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Kepiye Dokter ing Garis Sisih Ngadhepi Kepiyean COVID-19

Kepiye Dokter ing Garis Sisih Ngadhepi Kepiyean COVID-19

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In recent weeks, Jess’s worry has taken the form of an anxious anticipation. When people ask how she’s been feeling, as they often do these days, she sometimes responds with a story about the end of the first year of residency, when nine of her classmates decided to go skydiving over Hawaii. Jess and a friend took off in a plane about the size of a minivan, each of them strapped to a tandem instructor. Jess and her instructor jumped first. When they finally landed, exhilarated, her friend said that watching Jess step out of the plane had been the most terrifying part.

By the final weekend of March, when Governor Andrew Cuomo designated SUNY-Downstate a Covid-only hospital, Jess still had yet to see a confirmed case of the disease. Her days were spent, for the most part, on the phone with her suddenly house-bound patients, and on Zoom with her colleagues to prepare for the oncoming crush. The schedules for the new Covid-19 wards were changing every day, and Jess expected to start consulting on them at any moment. But that Sunday morning, while our kids were playing Just Dance Now on the Apple TV, she developed a dry cough. She immediately put on a mask, and, when it was time for lunch, isolated herself to eat. That afternoon I drove over to her boss’s house, to pick up a thermometer. (Ours was broken, and I had confirmed earlier in the day that there were none to be had for purchase anywhere in our neighborhood.) Standing on his stoop, at a safe distance, Jess’s boss told me that the networks through which information about Covid-19 was travelling, though faster now because of the Internet, reminded him of the early days of the AIDS epidemic, when he had been a young doctor. “It was just everybody asking each other what they were seeing,” he said.

Later that night, I started feeling sick, as well. My symptoms were nowhere close to unbearable, and I had none of the now-classic Covid-19 triad of fever, cough, or shortness of breath. Instead, I had a dull ache behind the eyes, coupled with a general weariness. It was the sort of thing that, in another season, I’d have written off as an obnoxious but manageable cold. On Tuesday, however, Jess was able to get tested for Covid-19. The next night, the chief resident texted her the result: positive.

One of the strange and unsettling features of Covid-19, as a disease, is that it appears to progress in a nonlinear fashion: people often feel bad, and then better, and then bad again. The possibility of a sudden downturn, it seems, is one that can’t be dismissed until you recover completely. For now, though, both of us have been lucky. Jess has not felt especially well, but she has been able to spend most of her daylight hours on the phone, helping her patients figure out how to get the routine medical services they need at a time when they can’t physically visit her clinic. Mental-health services, she says, are in particularly high demand: her patients, especially those with underlying conditions, are terrified that they’ll get sick, and that anxiety has become its own problem in need of resolution. Despite being able to do a version of her job from home, however, she is impatient to get back to the hospital, not least because she will likely have some immunity to the virus. By Thursday evening, SUNY Downstate had admitted more than two hundred and fifty inpatients with Covid-19, and, on Saturday, the president of the hospital told CNN that his supply of surgical gowns was so low that his medical staff would have to start using rain ponchos and garbage bags instead. “We’re in the middle of a global pandemic, and everyone wants to feel useful,” Jess told me. “For me, the thing I can do to be useful is to be back at work.”

Hooman Kamel started his Covid-19 rotation two weeks ago. In the days before he began, he told me, “I was just so despondent. It was so dark. And then I started, and I’m, like, all right, you know? Once you get into it, you see what you’re dealing with. I’ve been feeling much better. It’s still a terrible situation, and it’s stressful as hell. But it did feel like some of that gloom lifted.”

When his rotation started, Kamel decided to shave his head, as he had during residency. In part, he said, he was nervous to spend the half-hour it would take to get a haircut in close proximity to another person, but, like Elizabeth Kaplan, he also felt a deep connection to his years of medical training. “It just felt, like, O.K., if we’re going back onto that kind of footing, let’s do it.” To protect his wife and kids—as well as his mother, who is seventy, and who’s been helping with night feedings—Kamel moved out of his apartment in Manhattan and into one owned by a friend, in Brooklyn. Each day, while he was at work, his wife found his car and delivered a few basic necessities: T-shirts, trash bags, beer. Eventually the strain of that separation became too much: last Monday, Kamel moved back home.

“We’re technically on the front lines, but there are other people who have it much harder,” Kamel said, when I asked how he spent his days on the I.C.U. Paramedics and emergency doctors, he said, “are the ones who are working in much less controlled conditions. They really have no idea what they’re going to see. And then the airway team doing intubations—it is a tough thing, in general, in critically ill patients, but to be doing it with the layers of protective gear they have to wear, and the risk to themselves . . . ”

Kamel’s I.C.U. was one of the first in the hospital to be dedicated entirely to Covid-19 patients. The unit got its first case on March 15th, and by the time he showed up, on March 24th, all twelve of its available ventilators were in use. The ventilators will not cure anyone, but they will, with any luck, keep patients breathing long enough for their immune systems—at the moment, the only proven treatment for Covid-19—to eradicate the disease. “The virus causes very diffuse pneumonia, all throughout the lungs,” he told me. “And then the body’s response to the virus, inflammation, causes damage. So the lungs aren’t functioning well, and it’s very hard to keep the oxygen levels in the blood up to where they need to be. And sometimes the ventilator settings you have to use are not comfortable. So most of the challenge is: how do you use the ventilator in a way where you can get enough oxygen into their blood without causing more damage to the lungs?”

Kamel has had no trouble getting gowns, gloves, or procedure masks, but his hospital, like most, has a shortage of N95 masks. “Everyone at my place can get at least one N95, which they can then reuse,” he said. One mask per day, I asked him, or one per week? “They just get one,” he said. “It’s not ideal.” At the time we spoke, Kamel himself had three N95s—two of them sent to him by the primary-care physician in Minnesota—that he was cycling through. Each day, he wears one mask for the duration of his twelve-hour shift. At the end of the shift, being careful not to contaminate its concave surface, he puts the N95 in a paper bag and hopes that the forty-eight hours until its next use will be enough to kill any surviving virus. Then he goes home and puts on another mask to be around his wife and sons. “I am wearing a mask at all times, which is pretty terrible,” he told me. “I think the smell of surgical masks is going to be seared in my brain for life.”

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