Dr. Colleen Smith
Two videos and transcripts
Posted for linking to an article - not emailed to subscribers.
Dr. Colleen Smith’s video from inside Elmhurst Hospital in Queens (NYC) was published by The New York Times on March 25, 2020. [Story]
Transcript
[Machine beeping]
The frustrating thing about all of this is it really just feels like it’s too little, too late. Like we knew — we knew it was coming. Today is kind of getting worse and worse. We had to get a refrigerated truck to store the bodies of patients who are dying. We are, right now, scrambling to try to get a few additional ventilators or even CPAP machines. If we could get CPAP machines, we could free up ventilators for patients who need them.
You know, we now have these five vents. We probably — unless people die, I suspect we’ll be back to needing to beg for ventilators again in another day or two. There’s a mythical 100 vents out there which we haven’t seen.
Leaders in various offices, from the president to the head of Health and Hospitals, saying things like, ‘We’re going to be fine. Everything’s fine.’ And from our perspective, everything is not fine. I don’t have the support that I need, and even just the materials that I need, physically, to take care of my patients. And it’s America, and we’re supposed to be a first-world country.
On a regular day, my emergency department’s volume is pretty high. It’s about 200 people a day. Now we’re seeing 400 or more people a day. At first, we were trying to isolate patients with cough and fever and be more careful around them, but we weren’t necessarily being extra careful around all the other patients. And then we started to realize that patients who were coming in with no fever but abdominal pain actually had findings on their X-rays and chest CTs that were consistent with this coronavirus, Covid-19. So someone in a car accident gets brought in and we get a CT scan of them, and their lungs look like they have coronavirus. We were seeing a lot of patients who probably had Covid, but we didn’t realize.
Ten residents and also many, many of our nurses and a few of the attending physicians got sick. The anxiety of this situation is really overwhelming. All of the doctors, it’s hard for us to get tested even if we want to, even if we have symptoms. We’re exposed over and over again. We don’t have the protective equipment that we should have. I put on one N95 mask in the morning. I need to have that N95 mask on for every patient I see. I don’t take it off all day. The N95 mask I wore today is also the N95 mask I wore on Friday. We’re always worried that we’ll be out of N95 masks.
What’s a little bit scary now is the patients that we’re getting are much sicker. Many of the young people who are getting sick don’t smoke, they’re healthy, they have no co-morbidities. They’re just young, regular people between the ages of 30 and 50 who you would not expect to get this sick.
So many people are saying it’s going to be OK, everything’s fine, we have what we need. And if this goes on for a month or two or three or five like it did in China, and we’re already this strained, we don’t have what we need. I don’t really care if I get in trouble for speaking to the media. I want people to know that this is bad. People are dying. We don’t have the tools that we need in the emergency department and in the hospital to take care of them, and — and it’s really hard.
In early June 2020, Smith and other New York doctors participated in a “live storytelling event” hosted by the New York College of Emergency Physicians.
From the event page:
On June 9, 2020 New York ACEP hosted a live storytelling (Airway) event. This storytelling initiative for emergency physicians marks the profound moments that make emergency physicians' jobs powerful.
Transcript:
Well, this is a little bit harder of a story for me to tell, I think, than a lot than some of the other stories I've told, but if I could distill into words what led me to share with The New York Times, which isn't easy and I've told a lot of versions of it. I've had to think really hard about really what it was. I think it comes down to that it was the emergency medicine doctor and teacher in me that's always asking what's the worst thing that could happen and what will I do if it happens.
This is also something that I talked to my residents about all the time to ask about their patients. And, you know, in this case as we came into early March, we thought we were prepared. We had plans. We had supplies. We had the CDC and the W-H-O, and we thought we had backup. And as it turned out it was too little and some of what we had that we thought would work was inappropriate and we really didn't I think we really didn't know what was coming at us until it hit us.
And really soon - maybe a week into March, maybe 10 days into March, it became you were totally underprepared and there was nothing I could do and as I looked at at you know what was the worst thing that could happen. It was so much worse and it was getting worse every day. And you know we as we struggled to protect ourselves and our patients, to find space that didn't exist, to find oxygen tanks that we didn't have enough of, and to find evidence to guide our practice to overcome an increasing wait time with more, more critically ill patients than we'd ever seen at once, I came to see that our struggles in many ways were unrecognized, and even unrecognized by some of the people who I felt should have recognized them. Or maybe they saw them but there was nothing they could do either.
