Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day three hundred
Speaker 1: and thirty eight since coronavirus was declared a global pandemic.
Speaker 1: Today we're bringing you a special edition of the podcast
Speaker 1: from our friends at trade Offs. During the first week
Speaker 1: of February, hospitalizations for COVID nineteen in the US fell
Speaker 1: below one and ten thousand for the first time since December.
Speaker 1: The pace of vaccinations is also quickly ramping up. It's
Speaker 1: good news for sure, but for frontline healthcare providers, relief
Speaker 1: is still a long way off, and many of them
Speaker 1: are coming up on a full year of combating COVID. Today,
Speaker 1: what one doctor has learned in that year about death, denial,
Speaker 1: and this new disease. Host of trade Offs Dan Gorenstein
Speaker 1: has more. It was kind of like when the tornado
Speaker 1: sirens go off around here. Mike Cunahan is a thirty
Speaker 1: seven year old emergency room physician in Tulsa, Oklahoma. Mike
Speaker 1: remembers when COVID first appeared in the US, he was
Speaker 1: almost sure it was going to spread fast. That the
Speaker 1: sky is black and the birds are quiet. It's very spooky,
Speaker 1: and there's just this the loudest siren you've ever heard,
Speaker 1: and he just kind of brace. He was bracing for
Speaker 1: a wave of sickness and death, and he was bracing
Speaker 1: against his own fear that people would fail to meet
Speaker 1: this moment. I was worried at the beginning of the
Speaker 1: pandemic that we would know exactly what to do, you know,
Speaker 1: wear masks and distance and not go to gatherings and stuff,
Speaker 1: but not have the courage to do it. One of
Speaker 1: his first patients did have that courage. She was a
Speaker 1: woman in her nineties and I told her that she
Speaker 1: had COVID and she said, yeah, I don't want to
Speaker 1: vent a later Huh. She said, I've had a good
Speaker 1: life and you should give it to someone uh young.
Speaker 1: I mean, she didn't even need to bend the winder,
Speaker 1: but she didn't know that. She saw the news and
Speaker 1: I told her she had COVID, and she said, Uh,
Speaker 1: give it someone else. Mike recognized a kindred spirit in
Speaker 1: that woman, a person devoted to the greater good. It's
Speaker 1: why Mike left a well paid hedge fun job in
Speaker 1: Connecticut and took out loans to practice medicine. It's corny
Speaker 1: to say, he says, but it's true. He wanted to
Speaker 1: make a difference, just sort of been pursuing that ever since.
Speaker 1: I still feel exactly the same, nothing has changed at all.
Speaker 1: I think it's the best. It's an amazing job. Six
Speaker 1: years in he's treated heart attacks, strokes, shortness of breath,
Speaker 1: and gunshot wounds, and he's gotten pretty good at it.
Speaker 1: Now he's doing his asked to make a difference in
Speaker 1: a world overcome by COVID. It's been nearly a year
Speaker 1: since Mike saw that woman who declined the ventilator, and
Speaker 1: Mike's fears have been realized. Too few people had sacrificed
Speaker 1: to protect others, to slow down the pandemic. As of
Speaker 1: early February, Oklahoma has had more than three d eighty
Speaker 1: thousand COVID cases, more than thirty deaths. The point there's
Speaker 1: a cost to people's seeming indifference to the virus. Mike
Speaker 1: sees that cost almost every day. In fact, he basically
Speaker 1: gets a tour of it every time he steps into
Speaker 1: the e R. First, there's the waiting room. It's controlled chaos.
Speaker 1: Mike says he's hit by the noise, ambulance silence, dozens
Speaker 1: of conversations in many languages, People in pain, people packed in.
Speaker 1: I mean there's people sitting in chairs in the side
Speaker 1: of the hallway where and street clothes. They don't have
Speaker 1: a gown, they don't have a bit getting I v
Speaker 1: S and oxygen, and that would never happen. Before nurses
Speaker 1: draw blood, stable patients take a turn for the worse.
