WEBVTT - Combating COVID in the ER 0:00:01.480 --> 0:00:06.440 Welcome to Prognosis. I'm Laura Carlson. It's day three hundred 0:00:06.440 --> 0:00:10.280 and thirty eight since coronavirus was declared a global pandemic. 0:00:11.200 --> 0:00:14.800 Today we're bringing you a special edition of the podcast 0:00:14.960 --> 0:00:18.840 from our friends at trade Offs. During the first week 0:00:18.880 --> 0:00:23.360 of February, hospitalizations for COVID nineteen in the US fell 0:00:23.440 --> 0:00:28.200 below one and ten thousand for the first time since December. 0:00:29.960 --> 0:00:34.120 The pace of vaccinations is also quickly ramping up. It's 0:00:34.120 --> 0:00:39.080 good news for sure, but for frontline healthcare providers, relief 0:00:39.520 --> 0:00:43.160 is still a long way off, and many of them 0:00:43.240 --> 0:00:48.320 are coming up on a full year of combating COVID. Today, 0:00:48.720 --> 0:00:53.080 what one doctor has learned in that year about death, denial, 0:00:53.680 --> 0:00:58.880 and this new disease. Host of trade Offs Dan Gorenstein 0:00:59.360 --> 0:01:05.720 has more. It was kind of like when the tornado 0:01:05.800 --> 0:01:09.119 sirens go off around here. Mike Cunahan is a thirty 0:01:09.120 --> 0:01:13.039 seven year old emergency room physician in Tulsa, Oklahoma. Mike 0:01:13.160 --> 0:01:16.200 remembers when COVID first appeared in the US, he was 0:01:16.200 --> 0:01:19.520 almost sure it was going to spread fast. That the 0:01:19.560 --> 0:01:24.120 sky is black and the birds are quiet. It's very spooky, 0:01:24.200 --> 0:01:27.199 and there's just this the loudest siren you've ever heard, 0:01:27.680 --> 0:01:30.360 and he just kind of brace. He was bracing for 0:01:30.400 --> 0:01:33.920 a wave of sickness and death, and he was bracing 0:01:34.040 --> 0:01:37.600 against his own fear that people would fail to meet 0:01:37.680 --> 0:01:40.319 this moment. I was worried at the beginning of the 0:01:40.360 --> 0:01:44.040 pandemic that we would know exactly what to do, you know, 0:01:44.160 --> 0:01:48.920 wear masks and distance and not go to gatherings and stuff, 0:01:49.240 --> 0:01:51.880 but not have the courage to do it. One of 0:01:51.880 --> 0:01:54.680 his first patients did have that courage. She was a 0:01:54.720 --> 0:01:57.760 woman in her nineties and I told her that she 0:01:57.840 --> 0:02:01.920 had COVID and she said, yeah, I don't want to 0:02:01.960 --> 0:02:08.200 vent a later Huh. She said, I've had a good 0:02:08.240 --> 0:02:12.600 life and you should give it to someone uh young. 0:02:16.400 --> 0:02:17.880 I mean, she didn't even need to bend the winder, 0:02:19.440 --> 0:02:21.400 but she didn't know that. She saw the news and 0:02:21.400 --> 0:02:23.160 I told her she had COVID, and she said, Uh, 0:02:24.440 --> 0:02:28.320 give it someone else. Mike recognized a kindred spirit in 0:02:28.360 --> 0:02:31.440 that woman, a person devoted to the greater good. It's 0:02:31.480 --> 0:02:34.040 why Mike left a well paid hedge fun job in 0:02:34.160 --> 0:02:38.120 Connecticut and took out loans to practice medicine. It's corny 0:02:38.200 --> 0:02:41.000 to say, he says, but it's true. He wanted to 0:02:41.040 --> 0:02:45.040 make a difference, just sort of been pursuing that ever since. 0:02:45.960 --> 0:02:48.240 I still feel exactly the same, nothing has changed at all. 0:02:48.280 --> 0:02:51.040 I think it's the best. It's an amazing job. Six 0:02:51.120 --> 0:02:54.600 years in he's treated heart attacks, strokes, shortness of breath, 0:02:54.760 --> 0:02:57.960 and gunshot wounds, and he's gotten pretty good at it. 0:02:58.560 --> 0:03:01.280 Now he's doing his asked to make a difference in 0:03:01.280 --> 0:03:08.760 a world overcome by COVID. It's been nearly a year 0:03:08.800 --> 0:03:12.200 since Mike saw that woman who declined the ventilator, and 0:03:12.480 --> 0:03:16.600 Mike's fears have been realized. Too few people had sacrificed 0:03:16.639 --> 0:03:19.760 to protect others, to slow down the pandemic. As of 0:03:19.800 --> 0:03:23.040 early February, Oklahoma has had more than three d eighty 0:03:23.200 --> 0:03:28.600 thousand COVID cases, more than thirty deaths. The point there's 0:03:28.639 --> 0:03:32.440 a cost to people's seeming indifference to the virus. Mike 0:03:32.680 --> 0:03:36.600 sees that cost almost every day. In fact, he basically 0:03:36.680 --> 0:03:38.760 gets a tour of it every time he steps into 0:03:38.760 --> 0:03:43.600 the e R. First, there's the waiting room. It's controlled chaos. 