[emotional music]
- I'm a physician,
- I'm an ER doctor,
- Physician assistant,
- Emergency medicine physician,
- Vascular surgeon, - Primary care doctor.
[emotional music]
- 72 hours since our first corona patient.
[speaking in Spanish]
- Three and a half weeks.
- It's been about a month.
- Four and a half weeks.
- Five weeks ago.
- This is the fifth week.
- About five weeks ago.
- Five weeks.
- We saw our first case at Northwestern in early March.
- It's been about six weeks ago.
- Seven or eight weeks ago.
- Eight weeks.
- 12 weeks.
[emotional music]
- We have two positive cases at our facility currently.
[speaking in Spanish]
- Now we have about 30.
- There's around 30 positive cases.
- In total we have 94 patients
in the whole country in the ICU.
- For the whole of Washoe County,
I know there are around 360.
- We have over 400 patient admitted in the hospital.
- We have a minimum of 400 COVID cases in my facility today.
- We've got basically a 400 bed hospital
on a day to day basis,
and it's virtually 100% COVID at this point.
- Most of our folks are changing in the garage completely
and sanitizing themselves before they enter their homes.
- I have wipes in my car
'cause I'm driving patient to patient
so I wipe down my car before and after every visit.
And then when I come home, I usually leave
my jacket and shoes outside of the house
at least overnight.
- You change out of your clothes outside of the home,
you basically immediately shower at the hospital.
I have my protective equipment stashed in a place
that I know I'll be able to find it and
I take very close care of that protective equipment as well.
- You know, disinfecting my shoes,
immediately my clothes, myself.
The surroundings, anything metal in my home,
anything metal in my car is disinfected.
- Making sure that your phone is in like
a sealed plastic container,
your hair is in a hair net,
and all of the kind of usual precautions.
And then soon as your home,
making sure any clothes that you've been wearing,
even just at the hospital,
are kind of thrown into a high degree wash.
- I take off everything before I go inside,
including my whites, bodysuit, I go out in everything
and I put it outside for fresh air to kill,
and then I, or put it in the oven,
70 degrees Celsius, for my masks.
And then I take off my, all my clothes,
strip completely down, put it into laundry,
and then take a shower, and let it run.
Takes about 30 to 45 minutes.
- I have a dedicated footwear
to go back and forth to the hospital.
- I usually shower at the hospital
but I leave my sneakers outside, I put Lysol on them.
I wash my cell phone with alcohol, my hands.
I take out all of my clothes,
I put them on a different basket on the laundry.
[emotional music]
- Psychologically it's...
It is stressful.
- Obviously I miss, being around my family a lot.
That's the hardest thing.
- I am having nightmares at night
which I've never had before in my life.
[speaking in Spanish]
- As the day passes, you learn how to
put on your gear, you shower like three times a day,
it becomes a routine.
- With all of the new changes
and how protocols are switching from day to day,
are those things enough?
Or, you know, are we gonna find out that
we need to be doing more, or.
- It is, you know, sad to see a lot of the patients,
you know, be unventilated and things like that.
You gotta be as professional as possible as well.
- Broke down, three weeks ago, in the middle of a shift.
I never break down.
What's gonna happen to our mental health afterwards?
What's gonna happen to us afterwards?
You're gonna have a huge wave of survivor's guilt
after this pandemic is over.
- I mean it's definitely been exhausting.
I wanna be really careful not to bring the virus
into someone's home.
- I feel good because I know that I can do something
for my hospital and for my country and for the people,
which is, which is good, makes you feel good.
- We're starting to see some real hope
for getting some of these people back to their families
and back to productivity.
[emotional music]
[speaking in Spanish]
- I've had a patient who's 84 who I've seen once a month
for the last two years.
I've had to tell him that I cannot see him at home
because I don't even want to take the chance
that if I were to come into his home
and potentially give him the virus,
that would be extremely detrimental to his health, so.
I'm really his only social outlet at this point,
he really doesn't have a close family otherwise,
and it's been really tough for him to have to be
in isolation without proper care, you know,
with someone he's relied on for the last couple years.
