This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at https://www.nytimes.com/2020/04/13/nyregion/coronavirus-nyc-doctors.html
The article has changed 27 times. There is an RSS feed of changes available.
| Version 3 | Version 4 |
|---|---|
| ‘I Cried Multiple Times’: Now Doctors Are the Ones Saying Goodbye | ‘I Cried Multiple Times’: Now Doctors Are the Ones Saying Goodbye |
| (32 minutes later) | |
| The elderly coronavirus patient arrived at the Manhattan hospital extremely sick and rapidly deteriorating. Dr. Marissa Nadeau, an emergency medicine physician on the night shift, had little time to ascertain his wishes. | The elderly coronavirus patient arrived at the Manhattan hospital extremely sick and rapidly deteriorating. Dr. Marissa Nadeau, an emergency medicine physician on the night shift, had little time to ascertain his wishes. |
| The patient, gasping for breath but alert, made it clear he did not want to be intubated and put on a ventilator, which might have been his only hope for survival. | The patient, gasping for breath but alert, made it clear he did not want to be intubated and put on a ventilator, which might have been his only hope for survival. |
| Dr. Nadeau placed her hand on his shoulder, then used her phone to FaceTime with his family, telling them of his choice and holding up her phone so they could say what might be a final goodbye. | Dr. Nadeau placed her hand on his shoulder, then used her phone to FaceTime with his family, telling them of his choice and holding up her phone so they could say what might be a final goodbye. |
| It was the third time that night at Columbia University Irving Medical Center that Dr. Nadeau had helped critically ill patients communicate with their families over FaceTime; the two other patients had also rejected intubation — a decision with potentially life-ending ramifications. | It was the third time that night at Columbia University Irving Medical Center that Dr. Nadeau had helped critically ill patients communicate with their families over FaceTime; the two other patients had also rejected intubation — a decision with potentially life-ending ramifications. |
| One of the cruelties of Covid-19, the disease caused by the coronavirus, is that many patients may have just minutes to settle their affairs. With family members for the most part barred from visiting their loved ones, doctors often are left to facilitate such moments, full of emotion and tears. They are wrenching for physicians, too. | One of the cruelties of Covid-19, the disease caused by the coronavirus, is that many patients may have just minutes to settle their affairs. With family members for the most part barred from visiting their loved ones, doctors often are left to facilitate such moments, full of emotion and tears. They are wrenching for physicians, too. |
| “I cried multiple times on my shift last night,” Dr. Nadeau later texted in a WhatsApp group chat where her colleagues trade advice and experiences and try to comfort each other. | “I cried multiple times on my shift last night,” Dr. Nadeau later texted in a WhatsApp group chat where her colleagues trade advice and experiences and try to comfort each other. |
| “You guys are going to see me with red puffy eyes for the next few weeks,” she wrote. “I just feel like I went into this specialty to save lives, and it kills me that we can’t save everybody.” | “You guys are going to see me with red puffy eyes for the next few weeks,” she wrote. “I just feel like I went into this specialty to save lives, and it kills me that we can’t save everybody.” |
| In a pandemic, the normal rituals around death are suspended. In New York City, where on some days the illness has been killing someone every four minutes, some funeral homes have stopped holding wakes, cemeteries are limiting graveside gatherings and the authorities have warned people not to gather for religious services. | In a pandemic, the normal rituals around death are suspended. In New York City, where on some days the illness has been killing someone every four minutes, some funeral homes have stopped holding wakes, cemeteries are limiting graveside gatherings and the authorities have warned people not to gather for religious services. |
| The actions are meant to keep the living from congregating around the dead and dying. And nowhere is that principle more strictly enforced than in hospitals. | The actions are meant to keep the living from congregating around the dead and dying. And nowhere is that principle more strictly enforced than in hospitals. |
| Intensive care units in the city once saw a steady stream of visitors. Nurses and doctors learned about their patients through them: which patient had the spouse who spent every waking hour at the bedside, which patient had the large family. | Intensive care units in the city once saw a steady stream of visitors. Nurses and doctors learned about their patients through them: which patient had the spouse who spent every waking hour at the bedside, which patient had the large family. |
| Now bedside vigils, and visitors generally, are a thing of the past. | Now bedside vigils, and visitors generally, are a thing of the past. |
| In recent weeks, an exception has sometimes been made when a patient is on the verge of death. But even then, the visitor is usually not allowed in the actual room. | In recent weeks, an exception has sometimes been made when a patient is on the verge of death. But even then, the visitor is usually not allowed in the actual room. |
