This is another powerful and heart-wrenching twitter thread by Dr. Craig Spencer titled “When the coughing stops and the sense of helplessness begins”.
We have all become familiar with Dr. Craig Spencer who is Director of Global Health in Emergency Medicine at Columbia Medical and New York Presbyterian Hospital and Faculty in Forced Migration & Health at Mailman School of Public Health. Craig Spencer helped fight the West African Ebola outbreak in 2014, and then himself contracted the disease.
Dr. Spencer is on the front lines saving lives and in parallel has been writing and speaking about public health and policy issues in the fight against the Coronavirus.
I have copied and pasted the full thread here. The purpose of this diary is not to raise anxiety among us or to generate sympathy or gratefulness (OK, we can do that) for Dr. Spencer or the thousands of doctors and nurses that are putting their lives on the line for us. It is to provide a first hand view of the front line of this battle which very few of us experience. It is a fascinating, frightening and eye-opening view, as we watch a day in an ER through Dr. Spencer’s eyes. Another purpose of the diary is to broaden our perspective by taking a break from the stories we follow all day about trump’s latest tweet or proclamations on TV and hopefully provide this perspective to others.
Please read the full thread and let’s all be thankful that we are sitting at home while reading this.
The words, written in short sentences, feel like free-verse poetry. A melancholic poem of self-reflection, of a sense of helplessness in the midst of death and suffering, in spite of the tireless efforts of these heroes. It is a lamenting cry of a hero who cannot always stop Death as it roams the ERs and hallways of our hospitals, picking its next victim. It is a cry for recognition that these heroes are human. The poem also contains a message of hope and inspiration, that these heroes will keep working to save the life of every stranger that enters their ERs, day in and day out.
Dr. Spencer had written another similar thread 3 weeks ago, but this one is a bit darker and more introspective.
The somber symphony of monitor alarms is the only sound you hear.
- Their cadence is perfect & predictable.
- Beep.
- Beep.
- Beep.
- One, on repeat, is unsettling.
- But now its dozens. Each with an independent rhythm.
- A sea of similar sounds.
It hits you as you walk in. Even since your last shift, the whole place has been transformed.
- The kingdom of coughing has been overthrown.
- Because you can't cough when you're intubated and on life support.
- Now there are two beds and two patients in rooms only meant for one.
You check on every patient, every bed. Many on multiple IV drips — sedation, saline, blood pressure support.
- 1a: 72y female. Intubated.
- 1b: 84y female. Intubated.
- 2a: 64y male. Oxygen facemask. Breathing fast.
- 2b: 67y male. Oxygen facemask. Better than his neighbor.
- 3a: 54y male. Intubated.
- 3b: 48y male. Intubated.
- 4a: 42y male. Rapid heart rate. Low blood pressure.
- 4b: 57y male. Intubated.
- 5a: You know her well. She's been here many times before. Now she's intubated.
- 5b: 63y female. Oxygen facemask. On the phone. Breathing hard.
You're not even halfway done. All COVID.
- As you walk around, you flashback.
- Not since treating Ebola in West Africa have you seen so many sick patients.
- So many who will die, no matter what you do for them.
You asked yourself then. You ask yourself now:
- Are we doing the right thing?
- Are we having an impact?
"Flip them over. Maybe that'll work?"
- "Turn up the oxygen. Maybe that'll work?"
- "Turn down the drips. Maybe that'll work?"
- "Try these new experimental meds, maybe they'll work?"
- "Try these old-school meds, maybe they'll work?"
- We struggle. Because we don't know what works.
Last week a colleague cared for a woman with cardiac arrest from COVID. And her daughter. At the same time.
- Today one of your patients is on oxygen struggling to breath.
- You try to talk to her.
- But she is watching her mom, intubated, on a ventilator, in a bed across the ER.
The head nurse comes to you. Another new patient. Very sick.
- "He's in bed 9. Same thing. Low oxygen."
- You try to concentrate, but your thoughts are interrupted by the loudspeaker:
- RESPIRATORY STAT TO THE ER.
- ANESTHESIA STAT TO THE ER.
- On repeat. Like the alarms. All day.
You approach the new patient. It's immediately clear how bad this is.
- He's breathing 40 times a minute. Can't hardly speak.
- His oxygen dips. Put him on a facemask. It slowly climbs.
- You put your hands on him. But the purple gloves feel so cold, so distant. Maybe better not to?
You want to tell him it'll be ok. But you don't think it will.
- You want to tell him you'll help him. But he can't hear you. The mask muffles your voice.
- The sibilant hiss of oxygen pouring from masks drowns out your words.
- You try to look him in the eyes, but your goggles fog.
- "Hey is there anyone I can call for you?"
- You get his wife on FaceTime.
- She sees her husband of 47 years. Breathing fast. Struggling. Alone.
- She hears the alarms of patients on life support in the background, struggling to stay alive.
- She sees you in a mask, gown, and gloves.
You flashback.
- You remember.
- 19 days in isolation when you were treated for Ebola.
- 19 days & all you saw were masks. All you felt were gloves.
- You felt toxic.
- No matter what they said. No matter what they did.
- You felt toxic.
- This is what they see. This is what they feel.
So you try to connect. You want to comfort.
- But how do you connect when you cannot really touch?
- How do you comfort when they can hardly see through your foggy goggles?
- Or when the mask muddles every word?
- You wonder:
- Are we doing the right thing?
- Are we having an impact?
Dr. Spencer also penned this opinion piece today trying to talk to some sense into a president who is not only woefully unprepared for the job of the presidency but is actively working to undermine the efforts of these heroes.
I am no stranger to the consequences of the WHO's inefficiencies, having personally witnessed its slow response to the Ebola epidemic in West Africa. Saddled by an ambiguous mandate and the competing demands of its donor countries, the organization is forced into a near-constant state of reaction rather than preparation. Limited funding leads to limited capacity, which leads to suboptimal operations; in this case, suboptimal is often the difference between life and death.
But to doubt the importance of the World Health Organization is to misunderstand the nature of our international health system and its connection to global stability.
Let’s talk about strengthening — not diminishing — our collective ability to shorten this pandemic and prevent the next.
Let’s clarify the World Health Organization’s mandate as an international network for disease surveillance and an operational partner for pandemic response.
And let’s agree that we must align our expectations with our investment. If we truly want to anticipate public health threats and save lives, we must build up in the World Health Organization, not tear it down.
Yes, Dr, Spencer, you and your colleagues are having an impact, far beyond what you what you might feel in your daily fight against the forces of death. Yes, you are heroes; for every life that slips out of your hands, many more survive — both at the hospital and at homes as people follow your advise about social distancing. Humankind will remember you and thank you long after this crisis is over. Frankly, we do not deserve your sacrifices.
Unfortunately, the fight against the virus is far from over and scenes like these will continue for weeks and will get worse if trump forces States to reopen businesses and schools. It’s important for people around the country to understand what is happening in our hospitals and what lies ahead of us.
Let’s keep doing what we need to do in these trying times. Let’s plan for what lies ahead. Let’s make sure we take every step possible so that we or our loved ones do not end up in a hospital bed under the watchful and mournful eyes of someone like Dr. Spencer. And let’s keep neutralizing trump’s propaganda by spreading the truth. Let’s all redouble our efforts to expunge this virus from the White House and his enablers in Congress.