You might save a life.

Leah Naghi MD

Montefiore Medical Center, Internal Medicine PGY2


April 24, 2020

Unedited thoughts on COVID-19

3/30/2020. Home. Emails, you will probably be asked to work hours that are never deemed acceptable. You will do work that is substandard, it’s not you, it’s the circumstances. Forgive yourself now. Wow. I’m picturing myself as a bloody field surgeon described in Ret. Colonel Hackworth's South Korea War recounting, exhausted and numb, looking up at a camera with dead eyes and a butchers knife in hand. You will do work that feels wrong at times, just get over it. I will? I knew it in my heart but I still don’t want to believe it. I'll deal with that later, honestly it’s too upsetting to think about for now. I'll complain to some coworkers instead. Can you believe this? No. Conversation is left there because there’s literally nothing we can actually do about it. Sleeping, finally. Comfortable. Warm. Dreaming. Waking. Wondering. Wandering? I’m at work. Someone needs me. No I’m not, I’m still in bed. What time is it? Phone says 1:40 am. Texts and emails have piled up again. Work group chat is frustrated, friends are chatting, mom is asking if I’m OK. I text her back, going back to sleep. Everything OK? It is. Love you. Love you. Toss and turn. Up at 5:30, makeup on the eyes because it’s important to not look dead behind a mask. Mask has wreaked havoc on the rest of my face but at least no one can see that. Another reason to be good about wearing it all day... Entering the hospital, stopping by the hospital’s conference center to see how non-patient areas are being converted into wards. This is wild… Rounding on patients. Some better, some worse. Some stable. Tired. De-gown. Need to go back into room, patient took off their oxygen in their delirium. Nurse can I have another gown please. Nurse rolls her eyes, you have to go to the middle nursing station. OK. Nurse can I have a new gown please. Nurse number two rolls her eyes. OK. She takes out her keys and unlocks a cabinet. Here’s one. Oh thank you thank you. Back into patient’s room. Mr. X, your daughter wants to call you. Where is your phone? This poor man will die alone. MR X YOU HAVE TO KEEP YOUR MASK ON CAN YOU HEAR ME. He will die alone. He will die alone. Should I stay and endanger myself or leave?

4/3/2020. Rounding on patients. "Mr. Y looks bad." My intern looks worried. I'll come see him with you. Mr. Y indeed looks "bad" he is breathing at a rate of 50 per minute and visibly using the muscles between his ribs to do so. Mr. Y is not over the age of 58 and I do not want him to die. Please don't die. Calmly, Mr. Y you look like you're working to breathe. We're going to get some extra help for you. Calm. Calm. Please do not die. Calling in the intensivists to intubate him. Reminding the patient to speak to his family quickly before we sedate him. Calm. Not telling him the thing that is on my mind, that this may very well be the last conversation he ever has with his family. Moving on. Because we must. As my attending remarked earlier today when I spent "too much time" on this dying patient, this is a marathon. Suck it up, buttercup. How are our other 11 patients? Ms. A is "chilling on room air" according to my intern, but everyone else is on some form of oxygen. Except Ms. M, who passed overnight. She did? Yeah, around 3 am. OK. Surgery-resident-turned-medicine-intern is looking at their phone, we got another email. What does this one say? New protocol. Some doctors in the hospital are finding that steroids help. So we're supposed to give them to pretty much everyone on nonrebreather now. Oh, OK. What’s the evidence behind it? No, there isn't anything solid. But it seems to work so we're trying it. Well, I’m willing to try most things to avoid intubation, it makes sense per the mechanism of disease and I trust the attending this came from... so sounds good to me. I'll keep an eye out for more emails in case there are any other big changes to the way we treat the disease in the next hour or so. Lunch. Pizza, donated. Bless your souls.

4/8/2020. Home. Tested positive for COVID. My olfactory bulb has been attacked viciously and it better make a comeback. Ugh. Alone, tired, smell-less and taste-less. And this from working 90 hours. But you know what? Screw self-pity. My disease is indisputably mild. Good. I don't have anyone at home I am worried about giving it to. Good. I don't have an abusive partner at home making this even harder than it already is. Good. I don't have children at home I am worried about and whose education I am responsible for. Good. I don't have anxiety over job security. Good. I don't have elderly parents or grandparents at home or a fetus inside of me who I could give this to. Good. I don't have a chronic illness that I've been stressing over. Good. I don't have chronic pain or physical restraints that would make my job harder. Good. I do have a family who checks in on me regularly and makes sure I am intact physically and mentally, and respects my work schedule. Thank God. I do have a greater network of people through technology and social media who send much needed encouragement. Good. I do have the opportunity to work with a multidisciplinary team of doctors and nurses who inspire me every day. I am so blessed.

4/23/2020. Reflecting, I have been at home alone for 3 weeks. Not one single face to face conversation with another human, unless you count the grocery store cashier and my security guard, both of whom I flee from as quickly as possible to avoid hurting them. Online, people are asking for my perspective and it boggles my mind how different my responses are now than they were just a few weeks ago. I answered with such passion then, having seen patients just minutes or hours ago in the flesh, dying unnecessarily due to lack of known treatments and lack of manpower/equipment. Now I'm just another person under quarantine, figuring out how to amuse themselves in their apartment. I quote stats that I get from my hospital’s town halls, but I don't have any new patient anecdotes or specific pleas for help. I don't even know what the most recent protocols are for patients. Apparently, we're not giving patients plaquenil anymore because the evidence is so weak? Many of us definitely saw that one coming, but I digress. Sniffing some cloves to "physical therapy" my olfactory bulb back into existence (there's a paper on it, alright?) (Also, I'm desperate), I contemplate how out of touch I am. I'm ready to go back, feeling like a Marine who was sent home but would rather be overseas taking fire to cover for her buddies. Ask me how I'm doing next week when I’m back in the ICU.

We will win. Just remember to reach out to the people you know, even... no, especially if you haven't spoken to them in a while. You might save a life.


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