| In one Manhattan emergency room, a woman recently stood by the secretary’s desk. A doctor handed her a phone. “I love you,” she said. “Things will be OK.” | In one Manhattan emergency room, a woman recently stood by the secretary’s desk. A doctor handed her a phone. “I love you,” she said. “Things will be OK.” |
| The words were played through the call bell in her husband’s isolation room, 20 feet away. He was in a medically induced coma, dying. They had been married 40 years, according to a hospital employee who described the scene. | The words were played through the call bell in her husband’s isolation room, 20 feet away. He was in a medically induced coma, dying. They had been married 40 years, according to a hospital employee who described the scene. |
| Dr. Dylan Wyatt, a resident physician at NewYork-Presbyterian Brooklyn Methodist Hospital, said one recent image is seared into his memory: a woman who had been summoned to the hospital because her mother, in her 90s, seemed close to death. | Dr. Dylan Wyatt, a resident physician at NewYork-Presbyterian Brooklyn Methodist Hospital, said one recent image is seared into his memory: a woman who had been summoned to the hospital because her mother, in her 90s, seemed close to death. |
| “She wanted to go in to see her mother, but she couldn’t, so she was standing there crying with her hand on the glass, looking in,” Dr. Wyatt recalled. “What struck me most is just how lonely people are at the critical hour.” | “She wanted to go in to see her mother, but she couldn’t, so she was standing there crying with her hand on the glass, looking in,” Dr. Wyatt recalled. “What struck me most is just how lonely people are at the critical hour.” |
| Even that sort of goodbye is growing rare, as some hospitals strain under the number of critically ill patients. Some patients are dying unnoticed, doctors said in interviews. | Even that sort of goodbye is growing rare, as some hospitals strain under the number of critically ill patients. Some patients are dying unnoticed, doctors said in interviews. |
| Other times, doctors have no time to summon relatives, or the relatives are unreachable. | Other times, doctors have no time to summon relatives, or the relatives are unreachable. |
| When a 38-year-old man was dying of Covid-19 at Elmhurst Hospital in Queens last month, doctors searched for a relative to call. But the patient’s mother was in another hospital, sick with the same disease. | When a 38-year-old man was dying of Covid-19 at Elmhurst Hospital in Queens last month, doctors searched for a relative to call. But the patient’s mother was in another hospital, sick with the same disease. |
| Patients who are going to be intubated and connected to a ventilator are generally first placed in an induced coma. | Patients who are going to be intubated and connected to a ventilator are generally first placed in an induced coma. |
| When told what awaits them, some respond with disbelief and denial. Most patients, though, are just afraid. | When told what awaits them, some respond with disbelief and denial. Most patients, though, are just afraid. |
| “I try to explain that his breathing is getting worse and he’s getting tired because of it,” said Dr. Meredith Jones, an emergency room physician at Brookdale Hospital Medical Center in Brooklyn. “That puts a strain on the body, and sometimes it’s best to take that strain off and let the ventilator do the breathing for you.” | “I try to explain that his breathing is getting worse and he’s getting tired because of it,” said Dr. Meredith Jones, an emergency room physician at Brookdale Hospital Medical Center in Brooklyn. “That puts a strain on the body, and sometimes it’s best to take that strain off and let the ventilator do the breathing for you.” |
| They ask, “How long will this last?” Or, “Will I die?” | They ask, “How long will this last?” Or, “Will I die?” |
| We hope you will wake up in a week or two, say the doctors who believe in giving hope. Others just say, “We don’t know.” | We hope you will wake up in a week or two, say the doctors who believe in giving hope. Others just say, “We don’t know.” |
| But the doctors generally offer the same advice before proceeding. “Now is the time to call your loved ones and tell them all the things you want to say,” one doctor at NewYork-Presbyterian Hospital/Weill Cornell hospital said he tells his coronavirus patients before they are intubated. “I’ll come back in 15 minutes.” | But the doctors generally offer the same advice before proceeding. “Now is the time to call your loved ones and tell them all the things you want to say,” one doctor at NewYork-Presbyterian Hospital/Weill Cornell hospital said he tells his coronavirus patients before they are intubated. “I’ll come back in 15 minutes.” |
| It is difficult to overstate how isolated some of these patients are. Doctors and nurses try to avoid entering their rooms, for fear of infection. In one hospital, the I.V. pump lines are extended out of the room, so they can be managed at a distance. | It is difficult to overstate how isolated some of these patients are. Doctors and nurses try to avoid entering their rooms, for fear of infection. In one hospital, the I.V. pump lines are extended out of the room, so they can be managed at a distance. |
