NYC COVID Tour of Duty: From LAX to NYC

New York to me isn’t a stage, not a spectacle for all to see and be seen, but it is absolute an arena. 

A chance to be a part of something truly greater.  Service is the word. 

Dr. Larry Burchett – NYC Covid Tour of Duty, April 24th, 2020

Day 0.

I write you from seat 31A on United Flight 2304 from LAX to Newark, NJ, flying to New York City to volunteer in a Brooklyn hospital for a week.  After a little nap on my 9am flight (don’t judge, I’ve been working mainly nights in the ER lately, so this flight is early for this body), I tried to record something for the audio podcast, but the whole jet engine sound has made me turn to the pen.  Well, the keyboard.  And you.

In this article, I’m going to touch on—

-The volunteer process, including how I got this free flight.

-Current hospital management for Covid19

-Why I’m doing this, what it means to me

-Death, my death, my patients deaths.  Yep, death.

Over a month ago, when cases of Covid19 were increasing, the talk was that California was a week or 2 behind New York, and many (most, probably)—

(I just asked for coffee on the plane.  “No coffee or hot items due to Covid.”  Because Covid is a coffee born disease?  Sometimes I don’t get it.  Ok.  How about a coke?  Can I get a cup of ice with that?  “We have Coke, but no ice because of Covid.”  This new Covid world.  Covid rules…anyways, let’s back to a month ago).

Most were saying that California would have a surge a week or 2 after New York and that Corona was coming.  Made sense to me, San Francisco and San Jose being such ports to Asia, the first case in the US being in Seattle, Washington.  We were all preparing for the wave of sick to be overflowing from the hospitals and ICUs, with images of Italian suffering fresh in memory.  And then…

It didn’t happen.  I kept going to work in the various ERs that I worked in, mostly rural.  And there just wasn’t many sick people from Corona.  Some came to the ER for a Covid test, but few were sick.  The ICUs of hospitals I worked in were not filling up, and certainly weren’t overflowing.  Is this a rural thing?  Maybe safer out there?  No, California had flattened the curve.  Good policy acted upon early, and people that listened and stayed home and social distanced (is that even a word?  “Distanced.”)

That’s good.  For the 40,000 + lives that were saved in San Francisco.  Some experts had predicted some 44,000 deaths in SF from Corona virus, and have touted that these tens of thousands of lives have been saved.  And many have.  Thank goodness.

Working in the ER in this time, to be frank, was boring.  Our volumes were and still are, down.  Way down.  30-40%.  People are staying home, afraid to go out and certainly afraid of getting exposed to the virus.  The hospital is one of the mostly likely places you’ll find it.  I had one day where I worked an 8 hour shift from 8am to 4pm in a 8 bed ER that, usually in a day like that you might see 15-20 patients.  A busy day would be 25-30.  

We saw 4.  

I arrived for a night shift the other day at that same hospital where the day doctor saw 2 patients.  2.  And then read online all day.

Read about what’s going on in places like New York City, and Detroit.  Real surges, with thousands of Americans dying every day.  Some have declared a peak of Covid deaths in mid/late April at over 2,000 deaths per day (2,400 say), more than heart disease and cancer daily deaths (they each claim around 600,000 Americans annually).  Seeing the images of a semi with a freezer being used to hold dead bodies because the morgue is full.  Just reading about it.  Sitting on the sidelines.  Like so many of us, wanting desperately to help.  To contribute to the war effort.  To do something in a time when we feel so powerless.  And having the knowledge and skill to actually do so.  

Watching Covid from the sidelines was killing me.

It wasn’t so long ago that my med school alma mater Kansas Jayhawks were #1 in the rankings and heading into the Big 12 tournament in downtown Kansas City.  The Sprint Center and much of that development happened after I left for residency in California, and I’d never experienced that, and had wanted to for a while.  I booked a ticket and was going to go to some games with my dad, uncle and friends.  

If you remember, the tournament first games started on that Wednesday amidst rapidly evolving conversation about shutting things down.  The first games were played, although the crowds were thin.  Then they said, play the games, but no crowds.  And finally, they cancelled the whole tournament, and all of a sudden, sports were gone.  So was my trip home to see my dad and family, which had been a while.

My daughter is 10 and mostly lives with her mom.  She goes to a school that has an entire week off every 6 weeks, and I often get extended time with her then.  But working in the ER and the continual potential exposure I have at work in the ER, we have decided to limit me passing it to her and her mothers side of the family.  It’s the right thing to do.  And it’s hard.

