The Monsoon Diaries: A Doctor’s Journey of Hope and Healing from the ER Frontlines to the Far Reaches of the World

PROLOGUE

March 26, 2020

We have a code!

Make sure everyone’s got all their PPE on! I yell, running.

Habits take over. Hurry in. Handrails down. Begin CPR. Confirm roles. Wheel in crash cart. Push meds.

The resuscitation symphony begins. Ventilators chime. Monitors ring. Ribs crack. Check pulse. Resume compressions. Otherwise, silence.

The other patients watch in horror. There’s no space here to close privacy curtains, with stretchers and patients jammed into every spare inch of the emergency department, but out of instinct we try anyway. Our curtains then deliberately fight us by tangling themselves under the wheels of two separate gurneys.

Ah fuck the curtains, we’ll work with an audience.

The whole world has been our audience.

Hospital administrators informed us earlier this week that in order to do the greatest good for the greatest number of people, we won’t be able to do everything for everyone. But habits are hard to break. Some of us will try to do it all anyway. It’s all we know how to do.

The habit of adrenaline kicks in and emotions betray logic. Maybe I do like this. Maybe I still have a purpose.

No. How could you like this? You’re living a never-ending disaster.

OK. I hate this more than I like it.

I continue to give orders to my team, running the code even as I take stock of my own PPE too late to do anything about it; out of a delayed reflex I then reach for my forehead . . .

Oh whoops.

No. Not Oh whoops: It’s a bona fide Oh fuck. Not again: I don’t have any eye coverings on. Goner. Like Brendan Gleeson’s character Frank in 28 Days Later when a drop of zombie blood falls in his eye, that moment when you realize a new inevitable can feel so unfair . . . Whatever, too late now, can’t turn back time, got to do your best for him. Looking at this patient, I feel as if I’m now looking at my own future twenty-eight days later. You’re still standing and he’s not, don’t worry about what hasn’t happened yet, do what you can until it’s your turn on the stretcher. I almost throw my hands up in the air, but the best I can muster is a sigh and a frown.

Get yourself back in there. Your code is to run this code.

I continue: Keep pushing on his chest. Keep giving him those breaths.

Pulse check: pulse, pulse, pulse. We got him back; I stop the code. He’s alive for now. Are we alive? I check my own: pulse pulse pulse pulse pulse pulse. It’s faster than the patient’s. I need to breathe, too, so I consciously slow mine down: in . . . out . . . in . . . out . . . Pulses and breaths have become valuable commodities these days.

I call out and remind everyone: Wash your hands, spray yourselves down, and change your PPE . . . if there’s any left to change into. Everybody returns to what they were doing before, taking no notice of the panicky whites of my uncovered eyes. I don’t blame them. They have their own worries.

Who cares for the carer?

The patient’s nurse informs me that he was actually admitted yesterday but has waited down here in the ER for more than twenty-five hours for a bed that doesn’t exist. His doctor, the hospitalist upstairs, needs to be informed. I call and update him about the code, then call the patient’s family. His prognosis is grim. They understand.

My prognosis is grim. No eye coverings, fuck.

You will never be able to stop this.

Maybe I should just quit.

Get back in there.

Get me out of here.

I shake off the dueling voices of my subconscious as the respiratory therapist arrives with the hospital’s last ventilator.

Any new vents like they promised? I ask, referring to Governor Cuomo’s assurances that more mechanical ventilators to help patients breathe are coming from a national stockpile, and trying to distract myself from my potential exposure to the virus that is killing people before my very uncovered eyes.

No, we’re the leftovers, he says with a dark grin. I know what he means: Not all hospitals are created equal, and this one is less equal than most.

The hospitalist from upstairs comes down to see the patient for himself. Within minutes, the man goes into cardiac arrest again. It’s now the hospitalist’s turn to run the code. He, at least, remembers to have his eye coverings on.

Start chest compressions! Get me an epi!

