face shields were no longer to be found. customary gowns had mostly disappeared and the ones we started using are clearly substandard. masks are already being re-used in many instances, and there are plans in place to potentially begin sterilizing them for extended re-use. obviously this is all very sub-optimal. at our staff meeting last week, we were told the PPE situation at bellevue was not yet catastrophic. the hospital considered its current supply for the next few weeks adequate - but beyond that, very uncertain. bellevue’s accepting PPE donations and distributing them as needed. regarding ventilators, currently our ICU has enough, but that again is only for the time being and the projected need is very unclear.
more and more patients are being cared for in our covid super ICU, whether they’re being admitted straight from the ED, transferred from the floors, or transferred from other hospitals. on my last several shifts, i sent a floor patient to the ICU every day to be intubated. the feeling of walking through the unit and seeing patient after patient after patient on mechanical ventilation is genuinely unnerving. discussions are ongoing on how to prioritize care and communicate triage decisions with families if the ventilator shortage does arrive, similar to the gut wrenching scenarios faced by providers in italy. the news a few days ago of the 13 patients that died over the course of 24 hours at one of the other city hospitals was equally shocking and sobering. at work that day, we likewise heard through the media and friends at home about the mobile military morgue that had been set up outside our hospital.
the psychological toll is already real. as new york went into increasing degrees of lockdown, it was surreal to continue going to work, only to see fewer and fewer people outside, an increasing proportion of the stragglers in masks, all the while with national leaders continuing to lie and mislead the public about the situation on the ground. non-medical friends of mine in the city have lost their jobs and are unsure how they’ll pay their bills. dear friends and colleagues in the hospital are home sick with covid. many of us wonder if our perceived shortness of breath is a sign of infection or just the newest manifestation of our increasing anxiety. some think it’s inevitable that we’ll all have been infected before long, if we haven’t been already. there’s something very strange about describing the situation as it is now as already feeling cataclysmic, as it’s very possible we’re still just in the prologue.
most tragic of all obviously is the impact this is having on patients and their families. like other hospitals, visitors are no longer allowed at bellevue except in rare circumstances, namely - when patients are at the very end of life and expected to die. talking on the phone to families that can’t come to the hospital is more heartbreaking than ever.
i don’t know what to recommend to you and your communities. that covid has reached victoria is deeply unsettling. it’s almost certainly sneaking around my hometown and others like it around the country. the virus is unpredictably deadly for some patients, and i’ve seen multiple young and previously healthy and athletic patients starving for oxygen and unable to leave their bed for days and days. it also spreads far more easily than i would have imagined. there are patients that have been bedbound in single patient rooms for months that are now infected, suggesting that hospital employees have been unwittingly spreading this disease despite standard hospital hygiene practices. accordingly, some hospitals have implemented a policy that all employees wear surgical masks at all times when on campus. i don’t think you need to be walking around outside in an n95 or even a surgical mask. but in crowded or small spaces, i’d consider wearing something that covers your mouth - this is more to reduce the risk that you’ll unwittingly infect someone else and doesn’t necessarily have to be a mask. it seems like an extreme recommendation, but i read today that our national public health authorities are considering just this. obviously, thoughtful social distancing practices and self-hygiene are paramount.
many of you have asked how you can help. if you have medical supplies you want to donate to new york, you can e-mail BellevueCommandCenter@nychhc.org and they’ll be screened, received, and distributed as appropriate.
if your own community hospitals already have or soon begin to see more of these patients and an increasing strain on local staff, catered food is likely welcome. meals, snacks, and of course coffee are always appreciated. as our work hours grow longer and more intense, finding time to prepare food or even order it to the hospital becomes a growing burden. busiest patient-centered areas of hospitals are going to be the ED, ICU, and internal medicine departments. but please remember not just the nurses and doctors and NP/PAs but also the armies of pharmacists, workers in environmental, admin, IT, and security departments, as well as other ancillary staff that keep hospitals running 24/7. special shout-out to the respiratory therapists, perhaps first among the unsung heroes right now.
to those of you that have reached out with love and concern, i can’t thank you enough. i want to let know you that i’m well, and that your support and encouragement, combined with the endless inspiration provided by my tireless colleagues, has truly meant the world.
finally - to my many friends that are still smoking and vaping on the reg - now is kinda definitely the time to quit.
hey everybody -
wishing you and your families lots of love in these strange times.
as many of you know, i work as a doctor in new york. i want to share my experience of what the past few weeks have been like at work w/ the hope that you may find it interesting, enlightening, or helpful. spoiler - it’s been crazy and this will be long.
