1 00:00:01,480 --> 00:00:06,440 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day three hundred 2 00:00:06,440 --> 00:00:10,280 Speaker 1: and thirty eight since coronavirus was declared a global pandemic. 3 00:00:11,200 --> 00:00:14,800 Speaker 1: Today we're bringing you a special edition of the podcast 4 00:00:14,960 --> 00:00:18,840 Speaker 1: from our friends at trade Offs. During the first week 5 00:00:18,880 --> 00:00:23,360 Speaker 1: of February, hospitalizations for COVID nineteen in the US fell 6 00:00:23,440 --> 00:00:28,200 Speaker 1: below one and ten thousand for the first time since December. 7 00:00:29,960 --> 00:00:34,120 Speaker 1: The pace of vaccinations is also quickly ramping up. It's 8 00:00:34,120 --> 00:00:39,080 Speaker 1: good news for sure, but for frontline healthcare providers, relief 9 00:00:39,520 --> 00:00:43,160 Speaker 1: is still a long way off, and many of them 10 00:00:43,240 --> 00:00:48,320 Speaker 1: are coming up on a full year of combating COVID. Today, 11 00:00:48,720 --> 00:00:53,080 Speaker 1: what one doctor has learned in that year about death, denial, 12 00:00:53,680 --> 00:00:58,880 Speaker 1: and this new disease. Host of trade Offs Dan Gorenstein 13 00:00:59,360 --> 00:01:05,720 Speaker 1: has more. It was kind of like when the tornado 14 00:01:05,800 --> 00:01:09,119 Speaker 1: sirens go off around here. Mike Cunahan is a thirty 15 00:01:09,120 --> 00:01:13,039 Speaker 1: seven year old emergency room physician in Tulsa, Oklahoma. Mike 16 00:01:13,160 --> 00:01:16,200 Speaker 1: remembers when COVID first appeared in the US, he was 17 00:01:16,200 --> 00:01:19,520 Speaker 1: almost sure it was going to spread fast. That the 18 00:01:19,560 --> 00:01:24,120 Speaker 1: sky is black and the birds are quiet. It's very spooky, 19 00:01:24,200 --> 00:01:27,199 Speaker 1: and there's just this the loudest siren you've ever heard, 20 00:01:27,680 --> 00:01:30,360 Speaker 1: and he just kind of brace. He was bracing for 21 00:01:30,400 --> 00:01:33,920 Speaker 1: a wave of sickness and death, and he was bracing 22 00:01:34,040 --> 00:01:37,600 Speaker 1: against his own fear that people would fail to meet 23 00:01:37,680 --> 00:01:40,319 Speaker 1: this moment. I was worried at the beginning of the 24 00:01:40,360 --> 00:01:44,040 Speaker 1: pandemic that we would know exactly what to do, you know, 25 00:01:44,160 --> 00:01:48,920 Speaker 1: wear masks and distance and not go to gatherings and stuff, 26 00:01:49,240 --> 00:01:51,880 Speaker 1: but not have the courage to do it. One of 27 00:01:51,880 --> 00:01:54,680 Speaker 1: his first patients did have that courage. She was a 28 00:01:54,720 --> 00:01:57,760 Speaker 1: woman in her nineties and I told her that she 29 00:01:57,840 --> 00:02:01,920 Speaker 1: had COVID and she said, yeah, I don't want to 30 00:02:01,960 --> 00:02:08,200 Speaker 1: vent a later Huh. She said, I've had a good 31 00:02:08,240 --> 00:02:12,600 Speaker 1: life and you should give it to someone uh young. 32 00:02:16,400 --> 00:02:17,880 Speaker 1: I mean, she didn't even need to bend the winder, 33 00:02:19,440 --> 00:02:21,400 Speaker 1: but she didn't know that. She saw the news and 34 00:02:21,400 --> 00:02:23,160 Speaker 1: I told her she had COVID, and she said, Uh, 35 00:02:24,440 --> 00:02:28,320 Speaker 1: give it someone else. Mike recognized a kindred spirit in 36 00:02:28,360 --> 00:02:31,440 Speaker 1: that woman, a person devoted to the greater good. It's 37 00:02:31,480 --> 00:02:34,040 Speaker 1: why Mike left a well paid hedge fun job in 38 00:02:34,160 --> 00:02:38,120 Speaker 1: Connecticut and took out loans to practice medicine. It's corny 39 00:02:38,200 --> 00:02:41,000 Speaker 1: to say, he says, but it's true. He wanted to 40 00:02:41,040 --> 00:02:45,040 Speaker 1: make a difference, just sort of been pursuing that ever since. 