0:03:44.320 --> 0:03:48.640 Mike says he's hit by the noise, ambulance silence, dozens 0:03:48.640 --> 0:03:53.640 of conversations in many languages, People in pain, people packed in. 0:03:54.320 --> 0:03:58.520 I mean there's people sitting in chairs in the side 0:03:58.560 --> 0:04:01.080 of the hallway where and street clothes. They don't have 0:04:01.120 --> 0:04:04.200 a gown, they don't have a bit getting I v 0:04:04.360 --> 0:04:08.080 S and oxygen, and that would never happen. Before nurses 0:04:08.160 --> 0:04:11.160 draw blood, stable patients take a turn for the worse. 0:04:11.560 --> 0:04:14.960 An appendix ruptures. You've got twenty pots on the stove 0:04:15.080 --> 0:04:17.120 and you just can't let anything burn. You know, you 0:04:17.160 --> 0:04:20.080 just have to find anything bad happening and do that 0:04:20.279 --> 0:04:23.120 right away. Mike is careful to say that everyone in 0:04:23.200 --> 0:04:27.320 his hospital gets what they need, but the waiting is real. 0:04:28.240 --> 0:04:32.400 Next up on the tour phone calls. Mike makes lots 0:04:32.480 --> 0:04:36.279 of calls these days. Sometimes that's meant asking adult children 0:04:36.360 --> 0:04:40.080 to make urgent end of life decisions. I said, uh, 0:04:40.480 --> 0:04:42.919 I have said a hundred times. I'm sorry to wake 0:04:42.960 --> 0:04:45.760 you up. It's Dr Hunahan in the emergency room. I 0:04:45.800 --> 0:04:48.520 have your mother here, a semi conscious woman in her 0:04:48.640 --> 0:04:50.960 nineties had just arrived in the middle of the night 0:04:51.080 --> 0:04:57.640 from a skilled nursing facility. She had COVID. She's really sick. 0:04:58.360 --> 0:05:00.880 I think the best thing to do is to intubate her. 0:05:01.320 --> 0:05:04.800 Does she have a power of attorney or an advanced directive. 0:05:05.279 --> 0:05:08.160 The daughter started to cry. She said, do I have 0:05:08.240 --> 0:05:11.120 to do this now? She kept saying that do I 0:05:11.160 --> 0:05:14.120 have to decide right now? I said, yeah, you do, 0:05:14.800 --> 0:05:18.880 but she couldn't. She needed time. Half an hour later 0:05:19.000 --> 0:05:22.320 she called Mike back and she said she wouldn't want 0:05:22.360 --> 0:05:24.840 that do what you think is best. She would not 0:05:24.880 --> 0:05:28.640 want to be on a ventilator. Mike then broke the news. 0:05:29.080 --> 0:05:32.800 The woman's mother didn't need the ventilator after all, and 0:05:32.920 --> 0:05:36.400 that was great. Of course, a few simple interventions had 0:05:36.440 --> 0:05:41.120 actually stabilized her breathing. But the moment also revealed a 0:05:41.200 --> 0:05:46.320 simple truth. The uncertainty around COVID is always there, even 0:05:46.560 --> 0:05:51.400 for doctors. After the break, confrontations with patients, a letter 0:05:51.440 --> 0:06:08.360 to the editor and hope, we're back looking at how 0:06:08.440 --> 0:06:12.839 one e ER doc has coped with COVID. Like most 0:06:12.880 --> 0:06:15.960 e ER docs, Mike prides himself on sizing up a 0:06:16.000 --> 0:06:20.760 patient symptoms fast and acting. He's modeled himself after his mentors. 