The coronavirus pandemic has reshaped everyone’s lives. But for health-care workers, the impact of covid-19 is felt acutely, tragically, every day. To capture the lived reality of this, we asked Shaoli Chaudhuri, 29, who is in her third and last year as an internal medicine resident at Columbia University Irving Medical Center (CUIMC), to keep a 30-day diary of what she is experiencing. Chaudhuri works at CUIMC and the Allen Hospital in New York City, the epicenter of the pandemic in the United States.
Reflecting on keeping a 30-day diary, Chaudhuri writes: “Sometimes I think there are no words for what we are going through as health-care workers combatting covid-19. But looking at this journal, there seem to be plenty. Writing about the experience has helped me through the trauma, the ups and downs, and the search for light in the darkness. This is dedicated to the heroes we’ve lost, Lorna Breen, Romy Ocampo; and my personal heroes, my loving family, friends, podmates and colleagues in the trenches with me.”
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Day 1, March 17
A few days ago, I learned Columbia had one of the first covid-19 patients in New York City.
Today, I truly stepped into the pandemic. A nightmarish scene met me as I entered the intensive care unit (ICU) for the first time since the virus took hold in the city. The overnight case involved a man in his 40s with no foreign travel and no real medical history except hypertension. He had experienced typical cold symptoms for three days.
Then, in the emergency room, his oxygen saturation dropped suddenly, and he was put on a ventilator. His chest X-ray was abnormally white and filled with cotton-like opacities – all the fluid and inflammatory debris were keeping him from breathing.
“He’s so young,” I exclaimed more than once. And so sick.
The day progressed downhill. I rushed around the hospital, responding to pages for critically ill patients. Where were these people coming from? In less than 48 hours, the number of covid-19 patients in our hospital exploded from less than 20 to more than 200.
These weren’t the patients we always saw during flu season. They weren’t the run-of-the-mill 70-somethings with diabetes, emphysema, kidney disease. These were “normal” people, 20- and 30-somethings with few health problems, connected to ventilators, drips, pressors. Was this our new AIDS pandemic?
As I myself tried to catch my breath, I texted my colleague, “The hospital is FULL of COVID.” He had been at our sister hospital and messaged back that he had just intubated a young patient in his late 20s. All he had was mild asthma.
“Brian,” I replied, “I have mild asthma.”
I feel like I’ve fallen through the looking glass, into another reality where I’m just as vulnerable as my patients. A reality where it could be me on the other side of the glass, hooked up to a ventilator.
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Day 2, March 18
The two critical care attending physicians who run the ICU are its rockstars. Dr. D. is a whip-smart firecracker who is unfailingly kind, and refers to everyone as “honey” or “sweetheart.” Dr. S. is a tall, broad-shouldered Argentinian man whose main goal in life is, I assume, to make sure everyone is OK. I know because he constantly asks us all, “Are you OK? Everything OK?”
Per Dr. S., we must become the “world experts in covid.” Since yesterday, yet another covid-19 patient, an elderly man with multiple neurological problems, has taken up residence here. At this rate, Dr. S. should not be worried about our experience with the virus.
We are giving patients hydroxychloroquine, a medicine used to treat malaria, because they’re sick and there is nothing else. A small study came out of South France that everyone is going gaga about it, but I really wish the public could understand there’s virtually no evidence hydroxychloroquine works any better than water. People are losing their minds.
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Day 3, March 19
Today is my day off. I woke up around 5 a.m. after sleeping for three hours. I spent the morning reading the news and obsessively checking social media. For the rest of the day, I lied curled up on my couch, crying uncontrollably.
I’m living and breathing the anxiety of covid-19 in a way very few can understand.
My thoughts race around my head; the palpitations get me; I’m sometimes drowning in fear. First, it’s worries about being found dead in my apartment from the virus, surrounded by takeout containers. Or fears about my parents, who are both anesthesiologists in their 60s. They are considered “very high risk exposure” because they intubate patients, bringing them up close and personal with all those aerosolized particles.
Wrapped in my fleece blanket, I feel pinned down and paralyzed by dread.
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Day 4, March 20
“He’s about to code.”
I looked up from the workstation. It was an older man who’s constantly admitted with infections. He was suddenly maxed out on three pressors.
It ended up being our first covid-19 code, i.e. a cardiac arrest caused by the virus. It was also our first covid-19 death. The experience affected me so much I wrote about it in a Washington Post op-ed.
