At so many points I ask myself, Does it even matter anymore? It feels like the virus is everywhere, breathing on all the surfaces, exhaling itself into the atmosphere. It feels exhausting wearing one mask all day and covering it with another to keep it clean, having to think so much about not getting it soiled and wondering if I accidentally contaminate the inside of it when I hold it away from my face to breathe for a minute or take it off to chug water. Sometimes I see the individual virus particles — round with red, protruding crown-shaped spikes, like the C.D.C.’s rendering — everywhere in the hospital, on beds and monitors and phones and computers. I shudder, forcing myself to erase the image from my mind.
I’ve taken part in humanitarian relief missions in more than 20 countries, in settings as resource-poor as mobile clinics in South Sudan immediately after its secession, refugee camps in Kenya, an abandoned war hospital in Liberia, medical facilities in Somalia. Never have I personally felt unsafe, like I didn’t have enough protection for myself. People are now referring to ours as “a third-world country,” but in terms of P.P.E. in this pandemic, it’s actually worse than those overseas hospitals. While most of the specialists have been unflinchingly generous, offering extra hands in the E.R. and imperiling their own lives, a few doctors who are consulted for their expertise on certain medical conditions have balked at having to see patients here at all. They feel unsafe, they say. Deep down, I know they’re probably right.
By the end of my shift, every patient begins to blend into a single patient. “Fever and cough,” “fever and cough and shortness of breath,” “cough and trouble breathing,” “sent by doctor’s office for Covid rule-out,” “sent from urgent care for Covid test.” I can’t even keep track of them anymore. Usually I remember patients by their faces, but they all have masks on too, so all I see is their eyes, which more often than not are closed.
I become obsessed with oxygen levels, which seem to be the only reliable indication of how patients are doing. Is 92 percent much better than 90 percent? Should 93 be the cutoff to send someone home, or should I make it 94? I used to be able to rely on my gut and clinical judgment when I walked into a room and looked at the patient, but coronavirus is lawless. It obeys no rules. What is unusual, in this illness, is that many people come in talking to you, even as their breathing worsens. They can speak, but their oxygen readings are frighteningly low. As the hours tick by, they rapidly get sicker, to the point where they need a breathing tube. In most other situations, people who require breathing tubes in the E.R. arrive at the hospital too ill to interact with me, needing mechanical ventilation right away. That makes it a little easier.
Patients’ oxygen tanks run out. (It’s impossible to know unless you bend over, look behind the stretcher and glimpse the thin black needle ticked over to the red zone on the gauge.) Or whatever oxygen you did give them becomes suddenly insufficient, as their lungs grasp for ever more. Maybe an alarm bell sounds because their oxygen level has dropped. Or more likely, they’ve become disconnected from the monitor, a far-too-frequent occurrence, and you see them frantically trying to breathe. Or most likely, the oxygen, even if it’s blowing, is of no use, because they’re unable to take it in, barely inhaling at all, silently dying, alone.
What may have been unimaginable even a week ago seems completely possible, even likely, now. A colleague informs me that she had to push aside a dead body to plug in a ventilator for a new patient who was recently intubated. Is this how the dead leave the world now?
Before, I would check in with the Italian doctors, concerned for their and their patients’ well-being, but our roles have now reversed. I am now at the receiving end of their grief and sympathy. “How are you?” one texts me. “We hear it’s so bad there.” Yes, it really is. “Stay strong,” another says.