0:06:21.200 --> 0:06:23.800 I remember thinking the older doctors had superpowers, like when 0:06:23.800 --> 0:06:26.600 I started training, like they could just hold so much 0:06:26.640 --> 0:06:29.440 information in their head and they never panicked. They were 0:06:29.440 --> 0:06:31.960 always calm, and they could just figure stuff out. So quickly, 0:06:32.480 --> 0:06:35.680 but COVID is new, it's harder to be sure what 0:06:35.760 --> 0:06:39.040 he's seeing, like what that woman from the nursing facility. 0:06:39.080 --> 0:06:41.440 A big thing that's been really scary is that it 0:06:41.480 --> 0:06:45.039 seems like intibating these patients might not always be the 0:06:45.120 --> 0:06:47.960 right thing to do, and that was something that we 0:06:48.040 --> 0:06:52.720 always had a fallback on. Typically, when a patient struggles 0:06:52.720 --> 0:06:56.080 for air on her own, doctors inserted tube into her airway, 0:06:56.360 --> 0:06:59.160 and the tube is connected to a ventilator that pushes 0:06:59.240 --> 0:07:02.240 air into the law. If someone's oxygen was super low 0:07:02.960 --> 0:07:06.120 from heart failure or COPD or some other pneumonia, you 0:07:06.160 --> 0:07:08.880 could put in a breathing tube and feel pretty sure 0:07:08.920 --> 0:07:11.720 that you could fix it. But patients with COVID can 0:07:11.800 --> 0:07:15.080 be sick for weeks, and if she's on a ventilator 0:07:15.120 --> 0:07:18.320 all that time, she can lose the ability to breathe 0:07:18.320 --> 0:07:20.760 on her own. It's kind of like an astronaut, like 0:07:20.840 --> 0:07:23.880 if they're in space not doing anything for a month, 0:07:24.600 --> 0:07:27.280 they're week. When you put someone on a ventilator and 0:07:27.440 --> 0:07:29.840 COVID is just ravaging their lungs, they're going to be 0:07:29.880 --> 0:07:32.640 on the ventilator for three weeks. They can't get strong 0:07:32.760 --> 0:07:36.120 enough again. To come off the ventilator. Nearly a year 0:07:36.160 --> 0:07:39.880 into this thing, doctors are still figuring out the best 0:07:39.920 --> 0:07:43.040 way to care for their patients. People are surviving with 0:07:43.120 --> 0:07:46.080 low oxygen not intibated, and people are getting intibated for 0:07:46.120 --> 0:07:48.200 low oxygen and dying on the ventilator, and it just 0:07:48.680 --> 0:07:52.680 so much of it doesn't make any sense. The next 0:07:52.720 --> 0:07:59.239 stop patient rooms. COVID has on occasion pitted patient against doctor, 0:08:00.040 --> 0:08:03.800 like seeing patients in the hospital with COVID refused to 0:08:03.840 --> 0:08:06.680 wear a mask. I don't think it's real. And you're 0:08:06.720 --> 0:08:10.800 just watching all this carnage every day for a year. 0:08:11.880 --> 0:08:15.040 It's like your brain is not built to understand it. 0:08:15.760 --> 0:08:18.760 Through this all, Mike has lost his bearings a bit. 0:08:19.160 --> 0:08:22.440 He's devoted his medical career to helping the common good. 0:08:23.080 --> 0:08:25.240 He even wrote a letter to the editor and the 0:08:25.280 --> 0:08:28.840 Tulsa World last fall after he heard what President Trump 0:08:28.880 --> 0:08:32.320 had said in an October rally in Michigan. Our doctors 0:08:32.360 --> 0:08:36.680 get more money if somebody dies from it was kind 0:08:36.679 --> 0:08:41.320 of death by a thousand cuts. And that was the worst, last, 0:08:41.480 --> 0:08:44.800 deepest one. As if what we're already doing isn't hard enough, 0:08:46.600 --> 0:08:49.200 you know, a few days later, Mike went for a 0:08:49.240 --> 0:08:52.440 bike ride after a rough shift at the hospital, and 0:08:52.480 --> 0:08:54.560 I was just riding through this big park in town 0:08:54.920 --> 0:08:59.600 and almost no one had masks on. And it was 0:08:59.679 --> 0:09:04.640 this juxtaposition of leaving the hospital where all these people 0:09:05.640 --> 0:09:08.880 are just sick and dying. It's like you you walk 0:09:08.960 --> 0:09:13.480 into a different world. He didn't know what to do. 0:09:13.840 --> 0:09:18.400 Everything seemed to be piling up. He was angry, sad, disappointed. 