Don’t get me wrong, I like my me time.  Alone time, to think and write and read.  But not being able to see family or my daughter for the indefinite future and because I’m (sort of) on the front lines—health care worker isolation.  Can’t date.  No girlfriend or wife.  What the hell am I going to do about this?

Go to New York.

I almost always wanted to be a doctor, since grade school.  I went from wanting to be a neurosurgeon (7th grade) to cardiothoracic surgeon, to a family doctor that could care for most in a hut in Africa, to what I do now—ER and hospitalist, or hospital medicine.  I have a unique skill set in being able to diagnose, treat and stabilize life-threatening illness up front, and also take care of patients when they are admitted in the hospital.  The ER doc gets things started, the hospitalist carries the ball all the way to the end zone.  For years, as a hospitalist, I also took care of ICU patients, including vents.

But as my ideas of who I wanted to be in medicine evolved and landed on ER and hospitalist, I will say this—there is nothing like the feeling of saving someone’s life.  There is the satisfaction of making the right diagnosis and setting appropriate treatment, and doing it calmly.  And there is the adrenaline burst of the dying life in front of you, that to bring them all the way back and healthy to walk out of the hospital—nothing like it.  No amount of money, gold, anything is better.  The culmination of training and technology, of applied science and medical instincts.  In this way, I love taking care of people and will always do ER and care for the sick.  

In my career I’ve made mistakes, and some of them costly.  But I’ve also had some incredible saves.  One of my fondest memories was almost a decade ago.  It wasn’t long before that I had graduated from residency, which means—I didn’t know shit.  It took a couple years before I knew what I was doing, and really probably 5 years after residency until I was comfortable and truly mastering my work.

The ER was busy that day, only a 5 bed ER, me and 2 nurses, we did our best, and a good job.  There were a few people in the waiting room, and as I was walking by, preoccupied thinking about whether I should order this test or give that med to another patient, my ears somehow picked up the words “fever and a rash.”  I stopped.  Meningitis?  No, I’d never seen bad bacterial meningitis, only read about it in books really.  “Let me see who has fever and a rash.”  most of the time, it’s probably just a no big deal virus that would go away on it’s own.

A young 20 something tall man walked up to the counter and had a classic petechial rash, with small little red purple dots on his hands and arms.  “Holy shit,” I said inside to myself.  This is meningococcal meningitis.  In minutes, we threw him in room 3, I did a spinal tap, and the second I pulled the needle out of his spine, the nurse hung the antibiotics.  In those minutes, his rash was getting worse in front of our eyes, moving up his arms.  With Neisseria Meningitis, people die and fast.  The bacterial infection and body’s response results in loss of blood flow and amputation of limbs—I had seen patients who had survived, but lost hands.  This guy was sick.

We nailed it that day.  The spinal tap ended up growing that feared bacterial meningitis, and it grew in his blood, too—very sick.  He was admitted to the hospital, fully treated over the course of days/week, and walked out without any complication.  Not sure he even knew what we did for him that day.  

Seeing four patients a day just ain’t in the arena.  Not when thousands are dying in epicenters throughout the US.  I keep thinking about Gladiator, about Maximus in the Coliseum.  About WW2 young men on a boat headed to Normandy.  About Labron lacing up his shoes and stepping onto the court.  This is our arena.  It’s not played for money, nor fame, nor likes on the Gram or awards.  It’s something far greater, much deeper.

This Corona, is a huge moment on our lives.  What you do now, will stay with you forever.  Many of the docs I’ve talked to feel like we have been preparing for this our whole careers, our whole lives.  We are the soldiers who can fight this enemy.  We have a choice—to do so, or to run.  Now I work with many older docs—I would never judge anyone for sitting out with significant medical risk.  Doctors have died.  So have nurses.  We will lose more, and the older with more medical history, the greater the risk.  I’ve worked side by side a nearly 70 year old doctor with asthma, she keeps showing up.  I’m 40 and healthy, she’s got more courage than I.  I followed the shift of an 80 year old ER doc.  80, and still kicking during Corona.  That’s inspiring.

And I’ve seen some docs give up their shifts.  Relatively young, healthy ones.  Maybe they don’t need to work for money, and are saving their hides.  Draft dodgers, truly.  If you’ve got a medical condition and risk, no judgement.  But if you don’t—there is a duty there.  Because if you don’t do it, who will?

