Show Hide image North America 5 April 2020 “How long will we hold?” Inside New York’s struggle against coronavirus The US city has become the epicentre of the Covid-19 outbreak. In this remarkable account, one senior doctor describes life on the frontline of an emergency department. By Craig Spencer As the director of global health in emergency medicine at Columbia University, and an ER doctor at New York Presbyterian hospital, I have been on the frontline of the city’s battle against Covid-19 since the first cases were reported here on 1 March 2020. There is now really no way to describe what we are seeing. Ours is a new reality that verges on the unreal. The people and the places that we have known so well and for so long have been transformed. Entire emergency rooms have become intensive care units (ICUs). On the streets, and in the hospitals, everything looks and sounds and feels different. In just the space of a week, we entered a different world. There are tents outside our hospitals, and in our parks. Every time I see them, I stop, startled. Their drab and dirty flaps seem so out of place against the grand facades of world-class health facilities. But we are in utterly desperate times. The last time I worked in a tent was in west Africa in 2014. There, I was providing medical care to patients suffering from Ebola. In those same tents, I saw agony, loneliness and death. I saw people dying alone. I never thought I would have to experience that again. I never wanted to; once was painful enough. But in New York we have no other option now but to erect medical tents; our ICUs are filling up too fast, and the city’s hospitals will soon be at breaking point, unable to bear the number of those infected with the coronavirus. The patients I usually see at NY Presbyterian, those who arrive at the hospital experiencing heart attacks or appendicitis, are nowhere to be seen. Every person who now enters the emergency room (ER), many dozens a day, has Covid-19; every single patient. Working in the ER means walking through a corridor of unbroken coughing; all a slightly different pitch and frequency, but all caused by the exact same disease. But it’s not the volume of patients that is hitting us; it’s the severity of the symptoms: respiratory arrest, respiratory arrest, respiratory arrest. Each critical patient requires six to eight professionals: nurses, respiratory technicians, ER doctors, anaesthesiologists. Each resuscitation takes an hour or more: starting medications, putting in breathing tubes, setting up ventilators, managing blood pressure. Back to back for 12-hour shifts, every day. It’s not just the severity of cases either, and the hard, relentless hours. We are all being asked to do things that we have never done before, and to make decisions that were once unimaginable. Run a code as your goggles fog up and you can’t decipher the vital signals on the patient’s monitor. Try to predict which Covid-19 patient will crash if you send them home, and which won’t. Talk to palliative care. Talk to family members. Have long discussions about likely outcomes. Listen as family members sob. They aren’t physically present to say goodbye when they ask us to withdraw care from a patient; we FaceTime so they can say goodbye. We stop the drips. Turn off the ventilator. And wait. Your hands are upon theirs. You think of their family at home, and you think of your own. Someone starts saying a prayer. You can’t help but cry. You stand by. You wait. Time of death: 7:19pm. During my time in west Africa, I saw too many people die. You would have a long talk with them in the morning. You would go and have lunch. You would come back, and they would be dead. But what’s happening in New York is different. This isn’t what we do. But then again, none of this is. We signed up to save lives, not to stand by as they pass. I see it on my colleagues’ faces. We are tired, physically exhausted. Hours spent in goggles, gowns and masks feel like days. But we are only at the beginning. The mental exhaustion is only starting to set in. The things we do, the things we now see – I keep telling myself, “This isn’t what we do”. I worry about my colleagues. Every day one of them calls me up crying. How long will they hold? How long will I hold? I remember how this kind of consuming anxiety gnawed at me every day in Guinea in 2014. Is today the day I get infected? I won’t know for a week. The days add up. The worry adds up. I’ve never seen my colleagues so afraid, so unsettled. But I’ve also never seen them all work so well together. I’ve never seen us more unified, more focused, and more earnest. Yes, we worry about the availability of personal protective equipment. Yes, we worry about the lack of medications. Yes, we worry about each other. But in my 12 years as a doctor, I’ve never seen so much sense of purpose, nor sense of pride in what we do. I think of this when I get home each night. Clothes in a bag. Hot shower. Look in the mirror – the harsh indentations of the goggles still deep on my face and blisters on the bridge of my nose. How long will we hold? Craig Spencer MD MPH is the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Centre Subscribe To stay on top of global affairs and enjoy even more international coverage subscribe for just £1 per month!