41 00:02:45,960 --> 00:02:48,240 Speaker 1: I still feel exactly the same, nothing has changed at all. 42 00:02:48,280 --> 00:02:51,040 Speaker 1: I think it's the best. It's an amazing job. Six 43 00:02:51,120 --> 00:02:54,600 Speaker 1: years in he's treated heart attacks, strokes, shortness of breath, 44 00:02:54,760 --> 00:02:57,960 Speaker 1: and gunshot wounds, and he's gotten pretty good at it. 45 00:02:58,560 --> 00:03:01,280 Speaker 1: Now he's doing his asked to make a difference in 46 00:03:01,280 --> 00:03:08,760 Speaker 1: a world overcome by COVID. It's been nearly a year 47 00:03:08,800 --> 00:03:12,200 Speaker 1: since Mike saw that woman who declined the ventilator, and 48 00:03:12,480 --> 00:03:16,600 Speaker 1: Mike's fears have been realized. Too few people had sacrificed 49 00:03:16,639 --> 00:03:19,760 Speaker 1: to protect others, to slow down the pandemic. As of 50 00:03:19,800 --> 00:03:23,040 Speaker 1: early February, Oklahoma has had more than three d eighty 51 00:03:23,200 --> 00:03:28,600 Speaker 1: thousand COVID cases, more than thirty deaths. The point there's 52 00:03:28,639 --> 00:03:32,440 Speaker 1: a cost to people's seeming indifference to the virus. Mike 53 00:03:32,680 --> 00:03:36,600 Speaker 1: sees that cost almost every day. In fact, he basically 54 00:03:36,680 --> 00:03:38,760 Speaker 1: gets a tour of it every time he steps into 55 00:03:38,760 --> 00:03:43,600 Speaker 1: the e R. First, there's the waiting room. It's controlled chaos. 56 00:03:44,320 --> 00:03:48,640 Speaker 1: Mike says he's hit by the noise, ambulance silence, dozens 57 00:03:48,640 --> 00:03:53,640 Speaker 1: of conversations in many languages, People in pain, people packed in. 58 00:03:54,320 --> 00:03:58,520 Speaker 1: I mean there's people sitting in chairs in the side 59 00:03:58,560 --> 00:04:01,080 Speaker 1: of the hallway where and street clothes. They don't have 60 00:04:01,120 --> 00:04:04,200 Speaker 1: a gown, they don't have a bit getting I v 61 00:04:04,360 --> 00:04:08,080 Speaker 1: S and oxygen, and that would never happen. Before nurses 62 00:04:08,160 --> 00:04:11,160 Speaker 1: draw blood, stable patients take a turn for the worse. 63 00:04:11,560 --> 00:04:14,960 Speaker 1: An appendix ruptures. You've got twenty pots on the stove 64 00:04:15,080 --> 00:04:17,120 Speaker 1: and you just can't let anything burn. You know, you 65 00:04:17,160 --> 00:04:20,080 Speaker 1: just have to find anything bad happening and do that 66 00:04:20,279 --> 00:04:23,120 Speaker 1: right away. Mike is careful to say that everyone in 67 00:04:23,200 --> 00:04:27,320 Speaker 1: his hospital gets what they need, but the waiting is real. 68 00:04:28,240 --> 00:04:32,400 Speaker 1: Next up on the tour phone calls. Mike makes lots 69 00:04:32,480 --> 00:04:36,279 Speaker 1: of calls these days. Sometimes that's meant asking adult children 70 00:04:36,360 --> 00:04:40,080 Speaker 1: to make urgent end of life decisions. I said, uh, 71 00:04:40,480 --> 00:04:42,919 Speaker 1: I have said a hundred times. I'm sorry to wake 72 00:04:42,960 --> 00:04:45,760 Speaker 1: you up. It's Dr Hunahan in the emergency room. I 73 00:04:45,800 --> 00:04:48,520 Speaker 1: have your mother here, a semi conscious woman in her 74 00:04:48,640 --> 00:04:50,960 Speaker 1: nineties had just arrived in the middle of the night 75 00:04:51,080 --> 00:04:57,640 Speaker 1: from a skilled nursing facility. She had COVID. She's really sick. 76 00:04:58,360 --> 00:05:00,880 Speaker 1: I think the best thing to do is to intubate her. 77 00:05:01,320 --> 00:05:04,800 Speaker 1: Does she have a power of attorney or an advanced directive. 