Fail, fail, fail, fail, succeed

Author Archives: David Thomas Peacock

Helping Each Other in a Crisis

One of my neighbors, a construction sub-contractor, just rang my doorbell. He wisely maintained a six foot distance as I looked down to see he had placed a paper bag at my doorstep. In it were some N95 respirator masks and gloves.

Keep up the good work and stay safe” he said.

I thanked him, saying how much that meant to me, and told him to thank his family and be safe as well.

We’re all fighting this together, in our own way.

We tend to underestimate how important these interactions are. Reach out, if only to ask “How are you?

It’s powerful medicine.

Here’s a Good Idea

Reach out to people you care about and tell them.

Make sure they’re OK.

We’re all in this shitstorm together.

We’ll make it through it together.

Armageddon (Part 2)

I just slept 10 straight hours after working two 13 hour shifts in the ER. I might not have gotten up then if my wife (who is working at home) hadn’t woken me. I’m off for a few days, so I’m going to try not to post too much about this COVID-19 mess while I’m off – it’s important to psychically re-charge while I can. But before I try to disconnect I want to elaborate on some points I was too tired to make last night before I went to bed.

Looking back at my blog, it took three weeks for the virus to break the healthcare system here in NYC. The scary part is – it’s going to get worse before it gets better. Mind you, I’m talking about NYC here – for obvious reasons, it turned out we’re the tip of the spear here in the U.S.

What, you might ask, do I mean by “break?”

In ER’s, our normal state of business is to save lives. We’re generally at our best in the most critical life and death situations. We’re also good at treating people who aren’t dying, they’re just not our priority. I work in an ER that services a community of immigrants, so often we function as a rather poor substitute for primary care since many of them have no health insurance. I love this community and feel like it’s a privilege to serve them.

So on a normal workday, in twelve hours I might do 2, maybe 3 cardiac arrests, with some strokes, STEMI’s (heart attacks), sepsis, and respiratory failures thrown in. Some days I might have no cardiac arrests – the ER is highly unpredictable. But normally, whatever shows up – we can handle it.

It’s not unusual to have twice as many patients as “beds,” which are really just stretchers. Under normal circumstances, most of these are people who are just sick – not dying. They often go to chairs if they can sit, or we put them on a stretcher in a hallway.

Now, with COVID, we have three times as many patients as beds, and they’re all sick, with many of them dying. So many that we have to move dead bodies out of treatment bays to make room for the next one who might die because we literally have nowhere to put them. We cover the bodies with sheets until there’s room in the morgue. But because so many transporters are sick with the virus, there’s often no one to move them.

When you have critically ill patients, they normally go to the ICU. Except now the ICU is full, so they stay in the ER – often dying there. In the ICU, there are normally 2 nurses to each critically ill patient. In the ER, the number of patients is unlimited, because we have no way to stop them from coming in. We’re always open. Sick nurses means less nurses – less nurses means more patients per working nurse. More patients with fewer nurses means no breaks (no food or water, since taking off your protective gear is dangerous), which in turn weakens the immune systems of the nurses working, leading to more nurses coming down with COVID. This is part of what I mean by breakdown. There’s a limit to what even the strongest staff can handle before they break.

In order to care for critical patients, you need medicine and pumps – and we’re running out of them. You need ventilators and basic supplies – but they’re not there because we’ve run out. You need doctors and nurses, but there’s not enough staff because they’re getting sick. You need protection for the docs and nurses to keep them from getting sick – but they’re not there because we’re running out. I have an N-95 respirator mask that I hang in my locker and use over and over, shift after shift. You’re supposed to change these every time you see a new patient. I cover it with a surgical mask to try and protect it.

As I’ve pointed out before, there are no reliable statistics, because essentially no one is tested. If a doc or nurse gets sick – WE’RE NOT TESTED. Unless, god forbid, we get sick enough to be admitted to the hospital. So contrary to what you might read, no one really knows how much of the population has it. And unfortunately, no one ever will. At least not in NYC – because that phase has passed us by. Now we’re doing battlefield medicine – just trying to save those we can.

I want to point out THAT MOST PEOPLE DON’T DIE. So at least let that reassure you. But the old, weak, and sick are being devastated. Fortunately, with regard to myself, I’m really good at compartmentalizing. I already had to learn how to live with the possibility of my impending death when I had cancer. You do it one fucking day at a time. Now I’m an older ER nurse in a goddamn pandemic, but I don’t perseverate on it because if I did I’d be paralyzed by fear. So I can’t let my mind go there. I just do my job one day at a time, trying to do my best, and often feeling like I’m failing – because there’s a total breakdown of the system.