| In hospitals across the city, there are silent, lonely ranks of thousands of such patients. Some are face down. Others lie on their backs, eyes closed. Many have been temporarily paralyzed so their bodies can’t resist the ventilator that is breathing for them. “They appear very lifeless but for the work of the machine,” Dr. Colleen Farrell, a resident at Bellevue hospital, said. | In hospitals across the city, there are silent, lonely ranks of thousands of such patients. Some are face down. Others lie on their backs, eyes closed. Many have been temporarily paralyzed so their bodies can’t resist the ventilator that is breathing for them. “They appear very lifeless but for the work of the machine,” Dr. Colleen Farrell, a resident at Bellevue hospital, said. |
| Updated June 5, 2020 | |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Doctors try to call their families daily with an update. With this illness, days can go by with little to report. | Doctors try to call their families daily with an update. With this illness, days can go by with little to report. |
| Dr. Farrell said she often tells families, “I hope his lungs recover, but I worry that they won’t.” | Dr. Farrell said she often tells families, “I hope his lungs recover, but I worry that they won’t.” |
| Not all critically ill patients opt for a ventilator. “I want to die comfortably,” some patients explain, said Dr. Joseph Lowy, head of palliative care at N.Y.U. Langone Health. They are given a room and if appropriate, medication like morphine. | Not all critically ill patients opt for a ventilator. “I want to die comfortably,” some patients explain, said Dr. Joseph Lowy, head of palliative care at N.Y.U. Langone Health. They are given a room and if appropriate, medication like morphine. |
| Columbia University Irving Medical Center is expanding its palliative care response by training and deploying other doctors, like psychiatrists, said Dr. Craig Blinderman, director of the service. | Columbia University Irving Medical Center is expanding its palliative care response by training and deploying other doctors, like psychiatrists, said Dr. Craig Blinderman, director of the service. |
| At another Manhattan hospital, doctors, in their final calls to next of kin, have taken to asking if there is a song they should play. Some requests have surprised the hospital staff, like Cyndi Lauper’s “Girls Just Want to Have Fun.” | At another Manhattan hospital, doctors, in their final calls to next of kin, have taken to asking if there is a song they should play. Some requests have surprised the hospital staff, like Cyndi Lauper’s “Girls Just Want to Have Fun.” |
| A physician assistant holds the patient’s hand, while the doctor positions the phone so the dying patient can listen to a relative’s voice. The music covers up some of the coughing. | A physician assistant holds the patient’s hand, while the doctor positions the phone so the dying patient can listen to a relative’s voice. The music covers up some of the coughing. |
| Dr. Nadeau said she never thought that as an emergency physician she would have as many difficult conversations as she was having now. For reasons of privacy, she declined to provide more specifics on the three critically ill patients’ cases. | Dr. Nadeau said she never thought that as an emergency physician she would have as many difficult conversations as she was having now. For reasons of privacy, she declined to provide more specifics on the three critically ill patients’ cases. |
| She had taken it upon herself, she said, to learn the kinds of language and techniques that palliative-care doctors use so she can “have the right words to say with both patients and their families.” | She had taken it upon herself, she said, to learn the kinds of language and techniques that palliative-care doctors use so she can “have the right words to say with both patients and their families.” |
| Dr. Barbara G. Lock, a veteran emergency physician at NewYork-Presbyterian Hospital, said she remembered receiving Dr. Nadeau’s WhatsApp messages and had responded with support. | Dr. Barbara G. Lock, a veteran emergency physician at NewYork-Presbyterian Hospital, said she remembered receiving Dr. Nadeau’s WhatsApp messages and had responded with support. |
| “We are being asked to do things that are tearing at our souls,” Dr. Lock wrote. “We must not normalize this.” | “We are being asked to do things that are tearing at our souls,” Dr. Lock wrote. “We must not normalize this.” |
| Dr. Lock said even doctors who had not yet confronted dying patients were feeling anxiety at the deluge. | Dr. Lock said even doctors who had not yet confronted dying patients were feeling anxiety at the deluge. |
| “There is going to be no shortage of doctors who are crying at the end of their shifts,” she said. | “There is going to be no shortage of doctors who are crying at the end of their shifts,” she said. |
| After the crisis ends, Dr. Lock said, some doctors might feel like Vietnam veterans returning home from war. | After the crisis ends, Dr. Lock said, some doctors might feel like Vietnam veterans returning home from war. |
| “It seemed like they can only relate to each other,” she said, “because nobody else knew what they went through.” | “It seemed like they can only relate to each other,” she said, “because nobody else knew what they went through.” |