By Marc Ayoub, M.D.,
Mt. Sinai Health System, New York, New York
ASB Business Services LLC is proud to support our “Healthcare Warriors” like Dr. Marc Ayoub, MD and many others Healthcare Professionals working on the front lines in New York City, the current “Ground Zero” for this epidemic. They are battling a relentless biological enemy and making life and death decisions every day. This Blog is being shared with Dr. Ayoub’s permission to exemplify the dire situation our Healthcare System is in and the risks our healthcare professionals take while adhering to the principal precepts of bioethics “First, do not harm”. Thank-you Dr. Ayoub for sharing your first-hand experience with us. Thanks to all Healthcare Professionals, and First Responders for stepping up to fight this battle. You are American heroes. Supplies are greatly needed. What can you do to help?
I was initially skeptical of COVID-19. Today, it frightens me.
I am an internal medicine resident working at a nest blanket hospital in New York City. Ten days ago, we had zero patients with COVID in our hospital. Today, we have hundreds. Ten days ago, we were well rested with a supercharged attitude, ready to tackle the virus head on. Today, we are overburdened, exhausted, sick, and disappointed. Our supplies have dwindled, our census of critical patients has skyrocketed, and we are running out of healthcare providers due to the lack of adequate protective equipment. We are fighting a losing battle with no end in sight and need help – NOW.
Officially, we have 13 resident physicians at this hospital who fallen sick to the virus. Unofficially, it is likely much, much higher. As I walk through the halls, I see attendings and residents hiding their coughs, clearing their throats under their breath, or sniffling as they turn away. Why do we continue to work? Because if we don’t, who will? We are physically sick, but no one can replace us. We hide our emotions and our coughs from our fellow colleagues and try to comfort each other, but we don’t know how. All our energy is focused on our patients.
A few days ago, I was called into a code blue. Normal protocol requires that we bag mask the patient, but new COVID protocols state that we “should not bag mask to avoid aerosolization of viral particles”. As I watched him decompensate, I asked myself, “Do I protect my life, or risk his, a 41-year-old with a family and long life ahead of him?” We took an oath when we graduated medical school, and that is why we are here every day. That is why I decided to risk my life to bag mask him.
We have shut down multiple units in our hospital and dedicated them to the care of COVID patients. We call these areas the “COVID Caves.” Each day while working in the ICU, we get an average of 12 new consults for COVID patients. To find them, I walk down a dark hallway, past an endless row of stretchers until I find my new patient. When I reach the gurney propped up against the musty gray wall, I put on my mask, the same mask I have been using for days, and my suboptimal goggles, which I sanitize after each patient encounter. The patient has the “COVID appearance of doom.” We know he will require intubation soon. But we must then decide – how can we allocate our dwindling resources most ethically and effectively? We have already run out of ventilators in this hospital. We cannot provide everyone with the care they deserve. Multiple times per day, we are now faced with the nightmarish and chilling decision of choosing between intubating a 40-year-old patient and an 80-year-old patient. We took an oath to do no harm and act in the best interest of our patients. This country’s lack of preparedness, though, has made it so we cannot act in their best interests. We are here, making life and death decisions, because our markets and governments are systematically broken.
These are not tales from another country. These are truths from New York, your New York. And, soon, this will be the reality in your own town if major changes are not made across the country.
What do we need? We need supplies for patients – ventilators, beds, and medications. We need protection for medical providers – appropriate masks, goggles, and gowns. We need more providers so that those who are sick can stay home to heal and prevent the spread of infection. We need you to take hygiene and distancing protocols seriously. We are begging for help.
About the Author: Dr. Marc Ayoub, M.D. is an Internal Medicine Resident Physician at Mt. Sinai Health System in New York City. (Permission to re-post)