- So the decision as to when you intubate somebody
is a particularly weighty one with coronavirus
because the data that we have at our disposal shows
that it's difficult for many of these folks
and a majority of these folks really
to get off of the ventilator.
So making that decision has become,
it's already a complicated decision.
- So there have been a lot of difficult discussions
over telephone with devastated family members
who had their relatives dying in hospital
with nobody around,
and that was very, very difficult,
those conversations over telephone
when you can't even really build the rapport
that you'd like to because the telephone,
you can't see people's emotions, you can just hear crying.
- And unfortunately there are times when the virus wins
and we have to decide that we've done all that we can
for that particular individual.
And nobody likes to give up.
- This patient we treated on Tuesday,
she had been with internalized catheter for 15 years.
And she had no access.
So we were trying to get some venous access
so she could get dialysis
because she could not be dialyzed for 10 days.
And she coded on the angio suite.
and our decision was to, what do we do?
We don't have a lot of ventilators.
She's more than 70 years old.
What's going to happen?
But at the end we did cardiopulmonary resuscitation
and the patient is currently on ventilation.
She got one dialysis but, being unstable,
you, sometimes you cannot do the whole dialysis,
but you always think that,
"Okay, this elder patient, she's going to get a ventilator,"
then you could get two younger patients,
and at the end, well she was not a COVID patient so,
we decided to intubate her
and give her all of the maneuvers that we could.
- I will say, it is incredibly difficult
from an emotional standpoint to,
to interact with patients and their family members.
We don't let visitors into our hospitals
and there are no hospitals
around this country that do, right?
Our whole workflow around that is different now,
and so it's crazy to tell someone,
"Hey, you know your family member's critically ill
"but you can't come in here right now."
- One of the things that's really been
unusual for us is that we are limiting
the aerosolized medications,
so the medications that we give for people with
exacerbations of asthma or wheezing
or exacerbations of their COPD,
they are really concerned of our aerosilizing
and causing more spread of infection.
So whereas normally when a person had wheezing
we would just put on a mask and a nebulizer treatment,
not even think of it,
now we really have to make decisions,
is the risk to the patient and the crew
of having this aerosolized medication
compared to the benefit that they're gonna receive
from having that wheezing or shortness of breath relieved?
So two days ago I had a patient who was sick,
I don't know yet if they were COVID
but they were definitely in respiratory distress.
I went ahead and gave the albuterol treatment
with the HEPA filter on and then stopped it
before we made it to the hospital
and it did seem to improve them,
so I feel like it was the right thing to do
but all the time I was wondering, you know,
is this one really sick enough for us to do that way?
Or should I wait until they can have a different way
of delivering the medication?
Fortunately it worked out but,
you know, never had to think about it twice before.
- I think the hardest decisions
that we're having to make right now
in the US and around the world
are in terms of resource allocation.
And so continuing to have to triage people
and make educated guesses about who most needs to be tested
and who's most likely to be infected
continues to be a struggle.
- I think the hardest decisions still come,
comes back to when do you need to order tests
for your patient?
Ideally, it would be good if we can do tests for everyone
but realistically, they just not the resource to do that.
- I think, you know, treating patients with corona
is the patient that asymptomatic.
I have subsets of patients that
one is symptomatic and one is not.
Who do we test, who do we not?
- It'd be nice to have a retrospective scope
and say we could have done anything better, right.
The issue's that none of us,
human beings have been notoriously bad at predicting things
all the time.
So otherwise we would be prepared for this pandemic.
And if anything we could do better is really to
asking humanity to change human nature.
[emotional music]
- This has taken a very big emotional toll on me.
I miss my children, I miss my grandchildren,
and yes, it has taken a very big toll.
- I haven't cried yet, but I've definitely
been on the brink a couple times.
- [Interviewer] When was the last time you cried?
- Right before this interview [laughs].
- I'm sure my partner would say
that I've been emotionally burned out,
and that I've been horrendously moody, hungry,
and tired all the time.
- I've got patients with, you know,
really life-threatening and serious problems
and me being away from home
pales in comparison to all those.
