A day in the life of a doctor during the coronavirus pandemic

Craig Spencer, a New York City emergency physician who helped fight Ebola in West Africa in 2015, described his typical day during the COVID-19 pandemic. This is a long and extremely important thread.

Wake up at 6:30 am. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks too. It's all closed.

On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it's early. Regardless, that's good.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

Rise at 6:30. I try to brew as much coffee as possible for the whole day, because the coffee shop next to the hospital is closed. Starbucks too. All closed. I go to the hospital, and it feels like it's Sunday. There is not anyone. Perhaps it's the cold rain or the early time. Anyway, that's good.

Walk in for your 8am shift: Immediately struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone's protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.

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- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

I come for my shift at 8 am. The calmness of the morning streets disappears immediately. Bright fluorescent lights in the emergency room reflect off protective goggles. There is a cacophony from the cough. You stop. You put on a mask. You go inside.

You take signout from the previous team, but nearly every patient is the same, young & old:

Cough, shortness of breath, fever.

They are really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

You get appointments from the previous command, but almost everywhere the same thing, it doesn't matter if the patient is young or not: cough, shortness of breath, fever. One patient is very worried - breathing is so difficult that even with the maximum oxygen that we can give her, she still breathes very often.

You immediately assess this patient. It’s clear what this is, and what needs to happen. You have a long and honest discussion with the patient and family over the phone. It’s best to put her on life support now, before things get much worse. You're getting set up for that, but ...

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

You go straight to this patient. It becomes obvious what the matter is and what measures need to be taken. You have a long and honest conversation with her and her family on the phone. It would be best to switch her to intensive care before it gets much worse. You start to prepare, but ...

You’re notified of another really sick patient coming in. You rush over. They’re also extremely sick, vomiting. They need to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It's not even 10am yet

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

You are informed that another serious patient has just been admitted. You run to him. The person is very bad, he vomits. He also needs intensive care. So, two patients are in adjacent wards, both are getting a breathing tube. It's not even 10am yet.

For the rest of your shift, nearly every hour, you get paged:

Stat notification: Very sick patient, short of breath, fever. Oxygen 88%.

Stat notification: Low blood pressure, short of breath, low oxygen.

Stat notification: Low oxygen, can’t breath. Fever.

All day ...

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

Every hour until the end of the shift is approximately the same.

Status report: seriously ill patient, shortness of breath, fever. The oxygen level is 88%.

Status report: low pressure, shortness of breath, low oxygen levels.

Status Report: Low Oxygen, Cannot Breathe. Heat.

And so the whole day ...

Sometime in the afternoon you recognize you haven’t drank any water. You’re afraid to take off the mask. It's the only thing that protects you. Surely you can last a little longer - in West Africa during Ebola, you spent hours in a hot suit without water. One more patient…

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

At some point in the afternoon, you realize that you haven't been drinking water all this time. Taking off the mask is scary - it's the only thing that protects you. Of course, you can last longer: in West Africa during the Ebola epidemic, you spent hours in a stuffy suit without water. Another patient ...

By late afternoon, you need to eat. Restaurant across the street is closed. Right, everything is closed. But thankfully the hospital cafeteria is open. You grab something, wash your hands (twice), cautiously take off your mask, & eat as fast as you can. Go back. Mask up. Walk in.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

A few hours later, you need to eat. The nearby restaurant is closed. All closed. Fortunately, the hospital buffet works. Grab something, wash your hands (twice), carefully remove your mask, eat as fast as possible. You come back. You put on a mask. You go inside.

Nearly everyone you see today is the same. We assume everyone is #COVID ー 19. We wear gowns, goggles, and masks at every encounter. All day. It's the only way to be safe. Where did all the heart attacks and appendicitis patients go? Its all COVID.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

Almost all patients are the same. We suspect everyone has COVID-19. We wear disposable gowns, protective masks and goggles when examining each patient. All day. This is the only way to stay safe. Where have all the patients with heart attack and appendicitis gone? Only COVID-19 is everywhere.

When your shift ends, you sign out to the oncoming team. It's all #COVID ー 19. Over the past week, we’ve all learned the signs - low oxygen, lymphopenia, elevated D-dimer.

You share concerns of friends throughout the city without PPE. Hospitals running out of ventilators.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

When the shift ends, you write directions to the next team. COVID-19 is everywhere. Over the past week, we have learned to quickly identify symptoms: low oxygenation, lymphopenia, increased D-dimer. Friends are worried about the lack of personal protective equipment in the city, and this worries you too. Hospitals are running out of ventilators.

Before you leave, you wipe EVERYTHING down. Your phone. Your badge. Your wallet. Your coffee mug. All of it. Drown it in bleach. Everything in a bag. Take no chances.

Sure you got it all??? Wipe is down again. Can’t be too careful.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

Before you leave, you clean ALL your belongings. Telephone. Badge. Purse. A coffee mug. Literally everything. You drown in bleach, put it in a bag. You can't hope for anything. Are you sure you processed everything? Process again just in case. In such a situation, it is impossible to be too careful.

You walk out and take off your mask. You feel naked and exposed. It's still raining, but you want to walk home. Feels safer than the subway or bus, plus you need to decompress.

The streets are empty. This feels nothing like what is happening inside. Maybe people don’t know ???

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

You go out, take off your mask. You feel naked and vulnerable. It is still raining, but I want to walk home. It seems safer than taking the bus or the subway, plus you have to get away from it all. The streets are still empty - the exact opposite of the hospital environment. Maybe people don't know what's going on?

You get home. You strip in the hallway (it's ok, your neighbors know what you do). Everything in a bag. Your wife tries to keep your toddler away, but she hasn’t seen you in days, so it’s really hard. Run to the shower. Rinse it all away. Never happier. Time for family.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

You come home, undress right at the entrance (everything is in order, the neighbors know what you are doing). Everything is in the package. The wife is trying to keep the little daughter away from you, but the child has not seen dad for several days, and it is very difficult. You run into the shower. You wash everything off yourself. This is the happiest moment. Now you can spend time with your family.

You reflect on the fact that it’s really hard to understand how bad this is - and how bad its going to be - if all you see are empty streets.

Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don’t stop.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

You think about how difficult it is to understand how bad a situation is - and how much worse it will get - if you only see empty streets. Hospitals are about to overflow. Devices for artificial lung ventilation are running out. The sirens of the ambulances don't go off for a minute.

Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be stat notifications. More will be put on a ventilator.

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

Everyone we treat got infected a week ago or earlier. The number of patients will clearly increase overnight - this has been the case for several days. More people will go to the emergency room. There will be more patients requiring constant monitoring. Even more patients will need ventilation.

We were too late to stop this virus. Full stop. But we can slow it’s spread. The virus can’t infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don’t care as much about the economic impact as I do about our ability to save lives

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

We were late and could not completely stop the disease. But we can slow down its spread. The virus cannot infect those with whom it has not been in contact. Stay home. Social isolation is the only thing that can save us. I'm not as worried about the impact on the economy as I am about whether we can continue to save lives.

You might hear people saying it isn’t real. It is.

You might hear people saying it isn’t bad. It is.

You might hear people saying it can’t take you down. It can.

I survived Ebola. I fear #COVID ー 19.

Do your part. Stay home. Stay safe.

And every day I’ll come to work for you

- Craig Spencer MD MPH (@Craig_A_Spencer) March 24, 2020

Some say there is no virus. He exists.

Some people say that he is not that scary. He's scary.

Some people say he won't kill you. He can kill.

I survived Ebola. And I'm afraid of COVID-19.

Do what is up to you. Stay home.

Every day I will go out and work for you.