The other symptoms of BPD that I struggle with are the intense emotions and abandonment issues. The next morning, as I’m getting ready for work, I panic: I might not have showered last night when I got home from the hospital. During college, when I was still a virgin, I went to see a male ob-gyn. “From colleagues to journalists to bioethicists — we are in firing lines these days,” Bertolini adds. I see a room about half the size of the E.R. Should I change my sheets, scrub my apartment? Everything was supposed to be perfect at that point. ), “And it will,” he immediately replies. That wasn’t a conscious choice, just something I never felt the need to do. A few days ago, palliative-care doctors started helping us with some of the life-or-death conversations. As soon as I hear this, I venture out that night to buy two pulse oximeters, small devices that go on a person’s finger to monitor his or her respiratory status. “The coronavirus has stripped away my veneer of invincibility.”. I had Then we make another call. I’m afraid that people will get sick of dealing with me and get up and leave. As soon as I open the E.R. They also explain how patients could otherwise be made comfortable, if they don’t want to continue with more aggressive treatments. bed. A co-worker tells me he used three masks during the course of his shift. “It’s all in my head,” “I make things worse for myself,” and “Medication is a crutch.” Not only was I devastated, but I was miserable on the trip. Doctor in New York. Thirteen Covid patients died in one hospital in 24 hours. Everyone in medicine knows that one of the most heart-dropping phrases you can hear is: “You know that patient you saw the other day? Some of the pleas had an Excel file attached. I need to know what might come, what decisions I might be confronted with. It’s the only thing that provides some reassurance. Sometimes they are still there the next day. I don’t want to think that way, but it is the dismal truth of our new situation. Even wearing an oxygen mask, he could not sustain levels above 90 percent overnight. But we can’t give them too much in the way of IV fluids or we could flood the respiratory system. Participants ask questions about the availability of tests and how we should protect ourselves, but no one seems very worried by what’s unfolding in Italy. I have borderline personality disorder. Some of us are also eager for antibody testing, seeking a sense of security if we end up having antibodies, though it’s probably too early to say whether or for how long that could actually provide immunity. I am optimistic that for those who have a chance of surviving, we will be able to do everything for them. It has specifications that the Siaarti document lacks. “Our jobs are difficult but are the most beautiful ones.”. have started communicating through a Whats­App group chat so that we can openly discuss how we’re feeling about the pandemic response. (A few days after it opens, the Javits temporary hospital changes its admission policy to take in Covid patients; the Comfort does so the following week.). Although the man is designated D.N.R./D.N.I. Emails come through from hospital leadership and the city’s health department telling us to be “appropriate” and conserve our N95 masks. There’s nothing I can do about this now. She was delirious, lacking oxygen to her brain, and had also yanked out her IV lines. It’s not something that be cured. “It does whatever it wants.”. And it was taken so quickly. A male doctor was on duty – I didn’t want him anywhere near me, but they said there was no one else, so I gritted my teeth and got on with it. Usually I remember patients by their faces, but they all have masks on too, so all I see is their eyes, which more often than not are closed. After witnessing how many patients are suffering in the E.R., I immediately discharge two to self-monitor. And there is no space for imagination during humanitarian crisis. Can someone from another city understand what’s happening in New York? We’re unable to reliably predict who does well and who doesn’t. To help with this task in Bergamo, a few weeks into the outbreak, a doctor at the hospital comes up with a scoring system. You can make the choice to let go of the pressure, tackle your fears I don’t have some of the “required” symptoms on their lists, and I do have other symptoms that aren’t on their lists. Two Italian colleagues — a doctor and a nurse — have already warned me about the physical toll of wearing this equipment on their aching faces, their noses rubbed raw, the tracing of their masks etched into their skin. “So many patients, in every corner,” he says. “When we came out, we were silent for all the journey home,” he says. I want people to know; I don’t want doctors to die in anonymity. My promise to them has always been that when they come through those E.R. It took time to adjust to that idea I would never hold another baby (of my own) in my arms. for more than a week; most of the patients are too sick to talk; the few without breathing tubes who are able to cough are muffled by their masks. The PTSD is due to my childhood trauma. I’m sure these patients all looked OK a few days ago. “Stay strong,” another says. We are starting to see some cases in our hospitals, but it’s nothing like what doctors in Italy are describing. Every influence, every motive, that provokes the spirit of murder among men, impels these mountaineers to deeds of treachery and violence. I’m worried that I might do something, even slight, and they’re out the door. Even if we are exposed to a patient without proper personal protective equipment, we are expected to return to work if we don’t have symptoms. A colleague, feeling similarly, announces during a meeting: Soon I’m just not going to intubate the 80-something-year-old patient who doesn’t talk or walk so that there will be a ventilator available for the 30-year-old who comes in later. He realized that there was something wrong if only his relatives were coming inside.” The man knew in that instant that he was going to die, Duca says. Talking helps. I’m very, very lucky. Two years ago, Sherry Pollex was feeling off: She was super bloated (“I looked like I … No one from another region could understand what was happening in Lombardy. It took time to adjust to that idea I would never hold another baby (of my own) in my arms. (It’s impossible to know unless you bend over, look behind the stretcher and glimpse the thin black needle ticked over to the red zone on the gauge.) I can think of nothing else, but the last thing I want to do is describe to each person what’s happening in the hospital. I'm a Virgo myself. Through that I have made many friends in Here I am, trying to fight against the stigma of mental illness and I can’t even stand up to a friend. None of Us Will Ever Be the Same. But, lately I’ve tried to stand up, be proud of who I am and accept the fact that I am mentally ill. A Letter to Someone Who Doesn't Understand. I have gotten texts from colleagues about the chaos here, but I thought that those were just about one bad day, that they had already gone through the worst. My patient isn’t fooled. I’m also hopeful that external relief will come. We shock her out of the irregular, rapid rhythm her heart is in, put a breathing tube down her throat and start drips of multiple IV medications to stimulate her heart and constrict her blood vessels. When we hear that the Javits Center and the Navy hospital ship Comfort will care only for non-Covid patients, my colleagues and I find this laughable, because everyone has the virus. Maybe thats a common thing in the medical world. As the man’s breathing worsened, morphine was started. I have a hard time with normal, healthy attachments because of the borderline. They warn me that we are about two weeks behind them. The truth is, when treatment is rationed or withheld, the decisions are almost always reasonable, and hopefully the family will be involved. I'm a Virgo myself. I am super attached to Karen and my doctor because of this. Old or young, all seem wholly vulnerable. It was early on in New York’s outbreak, and we were still in patient-centered mode, as the doctors in Italy put it. I wonder if I’m more useful Face­Timing patients’ families rather than applying my skills as a doctor. But during a routine visit with my doctor at 39 ½ weeks, we found out our daughter, Harper, didn’t have a heartbeat. We manage to reinsert her breathing tube and replace her IV lines; she safely makes it to the I.C.U. “I only believe in statistics that I doctored myself” ― Winston S. Churchill Read more quotes from Winston S. Churchill How do I make it through the next 12 hours? When I’m not in the hospital, I feel a phantom mask on my face. But I didn’t feel brave in the The question of who gets a ventilator and who doesn’t comes up in every single Zoom meeting among E.R. She falls apart, tears streaming down her inflamed, marked cheeks. “The person you were coding was six years younger than me.”. Their respiratory needs are different from what I’m used to. Don’t get me wrong: therapy has helped so much. Just a little tired, don’t worry, he says. They are “completely living in another world,” Bertolini says, because “unless you are inside this situation, you cannot understand fully.” People are, it seems, woefully bad at grasping how future events will unfold, whether in the city next door tomorrow or across the Atlantic a couple of weeks later. I didn't because I was too frightened. I am scheduled to be off from work for several days. in this pandemic, it’s actually worse than those overseas hospitals. Three masks?! Thirteen Covid patients died in one hospital in 24 hours, Black and Hispanic patients are dying at twice the rates. physicians. When I share this with colleagues, a couple of them start to counter: “The current evidence says. doors, I will do everything I can to help them live. By the end of my shift, every patient begins to blend into a single patient. I never lost confidence in my ability to be a good lawyer, but I stopped seeing a clear path for myself through the legal profession. How could he help them do that? Isn’t the hospital full? Or whatever oxygen you did give them becomes suddenly insufficient, as their lungs grasp for ever more. If you use a lot for the first patient, then you have no treatment for the next patient. Family members and friends haven’t been allowed into the E.R. I would override what the family wanted and hope that afterward, they would understand. I want to do everything for my patients, as much as they and their families want, just as we have always done. “I love you,” she says to her aunt. I’m not sure whether you are aware of this or not, but I always considered our relationship important. It had been about one month into this crisis for her. I don’t think she’ll be able to talk, but she is actually able to express herself and tell me: “I don’t want a breathing tube. “Damage control,” we call it. If not, well, you know what to do. Go high on the oxygen and the post-exhalation pressure. I think that we do this to protect ourselves. I've never been to church and prefer to think for myself. It has been only a week since my colleague first posed the hypothetical case about resuscitating a Covid-infected patient whose heart has stopped. “The virus is as free as the wind,” Pietro Brambillasca, an anesthesiologist who works with Duca, tells me over the phone. I got praise for being strong, for handling things well, for not sinking to a lower level and arguing. “I knew that he was not doing well,” Duca says. I’m unable to sanitize again because there are no more portable hand sanitizers left. I have to touch a door handle to go into the workroom to type my clinical notes. I become obsessed with oxygen levels, which seem to be the only reliable indication of how patients are doing. She shares her recipe: 170 degrees for 30 minutes. I really don’t feel like healthcare institutions are set up to protect women of color.” “You were brave,” people say when I tell the story of my surgery discharge and what I had to do to stand up for myself. Either I am having one or the physician next to me is. … ” I think of all the doctors who sent their patients home because they looked well or are young or don’t have medical