YINW Vacczine

A Page from the COVID Diaries

With my regular office closed, my main workload these past few weeks has been at teaching hospitals in Brooklyn, where we have largely transitioned to tele-dermatology.  One of these hospitals has been declared 100% dedicated to treating COVID patients.

Last week, I responded to an email plea for volunteers at South Nassau Hospital (SNH).  It’s a relatively small local hospital, but they already have over 300 COVID patients.  The hospital is converting its units one by one into COVID units.  I got an immediate response: Yes, we need your help. In fact, they were thrilled to have me on board because I am familiar with their electronic medical record system and have been credentialed there through prior consults.  They put me in touch with one of their hospitalists.  Dr. T texts back: it's only 8pm and there are 30 new admissions already waiting, less than 12 hours before the next shift starts (That’s a lot!) . He also just picked up the service of one of the other hospitalists who just got off duty and called in sick with… guess what? COVID-19. 

It's been 25 years since I have been a medical intern.  I'm thinking:  How is a dermatologist going to be useful to patients who can’t breathe?  I haven't thought about the plumbing and air conditioning (my slang for cardiology and pulmonology) in years. Like most everyone, I am legitimately afraid of what COVID-19 can do to me, to my loved ones, my friends and my patients, but on this night, I loathe to think about what I will see in the hospital.  I am terrified to be a witness to suffering and find no G-d there. 

I meet Dr. T in an office at SNH with about 10 other hospitalists the next morning. Dr. T is grateful for some help and is gracious, but it is plain to see the stress and exhaustion.  He has sent his family out of town and is working 12 hour shifts. He tells me we are going to divide and conquer. The patients that he ‘inherited’ from the other doctor who called in sick are pretty stable and will be my primary responsibility - with him supervising, of course.  

We start with two patients in the emergency room.  We put on our PPE, including the gown and gloves, N95 respirator, covered by a mask covered by face shield, and enter ER Bay 15.  We should be changing gowns between patients, but he informs me that at this rate the hospital will run out of gowns in 2-3 days.  They are rationing N95 masks. Dr. T has largely given up on the gowns, but I end up carrying mine in a bag and reusing it when going room to room.  

Mr. K is a 66 year old man who is schizoaffective and hypertensive causing him mental status changes. He also has acute hypoxic respiratory failure from COVID-19.  He is tremulous and not answering questions. Dr. T pulls out his stethoscope and listens to the man’s chest.  Then he signals to me to have a listen.  I hesitate: You really don’t want to know what a dermatologist thinks of lung sounds.  He smiles and puts my scope on the patient and takes the time to tell me what I am hearing.  It becomes clear after seeing a few patients that one really doesn’t need a stethoscope to know what’s going on.  I quickly recognize when another patient we see is gripping the guard rail and retracting his abdominal muscles from labored breath. The patient can't keep this up and I presume he will need intubation. The patient is afraid. Dr. T reassures him repeatedly: I'm here! I won't leave you alone! 

I overhear Dr. T talking about a patient and I recognize the name. She is a nurse who worked with my father for decades.  We round on her together. She has been in the hospital for 11 days and she barely recognizes me. She has COVID-19, but no breathing problems, yet I can hardly believe how wasted away she is. She was lucky and got transferred out to a rehab facility the next day. Most of the patients are not getting discharged.

An MTA worker has been in house for 3 days.  He is breathing better than most and is one of the lucky few who will go home today.  He tells me he doesn't want to complain and understands the crisis and pressure, but he has been in this room for 3 days and no one has cleaned it, not once.  I turn and for the first time focus and see the trash overflowing onto the floor with gowns, gloves and cups.  I step outside and speak with the desk clerk on the floor.  She replies:  I'm on it and calls for a janitor.  It occurs to me that it’s not enough to greet the staff in the hospital as I have been doing, but that every employee deserves my thanks:  the clerks, secretaries, respiratory therapists, librarian, janitors, dietetics staff. The list goes on. All these people I walk by in the halls or ask for supplies or other help - the place would come to a standstill without them.

Thanks for caring enough to come in under overwhelming circumstances. Thanks for calmly doing the work. Thanks for taking the risk.  

I see several older physicians working there.  They are taking a bigger risk than most, and yet there they are and they deserve thanks.  I think of something I read by Rabbi Jonathan Sacks: "Saying thank you is more than good manners. It’s good spirituality."

There are absolutely no visitors allowed. The patient’s only line to their families are their cellphones, but some people are just too sick to talk.  The hospitalists spend hours every day calling family members, as the families can’t see the doctors or their loved ones.  

Many patients have a toxic metabolic encephalopathy- the viral infection has made them confused. I see a woman in her 60s, but she looks a lot older than that.  On my first day when I saw her in the ER, she kept repeating: I want to go home. I want to go home. She has underlying chronic bronchitis and can’t breathe well enough to leave.  The next day I see her, her roommate is gone, she again begs to go home.  I explain why she can't.  She pauses and then changes her mantra: I just want to die, just let me die.  I feel an emotional numbness that perhaps I can't help but feel, but compassion is something human beings can and do control.  I hold her hand and feel inadequate, but not indifferent.  I can find no G-d in that room, except what I have brought in with me.

I am used to codes being called over the speakers in hospitals, but now they are about every two hours: calls for emergency intubation. The doctors maintain a sense of humor, but it’s dark: 

Let's all have dinner together Friday night.  We all have COVID anyhow.

Dr. T tells me that they all feel demoralized. We are not used to losing so many patients.  We feel helpless. One of the hospitalists explains that she had a 50 year old previously healthy man under her care, she thought he would be ok and then he abruptly decompensated and died. She had just called his wife to tell her that her husband had passed away, but his wife responded that this can't be, that he was healthy and that they must have the wrong number. The hospitalist said agonizingly:  We haven’t been trained to deliver so much bad news and under such circumstances…by phone.  

Between telederm clinic coverage in the Brooklyn hospitals and Passover, I won’t be at SNH this upcoming week, so on Friday, I said my farewells to the team. I am in awe of the calm and courage of the doctors, nurses, office staff and all the support staff that keep on working.  I feel embarrassed when Dr. T and the other hospitalists thank me for volunteering.  I did very little, but they mostly appreciated that I showed up.  It helped their morale knowing that they weren't in this alone.  I left feeling gratitude for the opportunity to help and for the mostly inspired behavior that I witnessed.  I wait to be reassigned and deployed at Brooklyn’s SUNY hospital where they are calling us off lists to cover in Emergency Rooms, medical wards and ICUs.  

Take home message: Stay home, wash your hands often and wear your masks when shopping, so that you won't need a hospital, where you might have a dermatologist doing your rectal exam.

By: Dr. Eve Lowenstein (aka Dr. Eve Sidlow)