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By Mr. Defy & Miss Defy
Before Miss Defy and I left for New York we contacted 15+ organizations. For what seemed like an all-hands on deck national emergency, we were having a hard time getting into the game. We finally found a company that was building a makeshift hospital in the city and needed all types of medical personnel.
We were ecstatic. Instead of sitting around being frustrated that we weren’t helping, now we could dive into the fight. I remember feeling grateful and amazed that I had found a partner who could share my enthusiasm for getting to the front.
Mr. Defy and I embarked on our trip by taking two almost empty flights, each person having their pick of 5 rows in front or behind. When we arrived in NYC, the airport was barren. There were a few people scattered about, everyone wearing some sort of mask, and a sense of trepidation abounded. Everyone side-eyed each other thinking “What is this person doing traveling right now”? As we took a taxi into the magnificent maze of bridges and skyscrapers, you could feel the emptiness even if visiting for the first time. We had arrived in a ghost town.
After we checked into our hotel, we prepared to leave for the orientation. Miss Defy asked if we should bring our scrubs, and I said “absolutely” (thinking that I didn’t want our lack of wearing scrubs to be the only reason we weren’t allowed to treat patients on the same day we arrived).
Well, we could have left the scrubs at the hotel room for that night and more nights to come. The pop-up hospitals weren’t ready for patients, so we spent the next couple of days building hospital beds, unloading medical supplies and setting up nurse’s stations. We were aware that the rest of NYC was overwhelmed with patients, so I tried to convince myself that making a bed now would lead to helping patients in the future.
While we were helping set-up the facility, Mr. Defy and I learned more over the next few days. The initial goal of our location was to take non-Covid-19 patient overflow from local hospitals to offload the overall patient burden. However, due to the overwhelming number of Covid-19 infected people, our facility (and all others in the city) quickly shifted to taking only Covid-19 positive patients.
We prepared mentally for the possibility of pure heartbreak. We envisioned an overwhelming amount of critical patients and an understaffed crew of healthcare workers struggling to keep up. We prepared to be face to face with those who would die without family present, and thought about how we could best utilize our skills and empathy to help as many as possible. We had at least a hundred healthcare providers from all over the country with specialties ranging from ICU to dermatology.
A few days into our deployment we finally started to receive patients. First we received 4 patients and stayed there for a couple days. Then it was up to 11. During night shift a few days later the count was up to 20, then 23. After 9 days there were 30 patients. While the news was saying the hospitals were overwhelmed by 1000s of patients, we had just 30. It didn’t seem like we were making much of a dent.
In addition to the few patients, I was also growing concerned about the organization’s standards on personal protective equipment (PPE). The building was split into the hot zone (where the patient beds were located), warm zone (the area we took on and off our PPE) and cold zone (area for sitting away from the patients). In theory the zones are supposed to be separated, but our facility had some intermixing. If patients had to go to the bathroom they would be led through the warm zone, coughing while they walked by workers with less PPE on.
I was hoping we would be getting full body tyvek suits, but we instead received 3/4 length porous, hoodless gowns that stopped at the knees. For larger people, the gown would expose the entire backside (the same backside that would then sit on chairs in the cold zone for lunch). I remember feeling envious of a warehouse worker who cut a hole in a trash bag to wear as a poncho in the rain. I bet he didn’t even have to worry about the porous material or getting his exposed back wet.
It was unsafe. Don’t get me wrong, we went into this mission knowing we would be exposed to Covid-19 and had discussed that we may likely leave sick. However, a blatant disregard for employee safety was not what we imagined. All over the country, healthcare workers are short masks, gowns, face shields, goggles, you name it. However, we were told prior to coming to NYC that ample PPE would be provided at this facility. We were told only to bring scrubs, and that they had plenty of PPE. This was not the truth.