And so my appeal to the media kind of became the only thing I could do and even when I did it, I didn't know that the worst was yet to come. My video came out probably two weeks before we hit our peak at Elmhurst. It came out before we had created our IDI ICU unit. It came out before the worst happen. So you know we didn't know when my video came out that we would give up on some of the measures to protect ourselves such as some of the Airway things we were doing in order to maximize the tiniest of hopes that a patient might do better.
We didn't know at that point that we would innovate to the extent that we did. That we would recycle and reuse items that were never meant to be recycled and reused that we would invent that we would call on maker spaces and 3D print shops. We didn't know that we would have to find it in our power to cycle between holding hands as surrogate family members and being the compartmentalizing doctors that were used to be to being at a rate that we never would have imagined. And we didn't know that we would see death on the scale that we never could have foreseen
So, you know, looking back on it today I'm kind of…I'm really floored by the juxtaposition of the bad and good and the depths and the heights that we experienced in this. I think even Sandy [another doctor participating in the Storytelling event] touched on this maybe a little bit…to just the — and I remember walking to work in the mornings and hearing the birds chirping in late March as spring came and having this sense of not knowing whether to appreciate that I got to go outside and walk to work and hear the birds or whether I should be mad that birds were chirping in the middle of this catastrophe.
So, you know, and then ultimately I kind of feel similarly about the ramifications of my New York Times video. This sort of attempt at doing something, at gaining some modicum of control. Truthfully I'm not sure how much was good and how much was bad in the end. So in n the immediate aftermath of it, I had this just amazing outpouring of support. Colleagues, friends, old friends who I hadn't heard from in years, reached out to me. Texted me, called me. Strangers sent letters. I got a package of homemade tea
We got CPAP machines sent to us because I guess the New York Times decided to put a lot of me talking about CPAP on the video. Um, and I walked into the hospital the next day to applause from people who I didn't even know, knew who I was and probably didn't know who I was the day before, you know.
And the one thing that really stands out to me out of all of it is that throughout the course of the next week or two, many people came to me and thanked me for speaking out when they could not.
So if I'm honest I think the one real anticipated a real unanticipated effect of this video was that in publicizing my own fears and my own experience with the situation I helped normalize some of the fears and experiences of the other people in the hospital who I worked with who feel heard. Because after all of it, there was a real palpable bump in the morale of the staff at Elmhurst. After that I could see that people began to take pride in their innovations and pride in the fact that they were coming to work every day and doing really the best that they could for their patients
It gave us and me as well a breath — space to take a breath and to pick ourselves up and press on with a really a renewed determination. So, you know, I'll really never know what help we might have had anyway, right? But one of the things about doing some crazy thing, like what I feel like I did, is that you know people were coming to help us. Supplies were coming. Everyone knew that we needed these things and they were working on getting them. Maybe they came a little faster. Maybe things happened a little faster.
But I do know that what my video did that's good is it ,it uncovered this community of New Yorkers and Americans who stepped out up and came forward in whatever ways they could, in ways that are much more heroic than putting some videos on New York Times and that is really just an awe-inspiring outpouring of effort.
But there were some probably some downsides too. I mean, I'm pretty sure I made the lives of my bosses a lot harder. I think one of them may be on this call so..And I I know that some of this outpouring of donation and support that came was a little bit too much for my hospital to handle. I mean, we were already working so hard to try to keep up with the Covid disaster and then on top of it to have to sift through offers of donations and support and figure out which ones were legitimate and which ones weren't, and what n95 masks were good. I mean, that was a lot of work and I didn't have to do most of it.
So you know I sometimes ask myself to what extent did I take people away from doing a job that could have helped us more by putting this out there and stretching an already-stretched system even thinner.
And I’ll also really never know to the extent to which my actions may have negatively impacted our public relationship with healthcare.
I mean that video was scary because I was scared. Did I scare people away from the ED? Did I help with that? Maybe. We've been asking ourselves where are the strokes and the stemees. You know, are doctors losing our jobs because — are we, doctors, losing our jobs because people are scared away from the ED and so we don't have as much work to do?
I mean, if I can take credit for helping us get help, maybe I have to take this hit a little bit too so, you know? I'm glad I stepped up. I think I helped people who mattered to me in the moment. But I don't know that all of that decision was the best thing and I certainly wouldn't call myself a hero for it.
So, I mean, I guess if I'm gonna ask is there a moral to this story, I don't know, you know? Maybe it's ‘with great power comes great responsibility’ right? there's a good and a bad side to everything and up and down.
To be honest, I didn't realize this would go as viral as it did or be — or that I would have as much power as I did in that moment and, you know, maybe it's just sometimes people need to feel heard to feel whole. And that's the one thing that I'm proud of of all of it is that I think I helped our health system in New York feel heard.
