S1: Hey there. Before we start the show, I wanted to thank you for sharing your stories and our voicemail box. We are listening and we really appreciate it. We’re all pretty weirded out right now to tell us how you’re getting through it. Our number is 2 0 2 8 8 8 2 5 8 8.
S2: Or you can just tweet at me and that Mary’s desk. One more thing before we get started. Our guest today, she uses a couple of four letter words. All right. Onto the show.
S1: Derrick Haas is an emergency medical physician in New York, works the weekend shift, and she can still remember the first time she thought maybe I need a mask. Who do you think you’re first patient with? Kovac, 19 was?
S3: I don’t know. So this actually relates to question because I. I had taken care of a patient on February twenty ninth who I was like. This is a very weird presentation of a fever and a cough.
S4: And I went through this thing in my mind to know travel history showed no risk factors or none of the CDC criteria for who should be. We didn’t have a test at that point, but even like who you should flag. She didn’t meet any of those, but she stuck with you. Yeah. You know, and Castine. It was the first time I thought I should protect myself from patients.
S5: Darah is one of those people who knows everyone at work. She’s always giving out advice, not afraid to ask for advice herself. One of the other doctors on shift with her. He’d worked in Africa, gotten Ebola while he was there. So she called him in to talk this puzzling case out.
S4: And he came into the room after she didn’t talk to me. He was wearing a mask. And I was like, you’re already wearing a mask. But he’s like, I don’t mess around with PPE. This is literally what he said to me. And I was like, really? Every patient. He’s like, Dara, every patient. And I was like, okay. Cragg, every patient. And then the shift was over. Right.
S6: But by two weeks from then, so February twenty ninth to March 14th and 15th, the whole world changed.
S1: Darragh says there’s this way a hospital can feel as it tenses up braces for an emergency. She felt it on 911 after Hurricane Sandy. She felt it again when she returned to the E.R..
S3: Two weeks after that patient coughed on her that weekend felt the way I think a lot of other hospitals are gonna feel as this happens. There is a calm before the storm that is really scary because you wind up discharging a bunch of patients who most likely really don’t need to be there.
S7: So you discharge patients to basically make room for a surge.
S8: Yeah, and the system does that. Right. You realize that the day it happens, the E.R. is empty.
S6: And then it’s the next day and the next day that you start seeing the patients come in a little sicker, a little more short of breath, their oxygen levels a little lower. Now we’re intubating not just a 90 year old or intubating a 50 year old. Right. We’re admitting to patients at the same time.
S7: When did you start to feel sick?
S3: So I actually woke up on Monday morning and was like, damn, I’m tired.
S9: You know, Dara’s not going into work anymore. She’s quarantined at home. Positive for covered 19.
S10: It’s a little suspect how quickly I got infected. My husband was like, you really are not good at PPE, are you? It’s like, I guess not.
S1: It started with some muscle aches, spiraled into a headache.
S11: My friends like your coughing a lot. And I was like, all right.
S6: I’m coughing a lot, and I spoke to a friend of mine who’s a doctor. I registered officially as a patient, you know. And he ordered the test for me based on my symptoms and my exposure. And I went through one of the drive thru centers and got tested and had the results actually the same day.
S1: When you got the results, how’d you feel?
S8: Sorry. Strangely relieved. And then really scared. Why relieved? Because, A, I wasn’t crazy. I really did have it. B, I had already gone through three days of symptoms and I was still breathing. And then the fear came at. I’m they three of symptoms.
S12: Will I still breathe today on the show? Derek has talks about going from doctor to patient. Her question now is when can she get back to the E.R.?
S13: I’m Mary Harris. You’re listening to what next. Stick with us.
S1: Dr. Derek Haas lives at the epicenter of the U.S. coronavirus outbreak. New York City. And until her diagnosis, she was working E.R. shifts in Columbia University’s sprawling hospital system. She says her bosses there did all they could to prevent getting to the place where they are now.
S3: I’m proud to work at Columbia. I am proud of how Columbia has addressed this from the beginning. Working in one of the major medical centers in New York City, we always knew we would be overrun with patients when it came to New York. And they had been incredibly honest and consistent with their desire to help and to be leaders in this field. Is there a but here you can only do what you do. So they’re not testing nearly enough people because they can’t they’re not testing nearly enough health care workers because they can’t. It is a really difficult thing to tell people who probably have the virus. Yeah, you probably have it. I wish I could test you. I wish I could give you closure. It’s uncharted territory for us as doctors to watch patients who look like us get really sick.
S6: Without preparation, like the two analogies of the personal experience I’ve ever had as a doctor. Ah, when I start getting pregnant, you know, when I was deciding to have kids and other women would come in bleeding and pregnant and I would start reallythe undefined with that fear of not knowing if I was gonna lose the pregnancy as well. And then I was speaking to another friend of mine who’s gay, and he talked about when the HIV epidemic was really hitting what it felt like to be a gay man and a physician watching patients who were otherwise historically young and healthy come in with these mysterious, you know, ailments and how scary that was.
