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A day in the life of an ER doc — a brief dispatch from the COVID-19 frontline

This is a twitter thread from Dr. Craig Spencer titled “A Day in the Life of an ER Doc – A Brief Dispatch from the COVID-19 Frontline.”

Dr. Craig Spencer 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 was the first person in New York to be diagnosed with that virus. 

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 frontline of this battle which very few of us experience. It is a fascinating, frightening, and eye-opening view, as we watch a day in the life of a COVID-19 doctor 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.

Please read the full thread and let’s all be thankful that we are sitting at home reading this. 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 get to meet someone like Dr. Spencer in an emergency ward.

Wake up at 6:30am. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks too. It’s all closed.

On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it’s early. Regardless, that’s good.

Walk in for your 8am shift: Immediately struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.

You take signout from the previous team, but nearly every patient is the same, young & old:

  • Cough, shortness of breath, fever.
  • They are really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast.

You immediately assess this patient. It’s clear what this is, and what needs to happen. You have a long and honest discussion with the patient and family over the phone. It’s best to put her on life support now, before things get much worse. You’re getting set up for that, but…

You’re notified of another really sick patient coming in. You rush over. They’re also extremely sick, vomiting. They need to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10am yet

For the rest of your shift, nearly every hour, you get paged:

  • Stat notification: Very sick patient, short of breath, fever. Oxygen 88%.
  • Stat notification: Low blood pressure, short of breath, low oxygen.
  • Stat notification: Low oxygen, can’t breath. Fever.
  • All day…

Sometime in the afternoon you recognize you haven’t drank any water. You’re afraid to take off the mask. It’s the only thing that protects you. Surely you can last a little longer – in West Africa during Ebola, you spent hours in a hot suit without water. One more patient…

By late afternoon, you need to eat. Restaurant across the street is closed. Right, everything is closed. But thankfully the hospital cafeteria is open. You grab something, wash your hands (twice), cautiously take off your mask, & eat as fast as you can. Go back. Mask up. Walk in.

Nearly everyone you see today is the same. We assume everyone is #COVIDー19. We wear gowns, goggles, and masks at every encounter. All day. It’s the only way to be safe. Where did all the heart attacks and appendicitis patients go? Its all COVID.

When your shift ends, you sign out to the oncoming team. It’s all #COVIDー19. Over the past week, we’ve all learned the signs – low oxygen, lymphopenia, elevated D-dimer.

You share concerns of friends throughout the city without PPE. Hospitals running out of ventilators.

Before you leave, you wipe EVERYTHING down. Your phone. Your badge. Your wallet. Your coffee mug. All of it. Drown it in bleach. Everything in a bag. Take no chances.

Sure you got it all??? Wipe is down again. Can’t be too careful.

You walk out and take off your mask. You feel naked and exposed. It’s still raining, but you want to walk home. Feels safer than the subway or bus, plus you need to decompress.

The streets are empty. This feels nothing like what is happening inside. Maybe people don’t know???

You get home. You strip in the hallway (it’s ok, your neighbors know what you do). Everything in a bag. Your wife tries to keep your toddler away, but she hasn’t seen you in days, so it’s really hard. Run to the shower. Rinse it all away. Never happier. Time for family.

You reflect on the fact that it’s really hard to understand how bad this is – and how bad its going to be – if all you see are empty streets.

Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don’t stop.

Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be stat notifications. More will be put on a ventilator.

We were too late to stop this virus. Full stop. But we can slow it’s spread. The virus can’t infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don’t care as much about the economic impact as I do about our ability to save lives

  • You might hear people saying it isn’t real. It is.
  • You might hear people saying it isn’t bad. It is.
  • You might hear people saying it can’t take you down. It can.
  • I survived Ebola. I fear #COVIDー19.
  • Do your part. Stay home. Stay safe.
  • And every day I’ll come to work for you.

In response to the Twitter thread (which was subsequently picked up by the Washington Post), some other people posted their own thoughts:

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Posted by AKAlib. Cross-posted with permission from Daily Kos.