Combating COVID in the ER

The pace of vaccinations is also quickly ramping up. It's good news for sure, but for frontline healthcare providers, relief is still a long way off, and many of them are coming up on a full year of combating COVID. Today, what one doctor has learned in that year about death, denial, and this new disease. Host of trade Offs Dan Gorenstein has more. It was kind of like when the tornado sirens go off around here. Mike Cunahan is a thirty

seven year old emergency room physician in Tulsa, Oklahoma. Mike remembers when COVID first appeared in the US, he was almost sure it was going to spread fast. That the sky is black and the birds are quiet. It's very spooky, and there's just this the loudest siren you've ever heard, and he just kind of brace. He was bracing for a wave of sickness and death, and he was bracing against his own fear that people would fail to meet

this moment. I was worried at the beginning of the pandemic that we would know exactly what to do, you know, wear masks and distance and not go to gatherings and stuff, but not have the courage to do it. One of his first patients did have that courage. She was a woman in her nineties and I told her that she had COVID and she said, yeah, I don't want to vent a later Huh. She said, I've had a good life and you should give it to someone uh young. I mean, she didn't even need to bend the winder,

but she didn't know that. She saw the news and I told her she had COVID, and she said, Uh, give it someone else. Mike recognized a kindred spirit in that woman, a person devoted to the greater good. It's why Mike left a well paid hedge fun job in Connecticut and took out loans to practice medicine. It's corny to say, he says, but it's true. He wanted to make a difference, just sort of been pursuing that ever since. I still feel exactly the same, nothing has changed at all.

I think it's the best. It's an amazing job. Six years in he's treated heart attacks, strokes, shortness of breath, and gunshot wounds, and he's gotten pretty good at it. Now he's doing his asked to make a difference in a world overcome by COVID. It's been nearly a year since Mike saw that woman who declined the ventilator, and Mike's fears have been realized. Too few people had sacrificed

to protect others, to slow down the pandemic. As of early February, Oklahoma has had more than three d eighty thousand COVID cases, more than thirty deaths. The point there's a cost to people's seeming indifference to the virus. Mike sees that cost almost every day. In fact, he basically gets a tour of it every time he steps into the e R. First, there's the waiting room. It's controlled chaos.

Mike says he's hit by the noise, ambulance silence, dozens of conversations in many languages, People in pain, people packed in. I mean there's people sitting in chairs in the side of the hallway where and street clothes. They don't have a gown, they don't have a bit getting I v S and oxygen, and that would never happen. Before nurses draw blood, stable patients take a turn for the worse. An appendix ruptures. You've got twenty pots on the stove

and you just can't let anything burn. You know, you just have to find anything bad happening and do that right away. Mike is careful to say that everyone in his hospital gets what they need, but the waiting is real. Next up on the tour phone calls. Mike makes lots of calls these days. Sometimes that's meant asking adult children to make urgent end of life decisions. I said, uh, I have said a hundred times. I'm sorry to wake

you up. It's Dr Hunahan in the emergency room. I have your mother here, a semi conscious woman in her nineties had just arrived in the middle of the night from a skilled nursing facility. She had COVID. She's really sick. I think the best thing to do is to intubate her. Does she have a power of attorney or an advanced directive. The daughter started to cry. She said, do I have to do this now? She kept saying that do I have to decide right now? I said, yeah, you do,

but she couldn't. She needed time. Half an hour later she called Mike back and she said she wouldn't want that do what you think is best. She would not want to be on a ventilator. Mike then broke the news. The woman's mother didn't need the ventilator after all, and that was great. Of course, a few simple interventions had actually stabilized her breathing. But the moment also revealed a simple truth. The uncertainty around COVID is always there, even

for doctors. After the break, confrontations with patients, a letter to the editor and hope, we're back looking at how one e ER doc has coped with COVID. Like most e ER docs, Mike prides himself on sizing up a patient symptoms fast and acting. He's modeled himself after his mentors. I remember thinking the older doctors had superpowers, like when I started training, like they could just hold so much information in their head and they never panicked. They were