S7: So with Covered, is it just that you’re seeing lots of patients who are sort of young, looked like they could be working alongside you in the E.R. kind of thing?
S6: Yeah, I mean, we’re seeing. Look, it’s still overwhelming. The patients that come in that are sick and affected are gonna be over the age of 60. This disease does have a preference or a prevalence amongst older people, but it has nothing to do with it sparing younger people. So for the first time ever in our life, we are intubating patients that look just like us a lot. It’s not just that it’s one random person who has a lung disease or somebody that has a really extraordinary case of cancer or God forbid or whatever it is. It is the consistency that every day on every shift. There will be one patient under the age of 50 at least who will lose the ability to breathe on their own.
S8: And that’s that’s just it’s it’s just not what we see, not here.
S14: So it sounds like what you’re doing is you’re both talking to other physicians who have found themselves suddenly ill, but then also talking to physicians who are still slogging through it every day, but seeing themselves in their patients and feeling helpless.
S6: That’s exactly right. And that’s where the kind of cycle of anxiety and fear, I think, for the health care workforce is coming in is, you know, we are helpers first and foremost. We rearrange our lives for this. We are ready to take care of patients. Now we have this these other experiences. So it’s a fit into that. Well, if I come home with my family and my exposing them, what happens when I get infected and I get sick? Am I going to get to be one of those patients who’s not going to make it? And then amongst our peers, when you’re taken out of commission, when you’re home recovering every day, you think, is this a day that I’m gonna get sicker than I was before I woke up every morning in like the 9 or 10 day course, just breathing and being like, I can breathe today because you didn’t know if that was gonna be the case, right?
S8: Because what we have seen patients after five or six days, especially young patients, take a turn for the worse and lose the ability to breathe. Now, it makes it super existential as long as I can breathe today. I’m going to use my breath for a purpose. Right.
S7: So how many health care workers do you know, like you who are now positive?
S3: So it’s more and more each. Each day. Every day I get multiple texts from friends of mine who find out that they’re positive or they’re waiting for tests. I will tell you that there are many of my friends who are exposed at work in different health systems who still cannot get tested in New York City right now. If you are not sick.
S6: And I would not ever qualify myself as sick. Over the last nine days, I was infected. Right? Sick is high fever. Sick is worried about pneumonia. Sick is need supplemental oxygen, right?
S8: If you’re not sick, even as a health care worker, you still can’t get tested. You have to be sick and a health care worker to be tested.
S1: Even before Darah started feeling sick, she was planning her life as though infection was inevitable. She sent her kids to stay with family. They were out of the house before she showed any symptoms. One of her kids has an underlying condition. He got a liver transplant as a toddler. Darragh didn’t know if that put him at higher risk from Koven, 19, and she didn’t want to find out.
S8: So my kids, that’s why I brought them, the parents or my sister’s house, actually. And I came home with my husband and. It’s like it’s an eerie quiet. You make a decision that feels dramatic. But you do it because you want to protect your family from you. I mean, my husband stayed with me and I think he probably has it. You think he has it? I do. I think he has it.
S6: I think that he just started showing symptoms a couple of days ago. And so that’s a whole new wave of anxiety for me. But again, most people do fine. And I’m going to watch him closely and he’s going to take Tylenol and he’s going to do the same poll fact checks that I did.
S10: And he’s going to, you know, take deep breaths. And as long as he can breathe, too, we’ll be fine, you know?
S7: So you’ve got the kids out of the house. Then once you had that positive test result, did you then, like, divide up the house and like, OK, you’re gonna be on this floor and I’m gonna be on that floor?
S6: Yeah. So in our house, we divided our house into basically cobh it hot zones and covered call zones. A lot of our doctor friends had developed these decontamination protocols where we could enter our house completely stripped down, run up to the shower, bag the clothes, put them in the dish like in the washing machine, directly go into a shower, scrub down everything. I mean, as a whole, you know, there are side threads on washing your hair as you are doctors, because people are washing their hair every single day who had been doing it at that level of frequency. You know, there’s a level of personal like procedure change that you do in this way.
S7: You wrote something on Twitter. You said that during your quarantine, the nights are the worst. What do you think about.
S3: I was thinking if I could breathe. You know, am I still breathing, is my breathing weird? Am I having chest pain? What’s going on here? And then it’s. Oh, my God. The president said today that he’s going to consider getting rid of social distancing because he’s tired of this and he’s bored and he really wants to get the economy working again. What does that mean? We haven’t even gotten ahead of what’s going on in the world. We’re hearing all these messages, you know, from the White House. You know, scientists are being sidelined for, you know, what really amounts to propaganda. It’s not getting better. There are no magic medicines. There are no cures. This is going to be hard work for a lot of people and it’s going to take a long time. And if we’re the ones going on the front lines, seeing patients, taking care of patients, making sure that everybody is safe, how is it that the person is supposed to take care of us, is telling us it’s not that big of a deal?