i’m a hospitalist, which is a hospital-based internist. i work on the internal medicine floors, largely treating non-surgical patients whom the ER docs think are too sick to send home, but not sick enough for the ICU. my colleagues and i treat a variety of symptoms and illnesses, which notably include fever, cough, and shortness of breath. i work at bellevue, the flagship public hospital in NYC, and one of the primary training sites for NYU. it’s a chaotic environment in normal times. like many public institutions, we’re underfunded and understaffed. but we work hard, and we’re proud of what we do. i don’t hold any leadership positions or speak on behalf of anyone else, nor are my reflections representative of what’s happening at other hospitals in the city.
we began discussing covid preparations at our hospitalist staff meetings in january. protocols, volunteer teams, and call schedules were created, in our group and in other departments of the hospital. it was always a matter of when and to what degree - and never if - covid would come to bellevue. so at the time, i was apprehensive, but had confidence that our national public health system would spare us the turmoil we were seeing in china. i was out of the hospital for the second half of february, but i think work on the floors continued more or less as it always had.
i returned to work in early march, and the atmosphere in the hospital was palpably different. other countries fell like dominoes, and the failure of our national leadership and institutions was obvious and terrifying. the metaphorical storm loomed, from how far off we were uncertain, and the tension among staff increased daily. we mostly waited, reviewed plans and protocols, and hoped we were wrong about what seemed inevitable.
around march 9th bellevue’s internal medicine/hospitalist-led covid floor team went live, possibly responding to the first admitted patient with strong suspicion for the disease. i’m not sure when the first covid patients hit our ICU. our team was initially just staffed by one attending and a physician’s assistant (PA), employing an admission model that directed patients we suspected of having covid to this covid team, attempting to spare, for as long as possible, the care of these patients by the general medicine teams staffed by residents and students. over the next few days there was a steadily increasing trickle of patients admitted to this team with varying degrees of suspicion for covid. initial testing seemed haphazard. protocols were confusing and insufficient. but our leadership and the covid team responded admirably to a challenging situation that was changing daily. positive tests started returning for patients that had obviously been infected by way of community spread in new york.
covid presentation is variable. adults of all ages. including young people in their 20s and 30s without any previous health problems. by now you probably know that many people are asymptomatic and serve as unknowing reservoirs and transmitters of the virus. symptoms vary, and might - in isolation or combination - range from the sniffles, diarrhea, cold-like symptoms, flu-like illness, mild pneumonia, to severe pneumonia w/ complete respiratory failure. but the textbook case that our group began to recognize as most predictably covid positive was an adult with fevers and malaise at home for several days, often with a dry cough, sometimes with worsening shortness of breath that would ultimately prompt their ED visit. on admission, they might or might not have fevers and/or low oxygen levels in their blood. chest x-ray almost invariably shows a characteristic bilateral pneumonia, even in those without respiratory symptoms. labs often with normal or low white blood cell count w/ lymphopenia. some patients require oxygen immediately, others don’t at all. some are well enough go straight home from the ER w/ pending tests and instructions to self isolate, while others required immediate intubation and ICU care with mechanical ventilation. the patients in the middle came to our team on the internal medicine floors for ongoing evaluation and treatment. the luckiest are only in the hospital for a few days. others stay on our service for weeks, but eventually are well enough to go home. the least fortunate are ultimately transferred to the ICU.
our hospitalist/PA team caring for these patients on the floors began to see the same pattern described in other hospitals - those that would become the sickest would often take that turn after 7-9 days of symptoms. as their pneumonias worsened and massive inflammatory responses were triggered, their oxygen levels would continue to decrease to dangerously low values. often rapidly. the simplest and first-line method to deliver oxygen to patients is through a nasal cannula, a narrow tube that runs from the wall’s oxygen supply to your nostrils. generally, when treating low oxygen levels, if oxygen delivery by nasal cannula fails to improve a patient’s respiratory status, there are intermediate non-invasive modalities like high flow, CPAP, and BIPAP machines that are often used successfully and then eventually withdrawn when patients improve. intubation and mechanical ventilation isn’t usually necessary except in the most severe cases of pulmonary disease. but we’d learned from other hospitals around the world that these intermediate methods seemed to serve only as temporizing - and possibly dangerously delaying - measures in covid patients, while also increasing the risk of particle aerosolization, putting staff at increased risk of infection. once covid patients require more than 6 liters of oxygen by nasal cannula, with signs of ongoing respiratory decompensation, they get intubated and require ICU care. this is a huge deal and explains some of our national ventilator supply crisis - our typical second and third line oxygen delivery modalities are completely sidelined.