I had a patient who was a 50 something year old hospital nurse, with mild heart failure.  We talked about her getting a Covid test not because she was worried about her own health, but because she didn’t want to give it to her patients.  I told her I wanted her to stay safe, think about not working as much.  She didn’t sit this one out.  So many good, brave people out there.  It’s inspiring to be a part of that.

Recently I was training to work in a Covid hospital in Los Angeles.  People of all kinds, white, black, Asian, Latino.  All there for one reason—to take care of sick people.  To be a part of something truly great, a cause.  It feels incredible to be a part of something like that.

New York to me isn’t a stage, not a spectacle for all to see and be seen, but it is absolute an arena.  A chance to be a part of something truly greater.  Service is the word.  Giving of yourself to a worth cause.  An opportunity to be generous, and brave and just.  To be the kind of person you really want to be, to make yourself and your parents proud.  

And to do it in a never before seen in our lifetime context.  What you do now during Corona will stay with you forever.  I was telling a doc friend the other day when ranting about the doctor draft dodgers, that truly serving in the front lines (not my 4 patients a day stuff) but elbows deep in Corona, that will stay with you for the rest of your life.  You will feel good about that service, that giving, putting your neck out to treat strangers in a hospital—forever.  That is just the most badass thing there is.  And we can do that now.

And the doctor draft dodgers—they won’t forget that either.  There is no conscientious objection to this service, a Vietnam draft dodger could have done so on a moral basis.  Those able bodies that sit this one out will live with that for the rest of their lives, and I suspect, will respect and regard themselves less for the rest of their days.  But for those who serve, all who serve in this cause—nobody will ever be able to take that away from us.

There’s not a lot of WW2 vets left, may some in their late 90s.  A truly great generation, they beat Hitler and saved the world from some of the worst evil in history.  And for the rest of their lives, nobody could take that away from them.  They walked with a cool confidence because they knew.  It wasn’t about acknowledgement or praise, nor awards nor status.  It was knowing in the inside that they did and were a part of something truly great, that mattered.  That changed the world.  And those guys had a little inner swag if you will because of it.  This is no different.  We write out own eternity every day.

Hell yes I’m getting carried away.  This plane is landing, so I’ll wrap this up with some before questions.

1. How bad will it be?  Will I be shocked?
2. Will I feel powerless to help my sick Corona patients?
3. Where will I feel hope?
4. Will most of my patients be minorities, elderly and with medical issues?
5. What are the most effective treatment plans?  Proning, hydroxycholoquin, azithro, etc.
6. How will we communicate with families?
7. How many of my patients will die?  How can we comfort them and their loved ones during their loss?
8. How exhausting will this care be after 12 hour shifts x 7 days?
9. What is the feeling of NYC?  Empty?  Hopeful?
10. Will I be more afraid of dying myself of Covid?  Or will I see it more as a disease of old sick folks?

Quick summary of my “before” understanding of treatment.

Meds are experimental, none proven, including hydroxycholoroquin, azithro, antivirals, antiflu, vitamin C, zinc.

No steroids.

Proning helps.  Early intubate vs normal controversial.  No bipap 

Good supportive care, judicious fluid management (don’t overdo it), sedate with what you can, pressors PRN.

Treat DVT/PE, not D-dimer.  Same with troponin.

Keep families in the loop, clarify goals

Seatbelts fastened?  Ok, I know we’re landing.  I’m wrapping it up.

DEATH.  MY DEATH.  YOUR DEATH.  OUR DEATH.

I’d be lying if I didn’t say that at times, the fear of death from Covid has scared me.  A little anxiety there.  At 40 and healthy, it’s unlikely, but not zero.  Sometimes, I have this invincible young soldier attitude about it—no better way to go out that giving yourself for something you truly believe in.  We are all going to die.  How did you go?  What did you do with your time?  Live an uninspiring but long life?  Or an embodied lit existence, even if less than 80 years?  No reason I can’t hope for both long and meaningful.  But the deliberate act of coming here has been an enlightening exercise in recalling, reconnecting with the most important stuff deep inside.  Living that stuff.  

Please store your laptops and elevated your tray tables.

Sir, are you ready (raises her arms indicating to lift that tray table.)

Hell, yes, I’m ready.

Let’s do this.