Six Months In

Inside a New York City ER: Then and Now

Lessons from the Covid-19 frontlines through the eyes of Dr. Craig Spencer

This story is part of Six Months In, a special weeklong Elemental series reflecting on where we’ve been, what we’ve learned, and what the future holds for the Covid-19 pandemic.

Around six months ago, New York City was seeing its highest caseload of Covid-19 cases yet. Emergency rooms in the city were packed. There was a shortage of personal protective equipment for physicians, not to mention the fear of running out of ventilators for patients with cases so severe that they required supplemental oxygen. But, about half a year out, things in New York City are slowly making a change.

Craig Spencer, MD, is the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center. Before the coronavirus hit, he spent between three and six months each year helping with humanitarian crises around the world. But since February, he’s been grounded in New York City, working three days a week at the hospital’s emergency department; each shift about 12 hours long.

During the thick of the coronavirus spread in New York City, Spencer tweeted about how his days in the emergency room were spent tending one Covid-19 patient who needed supplemental oxygen then moving to the next nearly nonstop.

Today, as Spencer winds his way through the city streets on his way to work, listening to a podcast or some music, he’s watching the energy of the city start to come back. Whereas hardly anyone was outside during the peak of the pandemic in late March and early April, more residents are walking around, mostly masked. Restaurants and cafes have offered outdoor seating for their patrons, spilling human life into the streets and sidewalks. “People are trying to retain some sense of normalcy while continuing to remain safe,” he says.

“I think we got things under control, but only after we let things get out of control.”

Spencer enters the hospital and puts on an N95 mask underneath his surgical mask. There’s quite a bit of activity around 8 a.m. as the day shift takes over from the evening shift. “Every computer is surrounded by two people talking about vital signs, different patients and treatment plans, and consults,” says Spencer. He catches up with his colleagues while being mindful of their time. “You don’t want to linger too long. You want them to get out of there and go home,” he says.

He looks at the patients that he will take on first and talks with his colleagues about how each of them will be treated.

As he tends to his patients during the first half of his shift, Spencer gets the occasional notification on his work phone that there’s a patient who is really sick or a patient whose blood pressure has dropped significantly or someone who just had a stroke. “We drop everything, and we’ll go and evaluate them. That can happen as much as once every hour.”

In March and April, Spencer and his colleagues were seeing predominantly patients with the coronavirus. “It was Covid all the time, and when we saw someone [who didn’t have] Covid, it was like, ‘What the hell were you doing here?’ Not because we didn’t want them to be here; it was just so surprising for us,” he says. Now, Spencer and other emergency room physicians at Columbia are still seeing Covid-19 patients, but it’s becoming increasingly common to see folks with diabetes, heart attacks, or sepsis — their “bread-and-butter patients,” Spencer calls it. “We’ve had a nearly complete return to that. The difference has been we’re still in goggles and masks and hypervigilant about Covid in every single patient that we see.”

Spencer attributes the turnaround in Covid-19 cases in New York City and the emergency department in his hospital to a number of factors. For one, the city “got hit on the head” so early and fast that people quickly recognized how bad catching the virus could be. “People started listening to the public health guidance” — such as practicing good hygiene, wearing a mask, and staying at home — “and that quickly changed once we started worrying about our hospitals getting overwhelmed,” he says. “People in a lot of communities saw what was happening with their friends and family and made that switch in their behavior. I think we got things under control, but only after we let things get out of control.”

Hospitals, like NewYork-Presbyterian and many others in the NYC metropolitan region, had to adapt. Physicians from other specialties, like urology and cardiology, who would rarely visit the emergency department, started staffing the emergency room daily to provide support and expertise. Dealing with a pandemic isn’t something that hospitals are prepared for, Spencer says, and it took some time for the hospital to get the necessary protective equipment and ventilators and for physicians to come together in providing expertise and psychosocial support to each other. “There was an adaptive process that took some time, but once it got going, I think we individually as providers and we as institutions learned pretty quick about what we needed to be doing to better respond,” he says. There’s also the mental resilience and support system that has naturally developed out of everyone working together, he notes. “It’s really remarkable.”

Spencer knew that collaboration was necessary from working on infectious disease outbreaks across the world, and his experiences in West Africa fighting Ebola and hepatitis E in Chad. “It’s not just the physical exhaustion, but also the mental exhaustion that’s going to build up every day,” he says. “That’s one thing I was able to bring from my previous international work, where there were limited resources for dealing with diseases that we didn’t know as much about. That really prepared me well for the early phases of Covid.” On one trip from West Africa, Spencer ended up getting Ebola — an experience that brought him significant stigma at the time and has primed him to be more hypervigilant in taking the precautionary measures to avoid exposure to possible pathogens, Covid-19 included.

At the end of his shift, Spencer signs out, disinfects his phone and other medical equipment that he’ll take home with bleach, removes his N95 as he heads out the door, and begins the walk home.

He’s been walking to and from work for over a year — even in March and April when he’d finish a shift exhausted. “It certainly would have been easier to get on the bus or subway, but I didn’t want to be in an enclosed space,” he says. “I did need that outlet to come down and process [the shift], and that 20- to 25-minute walk was the perfect way to do it.”

Once he gets home, he strips in the hallway. His scrubs and mask go in a bag, he disinfects everything with a container of Lysol wipes he keeps immediately inside his apartment. “I try not to bring it any further than my apartment doorstep,” he says. Once inside, he immediately beelines for the shower; his family’s safety comes first. At home, his wife is happy to see him after a long day of balancing work with parenting their two-year-old daughter. Spencer helps with dinner, has a beer, and catches up on coronavirus developments.

Moving forward, one of Spencer’s worst fears is that people will continue to spread misinformation about the virus. Spencer may treat a patient with coronavirus who literally is trusting him with his or her life. “But as soon as they leave, they may flip through Facebook and say, ‘You know what? The doctors are all wrong.’”

Although he’s hopeful scientists will learn more about the virus and how it affects human health in the coming months, Spencer is less optimistic that there will be big structural and political changes that will profoundly alter the trajectory of the pandemic.

“The U.S. will continue to be an outlier in terms of how poorly we’ve responded to this, and the magnitude of how much we’re impacted by this,” he says. “We’re going to continue to have case numbers that certainly are not going to magically disappear. We don’t know who is going to be infected and what area is going to be infected next, but it’s inevitable that this virus is going to continue to infect communities throughout this country.”

In New York City specifically, Spencer is both hopeful and cautious. “New York City, despite its slow start, has been really cautious in re-opening, which has helped keep numbers low. But as schools and colleges reopen, and things like indoor dining resume later this month, it’s hard to not be worried that we could see more cases in our ERs soon,” he says. “I don’t suspect we will get to anything like we saw in March and April, but I am bracing for more cases in the coming months.”

The rapidly evolving situation will invariably stretch him and his physician colleagues all over the country — a challenge that, by then, they will no longer be strangers to.

Journalist based in Seattle.

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