we’re using medications you’ve heard about in the news. the combination of hydroxychloroquine and azithromycin is of very unclear benefit, and patients i started on this combo early in their at-first seemingly mild presentations later required intubation and eventually died. it’s no panacea and disinformation is dangerous.
my second week back at work in march, the surge in patients still hadn’t arrived, but we seemed on track to follow the epi curve seen in italy. all internal medicine teams began expediting discharges of our other patients. the ED stopped admitting patients that lacked an absolute indication for hospitalization. we were effectively clearing out the hospital. elective surgeries and procedures were cancelled. bellevue’s outpatient clinics began planning to stop most in-person visits and prepared for a predominately telehealth model. normal hospital business drastically changed, and non-covid patients are certainly suffering from the relative absence of routine medical care.
a mobile covid testing tent was set up in the courtyard. med students were dismissed from all clinical rotations, including on our floor teams, of which they’re vital members. an ICU-lite unit downstairs was turned into a covid respiratory unit, with crit care nursing staff walking around in futuristic air purifying helmets called CAPRs. most of our ED space was taken over by presumptive covid patients. dozens of residents were out sick, some of whom had already been confirmed as testing positive. yet still, on the internal medicine floors upstairs, most clinicians just waited in our half-empty hospital with a resigned sense of doom, continuing to care for the few non-covid patients still there. it was eerily calm, but the undercurrent of helplessness and dread was everywhere.
as that week went on, the trickle of covid-likely patients admitted to our service turned into a steady stream, and more attendings, PAs, and now also volunteer residents were added to our covid floor team to care for the growing patient load. likewise, the ICU was admitting patients for mechanical ventilation at a frightening pace. i left my normal inpatient team overseeing residents caring for non-covid patients on march 19th and joined the covid team. the night before, i said goodbye to new york friends i knew i probably wouldn’t see for a while. a day later, our makeshift dam broke, and we began transferring our low-acuity covid patients onto the resident staffed teams, as our covid team could no longer handle the growing patient volume alone. now a river, they just kept coming. and keep coming. from the ED. from other hospitals. for now, by the dozens.
at the beginning of last week, our leadership implemented what seems appropriate to call a war-time staffing model. all internal medicine teams would now treat the increasing number of covid patients. new inpatient teams were created. all of our internal medicine residents were re-allocated to our three hospitals (which include NYU-Tisch-Langone and the Manhattan VA) working in rotating 12 hour shifts on the floors and in the ICUs. many outpatient internists are joining the hospital medicine/covid teams, as are attendings and fellows from internal medicine subspecialities like GI, endocrine, and rheumatology services. our tenth floor normally houses distinct medical, surgical, cardiac, and neurosurgical ICUs. the entire floor is now a medical ICU predominately filled with covid patients on ventilators. areas of the hospital that were used for other services are being converted to covid medicine units on what seems like a daily basis. medical schools across the city petitioned the state to graduate fourth year students early in order to staff the hospitals. retired MDs are coming back to work. surgical attendings, fellows, and residents may soon join us on the medical covid floors.
our hospital’s efforts at coordinating an organized response has been absolutely awesome, but we were in no way prepared to handle all of the nuance required for a crisis of this scale. for example, from the start, hospital-wide messaging about appropriate PPE has seemed all over the place, leading to confusion and distrust across the hospital. a few weeks ago, internal medicine leadership adopted WHO and CDC guidelines regarding appropriate PPE for covid patients. although we were trained in january to use n95s and other more aggressive PPE, the new policy advised using a less protective surgical mask, along with eye protection, and basic gowns and gloves when interacting with patients during general encounters. n95s were only to be used during aerosolizing procedures, such as intubation, suctioning, and nebulizer treatments. this change was supposedly backed by some scientific evidence of its validity, but it was hard to ignore that it was implemented in light of the expected PPE shortages. smart people disagree about this, but i believe the data’s too limited as to be conclusive regarding what’s really necessary to protect providers. to some extent, internal medicine MDs and PAs on the covid team were expected to model the more liberal PPE practices for the rest of the staff at the hospital, so as not to contribute to panic and irresponsible use, considering the anticipated shortages of n95s and other supplies. seeing ancillary staff walking the halls in n95s while we were going into the rooms of sick coughing patients armed w/ simple surgical masks was frustrating, if not disturbing. there’s been substantial and heated internal discussions regarding how to balance our own protection with the need to preserve PPE for an epidemic with no end in sight. the truth is that if we had unlimited n95s, we would almost certainly be using them. but that isn’t the reality, and so most of us knowingly assume some unknown degree of risk in using surgical masks, hoping they’re sufficient for the majority of patient care. not ideal.