S1: When I spoke with Darah, this one recent news story was still stuck in her head. It was a comment from the Texas lieutenant governor, Dan Patrick. He thought the self-isolation, orders and business closures were going too far.
S15: And you know, Tucker, no one reached out to me and said, as a senior citizen, are you willing to take a chance on your survival in exchange for keeping the America that all America loves for your children and grandchildren? And if that’s the exchange I’m all in. Let’s get back to work. Let’s get back to living. Let’s be smart about it. And those of us who are 70 plus, we’ll take care of ourselves. But don’t sacrifice the country. Don’t do that.
S3: Don’t like it. You know, it’s funny because I am actually glad that I make I think I. Kirst. Yeah. There was two tweets recently that I cast. One was about women having given birth alone because that’s torture. And the other one was watching this ignorant fool stand on television as lieutenant governor of a state larger than most countries to speak about something that he does not know anything about.
S8: He says, oh, grandparents are gonna be fine. Well, I’m watching parents not be fine. If you want to be that ignorant and if you want to be that self-centered, then step out of leadership.
S11: Go to your ranch.
S16: Hang out with your cows or whatever you’re doing. I don’t care. But stop putting people at risk. We’re not closing small businesses because we’re anti-American. We’re saying stay home because we’re trying to save America. That disconnect is.
S17: Overwhelming in moments when you’re literally laying there trying to breathe.
S1: Now, thankfully, there is feeling better and she’s ready to go back to the E.R.. You’ve been quarantined for how long?
S3: The last thing I did was go get tested, and that was on Thursday of last week. So now it’s I have not left back. I have a deck. So I got to go outside and wave to a neighbor. But I’ve been home since then. I’m actually so I have had no fever at all and I am definitely feeling better. So I would be cleared to go back to work A.S.A.P..
S1: Technically, she’s allowed to go back to work if she goes three days without a fever. That rule doesn’t seem to be rooted in science, but no one’s requiring Darah tests negative before going back to work. There aren’t enough tests for that. How do you imagine your first day back going?
S18: I mean, I know what it looks like every day. I’ve been getting reports from friends and it will be what it will be. It will be overwhelming and super scary and very sad and a little bit inspiring, I think.
S1: What are those text sound like? Like. Can you. Would you even read me a couple?
S18: Yes, I’m. Sorry, I just finished sign out. Maybe I’m being emotional, I cried three times today, I mentally exhausted. I didn’t eat a snack today. This is so hard and I’m so nervous. We are going to get by Italy and poor people will be left behind. I said we are going to end up like Italy. We have no chance. She said, exactly. I’m crying all over again. I said we just need to hold each other during this time. She said, I agree. I said, it’s gonna be a rough few months for New York. She’s like, New York is already at a rough time. And that was on Saturday.
S1: So things have gotten worse since then.
S17: I mean, they’re gonna get worse every day. There was a paper, The New England Journal today about the responsible and moral choices we’ll have to make about who to ventilate and who not to ventilate.
S7: I saw that paper and it kind of broke my heart because it was saying in the wonkiest, Dr. Iest way, we’re going to have to make hard choices and here’s how we’re gonna make them. I think it recommended like some kind of panel to decide who gets taken off of life support. It got into these details like do not have the person who has been giving the care to the patient, be the person who removes the care from the patient.
S17: We are going to have to make decisions that none of us are prepared to make for our families, for our patients and for ourselves. That’s part of preparation, is deciding now what the algorithm looks like. Hood intimate, deciding now what to do with nursing home patients who get sick with this, who we know if they’re 90 years old with multiple co-morbidities and maybe they’ve had a stroke and maybe they’re demented. I’m like, I’m being really serious. He sounds like the death panels that were used as propaganda when the ACA was coming out. Yet we’re going to have to make those choices. Do we intubate and ventilate a 90 year old with dementia or a 40 year old with three kids?
S7: I was talking about that paper. I was talking about this idea of who do we give care to? And who do we not give care to? With some colleagues, one of my colleagues said, well, don’t we have these rules already? Like, don’t we have some kind of triage wartime rules about who gets the care? When the going gets tough? Do we know?
S17: We live in a consumption health care system where nobody is supposed to die, where there are no resources on them like that are limited except for people that are too poor to get them. We spent a majority of our healthcare dollars on those last couple of years, somebodies life. Well, those years have just been, you know, the timeline has been escalated.