problems, and they came back to the E.R. It’s the first day of our pulse-ox to-go program. Then I realize I am the absurd one. Find support and help support others on NAMI's message boards. … ” What evidence? I wish I didn’t, but it isn’t my choice. Officially, it is posttraumatic stress disorder, borderline personality disorder and major depressive disorder. She last wrote for the magazine about hospice homes for children. Oxygen hisses in the background. Are you sure you want to proceed?” She barely made it to daybreak. Health care workers and equipment are coming in from other states. Abandonment issues are the worse. We have to function as if everyone is infected. It was invasive and I flinched a lot. “And I’m saying this as someone who doesn’t believe in these guidelines,” he adds. I know the situation with ­Covid-19 is already dire in different parts of the world, Italy especially. I really don’t feel like healthcare institutions are set up to protect women of color.” “You were brave,” people say when I tell the story of my surgery discharge and what I had to do to stand up for myself. But I forced myself out of bed day after day. I tried not to get close to people so I wouldn’t lose them. “I ask myself if I’m more useful if I go outside my home, take paper and alcohol and disinfect the doorknobs of my neighbors instead of going to work as a doctor,” he says. It’s a lot of work. Patients who test positive for the virus are unintentionally roomed with those who test negative or whose tests are still pending, because the E.R. He had issued an executive order stating that physicians “shall be immune from civil liability for any injury or death” while caring for patients during the Covid outbreak, unless it’s a case of “gross negligence.” I ask my co-workers if anyone is still concerned about getting sued. I’d never looked after myself, let alone my daughter, and I didn’t know how to cope with my feelings.” Matt continued to go to the support group and went to counselling for two years. Am I infected? I was certainly not the mom she deserved. can be swamped, with patients doubled up in rooms and too few monitors and beds to go around. I fell in love with the bass player. Do we have enough tanks in the E.R.? His wife, an otolaryngologist, has also been recruited to the effort: She is now working in a Covid unit in a neighboring hospital. Sputum and blood and sweat are flying everywhere in the room. Many have died in the meantime, and many more are uncounted in the ­Covid-19 death toll because they succumbed at home or weren’t tested. I can hear their 1-year-old daughter in the background. A refrigerated truck is sheltering dead bodies there because the morgue is already full. — “do not resuscitate” and “do not intubate,” which instruct us not to pursue aggressive interventions like electric shocks and breathing tubes — his family, with death now looming, reverses his no-resuscitation order and decides, instead, that he should receive even the most extraordinary lifesaving maneuvers. I see a patient’s oxygen level shoot up. “To be honest with you, I didn’t see there was an issue with it myself. “They say we are God-playing.”. I’d do anything for them and am not sure how I’d live without them. I can’t run away from Brambillasca’s words about the virus: “It does whatever it wants.”. It’s been a lot of work and I’ve come a long way. “But I’ll become an ice-cream maker instead of a doctor if I have to go on this way.”. is a place I no longer recognize. With an E.R. Philip Montgomery is a photographer whose current work chronicles the fractured state of America. He won the 2018 National Magazine Award for feature photography on Ohio’s opioid epidemic. Even if I develop symptoms, I’m not able to get a test from employee-health services at my hospital anyway. Even in the best of circumstances, the E.R. During college, when I was still a virgin, I went to see a male ob-gyn. The clinical picture was different from what Duca and his colleagues expected. It’s complicated and it seems to me that you need some more information to more fully understand me and my experience. Our E.R. “You go on, you forget you have a person, a human in front of you. Such material is not meant to be taken seriously. T he next few weeks were hard. Someone intubates two patients — a procedure that risks exposing the medical worker to discharge from a patient’s nose and mouth — without a face shield because none were immediately available. Better to be lucky than to be good, I remind myself. It’s calm and quiet. We were in complete shock—shattered and utterly heartbroken. All Rights Reserved. Someone sends me ultrasound images of profound heart failure in a Covid patient he cared for. The document’s fundamental thrust, though, is that those with the highest chances of survival — the young and the healthy — get priority. “Everyone’s got to stop crying,” she says. I am hardly responding to family and friends anymore. Do everything possible, unless the patient or family has explicitly expressed otherwise. These observations happen repeatedly; I pendulum back and forth between my fascination with the disease and my despair for my patients. There have been times when I’d rather die than live through the pain of separation. Then I pause, realizing that this is a sign that the patient probably won’t do well. He had been high up in the Italian Alps through the last day of February, when the distressing messages started to come in from colleagues asking him to join a new Coronavirus Crisis Unit for Lombardy, a region in northern Italy. She sobs out words of anger and frustration and sadness. I push these thoughts away, immediately. I’m an E.R. Helen Ouyang in her rental car preparing for a shift in the emergency room, putting Band-Aids on her face to help protect it from her mask. He had to see the situation for himself. Until this point, I have been opposed to the idea of sending hypoxic patients home with pulse oximeters, especially after learning from the Italian doctors that their oxygen numbers often drop quickly to life-threatening levels — sometimes before the patients feel it. I have a complicated diagnosis.