Fail, fail, fail, fail, succeed

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.