78 00:05:05,279 --> 00:05:08,160 Speaker 1: The daughter started to cry. She said, do I have 79 00:05:08,240 --> 00:05:11,120 Speaker 1: to do this now? She kept saying that do I 80 00:05:11,160 --> 00:05:14,120 Speaker 1: have to decide right now? I said, yeah, you do, 81 00:05:14,800 --> 00:05:18,880 Speaker 1: but she couldn't. She needed time. Half an hour later 82 00:05:19,000 --> 00:05:22,320 Speaker 1: she called Mike back and she said she wouldn't want 83 00:05:22,360 --> 00:05:24,840 Speaker 1: that do what you think is best. She would not 84 00:05:24,880 --> 00:05:28,640 Speaker 1: want to be on a ventilator. Mike then broke the news. 85 00:05:29,080 --> 00:05:32,800 Speaker 1: The woman's mother didn't need the ventilator after all, and 86 00:05:32,920 --> 00:05:36,400 Speaker 1: that was great. Of course, a few simple interventions had 87 00:05:36,440 --> 00:05:41,120 Speaker 1: actually stabilized her breathing. But the moment also revealed a 88 00:05:41,200 --> 00:05:46,320 Speaker 1: simple truth. The uncertainty around COVID is always there, even 89 00:05:46,560 --> 00:05:51,400 Speaker 1: for doctors. After the break, confrontations with patients, a letter 90 00:05:51,440 --> 00:06:08,360 Speaker 1: to the editor and hope, we're back looking at how 91 00:06:08,440 --> 00:06:12,839 Speaker 1: one e ER doc has coped with COVID. Like most 92 00:06:12,880 --> 00:06:15,960 Speaker 1: e ER docs, Mike prides himself on sizing up a 93 00:06:16,000 --> 00:06:20,760 Speaker 1: patient symptoms fast and acting. He's modeled himself after his mentors. 94 00:06:21,200 --> 00:06:23,800 Speaker 1: I remember thinking the older doctors had superpowers, like when 95 00:06:23,800 --> 00:06:26,600 Speaker 1: I started training, like they could just hold so much 96 00:06:26,640 --> 00:06:29,440 Speaker 1: information in their head and they never panicked. They were 97 00:06:29,440 --> 00:06:31,960 Speaker 1: always calm, and they could just figure stuff out. So quickly, 98 00:06:32,480 --> 00:06:35,680 Speaker 1: but COVID is new, it's harder to be sure what 99 00:06:35,760 --> 00:06:39,040 Speaker 1: he's seeing, like what that woman from the nursing facility. 100 00:06:39,080 --> 00:06:41,440 Speaker 1: A big thing that's been really scary is that it 101 00:06:41,480 --> 00:06:45,039 Speaker 1: seems like intibating these patients might not always be the 102 00:06:45,120 --> 00:06:47,960 Speaker 1: right thing to do, and that was something that we 103 00:06:48,040 --> 00:06:52,720 Speaker 1: always had a fallback on. Typically, when a patient struggles 104 00:06:52,720 --> 00:06:56,080 Speaker 1: for air on her own, doctors inserted tube into her airway, 105 00:06:56,360 --> 00:06:59,160 Speaker 1: and the tube is connected to a ventilator that pushes 106 00:06:59,240 --> 00:07:02,240 Speaker 1: air into the law. If someone's oxygen was super low 107 00:07:02,960 --> 00:07:06,120 Speaker 1: from heart failure or COPD or some other pneumonia, you 108 00:07:06,160 --> 00:07:08,880 Speaker 1: could put in a breathing tube and feel pretty sure 109 00:07:08,920 --> 00:07:11,720 Speaker 1: that you could fix it. But patients with COVID can 110 00:07:11,800 --> 00:07:15,080 Speaker 1: be sick for weeks, and if she's on a ventilator 111 00:07:15,120 --> 00:07:18,320 Speaker 1: all that time, she can lose the ability to breathe 112 00:07:18,320 --> 00:07:20,760 Speaker 1: on her own. It's kind of like an astronaut, like 113 00:07:20,840 --> 00:07:23,880 Speaker 1: if they're in space not doing anything for a month, 114 00:07:24,600 --> 00:07:27,280 Speaker 1: they're week. When you put someone on a ventilator and 115 00:07:27,440 --> 00:07:29,840 Speaker 1: COVID is just ravaging their lungs, they're going to be 116 00:07:29,880 --> 00:07:32,640 Speaker 1: on the ventilator for three weeks. They can't