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Day 5, March 21
Personal protective equipment, known commonly as PPE, is precious. Disinfectant wipes are like gold. When I go to the emergency room, PPE is closely guarded, forcing me to bring my own. I sometimes worry about the supply among my team.
In the news and in the city, I hear horror stories about PPE. Nurses wearing patient gowns or garbage bags. Residents running to codes and not having N95 masks. How can health-care workers serve without adequate protection?
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Day 6, March 22
I wonder what they’ll call it in the future. Post-Covid Stress Disorder? Scrub Shock?
The toll of the pandemic is making its mark on health-care workers. When I leave the Allen ICU, I’m distracted by chest tightness, shortness of breath and subjective fevers. But in reality, my oxygen saturation and heart rate are normal. Everything is fine.
A psychiatrist reached out to my colleagues and me, offering her number and to talk anytime. As I opened up to her later about my fears regarding my parents and myself, she told me:
“You’re going through something traumatic. It is normal to feel this way.”
She was right. But nothing about this is normal.
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Day 7, March 23
In the ER, I met a man who was breathing at 40 times a minute. Upon laying eyes on him, I realized he would become the third intubation of this crazy morning. He’d had two weeks of symptoms, the progression of high fevers, diffuse pain, cough and now shortness of breath.
He is a normal, functional guy, who has high blood pressure and is overweight. But he was unlucky. As he struggled to catch his breath, I called his wife, who immediately said she was on her way.
A pause. “I’m sorry, no visitors are allowed anymore,” I said in Spanish. It is awful, having to keep families from seeing their loved ones during the most traumatizing moments of their lives.
The other day, the quarantined wife of a patient who’d just passed away said between sobs, “I just want to grieve with my family. I just want to touch him while he’s still warm.”
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Day 8, March 24
Things are starting to feel apocalyptic. Last week, we had two covid-19 patients. Now, 100% of our ICU has tested positive for the novel coronavirus. Many patients are in their 40s and 50s and have little medical history. I took in the whole unit: the intubated patients, the rhythmic “whoosh” of the machines, the beeps and alarms, the groaning mechanical sounds.
In the afternoon, one of our nurses, Marco, asked me: “You OK?”
I’d woken up with headaches and muscle pain but dismissed it; I figured I was just worn down and stressed. But as I tried to talk to my team, I couldn’t focus. My head was pounding, every muscle ached, all I wanted was to lie down on the floor. I snuck over to a thermometer and saw I had a low-grade temperature. As fast as I could, I left the Allen ICU, away from people, to call health and safety. They instructed me to self-isolate immediately.
I felt myself tearing up. The thing I’ve dreaded has happened. I have covid-19.
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Day 9, March 25
I feel very feverish. The muscle aches are mind-numbingly bad. I hurt from the tips of my fingers to the ends of my toes. I’m so fatigued, I can’t stay on my feet for long.
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Day 10, March 26
Fevers and headaches. Pain in my lower back and spreading across my body, layers of pressure and pain.
I didn’t want to tell my parents – who are back in Texas – that I am sick. I didn’t want them to worry or, God forbid, hop on a plane to take care of me. But the loneliness got to me today. I told my mom at the end of a phone call, in a rush.
Calmly, she said, “Are you sure? OK, take some Tylenol and drink plenty of fluids. You’ll be OK.”
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Day 11, March 27
I feel a bit better. Still headaches, back pain, fatigue. I did an interview for CNN today with Erin Burnett about being on the front lines. During the interview, I was symptom-free, and didn’t cough once. I did have to cake on the makeup, though.
As soon as it finished, the back pain and headaches rushed right back. The adrenaline had tricked me into thinking myself cured.
– – –
I woke up feeling overall better. Unfortunately, my “lumbago” and awful headaches came back in the evening.
I wish every person knew that young people are not only getting very sick – they’re dying.
I’ve seen and heard it from fellow residents. A woman in her 40s who only needed a bit of oxygen died suddenly, slumped over in the ER, leaving behind three grieving children. Another woman in her 50s was coded five times until the team finally called it. It’s also clearly a disease destroying communities of color, with neighborhoods like the South Bronx, Harlem, Elmhurst and my own Washington Heights particularly suffering.
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Day 13, March 29
Am I finally recovering? Fingers crossed!
