There's really no way to describe what we're seeing.

Our new reality is unreal.

The people and places we've known so long & so well have been transformed.

Our ERs are ICUs.

Everything looks, sounds and feels different.

Just one week and it's a whole different world.

THREAD

There are tents outside our hospitals. Every time I see them, I stop, startled. Their drab and dirty flaps seem so out of place against the grand facades of world-class hospitals.

Desperate times, desperate measures.

The last time I worked in a tent was West Africa.

In those same tents, I saw too much pain, loneliness, and death. People dying alone. I never thought I'd have to see or experience that ever again. I never wanted to. Once was painful enough.

We have no other option now.

Our ICUs are filling fast.

Our ERs are ICUs.

The patients I normally see are nowhere to be found. Every single person I see has #COVID19. Every single patient.

Working in the ER means walking through a corridor of coughing. All a slightly different pitch & different frequency, but all caused by the exact same thing.

It's not just the volume of patients that's hitting us. It's the severity.

Respiratory arrest.

Respiratory arrest.

Respiratory arrest.

Each takes 6-8 professionals. Nurses, respiratory techs, ER docs, anesthesiologists. Each takes an hour or more.

Back to back. All shift.

And it's not just the severity, back to back.

We're all being asked to do things we've never done before.

Run a code as your goggles fog & you can't decipher the vital signs on the monitor.

Try to predict which COVID patient will crash if you send them home. And which won't.

Talk to palliative care. Talk to family members. Long discussions about likely outcomes. Listen as family members sob. They aren't here to say goodbye when they ask to withdraw care. We FaceTime so they can say goodbye.

We stop the drips.

Turn off the ventilator.

And wait.

Your hands upon theirs.

You think of their family. At home. Sobbing.

Someone starts saying a prayer.

You can't help but cry.

This isn't what we do.

You stand by. You wait.

This isn't what we do.

You stand by. You wait.

Time of death: 7:19pm

In West Africa, I saw too many people die. Have a long talk with them in the morning. Go have lunch. Come back and they're dead.

But this is different.

This isn't what we do.

But then again, none of this is.

I see it on my colleagues' face. We are tired. We are physically exhausted.

Hours in goggles, gowns and masks feel like days.

But we are only at the beginning.

The mental exhaustion is only starting to set in. The things we do, the things we see. This isn't what we do.

I worry about my colleagues. Every day someone calls me crying. How long will they hold? How long will I hold?

I remember how this anxiety gnawed at me every day in Guinea in 2014. Was today the day I got infected? Won't know for a week. The days add up. The worry adds up.

I've never seen my colleagues so afraid, so unsettled.

But I've also never seen them all work so well together. I've never seen us more unified, more focused, more sincere.

Yes, we worry about PPE.

Yes, we worry about lack of medications.

Yes, we worry about each other.

But I've never seen so much sense of purpose. So much honor to do this job.

I think of this when I finally get home. Clothes in a bag. Hot shower. Look in the mirror. Indentations of the goggles still deep on my face. Bllisters on the bridge of my nose.

How long will we hold?