get strong 117 00:07:32,760 --> 00:07:36,120 Speaker 1: enough again. To come off the ventilator. Nearly a year 118 00:07:36,160 --> 00:07:39,880 Speaker 1: into this thing, doctors are still figuring out the best 119 00:07:39,920 --> 00:07:43,040 Speaker 1: way to care for their patients. People are surviving with 120 00:07:43,120 --> 00:07:46,080 Speaker 1: low oxygen not intibated, and people are getting intibated for 121 00:07:46,120 --> 00:07:48,200 Speaker 1: low oxygen and dying on the ventilator, and it just 122 00:07:48,680 --> 00:07:52,680 Speaker 1: so much of it doesn't make any sense. The next 123 00:07:52,720 --> 00:07:59,239 Speaker 1: stop patient rooms. COVID has on occasion pitted patient against doctor, 124 00:08:00,040 --> 00:08:03,800 Speaker 1: like seeing patients in the hospital with COVID refused to 125 00:08:03,840 --> 00:08:06,680 Speaker 1: wear a mask. I don't think it's real. And you're 126 00:08:06,720 --> 00:08:10,800 Speaker 1: just watching all this carnage every day for a year. 127 00:08:11,880 --> 00:08:15,040 Speaker 1: It's like your brain is not built to understand it. 128 00:08:15,760 --> 00:08:18,760 Speaker 1: Through this all, Mike has lost his bearings a bit. 129 00:08:19,160 --> 00:08:22,440 Speaker 1: He's devoted his medical career to helping the common good. 130 00:08:23,080 --> 00:08:25,240 Speaker 1: He even wrote a letter to the editor and the 131 00:08:25,280 --> 00:08:28,840 Speaker 1: Tulsa World last fall after he heard what President Trump 132 00:08:28,880 --> 00:08:32,320 Speaker 1: had said in an October rally in Michigan. Our doctors 133 00:08:32,360 --> 00:08:36,680 Speaker 1: get more money if somebody dies from it was kind 134 00:08:36,679 --> 00:08:41,320 Speaker 1: of death by a thousand cuts. And that was the worst, last, 135 00:08:41,480 --> 00:08:44,800 Speaker 1: deepest one. As if what we're already doing isn't hard enough, 136 00:08:46,600 --> 00:08:49,200 Speaker 1: you know, a few days later, Mike went for a 137 00:08:49,240 --> 00:08:52,440 Speaker 1: bike ride after a rough shift at the hospital, and 138 00:08:52,480 --> 00:08:54,560 Speaker 1: I was just riding through this big park in town 139 00:08:54,920 --> 00:08:59,600 Speaker 1: and almost no one had masks on. And it was 140 00:08:59,679 --> 00:09:04,640 Speaker 1: this juxtaposition of leaving the hospital where all these people 141 00:09:05,640 --> 00:09:08,880 Speaker 1: are just sick and dying. It's like you you walk 142 00:09:08,960 --> 00:09:13,480 Speaker 1: into a different world. He didn't know what to do. 143 00:09:13,840 --> 00:09:18,400 Speaker 1: Everything seemed to be piling up. He was angry, sad, disappointed. 144 00:09:18,600 --> 00:09:22,800 Speaker 1: He couldn't sleep, so on one of those sleepless nights, 145 00:09:22,960 --> 00:09:25,920 Speaker 1: he wrote the letter. We need every single person to 146 00:09:25,960 --> 00:09:28,640 Speaker 1: become a hero, because what's true on the front lines 147 00:09:28,760 --> 00:09:32,199 Speaker 1: is true everywhere. When your distance wear a mask and 148 00:09:32,360 --> 00:09:36,120 Speaker 1: wash your hands, you are saving someone's life. Mike hoped 149 00:09:36,160 --> 00:09:38,440 Speaker 1: his letter might make a difference, that his story as 150 00:09:38,480 --> 00:09:41,840 Speaker 1: an e ER doc serving his community might convince more 151 00:09:41,920 --> 00:09:45,760 Speaker 1: people to wear masks. But Mike knows his story didn't 152 00:09:45,800 --> 00:09:47,960 Speaker 1: work well enough. All he has to do is work 153 00:09:48,000 --> 00:09:51,520 Speaker 1: around his e R With the vaccine here, Mike's now 154 00:09:51,559 --> 00:09:54,679 Speaker 1: worried about people feeling a false sense of security, just 155 00:09:54,840 --> 00:09:58,480 Speaker 1: as more contagious variants are on the rise. He's worried 156 00:09:58,520 --> 00:10:02,240 Speaker 1: a year in people still don't get how serious this is, 157 00:10:02,559 --> 00:10:06,920 Speaker 1: how connected we all are, and that takes us to 158 00:10:06,960 --> 00:10:10,400 Speaker 1: the final stop of this e er tour. His computer 159 00:10:11,000 --> 00:10:13,679 Speaker 1: had a patient that needed surgery for his gall bladder. 