always calm, and they could just figure stuff out. So quickly, but COVID is new, it's harder to be sure what he's seeing, like what that woman from the nursing facility. A big thing that's been really scary is that it seems like intibating these patients might not always be the right thing to do, and that was something that we

always had a fallback on. Typically, when a patient struggles for air on her own, doctors inserted tube into her airway, and the tube is connected to a ventilator that pushes air into the law. If someone's oxygen was super low from heart failure or COPD or some other pneumonia, you could put in a breathing tube and feel pretty sure that you could fix it. But patients with COVID can be sick for weeks, and if she's on a ventilator all that time, she can lose the ability to breathe

on her own. It's kind of like an astronaut, like if they're in space not doing anything for a month, they're week. When you put someone on a ventilator and COVID is just ravaging their lungs, they're going to be on the ventilator for three weeks. They can't get strong enough again. To come off the ventilator. Nearly a year into this thing, doctors are still figuring out the best

way to care for their patients. People are surviving with low oxygen not intibated, and people are getting intibated for low oxygen and dying on the ventilator, and it just so much of it doesn't make any sense. The next stop patient rooms. COVID has on occasion pitted patient against doctor, like seeing patients in the hospital with COVID refused to wear a mask. I don't think it's real. And you're just watching all this carnage every day for a year.

It's like your brain is not built to understand it. Through this all, Mike has lost his bearings a bit. He's devoted his medical career to helping the common good. He even wrote a letter to the editor and the Tulsa World last fall after he heard what President Trump had said in an October rally in Michigan. Our doctors get more money if somebody dies from it was kind of death by a thousand cuts. And that was the worst, last,

deepest one. As if what we're already doing isn't hard enough, you know, a few days later, Mike went for a bike ride after a rough shift at the hospital, and I was just riding through this big park in town and almost no one had masks on. And it was this juxtaposition of leaving the hospital where all these people are just sick and dying. It's like you you walk into a different world. He didn't know what to do. Everything seemed to be piling up. He was angry, sad, disappointed.

He couldn't sleep, so on one of those sleepless nights, he wrote the letter. We need every single person to become a hero, because what's true on the front lines is true everywhere. When your distance wear a mask and wash your hands, you are saving someone's life. Mike hoped his letter might make a difference, that his story as an e ER doc serving his community might convince more people to wear masks. But Mike knows his story didn't

work well enough. All he has to do is work around his e R With the vaccine here, Mike's now worried about people feeling a false sense of security, just as more contagious variants are on the rise. He's worried a year in people still don't get how serious this is, how connected we all are, and that takes us to the final stop of this e er tour. His computer had a patient that needed surgery for his gall bladder.

He didn't have COVID, but I called twelve hospitals until I found one that had a bed where he could go. This guy had an emergency, and there are so many people with COVID that he would die in America if that ruptured. Imagine, says Mike, a doctor trying to save a patient of an imminently curable condition by desperately googling hospitals looking for anyone with enough capacity to take him in.

Maybe that'll hit home a little differently. Think about that, if you need your gall bladder cut out or you're gonna die, you'll wish that everyone had worn masks. Maybe that'll work. Mike still believes, in spite of everything, there's no place he'd rather be. On days when he struggles, he turns to moments from the past year that remind him of how good people can be to each other.

The anonymous thank you note on his windshield, the neighbor who started mowing his lawn, the surprise parade in front of his house, friends honking and waving, and the ninety year old woman who is willing to sacrifice for someone else. I'm Dan Gorenstein and this is Tradeoffs. That episode was produced by the team at Tradeoffs. You can subscribe to the Tradeoffs podcast on Apple Podcasts, Spotify or wherever you listen, or check them out at trade offs dot org. And

that's it for our show today. For coverage of the outbreak from one dred and twenty bureaus around the world, visit Bloomberg dot com slash Coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by Topher foreheads Magnus Hendrickson and me Laura Carlson. Today's main story was reported by the team

at trade Offs. Original music by Leo Cedrin. Our editors are Rick Shine and Francesca Levi. Francesco Levi is Bloomberg's head of Podcasts. Thanks for listening.