I want to make this clear – this isn’t a problem specific to my hospital. I like my hospital and think we deliver excellent care – this is a systemic failure in our healthcare system that just happened to show up in NYC first. It’s going to happen all over the country, and for my fellow healthcare professionals, I truly feel for you.

It’s worse than you can possibly imagine.

Armageddon (Part 1)

It’s late after another punishing shift in the ER – each one is worse than the last. There’s so much I need to talk about, but I’m too tired to be coherent.

It’s weird – right now, at my ER here in NYC, it literally seems like the end of the world. It’s not, of course – but you wouldn’t know it if you worked there.

If the rest of the country is this ill-prepared, our lives will never be the same. This is a civilization changing pandemic.

I’ve got to collect my thoughts after a good nights sleep.

More later.

I Don’t Feel Like a Hero

In my ER it almost feels like the end of the world, and there’s not a goddamn thing you can do about it.

Seriously – EMS, ER docs and nurses – we’re just trying to do our best to keep people alive, and it feels like trying to bail out the Titanic with a thimble.

All the while you’re gasping for air like you’re drowning. Mainly because you can’t breathe through your N-95. Which, trust me – you are seriously grateful for.

Meanwhile, they just keep dying, but not before you are up close and personal with the most dangerous kind of exposure – the point at which the virus is converted into an aerosol.

Anyway – trust me, I’m no hero. Just someone determined to do their fucking job, the one you trained for and worked hard to at least attempt to become expert at.

It’s late and I’m done. Hasta la manana.

Mindset

When you’re exhausted, weak, and tired and everyone around you looks just as bad as you or even worse – that’s the perfect time for you to make a statement.”

– David Goggins

What Makes it Hard?

You can’t escape the feeling you’re not doing enough, because there’s too many of them. While you’re medicating one, another one of your patients codes. All day long. For 12 and a half hours.

There’s not enough nurses and docs to take care of them because the nurses and docs, one by one, come down with it. You look around for support, but all you see is terror in their eyes.

The daily death toll just keeps mounting, and there’s no where to put the bodies because the morgue is filling up. You cover them up with a sheet and just roll the stretcher wherever you can.

There’s no space left to put the sick, so we stack them anywhere we can – hallways, chairs if they can sit, two to a room. There’s a tent outside but I’ve never had time to see it.

The ICU and floors are full, so the critical ones stay in the ER, and the nurses and docs taking care of them just keep getting more and more patients. You can’t drink because you’ve got take off your PPE to do it, and that’s dangerous.

You might go 9 or 10 hours with no break, because there’s no one there to relieve you. You start getting angry because you’re so hungry, thirsty, and beat up. You feel shitty because you realize you’re starting to lose it.

There’s not enough PPE, so you just hang what you have in your locker and reuse it, shift after shift, being REAL CAREFUL how you handle it, wondering how long it will last.

Wearing your PPE for 12 and a half hours is painful – you feel like you can’t breathe, mainly because you’re breathing the CO2 you’re exhaling. You keep it on so tight it breaks down the skin on your face. And still they keep coming.

The demented or delirious ones keep tearing off their masks and coughing in the open – and you’ve got to put in their IV’s and treat them. Haldol can help.

All the while you’re thinking “I’m not going to get this, I’m not going to get this, I can handle this,” but realizing that’s unlikely. The experts think it won’t peak for another couple of months. You can’t let yourself think beyond getting through this shift.

You might have 3 or 4 die on you in a single day, and you know it’s going to get worse before it gets better. You have discussions with the docs about who’s most likely to survive.

You think about your wife at home.

It’s hard.

Breaking Down

I’ve had an internal debate over how honest I should be in this blog concerning COVID-19, somehow feeling like it’s my job as an ER nurse to reassure anyone reading this. People are panicking already and I certainly don’t want to feed that fear.

But I’ve been an ER nurse for ten years, and I’ve never seen or experienced anything remotely like this. When I say “breaking down,” I’m not referring to myself, although I’d be lying if I didn’t admit this is pushing me to my limits. No, I’m talking about a breakdown of our entire healthcare system, something I never dreamed I would see.

What’s happening in ER’s all over NYC right now is unimaginable. What EMS in NYC is dealing with is unimaginable. The virus is spreading unchecked, completely out of control, and the healthcare providers on the frontline will carry this experience like a huge disfiguring scar the rest of their lives.

If anyone is reading this I want you to know this: We are trying our best, but I’m afraid it’s bigger than us.

It’s already beyond anything you could ever imagine in your worst nightmare. And I’m afraid the worst is yet to come.

American Epidemiology: Epic Fail

Well, I guess we now know how prepared we are to deal with a pandemic. It’s shocking to even me, and I can be a bit of a pessimist. I’m not saying the CDC is incompetent, because I’m sure they’re not. My best guess would be that their budget just kept getting cut over the years until there wasn’t much left. We already know how important universal healthcare is to our government, so this can’t be much of a surprise.

