1/18 So. I just returned from working at an ED in Queens on the frontlines of the COVID response. I have so many thoughts and feelings that it seems impossible to summarize, but here are a few initial musings:
#COVIDー19

2/18 This shit is real and it is scary. COVID is taking patients down, and we do not know how to stop it. The images of overflowing EDs, overworked providers, patients who cannot breathe—these are real and it is happening. Do not let anyone tell you its not.

3/18 These are the lungs of a person who cannot breathe. We do not know (yet) how to fix these lungs. The not being able to breathe is terrifying. The not knowing how to fix it is terrifying.

4/18 But people are showing up for eachother. Docs, nurses, techs, EMTs, PAs, NPs. People show up, put on their gear, and get to work. This is demanding and uncomfortable work (physically, emotionally, mentally). Day after day, we are just doing the next right thing. #covid19

5/18 We need to keep our residents safe. For every trainee who has worked tirelessly during this crisis, sacrificing their time, health, and education: there’s nothing we can do to adequately make this up to you. How about we start by forgiving all student loans? #loanforgiveness

6/18 Behind most frontline workers is a frontline partner and family. Make no mistake, they are the glue that is holding together this response. They are making it all possible with their behind the scenes work. This is how families make villages. #UnsungHeroes #COVIDー19

7/18 There are good things and we need good things right now:

8/18 THERE IS BRAVERY. So. Much. Bravery. It hangs heavy in the air and it soaks into our skin and we breathe it in and out because it is not stopped by N95s or face shields or goggles or gowns or gloves. #FirstResponders #COVID19

9/18 THERE IS INNOVATION! When we don’t have the right tool, we make one out of other things. When we don’t know the right treatment, we try something and then we try something else. Folks are thinking and problem solving ALL DAY LONG and it is making a difference.

10/18 THERE IS FLEXIBILITY. Working together has taken on a whole new meaning, and there is comfort and solace in the connections we have made. ENT residents staffing their own COVID unit. Peds residents forming an adult transport team. Gratitude >> annoyance; Camaraderie >>> ego

11/18 There seems to be a tension that has developed between recognizing the bravery/sacrifice of those on the frontlines and acknowledging the larger structural forces at play that have placed us in this impossible role. But these things are not mutually exclusive.

12/18 Bravery is present even (especially) in the most messed up situations. It is not just a red herring, a distraction from the incompetence of our leaders--because it is real! But let's not forget there are people and institutions that benefit from a distraction...

13/18 Energy is a precious and limited resource, especially during a pandemic. We should be careful how we use it. Be grateful for those on the frontlines (and find ways to show your gratitude). BUT ALSO, please, please, use your energy to demand governmental action and change.

14/18 We need leaders who know what they are doing. We need a health care system and infrastructure with the capacity and resources to respond to a crisis. @getusppe @SocialEmergMed #COVID19

15/18 We need health insurance that is universal and not tied to employment. We need, finally, to address the social determinants of racial and economic health disparities. These are the real things that will prevent or mitigate another crisis like this. #SDOH

16/18 Post script for my ED colleagues: brush up on your vent management skills! Know the vent itself, not just the theory and physiology-- know the buttons, the tubing, the connections, the filters, the troubleshooting.

17/18 Resist the urge to intubate just because you feel uncomfortable. Take a deep breathe, think about the indications, focus on mental status and work of breathing.

18/18 You don't have to be intubated to lay on your stomach. Awake proning works! Have your patients who are awake and on supplemental oxygen change positions-- supine, right lateral, prone, left lateral, sitting up, repeat.

We've got this.