Hello all,
Things are worse off here than I thought. Initially I thought maybe the Long Island hospitals wouldn't be as bad off and I guess that's true but this hospital (an underfunded, publicly supported academic medical center) has been severely impacted. I have a feeling this place was always under-resourced but it quite glaring now.
The surgical ICU, trauma ICU, cardiac ICU, pediatric ICU, and rehab units have all been converted to adult medical ICUs dealing with covid patients, majority intubated. I thought I'd get a little orientation, new badge, parking, maybe even a half-day learning the computer systems but instead was put straight onto the unit to lead rounds at 7 am. We ran all day. I am supervising a team of 5 interns, 3 residents and a critical care fellow in caring for 16-20 of these patients. They have all been working 100+ hour weeks. Medical students (all students actually) have been banned.
Since March 15th, this team has had only one patient extubated. Hospital-wide, 5 died yesterday. We've lost 2 today. I've lost count of the overhead 'Code Blue' or 'Stat Anesthesia' pages that indicate a crash since I arrived this morning but they are constant. I think other area hospitals are doing a little better (see resource comment above) in terms of extubating people.
Our team is still looking after the very first covid patient diagnosed on Long Island. He's still here, intubated since 3/11 and rather sick. There are constant shortages of critical supplies and medications but they have largely been able to adapt and improvise. The biggest shortage is personal, either because they are sick or have quit. Moral is low. Today, there were four RNs caring for our 16 patients (usual ICU ratio it 1:2 or even 1:1 for very sick patients). Apparently only 2 respiratory therapists came to work in the entire hospital today. I've yet to see one of them. They desperately need more help so it makes me feel good about the decision to come up, if only for a month. Everyone is hopeful this is the peak.
Needless to say, the place is primarily run by the residents who have continued to consistently show up. They are doing just about any and everything. Foleys, blood draws, medications administration, and vent management. When a iv pump runs dry, it is strange to see the the resident run to get it going again. There is just very little nursing support because they are stretched thinner than I've ever seen. They have the toughest job of all, they can't chart they are so busy keeping everyone alive. So far, we have enough ventilators for everyone (Currently 64 intubated patients and 70 ventilators). But that includes every 'ventilator' they can find, including anesthesia and bipap machines run as ventilators. The sicker patients get the proper machines - if you're still oxygenating OK you get by with the anesthesia machine. It's weird to see anesthesia machines all lined up in a row and connected to patients without an anesthesiologist watching each one individually.
Adventures aren't just happening at the hospital. Last night at 3 am my neighbor called EMS and I heard clear voices outside my window. An older man was breathlessly complaining of fever, chills and cough. The paramedics had him come outside (they didn't want to enter his house) and took his vitals and a brief history. Because his O2 sats were ok, they told him to stay home. Simple as that. Overwhelmed hospitals are reserved for sicker people. Earlier that night, around one, someone repeatedly try to break into my apartment - wait, did I drive to New York or Rio? Needless to say I didn't get much sleep last night and today was insanely busy.
Time for bed with the sincere hope that the demented homeless lady trying random codes on my front and back door locks doesn't come back again. It's been an insane start. My team is amazing and inspiring. They are working tirelessly and selflessly to help however they can, a truly Herculean effort. It's an honor to be here among them.
Jordan
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