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Gibson: Riding the COVID-19 wave

I am a surgical critical care physician currently working in the surgical intensive care unit at New York Presbyterian Hospital/Weill Cornell Medical Center in Manhattan. This means I have been and still am at the center of the COVID-19 pandemic.

Guest Writer

Guest writer and critical care physician Cameron Gibson M.D. grew up in McMinnville. After graduating from Mac High in 2003, he earned a B.S. at the University of Puget Sound, than an M.D. at the State University of New York. Following a five-year surgical residency at the Oregon Health & Science University in Portland, he returned to New York to complete fellowships in burn surgery and surgical critical care. He lives in Queens with his wife, two children and a dog .

 

The following is an account of my experience and what I hope will be a path out of the wilderness.

By the end of Week 1, March 8-14, the medical ICU was already half-filled with COVID-19 patients. Restaurants were still open, people were still free to come and go as they pleased and politicians in Washington were still minimizing the dangers of the coronavirus.

So was I. But if you paid close attention, you could feel a tremor in the ground and hear a rumble in the distance.

By the end of Week 2, March 15-21, the medical ICU had reached capacity. The cardiothoracic and cardiac ICUs were starting to fill the gap by taking on newly intubated COVID-19 patients.

Governors across the country, including our own Gov. Andrew Cuomo, responded by closing non-essential businesses and enacting stay-at-home orders. Over the complaints of no more brunches or trips to the hair salon, one could hear a dull roar. 

Our unit, the surgical ICU, remained COVID-free and was meant to stay that way. But just over the horizon one could make out a swell starting to build.

During Week 3, March 22-28, I myself was quarantined with a mild case of COVID-19. And while I was sidelined, the swell grew into a massive wave that came crashing down on New York City.

Our hospital, ranked fifth in the country in overall quality of care, quickly found itself underwater. My unit was filled with 20 ventilated patients.

Our operating rooms and recovery areas had to be converted into ICUs. All pediatric patients had to be transferred to the Children’s Hospital at Columbia so we could free up more beds and ventilators. 

It was as though we realized a tsunami was coming, but just as we were boarding up the windows and grabbing the sandbags, the wave hit us head-on.

 By Week 4, March 29-April 4, we began running dangerously low on ventilators, as well as medications and dialysis machines. Patients who would have been intubated and put on a ventilator just a week earlier were instead flipped onto their bellies and placed on 100% oxygen through a face mask. 

Nurses, respiratory therapists and medical colleagues were falling ill, some severe enough that they themselves had to be admitted to the hospital, and in some cases, placed on ventilators. 

One hospital in Brooklyn almost ran out of oxygen — the most essential medical supply of all. That would have forced it to transport all of its patients to other hospitals, already over capacity. 

We were all drowning. Gasping for air. Not knowing which way was up.

But just when we thought we couldn’t hold our breath any longer, the water began to recede. The number of newly intubated patients started to decrease.

Some patients who had been intubated early on improved enough to come off the vent. But many others — more than I like to think about — didn’t make it.

Reinforcements arrived from around the country, providing much needed relief for our overworked, overstressed staff. But most importantly, the number of newly admitted patients started to go down. People stayed home, so the virus had nowhere to go except back out to sea.

As we entered Week 6, April 12-18, we tried hard not to lose steam. We continued to reinforce the foundations of our hospital by expanding ICU capacity and restocking our supplies.

The stay-at-home order was extended, and the number of patients admitted on a daily basis continued to decrease. Social distancing was working well enough that our hospital could finally take a deep breath and began preparing for the long haul.

Now that we’re in Week 7 of this pandemic, April 19-25, we can finally begin the process of self-reflection.

What did we do right? What did we do wrong? How can we be better prepared, God willing, for the next pandemic?

The work will continue for many months to come. And we must be prepared for the possibility of another wave when — and it will be when, not if — life goes back to “normal.”

We all have heard about “flattening the curve.” To me, the analogy of a wave seems much more fitting. 

A wave evokes the awesome power of nature. You cannot stop a wave, just like we cannot entirely stop this virus.

It will continue to spread through the population, bringing death and destruction to communities throughout the U.S. Case-in-point, look at the Navajo Nation or the U.S prison system.

But just as we are building up the fortifications to hold the wave back, some are calling to open the windows and take down the sandbags.

As an intensive care specialist, I can tell you with total certainty that this is not “just another flu or cold virus.” Patients with severe cases of COVID-19 not only develop acute respiratory distress syndrome, or ARDS, but can also experience kidney failure, liver failure and severe complications from blood clots.

On average, intubated patients stay on a ventilator for more than two weeks. That puts them at increased risk for secondary lung infection, brain dysfunction and sepsis.

Why do some people develop very mild symptoms, while others who are just as healthy before contracting the disease go into multiple organ failure? This is what I think envokes the most fear in people, and to this day, we don’t seem any closer to having an answer.

I have seen the damage from the COVID-19 wave first hand. 

A 46-year old man leaving a wife and young children. A 74-year-old breast cancer survivor. A 69-year-old with a wife and daughter. A businessman, a janitor, a nurse. These were just some of the COVID-19 wave dying on my watch.

Tens of thousands of Americans have drowned in the wave that has swept the U.S. As we continue to build capacity, preparing for the worst, I ask just one thing: Please do not take down the window boards and sandbags until we know for sure there won’t be another wave.

Comments

SandyKnoll

Thanks for sharing this!

E.J. Farrar

Think what this doctor reports can't happen here? Think again.

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