In the time of COVID-19, healthcare workers are stepping up to care for massive numbers of patients. Often, they’re doing this without adequate resources. At the beginning of the pandemic, our hospital administration referred to this as “crisis standard of care”–which the US Institute of Medicine defines as “a substantial change in…the level of care it is possible to deliver, made necessary by a pervasive or catastrophic disaster.”
For many American doctors this model of care is new, but I would argue that for most health workers worldwide, it isn’t new at all.
The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.
It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.
“I’ll take him,” I tell my colleague.
The miracle was that this baby had lived at all. His mother called 911 while in labor, with heroin easing her pain and numbing her conscience. The paramedics arrived at the empty warehouse where she’d been living. She delivered her newborn son in a toilet. The paramedics scooped him out, cut his umbilical cord with her razor blade and brought mother and son to our hospital.
The fact that all this took place should be remarkable.
One morning seven years ago, I disappeared.
I started the day by swimming laps in the pool at the Northwestern University sports and recreation center in Evanston, IL, as I’ve done for at least fifteen years.
I have long suffered chronic muscle spasms and pain in my neck, hands and feet, and my daily swims, pain medications and mindfulness meditation make up part of a very helpful therapeutic regimen.
At around 9:00 am, having finished my laps, I felt some very mild tightness in my chest.
Thursday October 31, 2019, 11:00 pm: A forty-five-year-old woman named Maria drove her Subaru Forester along a Pennsylvania highway called the Blue Route, about fifteen miles west of Philadelphia. It was raining heavily. She drove more slowly than she ordinarily would, partly due to poor visibility but also because the wind seemed unusually strong. Her hands firmly gripped the vinyl steering wheel at 10:00 and 2:00, so as not to allow the vehicle to be blown about the road.
Maria was just about to switch the car radio to a news station, hoping to hear a weather report, when she saw the funnel cloud headed directly toward her.
Detroit, January 1997
In a haze of sleeplessness, I open the door to the general-surgery call room (aka “the Garage”) just after midnight. I’m one of two third-year medical students on this call team, and if I arrive first, I might be able to avoid the bunks with the most creased sheets and the pillows with head indentations still on them. The entire general-surgery team sleeps in this one room, with its messy bunks for eight and its odor of stale bodies. That is, we sleep during free moments, in rare fits, interrupted by pagers beeping and the door opening with a flash of light and closing with a loud click.
Climbing to an upper bunk, I get beeped: Code 1.
“There’s a transplant happening today,” said Sophie Lee, a resident, glancing at her pager.
It was a Saturday afternoon, and I was a second-year medical student doing a clerkship on the hepatobiliary surgery service (specializing in the liver and bile ducts).
I felt a pang of disappointment: Now I couldn’t go home until after dinner. But there was no use complaining. I followed Sophie to see the transplant recipient, Mr. Franklin.
For months, as I’ve visited Evan as his hospice social worker, he’s been praying to die. In his early nineties, he has been dealing with colorectal cancer for more than four years, and he’s flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.
On this visit, though, his depression seems to have lifted. He’s engaged and upbeat–and this sudden about-face arouses my suspicions: Has he decided to do it? Is he planning a way out?
A few months ago my friend Phil gave me a newspaper clipping from the Sunday New York Times on body-focused repetitive behaviors, from nail-biting to hair-pulling to skin picking. I know he gave it to me because he wanted to help me with my own problem. He’s heard me express my frustration about it at the support group for faculty in our family-medicine residency.