Medical Examiner

Why My ER Was So Blindsided by COVID-19

In early 2020, I believed that the virus was far away and would stay far away.

a small model of a doctor and a patient
Photo by Annie Spratt on Unsplash

This excerpt is adapted from Every Minute Is a Day: A Doctor, an Emergency Room, and a City Under Siege by Robert Meyer (an emergency room doctor at Montefiore Medical Center) and Dan Koeppel (Robert’s cousin and an award-winning writer). © 2021 by Robert Meyer and Dan Koeppel. Published in the United States by Crown, an imprint of Random House, a division of Penguin Random House LLC, New York.

Emergency room personnel have a job that seems, on the surface, rather narrow: We’re fundamentally about the first sixty minutes of the medical encounter, a period we call the golden hour. We triage, treat, and stabilize, and then move the patient on to the next step—sometimes to another part of the hospital, sometimes home. We rehearse for that golden hour in so many ways. But we don’t train for the type of systemic failure we’re now experiencing.

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It’s early March, 2020, and our hospital—Montefiore Medical Center, in the Bronx, New York City—is beginning to struggle under the weight of the emerging COVID-19 virus. It began slowly, with just three patients admitted to our hospital system by the end of the month’s first week. But then, the numbers began to grow: Two dozen by mid-March. Approximately two hundred a week later. By the end of the month, the number would surpass one thousand.

We have more patients than our team can handle. But we can’t call for diversion, and it’s not just a matter of policy. The other hospitals nearby are going through the same thing. We are all being crushed. There’s no place to divert to.

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This failure hurts. Because the thing is, I love this hospital, and I love the Bronx. Sometimes working here is like working in a foreign country, and it’s not just the 25 languages that are spoken here. (We translate all of them, through staff who speak different languages or via telephone linkups.) At Montefiore, we see everything ten-fold: every hurt, every disease. Some emergency room doctors in the Bronx see more gunshot and stab wounds in a year than most doctors outside New York City and other big urban centers see in their entire careers—although our emergency room doesn’t get a lot of those, since there’s a Level I Trauma Center at Jacobi Medical Center right across the street that’s better equipped to handle patients with such injuries.

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After I had been working here for a while, I noticed that patients started putting my colleagues and me down on forms as their primary care doctors. We’re not, but they know us. They know we’ll treat their hyperglycemia when they can’t afford their insulin. We’ll treat their asthma. They know that we’ll never refuse them a bed when it’s cold or they’re hungry. It makes me feel proud that they see us as the place they can turn to. But right now, that pride is being crushed by fear.

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Early in one of my shifts, a young patient named Arthur, about thirty years old, waves me over. It’s hectic in the ER, but I feel the need to connect with patients no matter how busy it is. So I walk over and sit on the edge of his bed. The first thing he does is show me a picture of his kids, and it’s a good move on his part, because I am instantly drawn in. I also have kids, though his are younger.

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He tells me the oldest one is seven years old, and he’s been dealing with kidney failure. His son is on peritoneal dialysis, which means he has catheters coming out of his belly to remove fluid. Either he or his wife has to manage this, or the boy will die.

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I take a quick look at Arthur’s chart and see that he’s reporting that he hasn’t felt well for two weeks. That’s a long time. He’s an electrician, and he’s been out of work. He’s been quarantining in the bathroom of the tiny apartment where he lives with his wife and sick child, afraid to come to the ER.

“I’ve basically been managing my care through 311,” he says. He’s been calling the New York City public information line to figure out what he needs to do if he has certain symptoms—when he can go to work, when he has to stay home. He learned that he could go back to work only if he had a doctor’s note saying he was okay. Then he tells me something that really stuns me.

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“I started out with $3,100 in my bank account, Doc,” he says. “I was down to $4, so I had to do it.”

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“Had to do what?”

“I figured out what the doctor’s note needed to say, and I wrote it myself.”

He looks at me, and tears start rolling down his face. The letter didn’t work. They saw how sick he was and sent him home. He has lucked out in that he has pneumonia, not COVID, but he doesn’t know if he is going to be allowed back to work, given his health status. He has an empty bank account and a sick child. What is he going to do?

COVID doesn’t put only patients’ lives at risk. It’s a danger to all of us who work at the hospital. I find myself feeling contempt for them, which is something I have never experienced during my entire career, and I’m ashamed of it. How can a doctor be resentful toward a bunch of sick people? It’s not their fault.

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The patients from the nursing homes didn’t ask to be brought here. We’re giving them Tylenol, fluids, and hydroxychloroquine, which seems like a promising remedy but will later be discredited. We’re giving them lots of oxygen, through a face mask or nasal cannula. We intubate them. And still so many die.

We don’t have solid guidelines, and we’re struggling with the very thing we’re trained to do: save people’s lives. In a world of evidence-based medicine, an unprecedented event like this puts us at a disadvantage. And maybe—though we’re too busy to truly worry about it right now—we know we could have done a better job anticipating this, preventing this.

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We’d gotten something of a warning in the form of vague reports from friends working at other hospitals in other cities. In early March, one of my medical school buddies who practices in Los Angeles had an alarming case: A guy in his mid-forties came in with breathing problems. He was tested three times for COVID, the tests came back negative all three times, and he wasn’t confirmed as having had COVID until after he was dead. There was nothing they could do to save him. Another one of my colleagues who moonlights at a walk-in clinic in Queens is convinced that he was seeing cases in December. But there was no test back then. So despite these murmurings, we were blind-sided. Like so many people in this country, we believed that the virus was far away and would stay far away. It was in China, in other foreign countries, but it wasn’t going to come to the United States.

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Even the New Rochelle cases seemed distant, somehow, though I live just minutes from that town. An acquaintance told me about a man from his congregation who’d gotten ill. That man turned out to be the state’s infamous “patient zero.” But maybe because the news came from a friend rather than a public report, I didn’t think about the situation from an epidemiological perspective. To me it seemed like an isolated event at the time. In fact, I had been so dismissive that when I received a text from my buddy Charles in February asking, Doc, is this coronavirus thing going to be a big deal? my clueless response was, Nah, no different than the flu.

I’ve never been more wrong in my life.

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