BTW, when I say we’re not testing for the virus in NYC, I mean we’re really not testing. If any ER nurse or doc comes down with it, we’re not tested. That’s right – even the healthcare professionals working the frontlines don’t get tested (unless, god forbid, you’re sick enough to be admitted to the hospital).

And honestly, as an exhausted ER nurse, I no longer really care. In the beginning it was important because we could have targeted hotspots and tracked the disease’s trajectory, building solid epidemiological data. But now it’s way too late for that.

The prevailing view among the docs and nurses I wrk with is that we’re all going to get it, and I certainly understand that feeling. But I’ve got to be truthful here – I’m going to work everyday just like any other day. I’m proud to be paid to take care of sick people. It’s intellectually, physically, and spiritually stimulating.

The only difference is that from the moment I walk onto my unit until 12 and a half hours later, I’m wrapped up tight. I only take off my PPE when I have to eat or drink – and that’s quite a production.

I’m trying my damndest to get through this shit without getting sick, and so far I’m good.

Necessary Distraction

Trying to find a good book to read, something to get my mind off this mess between shifts. After starting and stopping a few, I finally found one. It’s a doozy…

“LaBrava” by Elmore Leonard, circa 1983. Drew me right in – I can be sitting in the dirty cafeteria at work, trying to eat and get my mind off the madness of the ER and this goddamn pandemic, and all I’ve got to do is start reading and boom! I’m instantly transported to the underbelly of early ‘80’s Miami, with indelibly written characters right out of a 1950’s film noir. His style is spellbinding – almost the entire novel is written in dialogue.

So right now this is my drug of choice.

Like I’ve said before, sometimes you’ve just got to tune out if the world is making you too crazy and there’s nothing you can do to fix it. Nothing wrong with that. Right now, for me, it’s meditation, Elmore Leonard, and the usual vices.

It’s enough.

Holy Fuck

Just spent 12 and a half hours in the ER at ground zero of North America’s COVID-19 pandemic: New York City. It’s quite a show – definitely not for the faint of heart.

Social distancing isn’t much of a strategy for a city that is, by definition, a large gathering of people. Seven million plus stacked on top of each other like a giant ant colony.

It’s spreading like a brush fire out of control. There’s no stopping it at this point – we just have to let it burn itself out by infecting the entire population, finally resolving itself because essentially everyone will have had it, hopefully building up a massive herd immunity.

For what’s it worth from an ER nurse in the middle of this catastrophe, that’s my best guess. Tomorrow, my hospital, the largest in the city, is actually erecting a tent because we’ve run out of space.

The speed it’s happening is breathtaking.

But if anyone’s reading this, I want you to know that we’re going to get through it.

For the moment, that’s my story and I’m sticking to it.

Take a Deep Breath: Here’s Some Anectdotal Good News

Item 1:

A good man and brilliant ER doc I work with tweeted this today: “Finally home after 13 hours in the ER. Today >90% of my patients were confirmed or likely #COVID19. Many really sick, some in their 30s like me. The sirens on otherwise empty NYC streets are unending & haunting. I’m tired. But really honored to be back in the ER in the morning.”

Item 2:

My last five shifts in the ER I have worked in triage – literally triaging hundreds of patients, and I can concur with this doc’s assessment. Almost everyone coming in has COVID-19. But the good news is that the overwhelming majority of people with this illness are going to survive. Of course, it’s an ER, so we are going to see the worst cases as well – but I want to dwell on this somewhat more positive thought for a moment.

I know how easy it is to slip into a panic over this. Yes, it’s a real pandemic. Yes, there is a high likelihood that most of the population of North America will end up with it at some point. But it’s not a death sentence. Sometime in the future, enough people will have come down with it that herd immunity will kick in, and it’s likely that by that time some type of vaccine or treatment protocol will be in place.

So take all precautions and try to be one of the ones who make it through without coming down with it. But most of us have been sick at some point in our lives, and we’re still here, aren’t we? BTW, the doc who tweeted that contracted EBOLA and survived it.

So please adhere to your local Department of Health’s recommended precautions, and allow me to recommend one of the best ways to alleviate anxiety.

Reach out and help someone else.

True Colors

Who you really are tends to get revealed in a crisis, and people won’t forget what they see. You might be panicking and feel justified at the moment, but one day this will all be over and you’ll have to live with your actions.

Think about that.

Choose Your COVID Resources Wisely (Part 1)

By all means continue to read the New York Times for COVID-19 coverage, but as a healthcare professional let me recommend three other resources.

