
I'm Married to an ER Doc in NYC - smalera
https://superorganizers.substack.com/p/im-married-to-an-emergency-room-doctor
======
dr_
Not an ER doc, but a doc in long term care facilities which have been hit
particularly hard. Fortunately things have slowed down considerably now, but
at its peak it was absolutely nerve racking. There’s an element to this
pandemic which many people working in healthcare have felt. We see patients
fall sick often, and we see them die often, although this was at an near
overwhelming scale. But what we don’t see often is our own colleagues falling
sick and, in some cases, dying. This adds a level of despair that I personally
had never experienced before, and adds to the stress of the job. Which is why
when it is written off by some as nothing more than a bad flu season, I get
upset. This is something worse, and despite all the research that’s been done
in a short time, still something we don’t fully understand - and something
that is not over.

~~~
m4rtink
This is what I thin many forget when they speak against lockdown and for
"heard immunity" \- that this would not only result in a huge ammount of
unnecessary deaths, but also pretty much wear out if not outright kill a
signifficant part of medical personel.

It's basically condemning them to working nonstop for months if not years,
watching people die all day long & being in infection danger at all times
while at work.

And you can't replace all the people that burn out, get ill or die quickly -
training medical professionals takes many years.

~~~
40four
I think it is more complicated than that.

Almost all states very early on had some level of 'lock-down', stay at home
order, or what have you. This has limited movement of people, and as a side
effect, or maybe even direct order from governors, closed down/ limited many
business. Including hospitals.

Hospitals in America, believe it nor not, are for profit businesses. It is un-
intuitive, but many of them are in serious financial trouble, despite the
influx of Covid-19 patients. At a cursory level, I think most people would
assume the hospital business is booming, but this assumption couldn't be more
wrong.

At this point, nobody wants to go in for routine examinations or non-emergency
procedures. For-profit hospitals (almost all of them are) as a business,
depend on providing these non-emergency services/ surgeries/ procedures.
Hospitals across the country are laying off health-care workers en-masse.

So it is not correct to imagine all hospitals are running at full capacity,
and burning out their workers. In fact, many health care professionals are
drawing unemployment at this point.

I know this is doesn't make sense at the surface level, but it is something we
all need to consider when continuing to advocate for lock-down or stay at home
strategies. Our economy depends on movement of people/ goods/ services. That
includes hospitals. I wish there was more serious discussion about this, and
how we keep things moving as much as possible, while also protecting one
another from spreading the virus.

Lock-down alone is not an solution. If your areas hospitals are at risk of
reaching capacity, for sure close it down. But almost nowhere in America
outside of NY/NJ is there a risk of that right now. We've tried it for a
while, but now we have more understanding. Now I want us to re-imagine how we
can continue a life of movement, and also reduce risk of infection.

~~~
akiselev
_> At this point, nobody wants to go in for routine examinations or non-
emergency procedures. For-profit hospitals (almost all of them are) as a
business, depend on providing these non-emergency services/ surgeries/
procedures. Hospitals across the country are laying off health-care workers
en-masse._

Nitpick: Over half of US hospitals are nonprofits or government owned [1]
though I believe hospitals are vastly outnumbered by private clinics and
independent practices. Doesn't change your overall point - even the hospitals
run by governments, the Catholic church, and other institutions have budgets
and are watching their main incomes disappear without much hope for the near
future.

[1] [https://www.aha.org/statistics/fast-facts-us-
hospitals](https://www.aha.org/statistics/fast-facts-us-hospitals)

~~~
m0zg
While factually true, this does not defeat the point: those non-profit and
public hospitals rely on paid procedures to pay their employees. And yes,
those employees are furloughed and laid off en masse.

------
spodek
I recorded a podcast episode with my brother-in-law, a New York City surgeon,
that has become one of my most downloaded. He talks about not knowing
important information early, the challenge of going between surgery and home,
but most of all, seeing the possibility of having to triage between who might
live or die.

We cover non-pandemic stuff too.

[https://joshuaspodek.com/guests/michael-turner-dds-
md](https://joshuaspodek.com/guests/michael-turner-dds-md)

------
klmadfejno
The way things are described make the doctors sound powerless. I've been
frustrated by the lack the information on the usefulness of hospitals. The
impression I've gotten is that they cannot do much, and if they would go as
far as intubation, you're highly likely to die even with intubation.

~~~
ketanmaheshwari
I have never admitted to a hospital in the US but have heard stories of other
folks who have been. I just get a feeling that once you are admitted in a
hospital nobody has any power including yourself. Everything is taken over by
the "system". This is my biggest fear why I would never want to be
hospitalized.

~~~
nashashmi
It actually benefits you to have a doctor in the family who is there
navigating and talking to the doctors. The doctors are more receptive to each
other and listen carefully. Otherwise you are just a number. And the doctors
won't try so hard on patients who really don't have any understanding of
medicine in the first place.

~~~
isolli
My wife went to the ER (in Manhattan) with septicemia a week after giving
birth. She was left lying on a stretcher for 17 hours without as much as water
to drink before they finally "found" a room for her. (Thankfully she
recovered.)

A few months later, a friend who works at the hospital told me: I wish you had
called me, I could have gotten you a room. And I thought: this is just like a
third world country, where you need connections to get basic care.