I try to be helpful in the role reversal and dial the patient’s family again. They pick up immediately, knowing another call this soon can mean only one thing. They don’t want to replay this horror scene again and again, so they tell me it’s time to let him go naturally. In peace. Away from us.

I walk over to inform the hospitalist, who’s continuing compressions, and he gets on the phone for a double confirmation. A few seconds later he calls off the code. Family confirmed the DNR. I’m calling it.

He pronounces time of death, 9:03 p.m., nods at me, and starts his run back upstairs . . . where another code is being called. We might have an open bed soon, he says darkly. His run is a zombie shamble. I notice his exhaustion, then he’s gone.

The patient will stay downstairs with us, alone, until he can be moved to the morgue. I’ve spent more time among the dead and dying lately than with my own friends. The dead are my new friends. Will I miss them when they’re gone? What kind of nightmares would I have if I weren’t already living in one?

I give his family on the phone a number for the hospital’s social workers as I scan the room. They couldn’t physically squeeze in here even if pandemic protocols allowed for it. Before I can hang up, the next call comes:

We’ve have a code!

Habits take over. The resuscitation symphony plays again.

***

During many a late night after a shift, I sat shell-shocked in front of a screen—whether of a phone or a monitor—mindlessly scrolling for information that did not yet exist. Spending months on the uncharted waters of the first pandemic of our generation, we struggled with how this was not something anyone could easily Google or Wikipedia their way out of. Whatever little we knew about this virus on the frontline was already more than anything you could find online.

If they’re not of the pandemic, recurring nightmares still fool me into believing I’m back in college or medical school, and I had totally forgotten about a course or exam I needed to study for all year. Even after startling myself awake to reassure myself that the syndrome of feeling like an imposter back in school should long be over, an insecurity remains over whether I may have missed something that could have altered an outcome for the better. Another life that could have been saved.

If we could not be as confident of the outcome for any of our patients during this pandemic, how could we fully ascertain the risk of whether we would come out of this unscathed? And once it struck me there was no guarantee we would make it out of the pandemic alive either, I began to write.

I wrote not for you, but for me. I wrote by habit.

Or, if the worst were to happen, I wrote for whomever would be left to pick up the pieces and try to make sense of it all. Every moment put to virtual paper was confirmation, an affirmation to myself, that I was still alive.

This happened. These moments, captured on a break by hasty thumbs or recalled in my apartment after a death-washed double shift, happened. I lived them. I lived through them. I live to write this.

I write to live this.

I have a right to live.

Now that these moments are memory, and we look together on what we survived and toward whatever comes next, I think I was writing for us all along.

For now, we’ve made it.

The first wave of our pandemic is no longer pointing a gun at our heads. Let’s go forth and live.

PRODROME

February 24–March 7, 2020

n. (prō•drōm) an early sign or symptom that indicates the onset of disease.

The gun is pointed at my head.

Staring through a face shield into his goggles, my eyes lock with his.

Beep.

I survive the invisible bullet, my body temperature normal, and proceed to passport control, past a conspicuous sign (see next page) I can’t read but have little trouble puzzling out.

Posted prominently (but only in Portuguese) for the handful of tourists arriving in Angola’s only major international airport, that sign is already more than anything I’d seen the night before when leaving the United States. Public health authorities in a developing southwestern African nation are apparently more concerned than those in Washington, DC, about the spread of coronavirus influenza, which I had overheard being uttered back home just before departing. (That is a combination of two different viruses, by the way, so make up your mind: which one is it?) The folks in Angola, at least, appear to believe it poses a valid threat. There are ubiquitous temperature checks, hand sanitizers, and medical screeners armored in head-to-toe personal protective equipment (PPE). The best our own officials back home can muster are a couple of press releases on monitoring the situation.