0:09:18.600 --> 0:09:22.800 He couldn't sleep, so on one of those sleepless nights, 0:09:22.960 --> 0:09:25.920 he wrote the letter. We need every single person to 0:09:25.960 --> 0:09:28.640 become a hero, because what's true on the front lines 0:09:28.760 --> 0:09:32.199 is true everywhere. When your distance wear a mask and 0:09:32.360 --> 0:09:36.120 wash your hands, you are saving someone's life. Mike hoped 0:09:36.160 --> 0:09:38.440 his letter might make a difference, that his story as 0:09:38.480 --> 0:09:41.840 an e ER doc serving his community might convince more 0:09:41.920 --> 0:09:45.760 people to wear masks. But Mike knows his story didn't 0:09:45.800 --> 0:09:47.960 work well enough. All he has to do is work 0:09:48.000 --> 0:09:51.520 around his e R With the vaccine here, Mike's now 0:09:51.559 --> 0:09:54.679 worried about people feeling a false sense of security, just 0:09:54.840 --> 0:09:58.480 as more contagious variants are on the rise. He's worried 0:09:58.520 --> 0:10:02.240 a year in people still don't get how serious this is, 0:10:02.559 --> 0:10:06.920 how connected we all are, and that takes us to 0:10:06.960 --> 0:10:10.400 the final stop of this e er tour. His computer 0:10:11.000 --> 0:10:13.679 had a patient that needed surgery for his gall bladder. 0:10:14.000 --> 0:10:18.520 He didn't have COVID, but I called twelve hospitals until 0:10:18.559 --> 0:10:21.240 I found one that had a bed where he could go. 0:10:22.080 --> 0:10:24.679 This guy had an emergency, and there are so many 0:10:24.720 --> 0:10:28.840 people with COVID that he would die in America if 0:10:28.880 --> 0:10:32.720 that ruptured. Imagine, says Mike, a doctor trying to save 0:10:32.760 --> 0:10:36.680 a patient of an imminently curable condition by desperately googling 0:10:36.800 --> 0:10:40.640 hospitals looking for anyone with enough capacity to take him in. 0:10:41.280 --> 0:10:44.679 Maybe that'll hit home a little differently. Think about that, 0:10:44.760 --> 0:10:46.959 if you need your gall bladder cut out or you're 0:10:46.960 --> 0:10:52.199 gonna die, you'll wish that everyone had worn masks. Maybe 0:10:52.200 --> 0:10:58.319 that'll work. Mike still believes, in spite of everything, there's 0:10:58.360 --> 0:11:02.000 no place he'd rather be. On days when he struggles, 0:11:02.160 --> 0:11:04.440 he turns to moments from the past year that remind 0:11:04.480 --> 0:11:06.880 him of how good people can be to each other. 0:11:07.360 --> 0:11:10.400 The anonymous thank you note on his windshield, the neighbor 0:11:10.520 --> 0:11:13.640 who started mowing his lawn, the surprise parade in front 0:11:13.679 --> 0:11:17.480 of his house, friends honking and waving, and the ninety 0:11:17.520 --> 0:11:21.240 year old woman who is willing to sacrifice for someone else. 0:11:22.160 --> 0:11:32.560 I'm Dan Gorenstein and this is Tradeoffs. That episode was 0:11:32.600 --> 0:11:36.320 produced by the team at Tradeoffs. You can subscribe to 0:11:36.360 --> 0:11:41.199 the Tradeoffs podcast on Apple Podcasts, Spotify or wherever you listen, 0:11:42.000 --> 0:11:46.880 or check them out at trade offs dot org. And 0:11:46.960 --> 0:11:49.040 that's it for our show today. For coverage of the 0:11:49.080 --> 0:11:51.480 outbreak from one dred and twenty bureaus around the world, 0:11:51.760 --> 0:11:56.080 visit Bloomberg dot com slash Coronavirus and if you like 0:11:56.160 --> 0:11:58.559 the show, please leave us a review and a rating 0:11:58.800 --> 0:12:02.120 on Apple Podcasts or Spotify. It's the best way to 0:12:02.120 --> 0:12:06.600 help more listeners find our global reporting. The Prognosis Daily 0:12:06.760 --> 0:12:10.640 edition is produced by Topher foreheads Magnus Hendrickson and me 0:12:11.080 --> 0:12:14.880 Laura Carlson. Today's main story was reported by the team 0:12:15.000 --> 0:12:19.679 at trade Offs. Original music by Leo Cedrin. Our editors 0:12:19.679 --> 0:12:24.000 are Rick Shine and Francesca Levi. Francesco Levi is Bloomberg's 0:12:24.040 --> 0:12:26.600 head of Podcasts. Thanks for listening.