I look up and down the street at the tightly closed storefronts and snort.
But apparently, I am sitting in the one hot spot of service in Puerto Villamil, because when I check my inbox, somehow there is an email that has downloaded from Finn. I sit down cross-legged and start to read, absorbing his words like they are an oasis in a desert.
From: [email protected]
I can’t believe it’s only been two days. The schools are already shut down here, and bars and restaurants. We’ve got 923 cases in the city alone. Ten deaths. The subway is empty. It’s like New York is a shell, and all the people are in hiding.
Not that I’d know, because I haven’t left the hospital. They scrapped the model for surgical residents. You know how I used to bitch about being a junior resident, because I’d have to do nights and ED consults while the senior residents scrubbed in to the actual surgeries—and how you said that one day it would be my turn? Well, nope. I may be a fourth-year resident but that’s gone. No one is doing surgery anymore. All elective procedures—and even emergent ones, like appys and gallbladders—have been canceled, because the surgical ICU is filled with Covid patients. Residents are expendable, I guess, so we’ve all been reassigned to Covid, too.
To be fair, it’s the only illness we’re seeing. But I was trained as a surgeon, and suddenly I’m supposed to be an internal med doc treating infectious disease, and I have no idea what I’m doing.
Neither does anyone else.
I’m on hour 34 of my 12-hour shift, because there aren’t enough of us to take care of the patients. They started arriving and they haven’t stopped. They all show up gasping and by the time they get here, they’re already screwed. They try to suck in air, but there’s nowhere for the air to go, so they wind up damaging more lung—it’s this vicious cycle. Normally, we’d put patients like that on high-flow nasal cannulas, which can get them ten times as much oxygen, but they also would aerosolize the virus all over the place. So instead we use non-rebreather masks or small nasal cannulas. They don’t work. Nothing in our bag of tricks does. People are crashing left and right because they aren’t getting enough oxygen, and the only thing left to do is intubate. Which is the most dangerous thing of all, because we can’t get a patient on a vent without literally spreading the virus all over ourselves.
So we have armor, I guess, even though there’s not enough of it. Now, just to see a patient, I have to put on my hair covering, my N95 mask, then my face shield, then my paper gown over scrubs, then two pairs of gloves. We were sent videos to memorize the order, and we have spotters watching us to make sure we haven’t forgotten anything before we march into battle. It feels ridiculous, that this little filter over my face is the only thing protecting me from this virus. It takes six minutes to get into PPE, but twelve minutes to get it off, because that’s when you are more likely to infect yourself. It’s hot and itchy and miserable and I worry what it must feel like for the patients—we are acting as if they have the plague.
Which, maybe, they do.
We try not to stay in their rooms. We don’t touch them unless we have to. No one really knows how long the virus lasts on surfaces, so we assume the worst. When we come out we take off our gloves, toss them into the trash, and wash our hands. Then the cap goes into the trash, and we wash our hands. The gown is placed in a plastic bin, and we wash our hands. Then the shield comes off, and we wash our hands. Our N95 masks we have to reuse, because there aren’t enough. So we take them off and stick them in little cubbies, tagged with our names, and wash our hands. In Italy, docs are wearing hazmat suits like they’re entering a nuclear reactor, and I’m washing down my face mask with a fucking wipe.
My knuckles are cracked and bleeding.
I should not complain.
Today I had to do an emergency cricothyrotomy on a Covid patient. He was crashing, minutes away from going into cardiac arrest. I called RICU—the respiratory team—stat, but the guy’s neck was too thick and the anesthesiologist couldn’t get a good visual to intubate him fast enough. It was just me and the anesthesiologist and the nurse and the man gasping for air. I had to step in and do the emergency cric to secure the airway and get him intubated before it was too late. I was terrified, because, you know, if you do it wrong, if you miss one detail, you might get infected. I had to squeeze my hands together to keep them from shaking before I made the incision. I kept telling myself to do this efficiently and quickly and to get the fuck out of that room and sanitize myself.