S19: And now we have to choose. I mean, these are the things that I am thinking about at night when I realize I can still breathe. That’s why people have to stay home.
S17: You know, look, I wanted to emerge as medicine for a lot of reasons. And there are people that are built for these moments, right? The chaos, the anxiety, the save. But most of those days end with a save. This is why it’s different. It’s different because most of these days will end with people not being saved. Certainly not the majority of people or certainly not all the ones that you wanted to save or even could save.
S1: Can I ask what you’re gonna do for your husband? Because you’re saying he woke up feeling unwell.
S10: Yeah. It still feels as if, you know, I’m going to do the same thing I did for me. I gave him a bottle of Tylenol, a pulse ox, which is the thing you put on your finger that gives your heart rate and your your oxygen level. I bought it on Amazon. And the reason I use that is because it helps make you feel better that you can breathe. Like it’s a validating thing. Right. And it also shows you when you can’t. But it is. So I handed him a bottle of Tylenol, a pulse ox and an albuterol inhaler. He’s not having shortness of breath, but that algorithm and a thermometer was here he had with a bottle water.
S11: And Abed and I just said, go down.
S20: So funny, you’re like deal with it, but you’re not. Are you gonna get him tested? I don’t. He doesn’t make criteria to be tested even though he’s been living in the same house with you. That’s not criteria right now.
S18: The criteria is sick and known contact or sick and health care worker. I got tested through a window of opportunity that I don’t think exists anymore.
S7: So your doctors are known for being kind of macho, like there’s this there’s this term for them. Barford bad ass fucking E.R. doctor.
S20: I kind of I want that mojo. I want to feel like a bad ass right now. You seem to feel like a bad ass right now. How do I get that energy? OK.
S10: I will say I have never personally written refer to myself as a barford. Why is this kind of sense of cowboy ness to it? You know, it’s like there’s a sense of bravado there that I don’t think a lot of us have to have. But there is a sense of ability to compartmentalize anxiety, which I think is really what you’re asking about.
S3: Right. You know, what we do in emergency medicine, which I think helps, is we control the things we can control. And we try really hard not to control the things we can’t.
S1: Sounds like Buddhism. Well, I mean, I guess so.
S6: Right. Like, I know that when somebody comes into my E.R., sick and dying.
S11: I will do whatever I can to save their life. But if they don’t make it. I didn’t do that to them.
S3: There is a will of God. There is a algorithm, there is a train that I’m not always going to get in front of. Right. The problem is, like I said, most of the time we get to get in that way. We get to save the person. We get to derail them from dying for the most part. Or we don’t. And we accept that as inevitable. The frequency by which we’re not going to be able to derail the train is gonna be overwhelming for my people, for regular people. It’s this sense that everything is falling apart at once.
S7: So even the Bamford’s are feeling a little less like Bamford’s.
S3: If they’re not feeling a little lost like Bamford’s, they’re lying to you.
S21: Dairy has thank you so much for joining me. Thank you so much for having me.
S22: Derek Haas is an emergency medicine physician at New York Presbyterian Hospital and Columbia University Medical Center in New York. She spoke to me from her home where she’s been in quarantine after testing positive for Cauvin, 19.
S21: That’s the show we’ve been listening to your voice mails about how you’re dealing with the outbreak, dealing with the lockdowns, dealing with more uncertainty than a lot of us are used to.
S23: Hello, I’m honored. I am in a suburb of Chicago in Illinois. I was going to be as graduating senior from college this last year. But we’ve all been sent home, so it doesn’t really feel as real anymore. None of us are really planning on walking at graduation just because we’re pretty sure it’s not going to happen. Even though the college hasn’t canceled yet. So what I’ve been trying to get together with a couple of friends is if you have instruments in your house to arrange pomp and circumstance for those instruments and each player individually in our houses and record it and then put it together and make one final version of us playing pomp and circumstance as a sort of graduating within your own home. And right now we have two violins and a trombone, which is not an amazing orchestration. But yeah, I would love to make it work. So that’s what I’m distracting myself with these days of learning how to arrange. And I hope all the other singers out there can do something else to make their graduation feel a little bit special.
S21: If you want to join in on Annika’s remote orchestra, tweet at me. We can do this, folks. But seriously, these messages are making us all feel more connected during a really solitary time. So call us the numbers 2 0 2 8 8 8 2 5 8 8. Or you can find me on Twitter. I’m at Mary’s desk. What next is produced by Mary Wilson. Daniel Hewitt, Morris Silvers and Jason De Leon. Check the feed tomorrow for what next TBD. That’s our tech show. Lizzie O’Leary is going to be talking to New Yorker contributor Robert Baird. He’s been covering the quest to do more covered 19 testing. His reporting on this issue has been excellent. Make sure to listen. Stay well. I’m Mary Harris. I will talk to you on Monday.