~~~
koheripbal
You are lucky. People in Quebec hospitals are left in hallways permanently,
due to space issues - even before covid.

------
thedrbrian
> I haven’t hugged my family in over two months — anything to keep them from
> contracting a virus that could kill them.

It could but they look fairly young and as long as they’ve no comorbidities
they’ll be fine.

~~~
dannyw
It’s incredibly true. We know coronavirus is only really dangerous to the
elderly and those with weakened immunity systems.

So why aren’t we focusing all the attention and effort on protecting the most
vulnerable, instead of spreading misinformation like “COVID doesn’t
discriminate” (it does) and panicking over schools while sending confirmed
positive patients back to nursing homes?

~~~
J-dawg
I agree - this kind of misinformation is so widespread now. It seems
completely counter productive.

The other bit of widespread misinformation is the 2m/6ft distancing thing.
It's just an arbitrary number.

Weirdly the fearmongering makes me feel like being _less_ careful, not more.
The way I see it, if COVID is really so contagious that I'm likely to catch it
from a stranger's exhaled breath as I pass them in the street, then I'm
guaranteed to catch it eventually, so what's the point?

I'm sure it can technically be transmitted in this way, but what's the actual
probability? Tiny enough to not be worth worrying about, I expect.

~~~
gizmo
Tiny exposure to covid (by passing somebody on the street) is exceptionally
unlikely to make you sick, but it will help your immune system recognize the
enemy. This builds partial immunity and if you get exposed for real at some
later point your immune system will be able to kick into gear right away.

~~~
pas
Has this been demonstrated? Is this true? Is this really how the immune system
works?

~~~
gizmo
Yes, for instance in this 2015 study on influenza:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342672/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342672/)

Higher initial dose results in worse outcomes. Low dose still helps build
immunity. Covid19 should be assumed to work like other RTIs.

(This is also why obsessively washing your hands and cleaning your house with
bleach isn't a good idea, because being in too sterile an environment harms
your immune system.)

~~~
pas
Wow, conducting this study (and the IRB review) must have been great.

Hm, okay, at first I just saw the very linear response and wasn't sure how
that translates low dose still helps build immunity, but then went back and
read your comment up thread, which captures it better: the partial sickness
gives partial immunity, thus "priming" the body for the full-blown thing.

Though getting the active transmission rate down could be more important in
some places.

------
izietto
Reading the title I thought the topic was a marriage with an Entity
Relationship document

~~~
dennis_jeeves
lol

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el_nahual
> _When Alex finally gets home, he takes his scrubs off outside our front door
> and stuffs them into a plastic bag that he ties off tightly. He takes his
> hospital clogs off and leaves them outside, along with his backpack and
> coat._

Why do doctors and nurses walk around outside in their hospital scrubs? It was
unsanitary even before COVID and I just don't get it. How hard can it be to
change into street clothes before leaving the hospital?

I see nurses and doctors in scrubs on public transit, in coffee shops,
cafeterias... they are either taking whatever illnesses were in the hospital
outside, or taking the dirt and grime of the outside world into the hospital.
It's baffling that this behavior is so normalized that it's described as
heroic in TFA.

~~~
throwawaylalala
It's actually not easy; not every place has facilities for that. Wife is a
nurse, and we went through this discussion of the best process when she was an
ICU nurse during the Ebola scare five years ago.

Remember too, sometimes folks are on the way _to_ work in their scrubs, not
necessarily leaving work.

~~~
el_nahual
What "facilities"? We're talking about _changing clothes_. Shower curtain
ought to be enough! And the point about going to work in scrubs is also bad:
scrubs should be as much about keeping stuff _out_ of the hospital as _in_.

If a neighborhood yoga studio can provide a place to change, pretty sure any
healthcare facility can too.

~~~
akiselev
When's the last time you saw a yoga studio the size of an average hospital?
Most hospitals have staff numbering into the hundreds or thousands with 24/7
operations [1]. We're talking large locker room facilities all over the place
with many departments getting their own, especially after COVID, which
themselves become central points for disease spread since shift changes aren't
evenly spread out.

I don't think it's a bad idea to make big investments into such infrastructure
now but I think it's completely reasonable it wasn't a priority before.

[1] The average hospital with 50 to 99 beds has a FT+PT staff of about 400 (
beckershospitalreview.com/hospital-management-administration/50-things-to-
know-about-hospital-staffing.html ) and half of all hospitals in the US have
under 100 beds.

~~~
lefstathiou
Most bathrooms in hospitals are private.

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anonu
the tldr is: being a doc in NYC right now is a high stress - maybe battlefield
like scenario. Lots of patients, lots of death, hard to cope with a routine
like that.

~~~
nashashmi
Tldr artistic writing like that? And then miss out all the details? Cruel.

