After weeks of deafening panic in the fight to save coronavirus patients, emergency rooms in New York City are getting disturbingly quiet. That’s not a good thing. Emergency room doctor Dr. Snehalata Topgi says many non-COVID-19 patients are avoiding the hospital, suffering and possibly dying at home as the medical world puts its focus on treating those battling the virus. Topgi, also the Associate East Coast Medical Director for the event medical staffing company ParaDocs Worldwide Inc., declined to share the name of the Brooklyn hospital she’s been working at, for employment reasons. But in this coronavirus diary, she shares with The Post details of this week’s eerie silence in coronavirus-stricken hospitals.
My shift begins at 3 p.m. I feel lucky that I am able to drive to the hospital. I can no longer safely take the subway given the high level of exposure. I drive through the largely deserted Brooklyn streets and notice a few people outside. I see someone unmasked. This is a collective effort. We need to protect not only ourselves but everyone around us.
My mentors always told me that the ER is where the streets meet the hospital system. And this is true as I walk into the hospital today. The ER is somewhere between the empty streets and the packed hospital — a far change from two weeks ago. Last week I heard nothing but vents dinging, code blues, coughing and the whooshing of oxygen masks. Thanks to social distancing, the number of patients coming to my ER has drastically declined. Yet inside the hospital, beds are filled with complicated COVID patients.
Years of training have taught me which patients will do poorly. Unfortunately, my elderly patient meets the criteria. He struggles to breathe on maximum oxygen, as his lab studies confirm what I already know: His heart and kidneys are shutting down. My heart breaks. He worsens and I connect him to life support, putting him in a medically-induced coma. Almost all COVID patients put on a ventilator end up dying in the hospital. I call his family to discuss his declining condition. He will die alone, without saying goodbye. I grapple with our “no-visitor policy.”
Before COVID, I had time to sit with families to discuss end of life care for loved ones. There was time to say goodbye and to clarify medical options. Often, family conversations happened in the intensive care unit. Now these discussions take place in minutes over the phone. Decisions must be made quickly to save lives.
By 11 p.m., the rest of my shift is eerily quiet. I wonder, “How many patients are dying of treatable heart attacks at home? Where are my stroke patients? Where are the cuts and broken bones?” People that should be coming to the ER for help may be too scared. Where is the man with high-risk chest pain who needs vessel intervention? Where is the elderly woman with a two-hour limp left arm and trouble speaking who needs stroke treatment? I worry. I know that they are at home, avoiding the hospital and a possible COVID infection, but likely needing life-saving interventions.
At 11:30 p.m., I head home and run through my decontamination routine. I throw my clothing immediately in the wash, and finally relax in the shower. I am exhausted and worry about exposing the people I love at home. Some of my colleagues have moved away to protect their families, so I feel lucky to have a wonderful support system.
At 1 a.m., I lie in bed, wishing life were back to normal. What will the new normal look like? Summer festival season is coming, a busy time for me as an event doctor for ParaDocs Worldwide Inc., surrounded by people I love, taking care of patients in a happier setting, like music festivals. With canceled events and closed venues, our summer plans will change. But we need more testing.
Wide awake, I turn on the TV. We cannot change what has happened, but we can look to the future. We must invest in global health infrastructure for the next pandemic. We spend billions on our military and nuclear deterrence. Yet we can’t provide adequate protective equipment to keep health-care workers safe. In this war against an invisible enemy, doctors are our new soldiers and public health is our next intelligence agency.