Following through on an invitation made months ago by a friend from the Netherlands named Rik, with whom I have occasionally co-led trips ever since we visited Venezuela together in 2015, I spend the next two weeks with his group of travelers in Angola. I learn more during that time about the spread of SARS-CoV-2 from their state-owned TV news than I had from all the independent media in my own country. There are updates each day on new places in the world where the virus has been identified; with each new report, my gut burns hotter for an early return home. But that’s easier wished for than done in a young nation less than two decades out from a three-decade civil war.

One evening at dinner by Kalandula Falls in the lush Malanje Province, one of the Dutch travelers in our group asks me to examine him because of a toothache. I take a look and, sure enough, there is significant swelling that suggests infection. I advise him on antibiotics and to see an oral surgeon as soon as possible to drain the collection underneath, but after inquiring about alternate travel possibilities or even medical evacuation, we are told the earliest he could leave is on our already-scheduled flight out.

One of us in the group—we call ourselves monsooners—reassures him by reframing the situation, determined to enjoy what’s left of the trip. We’re probably safer here anyway with that new virus out there.

I am left to ponder the irony.

***

As the day of our departure from Angola approaches, I do my usual before a long-haul flight: load up on music. But this time I also download recent medical podcasts on the illness now dubbed COVID-19, to hear how some of my colleagues are thinking about treating the virus and our potential exposure as healthcare providers.

One expresses a sentiment that turns me cold inside: We’re about to enter a lottery none of us wants to play.

I also download New York State’s ventilator allocation guidelines, which has been a public document available online since 2015. Reading its 272 pages is not for the faint of heart, discussing as it does in minute detail what protocols to follow in the extremely unlikely event that patients ever overwhelm hospitals to the degree that ventilators must be rationed. The pandemic has barely gotten rolling, not really at least, and I’m already preparing for the worst—never imagining that the worst is exactly what’s to come.

We arrive in Frankfurt where I part ways with Michael, whom I befriended on the trip. We give each other a final hug goodbye, knowing it would be one of our very last as such an act between fellow travelers would soon become a casualty of the virus.

Passing time on my layover, I then commit an infographic to memory:

Recommendations for COVID-19 Intubation

DO

Wear an N95 mask

Don fluid-resistant gowns, gloves, and face shields

Use isolation rooms with negative-pressure

Rapid Sequence Intubation

DON’T

Don’t initiate high-flow oxygen (including BIPAP, nebulizers, high flow nasal cannula, etc.)

Don’t permit any non-critical staff inside the room

If possible, refrain from bagging the patient

Don’t allow any reason to prolong intubation attempt (DO use the most qualified provider with the quickest technique)

Don’t allow used PPE to leave the room (unless appropriately discarded)

I’ve spent the past two weeks traveling through a region still recovering from a civil war, and yet at least some part of me feels that returning home may be the greater danger.

I land at Newark Liberty International Airport at 5:00 p.m. on March 7, 2020. Welcome Home! is the only sign I see.

14 YEARS AGO

Summer 2006: Taking the Reins

A teenager’s mind is a dangerous place to call home. It straddles the jagged line between childhood and the adult world, at once cocky and vulnerable, determined to fake it till you make it even as a lifetime of imposter syndrome sets in, sometimes so overwhelmed by its discovery of cognitive dissonance and the color of brumous gray that it freezes up and inclines itself toward self-destruction.

I can’t help but feel I’m mishandling this grief over my father’s death. One minute I’m still grateful to be alive at the age of nineteen, the next I feel radioactive, a danger to everyone around me, as though puberty is happening all over again. My frontal lobe, responsible for rational thinking and critical judgment, has been taken offline for unscheduled maintenance.

Three weeks ago, my father and I got into another shouting match. I then stormed off to my work in Washington Heights while he headed for stress relief at a New York Sports Club. A few hours later I would receive a phone call from a paramedic who tried to deliver the news that my father may have suddenly collapsed while on a treadmill and was found on the floor in cardiac arrest. But all I could hear was my mother’s screams in the background.

After returning from the Emergency Room at Saint Vincent’s