The first red flag came when the N95 mask fitting only had one size available. These normally come in at least 3 sizes, but they were just trying to make a one size fit all approach. I found a way to make my extra large mask “fit” by clamping my nose shut and wrapping the elastic bands around my ponytail. I felt I could deal with the ill-fitting gear until the promised smaller N95s were delivered. However, when I asked for another mask 7 days later, I was told that there were none available, and I should keep reusing the same one. This being after they just explained how our single-use mask was contaminated once we were within 5 feet of a patient (aka everyone in the hot zone).
Further, in our initial orientation we were told that 80% of healthcare worker infections come from taking on and off PPE. Then, as the days went on, the organization quickly began running out of gowns. The PPE safety demonstration moved from showing how to properly throw a contaminated gown and gloves into the trash, to being changed on how to “properly” fold your gown for re-use later. Double-gloving was discouraged, yet the gloves did not fit on the gown properly so had to be taped to my wrists.
Even with my frustrations with the lack of patients and poor PPE standards, I was grateful we were still able to treat patients. We had spent so long trying to avoid this faceless invader- resisting the urge to itch your face, changing travel plans and practicing social distancing. For something that was playing such a large role in our lives, in some ways it still felt like a fictitious nightmare out of an apocalyptic novel.
And then the virus was suddenly right in front of me- a patient with confirmed COVID-19. I don’t know what I expected, but I began to see the human story behind the infection rates. A Fedex warehouse worker who had been in the hospital for two and a half weeks now needed another two weeks off work to quarantine at home. An Uber driver from Nepal who was worried because his wife was now feeling sick, but if she went to the hospital there would be no one to take care of their children. A man who was in between homes and may not have originally had COVID-19 but decided to stay longer in the hospital for the 3 meals a day and warmth.
When I finally went to the “hot zone” it was a taste of what I expected all along. We had many patients who were mostly recovered, but also a few ICU patients with multiple medical conditions needing close monitoring. I had joined an interdisciplinary team to treat people with a disease we were all still trying to figure out. There were many theories, studies, diagnostics, and treatment plans. I was finally getting to help in the way I had anticipated.
My favorite patient was a woman in her 80s who did not speak English, but you could tell she was a beautiful soul. She, like everyone else, was not allowed to have family with her. This was someone’s wife, mother, grandmother and friend. Surrounded by people in goggles, face shields, and pastel paper gowns who were trying their best to not contaminate themselves. I thought of how impersonal and cold it must feel to not be able to communicate, touch, or really look into the eyes of your healthcare provider. I reached to touch her hand to show that I was here for her, and the smile returned will be one I will not forget.
After this time in the hot zone I was getting amped to see more patients and again mentally preparing for the foreseeable chaos of hundreds of patients. This, it turns out, was a vision that would never come to fruition.
I felt engaged while treating the patients, but because the organization hired enough medical staff for 500+ beds, the 30 occupied beds had more than enough attention. So when the organization offered for a handful of people to be sent to the hospitals, I jumped at the chance. I knew what we had at our makeshift hospital- higher risk of exposure because of inferior PPE and sitting around (in contaminated areas) waiting for patients. My supervisor warned me that he had no idea what work I would be doing at the hospital, and said I most likely wouldn’t be practicing within my full scope (so I might be doing admin work). I told him I didn’t mind, anything to get closer to the frontlines.
He put me on the list and told me not to come into our pop-up facility because I could be deployed to one of the physical NYC hospitals at any moment. I waited for 4 days, each day being told I might leave imminently, that the organization was setting up my transfer. I finally resorted to contacting the hospitals myself. I called 8 of the hospitals and sent out 15 more emails without any luck. I felt like screaming, “I’m a medical worker, and I’m here to help! Where do you need me?” but the transfer never materialized.
While Mr Defy was trying to get into a hospital, I stayed at the makeshift hospital over the next four days. Every day we were at the facility we would be told “we are going to get patients soon” and “we are almost ready”. We would wake up and get prepared to see a slew of very sick people and even had a refrigerated truck outside that was staged for deceased bodies. Then we would wait…
As to why we didn’t receive patients, it’s not exactly clear and involves higher level decision-making. After talking with some of the top brass and witnessing for myself on the ground, I think it was a myriad of reasons. For starters they were building a hospital from the ground up. Oxygen had to be installed and piped to all of the 500+ rooms. All the supplies needed by a hospital had to be ordered from gauze to heart monitors (our first defibrillators arrived 8 days after we landed). Some said that there were political considerations involved with who got credit for “opening” the hospital. Others said that the hospitals wanted to give us patients, but the ambulances couldn’t find time to do inter-facility transports.
