A call to arms
The thought never crossed my mind that as an ophthalmology resident, I would play a direct role in treating patients with this novel virus. The rapidity with which the virus had spread would become a poignant reminder of the lethality of pandemics. In a few short weeks of the first COVID patient arriving in NYC, increasing social distancing measures were taken as the city’s hospitals became overwhelmed. The stark contrast in medicine was that ophthalmology and other specialties had less work than ever before. It had been exasperating watching my friends and internal medicine colleagues from afar risking their lives while I stood idly by. There simply weren’t enough physicians to handle this new crisis. I remember the morning of March 27th vividly. The email subject title read, “urgent call for help,” which discussed a need for volunteers. Feeling a sense of privilege of being asked to assist, I replied with a resounding “yes.” I felt compelled to place my ophthalmoscope aside and pick up my stethoscope. During Governor Cuomo’s daily press briefing, he said: “This is a time you will forever remember.” With my smartphone, and with Governor Cuomo on TV, I captured a picture of my two colleagues who were joining the fight. He was right. These days would be forever etched into our memories.
Thoughts raced through my mind as I prepared for the first night of my medicine shift as an ophthalmology resident. My first year as a doctor was entirely internal medicine focused and gave me the skills and knowledge needed to succeed. As I reached out to my program director for guidance, he gave me unforgettable words of wisdom. “It must be feeling like standing on the edge of a very high diving board. The uncertainty of what it will feel like to jump is always worse than hitting the water”. I dove into that water on the morning of April 3rd. My mission with my team was to assist the overwhelmed medicine service by treating and discharging as many COVID patients back home safely to their loved ones. Although we achieved that goal for many patients, we lost battles along the way. On my second shift, I received a call from a nurse. “Patient Ms. G is confused, removed her mask, and is desatting to 70s. Please come!” the nurse shouted frantically on the phone.
Ms. G had been on BiPAP, a mask that delivers a high concentration of oxygen and is the last resort prior to intubation. The N95 pressed tightly against my face, indenting my nasal bridge to the point of causing pain. A surgical mask was draped over the N95, like a suffocating embrace. I could only imagine the air hunger these patients were feeling—the perspiration soaking through the foam of my face-shield while I spoke in Spanish loudly. I attempted to bypass the rhythmic rushing air of the BiPAP, incessant beeping of the machine, and muffling of my mask to try to re-orient her. Would today be the day she has to be intubated? We placed the BiPAP mask onto her face, and our eyes were fixed to the oxygen saturation on the monitor. The number steadily rose, and another crisis had been averted, at least for now. Next door, Mr. F, an eighty-year-old previously functional and independent human being, had increasing oxygen requirements. He was eventually placed on comfort care measures and was treated with medication to decrease his struggle to breathe. Mr. F, unfortunately, passed without family at the bedside, as did all the patients in the hospital who did not survive. At that moment, the cruel reality of the pandemic struck me.
There were certainly moments in which we were staving off this new virus. Several of our patients were on a cocktail of new medications and were starting to improve. Had the medications saved them, or were they improving on their own? Regardless, I had great news to tell their families through daily phone calls, and several of our patients were discharged home. The bonds I formed with patients such as Mr. D were the reason I entered medicine. Two weeks prior, he had been on the cusp of life and death. On the highest BiPAP settings, he would struggle to breathe, and his oxygen saturation remained in the 80s. At a time when intubation meant almost certain death, it made everyone nervous. Thankfully, day by day, he showed signs of improvement in his oxygen requirements. As I walked in to check on him, he would say, “Every time you come in to see me, I am happy,” with a smile from ear to ear. When things seemed most dire, and many were dying, Mr. D had given me hope.
As I left the hospital every evening, the walkthrough empty streets and public transportation allowed me time for reflection. Upon entering my apartment, I immediately removed my clothes and made a beeline for the shower. Vigorous hand washing and disinfecting had now become a sacred daily ritual. At 7 p.m., the cheers of New York City’s residents resonated throughout the streets. That cheer is for the health care workers risking their lives on a daily basis. It is for the housekeeping staff, transport services, and security staff that keep a hospital operational. It’s also for essential business workers and everyone who helps in making this disease end as quickly as possible. As the COVID-19 pandemic rages on, we must not forget all the lives that have been lost and those still fighting. I never imagined that I would be on the frontlines of this historical moment in time. I was afraid I would not be able to contribute, but I was inspired to see specialists from all fields uniting to help strangers. To all those wishing to volunteer but afraid they might not be able to help, remember that “the uncertainty of what it will feel like to jump is always worse than hitting the water.”
Cesar A. Alfaro is an ophthalmology resident.
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