regarding our PPE supply - there are pictures online of staff at other hospitals in the city using garbage bags as gowns. bellevue isn’t there yet. but last week, the shortage of gowns and masks with face shields was noticeable. they are being rationed in a disorganized way and sometimes have required hunting around the wards to find them. it’s exhausting and demoralizing. towards the end of last week, staff members were issued goggles to be kept and reused, as face shields were no longer to be found. customary gowns had mostly disappeared and the ones we started using are clearly substandard. masks are already being re-used in many instances, and there are plans in place to potentially begin sterilizing them for extended re-use. obviously this is all very sub-optimal. at our staff meeting last week, we were told the PPE situation at bellevue was not yet catastrophic. the hospital considered its current supply for the next few weeks adequate - but beyond that, very uncertain. bellevue’s accepting PPE donations and distributing them as needed. regarding ventilators, currently our ICU has enough, but that again is only for the time being and the projected need is very unclear.
more and more patients are being cared for in our covid super ICU, whether they’re being admitted straight from the ED, transferred from the floors, or transferred from other hospitals. on my last several shifts, i sent a floor patient to the ICU every day to be intubated. the feeling of walking through the unit and seeing patient after patient after patient on mechanical ventilation is genuinely unnerving. discussions are ongoing on how to prioritize care and communicate triage decisions with families if the ventilator shortage does arrive, similar to the gut wrenching scenarios faced by providers in italy. the news a few days ago of the 13 patients that died over the course of 24 hours at one of the other city hospitals was equally shocking and sobering. at work that day, we likewise heard through the media and friends at home about the mobile military morgue that had been set up outside our hospital.
the psychological toll is already real. as new york went into increasing degrees of lockdown, it was surreal to continue going to work, only to see fewer and fewer people outside, an increasing proportion of the stragglers in masks, all the while with national leaders continuing to lie and mislead the public about the situation on the ground. non-medical friends of mine in the city have lost their jobs and are unsure how they’ll pay their bills. dear friends and colleagues in the hospital are home sick with covid. many of us wonder if our perceived shortness of breath is a sign of infection or just the newest manifestation of our increasing anxiety. some think it’s inevitable that we’ll all have been infected before long, if we haven’t been already. there’s something very strange about describing the situation as it is now as already feeling cataclysmic, as it’s very possible we’re still just in the prologue.
most tragic of all obviously is the impact this is having on patients and their families. like other hospitals, visitors are no longer allowed at bellevue except in rare circumstances, namely - when patients are at the very end of life and expected to die. talking on the phone to families that can’t come to the hospital is more heartbreaking than ever.
i don’t know what to recommend to you and your communities. that covid has reached victoria is deeply unsettling. it’s almost certainly sneaking around my hometown and others like it around the country. the virus is unpredictably deadly for some patients, and i’ve seen multiple young and previously healthy and athletic patients starving for oxygen and unable to leave their bed for days and days. it also spreads far more easily than i would have imagined. there are patients that have been bedbound in single patient rooms for months that are now infected, suggesting that hospital employees have been unwittingly spreading this disease despite standard hospital hygiene practices. accordingly, some hospitals have implemented a policy that all employees wear surgical masks at all times when on campus. i don’t think you need to be walking around outside in an n95 or even a surgical mask. but in crowded or small spaces, i’d consider wearing something that covers your mouth - this is more to reduce the risk that you’ll unwittingly infect someone else and doesn’t necessarily have to be a mask. it seems like an extreme recommendation, but i read today that our national public health authorities are considering just this. obviously, thoughtful social distancing practices and self-hygiene are paramount.
many of you have asked how you can help. if you have medical supplies you want to donate to new york, you can e-mail BellevueCommandCenter@nychhc.org and they’ll be screened, received, and distributed as appropriate.
if your own community hospitals already have or soon begin to see more of these patients and an increasing strain on local staff, catered food is likely welcome. meals, snacks, and of course coffee are always appreciated. as our work hours grow longer and more intense, finding time to prepare food or even order it to the hospital becomes a growing burden. busiest patient-centered areas of hospitals are going to be the ED, ICU, and internal medicine departments. but please remember not just the nurses and doctors and NP/PAs but also the armies of pharmacists, workers in environmental, admin, IT, and security departments, as well as other ancillary staff that keep hospitals running 24/7. special shout-out to the respiratory therapists, perhaps first among the unsung heroes right now.
to those of you that have reached out with love and concern, i can’t thank you enough. i want to let know you that i’m well, and that your support and encouragement, combined with the endless inspiration provided by my tireless colleagues, has truly meant the world.
finally - to my many friends that are still smoking and vaping on the reg - now is kinda definitely the time to quit.