Speaker 1: An appendix ruptures. You've got twenty pots on the stove
Speaker 1: and you just can't let anything burn. You know, you
Speaker 1: just have to find anything bad happening and do that
Speaker 1: right away. Mike is careful to say that everyone in
Speaker 1: his hospital gets what they need, but the waiting is real.
Speaker 1: Next up on the tour phone calls. Mike makes lots
Speaker 1: of calls these days. Sometimes that's meant asking adult children
Speaker 1: to make urgent end of life decisions. I said, uh,
Speaker 1: I have said a hundred times. I'm sorry to wake
Speaker 1: you up. It's Dr Hunahan in the emergency room. I
Speaker 1: have your mother here, a semi conscious woman in her
Speaker 1: nineties had just arrived in the middle of the night
Speaker 1: from a skilled nursing facility. She had COVID. She's really sick.
Speaker 1: I think the best thing to do is to intubate her.
Speaker 1: Does she have a power of attorney or an advanced directive.
Speaker 1: The daughter started to cry. She said, do I have
Speaker 1: to do this now? She kept saying that do I
Speaker 1: have to decide right now? I said, yeah, you do,
Speaker 1: but she couldn't. She needed time. Half an hour later
Speaker 1: she called Mike back and she said she wouldn't want
Speaker 1: that do what you think is best. She would not
Speaker 1: want to be on a ventilator. Mike then broke the news.
Speaker 1: The woman's mother didn't need the ventilator after all, and
Speaker 1: that was great. Of course, a few simple interventions had
Speaker 1: actually stabilized her breathing. But the moment also revealed a
Speaker 1: simple truth. The uncertainty around COVID is always there, even
Speaker 1: for doctors. After the break, confrontations with patients, a letter
Speaker 1: to the editor and hope, we're back looking at how
Speaker 1: one e ER doc has coped with COVID. Like most
Speaker 1: e ER docs, Mike prides himself on sizing up a
Speaker 1: patient symptoms fast and acting. He's modeled himself after his mentors.
Speaker 1: I remember thinking the older doctors had superpowers, like when
Speaker 1: I started training, like they could just hold so much
Speaker 1: information in their head and they never panicked. They were
Speaker 1: always calm, and they could just figure stuff out. So quickly,
Speaker 1: but COVID is new, it's harder to be sure what
Speaker 1: he's seeing, like what that woman from the nursing facility.
Speaker 1: A big thing that's been really scary is that it
Speaker 1: seems like intibating these patients might not always be the
Speaker 1: right thing to do, and that was something that we
Speaker 1: always had a fallback on. Typically, when a patient struggles
Speaker 1: for air on her own, doctors inserted tube into her airway,
Speaker 1: and the tube is connected to a ventilator that pushes
Speaker 1: air into the law. If someone's oxygen was super low
Speaker 1: from heart failure or COPD or some other pneumonia, you
Speaker 1: could put in a breathing tube and feel pretty sure
Speaker 1: that you could fix it. But patients with COVID can
Speaker 1: be sick for weeks, and if she's on a ventilator
Speaker 1: all that time, she can lose the ability to breathe
Speaker 1: on her own. It's kind of like an astronaut, like
Speaker 1: if they're in space not doing anything for a month,
Speaker 1: they're week. When you put someone on a ventilator and
Speaker 1: COVID is just ravaging their lungs, they're going to be
Speaker 1: on the ventilator for three weeks. They can't get strong
Speaker 1: enough again. To come off the ventilator. Nearly a year
Speaker 1: into this thing, doctors are still figuring out the best
Speaker 1: way to care for their patients. People are surviving with
Speaker 1: low oxygen not intibated, and people are getting intibated for
Speaker 1: low oxygen and dying on the ventilator, and it just
Speaker 1: so much of it doesn't make any sense. The next
Speaker 1: stop patient rooms. COVID has on occasion pitted patient against doctor,
Speaker 1: like seeing patients in the hospital with COVID refused to
Speaker 1: wear a mask. I don't think it's real. And you're
Speaker 1: just watching all this carnage every day for a year.
Speaker 1: It's like your brain is not built to understand it.
Speaker 1: Through this all, Mike has lost his bearings a bit.