160 00:10:14,000 --> 00:10:18,520 Speaker 1: He didn't have COVID, but I called twelve hospitals until 161 00:10:18,559 --> 00:10:21,240 Speaker 1: I found one that had a bed where he could go. 162 00:10:22,080 --> 00:10:24,679 Speaker 1: This guy had an emergency, and there are so many 163 00:10:24,720 --> 00:10:28,840 Speaker 1: people with COVID that he would die in America if 164 00:10:28,880 --> 00:10:32,720 Speaker 1: that ruptured. Imagine, says Mike, a doctor trying to save 165 00:10:32,760 --> 00:10:36,680 Speaker 1: a patient of an imminently curable condition by desperately googling 166 00:10:36,800 --> 00:10:40,640 Speaker 1: hospitals looking for anyone with enough capacity to take him in. 167 00:10:41,280 --> 00:10:44,679 Speaker 1: Maybe that'll hit home a little differently. Think about that, 168 00:10:44,760 --> 00:10:46,959 Speaker 1: if you need your gall bladder cut out or you're 169 00:10:46,960 --> 00:10:52,199 Speaker 1: gonna die, you'll wish that everyone had worn masks. Maybe 170 00:10:52,200 --> 00:10:58,319 Speaker 1: that'll work. Mike still believes, in spite of everything, there's 171 00:10:58,360 --> 00:11:02,000 Speaker 1: no place he'd rather be. On days when he struggles, 172 00:11:02,160 --> 00:11:04,440 Speaker 1: he turns to moments from the past year that remind 173 00:11:04,480 --> 00:11:06,880 Speaker 1: him of how good people can be to each other. 174 00:11:07,360 --> 00:11:10,400 Speaker 1: The anonymous thank you note on his windshield, the neighbor 175 00:11:10,520 --> 00:11:13,640 Speaker 1: who started mowing his lawn, the surprise parade in front 176 00:11:13,679 --> 00:11:17,480 Speaker 1: of his house, friends honking and waving, and the ninety 177 00:11:17,520 --> 00:11:21,240 Speaker 1: year old woman who is willing to sacrifice for someone else. 178 00:11:22,160 --> 00:11:32,560 Speaker 1: I'm Dan Gorenstein and this is Tradeoffs. That episode was 179 00:11:32,600 --> 00:11:36,320 Speaker 1: produced by the team at Tradeoffs. You can subscribe to 180 00:11:36,360 --> 00:11:41,199 Speaker 1: the Tradeoffs podcast on Apple Podcasts, Spotify or wherever you listen, 181 00:11:42,000 --> 00:11:46,880 Speaker 1: or check them out at trade offs dot org. And 182 00:11:46,960 --> 00:11:49,040 Speaker 1: that's it for our show today. For coverage of the 183 00:11:49,080 --> 00:11:51,480 Speaker 1: outbreak from one dred and twenty bureaus around the world, 184 00:11:51,760 --> 00:11:56,080 Speaker 1: visit Bloomberg dot com slash Coronavirus and if you like 185 00:11:56,160 --> 00:11:58,559 Speaker 1: the show, please leave us a review and a rating 186 00:11:58,800 --> 00:12:02,120 Speaker 1: on Apple Podcasts or Spotify. It's the best way to 187 00:12:02,120 --> 00:12:06,600 Speaker 1: help more listeners find our global reporting. The Prognosis Daily 188 00:12:06,760 --> 00:12:10,640 Speaker 1: edition is produced by Topher foreheads Magnus Hendrickson and me 189 00:12:11,080 --> 00:12:14,880 Speaker 1: Laura Carlson. Today's main story was reported by the team 190 00:12:15,000 --> 00:12:19,679 Speaker 1: at trade Offs. Original music by Leo Cedrin. Our editors 191 00:12:19,679 --> 00:12:24,000 Speaker 1: are Rick Shine and Francesca Levi. Francesco Levi is Bloomberg's 192 00:12:24,040 --> 00:12:26,600 Speaker 1: head of Podcasts. Thanks for listening.