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Day 14, March 30
I woke up feeling almost normal. Then my old friends, headache and fever, returned.
From talking to my friends, things have gotten bad at both our hospitals, but especially at the community hospital. The 12-bed ICU no longer exists – it’s overflowed into the regular floor so that we have 18 to 20 ICU patients. The ER has morphed into an ICU itself, which will fuel the chaos and difficulty managing patients. It could become untenable.
A phenomenon of “pop-up” ICUs is sweeping the hospitals. Because we are having to double and then triple our capacity, we just … invent ICUs. We’re like Oprah in our distribution of them: “Seventh floor, eighth floor, you get an ICU!”
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Day 15, March 31
Trump non-subtly implied that health-care workers are stealing PPE. It takes a lot of audacity to accuse people who are literally saving lives of stealing. I wish someone could mute him.
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Day 16, April 1
I’ve pondered whether it’s different as a woman in health care during the pandemic. In some ways, it has actually become an equalizer. No one mistakes me for a nurse anymore (obviously, nurses are the real heroes). And when men “catcall” me on the street, they’re actually clapping and thanking me for my service.
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Day 17, April 2
Sirens are the new birds. You know how in most places when you wake up, the only sound you hear is that of birdsong? Now, in New York City, it’s the sirens of ambulances.
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Day 18, April 3
I heard that three young residents – doctors in training, like me – died of covid-19 today. Two in New York, one in Detroit.
I don’t know that there’s anything more to say except shame on us for letting this happen.
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Day 19, April 4
I spend 12 hours a day on telemedicine consultations, where I either offer a covid-19 therapy that amounts to a placebo or one with unknown benefit. It’s the most demoralizing thing I’ve done in my three years of residency. We are treating ourselves, not the patients.
Trials are starting up for treatment medications (remdesivir, sarilumab, convalescent plasma), but we are limited in staffing and doses.
The truth is there’s no magic bullet except for people to stay the heck home.
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Day 20, April 5
I don’t bring much beauty into the world. I don’t have a cure for what ails my patients. I can’t stop death after death. I’m not an OB/GYN who brings life into the world, nor a pediatrician who treats a resilient child who bounces right back. So let me create for once; I can make beauty. Here’s a poem I wrote:
Beauty, Through it All
It’s in the transparent sheen of a new face shield
The boxes of masks from strangers
The hymn sung through FaceTime
To a dying mother
The knowledge that I’m still here
The stroking of my patient’s hand through purple gloves, soothing him in the last minutes
The home-cooked Korean food wrapped securely in Saran Wrap
The comforting of a newly widowed woman who is also sick
The knowing that my family is still here
The release of jagged-edged tension from my chest when my parents say they feel well
The laughing to tears because words like “fomite” and “drupe” are still funny
The troupe of colleagues who rush to a code with me
The knowing that my friends are still here
The pearl pink cherry blossoms peering through Hudson fog sunshine
The knowing that I’m still here
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Day 21, April 6
At 7 p.m., I frowned at sounds of people whooping, clapping, cars honking. I was totally confused. It was cacophonous. And I realized it was New York cheering for us.
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Day 22, April 7
I am back to work after my quarantine and it is busy. Our team cares for 30-plus sick patients, all with covid-19. Every floor is a covid floor, every ICU a covid unit. All covid all the time in this covid hospital of Covid City, New York.
I’d felt guilty about being home when I know I have unwittingly been training for this pandemic for years. Residents in New York are expected to do unbelievable tasks for extremely sick patients, and we’ve done it at the cost of sleep and sanity. My program has also trained me well in intensive care. It’s disaster medicine at its finest, finally paying off.
And all of a sudden we are being applauded for it.
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Day 23, April 8
I worry that across the country, bureaucrats are pushing staff to their limits, diminishing their traumas. Our government refers to us as heroes instead of admitting to putting us in this god-awful situation to begin with.
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Day 24, April 9
One hundred days ago, Chinese officials confirmed the first case of SARS-CoV-2. It seems a lifetime ago.
More than 7,000 people have died in New York as of today. That’s more coronavirus cases than any country, except the United States.
I know people are shocked by the number, but in the middle of the hospital, I hear those codes, I hear those deaths, 7,001, 7,002. The calls for, “Anesthesia, stat!” ring out, then, “Arrest, stat!”