But it's certainly an experience that none of us
will ever forget as long as we're, as long as we're around.
- Like, okay I'm doing this pretty good thing
for my country, but what if I get infected,
what if I infect my family?
I cannot see my family.
And also, it's not, it's not easy for anyone,
but you have to stay positive.
If you start thinking about how, like,
all the possible scenarios, you cannot win,
because you are going to be scared the whole time
and sad the whole time.
- I can't remember the last time I cried
but it's definitely very emotional, I mean.
It's all been pretty hard to be honest with you.
Not being able to hold my daughter or my newborn daughter.
- The tears haven't been shed yet
because I wanna make sure that I'm a rock for other people.
But this crisis team, we've actually all check in,
we have our own internal crisis team for the hospital
and every week, they're rotating through
and making sure that we've got time together,
that we're having those debriefings when they're warranted.
And in of the fact, one of the nurses who sits
on this team actually stopped me in the ER
the other day as I was running,
like racing by and grabbed my arm and said,
"How are you?"
And I'm, "I'm good."
She says, "No, really, like how are you."
And really just kind of nailed that home,
like, "I'm checking in with you, sister," you know and--
- When I was in the hospital, there was so many,
everyday you had an opportunity of realizing that
crying would have been a good way of, you know,
releasing some tension.
Never cried for fear.
Cried for patients, for situation, for friends.
[speaking in Spanish]
[emotional music]
- I think right now where we are in northern Nevada,
is just at the beginning.
We're going to be seeing a flux of patients
but I can see that it's creeping up
and that we are probably just getting into
the really high volumes that other more urban areas
have been receiving already.
- Our whole facility just does not
have the capacity to handle the bandwidth
for large volumes of patients.
- We're exceptionally lucky in Ireland
that a lot of the social distancing
and government precautions and sentences put in place
have minimized a lot of patients being exposed.
- So right now in southern California,
I think there's a glimmer of hope
that social distancing is working.
And I think that we're gonna start to see
more regional differences in terms of caseload.
- Kind of the attention span, I worry,
of folks has been used up, meaning that we have been
under shelter-in-place or stay-at-home orders
for several weeks now,
and we are beginning to see
some of the messaging on the news
that the numbers, even in the worse hit areas,
are beginning to get somewhat better.
This, in my view, is actually the most critical portion
of time where you have to double if not triple down
on all the preventative measures
that we're taking as a society.
- It also depends on whether people get frustrated
and they, the weather's really nice,
and they go outside, they take that risk.
Because all it takes is one person
to encourage others to go outside, to encourage others.
And New York City's back outside
and we're spreading to one another.
You know, it's a critical mass,
then we're gonna be back into where we were three weeks ago.
- I think if people don't, don't stay at home,
this will get a lot, a lot worse.
- It appears that in certain areas,
things are starting to improve,
and once we get testing more readily available
I think that will make a big difference.
- We're seeing that to some degree at Woodhull.
And we are hopeful that we're at or perhaps just past
the apex of things.
Guarded optimism would be a good way to put it.
- Hoping that we will see a trend down,
but that trend down will take a long time,
it's not gonna be one week or two weeks.
And it's day by day.
- My outlook is
cautiously optimistic about the efforts we've done
for curve flattening.
I don't see the virus going away after this surge.
I don't see it going away entirely,
and I expect there to be secondary peaks
because of the activities we've done so far.
[emotional music]
- At the end of the day,
we're all gonna get through this together.
- The courage that I've personally seen
has been awe-inspiring.
- I will sure we want to be safe.
- We will look out for each other,
we will work for the same cause.
- You're not alone.
- Remember you're doing important work.
- This will pass too and we are going to make it through it.
- I'm proud of you guys.
- We could all learn from those experiences.
- You will never be prouder than you will be
looking back on what you did during this time.
- Stay in touch with your love ones.
- Thank you.
- God bless you and appreciate you.
[speaking in Spanish]
- Never ever lose the strength and the willingness
of communicate with people what is the real need.
Which is telling about isolation,
telling about protection,
and telling that this is the solution.
A good hospital can save an important number of lives.
A proper isolation is going to save millions of lives.