Speaker 1: He's devoted his medical career to helping the common good.
Speaker 1: He even wrote a letter to the editor and the
Speaker 1: Tulsa World last fall after he heard what President Trump
Speaker 1: had said in an October rally in Michigan. Our doctors
Speaker 1: get more money if somebody dies from it was kind
Speaker 1: of death by a thousand cuts. And that was the worst, last,
Speaker 1: deepest one. As if what we're already doing isn't hard enough,
Speaker 1: you know, a few days later, Mike went for a
Speaker 1: bike ride after a rough shift at the hospital, and
Speaker 1: I was just riding through this big park in town
Speaker 1: and almost no one had masks on. And it was
Speaker 1: this juxtaposition of leaving the hospital where all these people
Speaker 1: are just sick and dying. It's like you you walk
Speaker 1: into a different world. He didn't know what to do.
Speaker 1: Everything seemed to be piling up. He was angry, sad, disappointed.
Speaker 1: He couldn't sleep, so on one of those sleepless nights,
Speaker 1: he wrote the letter. We need every single person to
Speaker 1: become a hero, because what's true on the front lines
Speaker 1: is true everywhere. When your distance wear a mask and
Speaker 1: wash your hands, you are saving someone's life. Mike hoped
Speaker 1: his letter might make a difference, that his story as
Speaker 1: an e ER doc serving his community might convince more
Speaker 1: people to wear masks. But Mike knows his story didn't
Speaker 1: work well enough. All he has to do is work
Speaker 1: around his e R With the vaccine here, Mike's now
Speaker 1: worried about people feeling a false sense of security, just
Speaker 1: as more contagious variants are on the rise. He's worried
Speaker 1: a year in people still don't get how serious this is,
Speaker 1: how connected we all are, and that takes us to
Speaker 1: the final stop of this e er tour. His computer
Speaker 1: had a patient that needed surgery for his gall bladder.
Speaker 1: He didn't have COVID, but I called twelve hospitals until
Speaker 1: I found one that had a bed where he could go.
Speaker 1: This guy had an emergency, and there are so many
Speaker 1: people with COVID that he would die in America if
Speaker 1: that ruptured. Imagine, says Mike, a doctor trying to save
Speaker 1: a patient of an imminently curable condition by desperately googling
Speaker 1: hospitals looking for anyone with enough capacity to take him in.
Speaker 1: Maybe that'll hit home a little differently. Think about that,
Speaker 1: if you need your gall bladder cut out or you're
Speaker 1: gonna die, you'll wish that everyone had worn masks. Maybe
Speaker 1: that'll work. Mike still believes, in spite of everything, there's
Speaker 1: no place he'd rather be. On days when he struggles,
Speaker 1: he turns to moments from the past year that remind
Speaker 1: him of how good people can be to each other.
Speaker 1: The anonymous thank you note on his windshield, the neighbor
Speaker 1: who started mowing his lawn, the surprise parade in front
Speaker 1: of his house, friends honking and waving, and the ninety
Speaker 1: year old woman who is willing to sacrifice for someone else.
Speaker 1: I'm Dan Gorenstein and this is Tradeoffs. That episode was
Speaker 1: produced by the team at Tradeoffs. You can subscribe to
Speaker 1: the Tradeoffs podcast on Apple Podcasts, Spotify or wherever you listen,
Speaker 1: or check them out at trade offs dot org. And
Speaker 1: that's it for our show today. For coverage of the
Speaker 1: outbreak from one dred and twenty bureaus around the world,
Speaker 1: visit Bloomberg dot com slash Coronavirus and if you like
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Speaker 1: on Apple Podcasts or Spotify. It's the best way to
Speaker 1: help more listeners find our global reporting. The Prognosis Daily
Speaker 1: edition is produced by Topher foreheads Magnus Hendrickson and me
Speaker 1: Laura Carlson. Today's main story was reported by the team
Speaker 1: at trade Offs. Original music by Leo Cedrin. Our editors
Speaker 1: are Rick Shine and Francesca Levi. Francesco Levi is Bloomberg's
Speaker 1: head of Podcasts. Thanks for listening.