Tuesday, March 24, 2020

On The Frontline In The War Against COVID-19

An ER Doctor wrote about a typical day dealing with this terrible pandemic.
Follow him on Twitter here: Craig Spencer MD MPH


Many of you asked what it was like in the ER right now. I want to share a bit with you.

A Day in the Life of an ER Doc - A Brief Dispatch from the #COVID19 Frontline:

Wake up at 6:30am. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks too. It's all closed.

On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it's early. Regardless, that's good.

Walk in for your 8am shift: Immediately struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone's protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.

You take signout from the previous team, but nearly every patient is the same, young & old:

Cough, shortness of breath, fever.

They are really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast.

You immediately assess this patient. It's clear what this is, and what needs to happen. You have a long and honest discussion with the patient and family over the phone. It's best to put her on life support now, before things get much worse. You're getting set up for that, but...

You're notified of another really sick patient coming in. You rush over. They're also extremely sick, vomiting. They need to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It's not even 10am yet

For the rest of your shift, nearly every hour, you get paged:

Stat notification: Very sick patient, short of breath, fever. Oxygen 88%.

Stat notification: Low blood pressure, short of breath, low oxygen.

Stat notification: Low oxygen, can't breath. Fever.

All day...

Sometime in the afternoon you recognize you haven't drank any water. You're afraid to take off the mask. It's the only thing that protects you. Surely you can last a little longer - in West Africa during Ebola, you spent hours in a hot suit without water. One more patient...

By late afternoon, you need to eat. Restaurant across the street is closed. Right, everything is closed. But thankfully the hospital cafeteria is open. You grab something, wash your hands (twice), cautiously take off your mask, & eat as fast as you can. Go back. Mask up. Walk in.

Nearly everyone you see today is the same. We assume everyone is #COVIDー19. We wear gowns, goggles, and masks at every encounter. All day. It's the only way to be safe. Where did all the heart attacks and appendicitis patients go? Its all COVID.

When your shift ends, you sign out to the oncoming team. It's all #COVIDー19. Over the past week, we've all learned the signs - low oxygen, lymphopenia, elevated D-dimer.

You share concerns of friends throughout the city without PPE. Hospitals running out of ventilators.

Before you leave, you wipe EVERYTHING down. Your phone. Your badge. Your wallet. Your coffee mug. All of it. Drown it in bleach. Everything in a bag. Take no chances.

Sure you got it all??? Wipe is down again. Can't be too careful.

You walk out and take off your mask. You feel naked and exposed. It's still raining, but you want to walk home. Feels safer than the subway or bus, plus you need to decompress.

The streets are empty. This feels nothing like what is happening inside. Maybe people don't know???

You get home. You strip in the hallway (it's ok, your neighbors know what you do). Everything in a bag. Your wife tries to keep your toddler away, but she hasn't seen you in days, so it's really hard. Run to the shower. Rinse it all away. Never happier. Time for family.

You reflect on the fact that it's really hard to understand how bad this is - and how bad its going to be - if all you see are empty streets.

Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don't stop.

Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be stat notifications. More will be put on a ventilator.

We were too late to stop this virus. Full stop. But we can slow it's spread. The virus can't infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don't care as much about the economic impact as I do about our ability to save lives

You might hear people saying it isn't real. It is.

You might hear people saying it isn't bad. It is.

You might hear people saying it can't take you down. It can.

I survived Ebola. I fear #COVIDー19.

Do your part. Stay home. Stay safe.

And every day I'll come to work for you

You can follow him on Twitter here: Craig Spencer MD MPH.

Note: This thread is related to #Coronavirus #COVID19

Follow the World Health Organization's instructions to reduce your risk of infection:

1/ Frequently clean hands by using alcohol-based hand rub or soap and water.
2/ When coughing and sneezing cover mouth and nose with flexed elbow or tissue - throw issue away immediately and wash hands.
3/ Avoid close contact with anyone that has fever and cough.

Craig Spencer MD MPH@Craig_A_SpencerDirector of Global Health in Emergency Medicine @ColumbiaMed/@NYPhospital and Faculty in Forced Migration & Health @ColumbiaMSPH | @MSF_USA BoD |#Ebola survivorMar. 24, 2020

Tuesday, March 17, 2020

My Coronavirus playlist

In addition to the REM song in my previous post, here's some other songs to help you enjoy your social distancing/isolation/quarantine. I'll probably add to it as I think of new songs. In some cases I'm just picking the song based on the title alone.

Okay this is an obvious choice:
Hey Nineteen - Steely Dan

Here's one that is definitely appropriate if you enjoy bars and clubs:
Ghost Town - The Specials

Going along with the undercurrent of apocalyptic social change and basic survival:
Life During Wartime - Talking Heads

Yeah, this was an easy one:
Waiting for the End of the World - Elvis Costello

Although it's about Pompeii being destroyed by Vesuvius, it kind of goes along with the impeding apocalyptic feel of today's situation.
Cities in Dust - Siouxsie And The Banshees

Another obvious one. It's widely known as the theme from "Jackass", but it's called Corona, so...
Corona - Minutemen

...more to come...

Sunday, March 15, 2020

It's the end of the world as we know it

Yes, the world as we know it is ending.

We are all about to embark on a weird, dangerous voyage through a viral nightmare.

And if or when we come out on the other side, the world will be forever changed.

Our behaviors will change.

Our fears and hopes will change.

Our former feelings of security will change.

The future will smell of low-grade anxiety and lemon-scented hand sanitizer.

It's the end of the world as we know it...

...and I don't feel fine about it.

But here we are.

Welcome to the new reality.

Sunday, March 01, 2020

Sunday Night Music Club v.53

David Byrne of the Talking Heads performed a well-known hit from his work with the band.

The performance was on Saturday Night yesterday (2/29/2020) and it was the same as when I saw American Utopia in January at the Hudson Theater in NY. The show ended in early February but immediately after the run they announced a return engagement starting in September.

It was a terrific show, entertaining and captivating, and loads of fun! If you can't make it to the live performance, I'd recommend a viewing of the 1982 concert film "Stop Making Sense", which for my money is the best concert film ever made.

Here's Once in a Lifetime on SNL:
EDIT: They took down the video. Hopefully they'll release it again, and I'll link it below.