When you wake up you wonder:

Would they still call us heroes?

If they knew we felt so helpless?

We thought we'd get use to it.

It's been a month, but feels like forever.

Back in the ER today. Jump on an empty subway at 7:30am. Streets are quiet.

Walk into the hospital.
The somber symphony of monitor alarms is the only sound you hear.

Their cadence is perfect & predictable.

Beep.

Beep.

Beep.

One, on repeat, is unsettling.

But now its dozens. Each with an independent rhythm.

A sea of similar sounds.
It hits you as you walk in. Even since your last shift, the whole place has been transformed.

The kingdom of coughing has been overthrown.

Because you can't cough when you're intubated and on life support.

Now there are two beds and two patients in rooms only meant for one.
You check on every patient, every bed. Many on multiple IV drips — sedation, saline, blood pressure support.

1a: 72y female. Intubated.
1b: 84y female. Intubated.

2a: 64y male. Oxygen facemask. Breathing fast.
2b: 67y male. Oxygen facemask. Better than his neighbor.
3a: 54y male. Intubated.
3b: 48y male. Intubated.

4a: 42y male. Rapid heart rate. Low blood pressure.
4b: 57y male. Intubated.

5a: You know her well. She's been here many times before. Now she's intubated.

5b: 63y female. Oxygen facemask. On the phone. Breathing hard.
You're not even halfway done. All COVID.

As you walk around, you flashback.

Not since treating Ebola in West Africa have you seen so many sick patients.

So many who will die, no matter what you do for them.
You asked yourself then. You ask yourself now:

Are we doing the right thing?

Are we having an impact?
"Flip them over. Maybe that'll work?"

"Turn up the oxygen. Maybe that'll work?"

"Turn down the drips. Maybe that'll work?"

"Try these new experimental meds, maybe they'll work?"

"Try these old-school meds, maybe they'll work?"

We struggle. Because we don't know what works.
Last week a colleague cared for a woman with cardiac arrest from COVID. And her daughter. At the same time.

Today one of your patients is on oxygen struggling to breath.

You try to talk to her.

But she is watching her mom, intubated, on a ventilator, in a bed across the ER.
The head nurse comes to you. Another new patient. Very sick.

"He's in bed 9. Same thing. Low oxygen."

You try to concentrate, but your thoughts are interrupted by the loudspeaker:

RESPIRATORY STAT TO THE ER.

ANESTHESIA STAT TO THE ER.

On repeat. Like the alarms. All day.
You approach the new patient. It's immediately clear how bad this is.

He's breathing 40 times a minute. Can't hardly speak.

His oxygen dips. Put him on a facemask. It slowly climbs.

You put your hands on him. But the purple gloves feel so cold, so distant. Maybe better not to?
You want to tell him it'll be ok. But you don't think it will.

You want to tell him you'll help him. But he can't hear you. The mask muffles your voice.

The sibilant hiss of oxygen pouring from masks drowns out your words.

You try to look him in the eyes, but your goggles fog.
"Hey is there anyone I can call for you?"

You get his wife on FaceTime.

She sees her husband of 47 years. Breathing fast. Struggling. Alone.

She hears the alarms of patients on life support in the background, struggling to stay alive.

She sees you in a mask, gown, and gloves.
You flashback.

You remember.

19 days in isolation when you were treated for Ebola.

19 days & all you saw were masks. All you felt were gloves.

You felt toxic.

No matter what they said. No matter what they did.

You felt toxic.

This is what they see. This is what they feel.
So you try to connect. You want to comfort.

But how do you connect when you cannot really touch?

How do you comfort when they can hardly see through your foggy goggles?

Or when the mask muddles every word?

You wonder:

Are we doing the right thing?

Are we having an impact?
You end your shift.

You walk around the ER.

Still so many struggling to breathe.

Still so many on life support.

You can't help but wonder.

Would they still call us heroes?

If they knew we felt so helpless?
You can follow @Craig_A_Spencer.
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