I wonder if “stat” and “urgent” lose their meaning after you hear them 10 times in a row.
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Day 25, April 10
I discharged three people this week. It’s thrilling to see your patient walk out of the hospital, when just 10 days ago he was intubated in the ICU. People get better!
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Day 26, April 11
I have a young patient dying of AIDS on my list. He will be considered a “win” because he happens to not have covid-19.
This is how we conquer pandemics.
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Day 27, April 12
It’s been a pretty horrific couple of days. Three of my patients died in the last 24 hours and three others are expected to die this week. When I opened my list this morning, one of my patient’s locations was literally “MORGUE.”
In the ER, I realize some nurses have given up on wearing gowns; I see patients with oxygen saturations of 50%, gasping for air.
I feel so terribly, soul-crushingly helpless. I’m just this machine, sucking up near-dead bodies and churning out dead ones, barely having treated them. I broke down on the phone talking to my dad as I described the scenes. This isn’t what being a doctor is about.
Update, my fourth patient just died.
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Day 28, April 13
I did not want to go into work today. I couldn’t see anyone else die.
Luckily, it was a better day. I finally weaned a young woman off oxygen. She has a loving husband, who, on the phone, sounds like a jolly, sturdy kind of man. Today, he mentioned something about seeing his wife later today. Huh?
Turns out that every day, he walks the 10 blocks from his apartment to the hospital. He knows where his wife’s second floor room is located, so he stands beneath her window day-in and day-out. There, positioned in front of red tulips, he talks and jokes with his wife, prays with her and tells her how much he loves her.
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Day 29, April 14
I stayed two hours past the end of my shift to help a family say goodbye to their father. Sallow, sometimes struggling for breath, his eyes were closed. He was somnolent, his pain and suffering eased by morphine. His children watched through the iPad and said their I love yous. Occasionally his eyes fluttered open. His daughter began to sing, deep and rich and broken:
“I sing because I’m happy / I sing because I’m free / His eye is on the sparrow / And I know He watches me.”
I felt myself a voyeur, intruding on a family’s last goodbyes. But I also feel honored to be part of such incandescently beautiful moments.
As I left the hospital late at night, I read the headline on my phone. Today marks over 10,000 coronavirus deaths in New York City.
– – –
Day 30, April 15
It was a weird, but nice, day. There was lots of joking in the doctors’ workroom; at one point, I cried laughing, which I never do. ABBA and Cardi B blasted through the speakers and we referred to one another as “party people.” We drew each other’s blood, probably because we’ve lost our minds.
I followed up on my ICU patients. The first covid-19 patient I ever took care of (and wrote about on March 17) has gone through a tumultuous rollercoaster of respiratory failure, kidney failure, clots, superimposed infections and multifactorial shock. He’s spent a month in the hospital and guess what!? For the first time, he opened his eyes. He is awake and breathing independently!
Although the breathing tube is still in, he is finally alert enough to communicate with the medical team.
Today, the first thing they told him was that his wife loved him. He cried.
– – –
By the time I write my last entry, my hospital system has admitted over 7,000 covid-19 patients and, I’m told, more covid-19 ICU patients than any hospital in the country. As of publication, more than 12,000 have died of covid-19 in New York City alone. Worldwide, the toll is more than 200,000.
Our world is in chaos, patients and health-care workers alike dying. Although at times I go about my day as if it’s a typical one, there is no such thing as “typical” or ordinary anymore. I am grateful for the colleagues and friends who have been there for me, as well as my family in all corners of the world.
As the country talks of lifting restrictions, I think of this quote: “To say ‘the curve is flattening, time to lift restrictions’ is like saying ‘the parachute has slowed our rate of descent, so we can take it off now.'”
I love to dream about “when this is over.”
When this is over, I will spend as much time as I can with my loved ones. I’ll fly off to an island, swim in crystalline seas and laze on a beach.
There’s a restaurant up the Hudson River called Blue Hill. My friends and I imagine a picturesque farmhouse with a cozy fireplace and eyebrow-raising prices. As I lamented the suffering we’ve all witnessed, Daniel told me: “When you’re down, just think of Blue Hill. There will be goats, chickens and green grass. And we’ll have a nice bottle of wine together.”
One day, Blue Hill. One day, golden beaches. And one day, things will be beautifully, perfectly typical.
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Chaudhuri is a third-year resident at Columbia University Medical Center.