I would like to think it was a mix of all the above factors and did not involve an organization getting a fat government contract and then limiting their exposure by not doing very much, but I don’t have all the answers. They took so long the curve began to flatten. Overwhelmed hospitals somehow found the capacity to treat the floods of patients, so any slowing would seem better than before.
I contacted friends working at local hospitals to find out if everyone was feeling the same as us. As it turns out, the hospitals were still slammed and over capacity. They echoed stories in the news of being short on providers and space. As we were waiting for our facility to get its stuff together, NYC hospitals and other pop-up clinics seemingly scrambled to stay afloat as death tolls increased daily.
I felt guilty. We would have worked for free, in fact, I signed us up for at least 5 volunteer organizations before taking this contract, but no one ever returned my calls or emails. This contract seemed like the best opportunity to really help at the epicenter of this crisis. Now here we were, medical professionals being paid to sit in a facility to work with patients only every few days, while there were hospitals in this very city who could use our help. What is wrong with this picture?
Like Mr. Defy, I eventually tried to get transferred to a local hospital, but to no avail. The pleas from politicians asking for anyone and everyone to come help is just not realistic. Our healthcare system does not operate that way. There are regulations for each state and each hospital system within that state. Different onboarding processes, procedures, electronic medical records, and safety videos to watch. We were told many times by our organization that “if we weren’t in the US” than this or that would have been done. NY was able to lift the state license requirements to get healthcare professionals from all over the country (you just had to have a license in your home state). However, the layers of bureaucracy within hospitals made it impossible to simply just go to the place of most need.
After two and a half weeks of mostly sitting in NYC with minimal patient contact, we talked with our supervisors and put in our resignation letters. Risk a lot to save a lot, risk little to save little. My wife and I were both content to put our health on the line to help others, but to endanger our lives with an over-staffed hospital treating lower acuity patients with sub-standard PPE? It was time to go home.
And we feel like we can continue to help at home. COVID-19 cases have increased in Colorado since we left and there are a number of ways we can help- through returning to our regular jobs, donating plasma (because we were most likely infected given high-risk exposure) or helping screen people as the country reopens.
To portray myself as any type of hero in NYC would be entirely misleading. I felt like the majority of what I did in NYC was sit around and wait to go treat patients. I appreciate it when people say they’re grateful for what Miss Defy and I have done by going to NYC, but the truth is we didn’t really help that much. I appreciate the sentiment if it is directed at the decision to go, but it’s misplaced if it’s directed at all the actions we made on the ground.
I’m bummed because I feel like we really tried to be part of the COVID-19 response. I feel remorse when my friends and family say they’ve been watching the news about New York and they say it must be so crazy there. Actually, I treated a handful of patients every few days and kept waiting for the promised patients to arrive… If the media was calling our response to COVID-19 as our generation’s WWII moment (which I’m not convinced they’re the same), then I was doing clerical work in the United Kingdom while others were storming the beaches of Normandy.
Despite our inability to get to the area of greatest need, there were many positives in going to NYC. For starters, there are a lot of people in the world willing to help and make a difference. I met many inspiring health professionals from all over the country who came to lend a hand, knowing they could very well contract a deadly virus. Secondly, the community of NYC was amazing and would cheer on their healthcare workers at 7pm every night. You could hear the cowbells and the cheers from our hotel, and we were joyful that the city had embraced those hospital workers who were fighting with patients daily. And lastly, our family and friends who sent us messages and words of encouragement were a constant reminder of why we did this in the first place. We wanted to use our skills to help others, and we hope we can use what we learned with this experience and bring it back to our own community.
