Letter from Elmhurst Hospital, March 30, 2020

My friends –

I really want to thank each of you for reaching out to me, sending words of encouragement, keeping me in your prayers. I’m sorry if I’ve been delinquent in getting back to you, but it has been hard for me to process everything. To be honest, most days I’m not sure how I’m doing, even moment to moment, so I wanted to provide more of a broad survey of the past three weeks of trauma. I hope this isn’t too much of a burden. I’m trying to avoid being dramatic. But this is real. People are dying.

Elmhurst is the hardest hit hospital in the United States right now. We are nearing the end of our third week of being overrun by COVID-19. Our emergency department and my job bear little resemblance to before the onset of this nightmare. I am very used to treating death, but the volume of this virus has been overwhelming. I used to have a team of three residents and three nurses working with me. But it’s not unusual now to have more than 10 critically ill patients to care for by myself, with one or two nurses if we’re lucky. To date, the entire hospital has only had two of our critically ill patients survive. Only two have survived. I’ve seen every one of my coworkers break down at some point over the last week. And we are a hardened crew. We have seen everything — but this.

Several of our staff talk openly about retirement when this is over. Many of my nurses, a few of my co-attendings and a dozen of my residents have gotten sick. Several needed to be hospitalized, but as of yet none have been critically ill. One of my former PAs (who now worked at an ED in Brooklyn) died yesterday.

We have an unusual number of patients in their forties and fifties who have become critically ill. But I’ve had very sick patients as young as 19 and as old as 98. We have three times as many critically ill men as women. At the moment, we have very limited treatments. Those that survive on a ventilator average two weeks before they are able to come off ventilation. Nevertheless, patients have been dying in droves. These are a few things particularly distressing me.

I normally have brief interactions with patients, several hours max. But the hospital is beyond full and we are usually boarding 100 admissions. So I am not only treating the new patients that come in but also watching yesterday’s patients deteriorate. I sometimes intubate them 48 hours into their hospital course. I slowly watch their breathing fail and it is brutal.

They are always thirsty and beg for water. But just the effort exerted in drinking a few sips of water has caused several of my patients to become too labored in their breathing and necessitated an intubation. Despite this, I still give them water when they ask.

There have been no visitors allowed in the ED for weeks as an infection precaution. So when patients die they die alone. We try to get them to call or FaceTime their families before they get intubated but most of them are too weak or distressed to be able to do so. Most of them will never get off the ventilator. I have felt that one of my strengths as an ER doctor was in communicating bad news to families. But the families aren’t allowed in, so now I have to call them to tell them their loved ones have died. It is miserable.

Last week, several of the relatives of my dead patient broke through security and ran to see his body. His son sobbed at his bedside and then embraced me. Both father and son probably had COVID.

I have never worried about my own safety while treating patients. We trained for Ebola but never had a case. But now that’s always in the back of my mind, especially as the volume of exposure seems to convey a more severe illness. We use one set of equipment all day. And I consider myself lucky to get to change it out the next day. But it is not meant to be used for that long and it stretches out and you worry that you aren’t protected.

Also, between the masks and the ventilators and the air filters it is incredibly loud. To even hear what a patient says you have to put your ear right in front of their mouth. The highest risk of exposure comes during an intubation and I will do that procedure a half dozen times per shift.

Last Tuesday was my low point. I worked until midnight, took an empty subway to the empty Upper West Side, walked down the middle of Broadway because there was not a soul around and wept.

I have trouble reading or even watching TV when I’m not working. Running is the main activity I can still do. I can sleep at times.

I feel anxious when I’m not at work; I feel so much more calm when I’m there. It’s easier to process things one task or patient at a time.

I have had trouble reading Scripture except for the Psalms. I have found particular comfort in Psalm 27, especially the end: “I am still confident of this: I will see the goodness of the Lord in the land of the living. Wait for the Lord; be strong and take heart and wait for the Lord.” I recite that to myself several times a day. I recite Psalm 23 before I walk in to work every day.

Again, I really appreciate your prayers. Pray for my patients, for peace, for health. Please continue to reach out to me. I see it even if I don’t respond. It really is an encouragement to me.

I hope this email wasn’t too melodramatic. But just writing some of these things down was its own catharsis.

Love, Micah