  1. Follow Helen Branswell on Twitter. Her bio: Helen Branswell, is the real thing: A reporter who has been on the beat for 20 years, including covering the SARS outbreak. As early as December 31, Branswell voiced concerns on Twitter about a mysterious new outbreak in China. Her Twitter feed has been a go-to source for dispassionate parsing of the research and news developments on the coronavirus, earning her almost 100,000 new followers since that initial tweet.
  2. Read Tyler Cowan’s daily blog – Bio: Tyler Cowen has a Ph.D in economics from Harvard University and is currently a professor of economics at George Mason University.
    More importantly, he has decided to turn his substantial intellectual resources to disseminating information on the COVID-19 pandemic in a thoughtful and responsible manner, including setting up monetary prizes for solutions to problems facing healthcare workers.
  3. Listen to Michael Osterholm’s podcast interview with Joe Rogan. His bio: Dr. Osterholm is Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School, all at the University of Minnesota. 

That’s it for now – tomorrow I’m back in the ER. Wash your hands, stay at home, and be safe.

Do what you can to help others, but don’t stop living and enjoying life. You’re not getting this day back.

What’s Wrong With This Picture?

Ok, I feel compelled to comment from the front lines of people treating COVID-19 patients (for anyone stumbling on this blog – I’m an ER nurse). This one has to do with science and not the state of ER’s attempting to handle this mess.

Epidemiology is predicated on analyzing objective data – in the case of the spread of COVID-19, we’re essentially talking about how many cases exist in the general population, and perhaps more importantly, what the mortality rate of the disease is.

And yet – from my perspective (and I work in an ER in the largest hospital in New York City), basically no one is tested. That is, unless you are being admitted to the hospital.

No one.

Just mull THAT over for a minute. Mind you, I’m no infectious disease expert, but how can you possibly track a disease you’re not even testing for?

Now, I have no idea what government agency is responsible for bungling this mess, and quite frankly, I don’t give a shit. ‘‘Twas ever thus in this country – to quote Billie Holiday: Them that’s got shall get, them that’s not shall lose.”

So don’t believe what you read in the papers or hear online – no one has a fucking clue how many people have contracted it. I know, because I work closely with quite a few brilliant ER docs, and I’m constantly grilling them for information on how we’re handling testing. They are all exasperated and quite forthcoming about their frustration.

Hopefully this will change, and when it does, I’ll report it here, if for no other purpose than to simply give me a timeline of where we are in this shitshow at this point in time.

Unsurprisingly, given the current state of America, it’s a steaming plate of incompetence.

Of epic proportions.

Not Sure if this is Sustainable

I’m seeing Multiple COVID-19 positive patients everyday in the ER, and most symptomatic patients aren’t even tested. We send them home for Christ sake, and I’m quite sure there’s no follow up by the DOH. Why would there be? If they never tested for COVID, of course they don’t show up in any pesky infectious disease statistics. Starting to get the picture where things are headed?

I can be triaging someone for afib, when they’ll drop “I’ve had this annoying cough for a week,” and because they’re being admitted to telemetry for their heart condition, the hospital will approve a COVID test. In point of fact, no one gets tested unless they’re being admitted.

To say that stress levels among staff already feels oppressive is to compare them to the passengers on the Titanic who said “Look at that lovely little floating piece of ice,” just before you know what happened. We all know how that ended.

Every shift I feel like I’m dodging bullets for 12 and a half hours and yet I know things haven’t even started yet. Did I mention the staff already out on quarantine because they were exposed without PPE? There’s a certain fatalism in the air among ER docs and nurses, a kind of grim realization that there’s a very good likelihood none of us are going to make it through this without getting infected.

And yet – this is what we do. Everyday. No matter how sleep-deprived or exhausted. This is what we signed up for – because (whether we want to admit it or not), most of us find great satisfaction in caring for people in need. Without that, no amount of money would make this particular job worthwhile.

But I guess my point here is there’s no shame in admitting you’re struggling. It’s part of what makes us human.

Struggling here boss.

Modern Day Shaman

Things are getting pretty tense, no? Well, if your anxiety is starting to get away from you, I’ve got a quick fix that’s guaranteed to make you feel better…

“Richard Pryor: Live in Concert” is streaming on Netflix, and to say it has held up as one of the great masterpiece‘s in the history of comedy would be a gross understatement. Watching it again last night, hoping for a relief from pandemic madness, I wasn’t disappointed.

I literally laughed (or at least smiled) for the full 90 minutes – and I’m a jaded comedy fan who had seen it multiple times before, although not in my years. For a comedy special filmed in 1979, I was a bit shocked at how well it aged – with perhaps one exception, it holds up as even in the context of today’s “cancel culture.” That’s how much vulnerable humanity Richard expressed through his comedy.

So return to a shaman of comedy for your dose of just the right medicine. In fact, bookmark it – we’re probably going to have to return for a few more doses before this thing’s over.