Diary of a Trauma Surgeon: 10 Weeks of Covid-19 | WIRED

i'm annie onishi and i am a trauma surgeon and surgical critical care doctor in los angeles california and today is thursday march 19th hello again it's may 19 2020. for the past 10 weeks i've been chronicling what my life has been like during the copa 19 pandemic live from my apartment good morning it is wednesday march 18th thursday may 14th it's been really busy a week's worth of night shifts made myself a nice stiff drink this is my story as of today at 12 p.m there's in los angeles county 231 cases to deaths good morning it is wednesday march 18th it's about 5 45 or 5 50 in the morning i'm walking into work right now i feel like when you're a kid at the beach and you see a big wave coming and you know it's going to knock you down and there's really nothing you can do about it everyone's sort of waiting for the onslaught that's coming in the next couple of weeks once the medical icu has reached their capacity of 50 patients then they're going to start to get admitted to my unit the trauma and surgical icu so we're getting ready for it everybody's a little nervous everybody's a little quiet the place is empty happy wednesday everyone i take the five to work which is i guess one of the busiest freeways in america and there's no traffic so that is all the information that you need so the n95s are hard to come by we are being asked to reuse them five times before we dispose of them if you take it off you touch viral particles it gets soaking wet in there it's disgusting to ask us to reuse it is like insane recently one educational effort that came through my icu was the medical icu nurses teaching these surgical icu nurses how to what's called prone a patient when a patient needs to be prone we order a special bed from a special company that straps them down and rotates them and they just lie face down so we are learning how to manually prune the patients so flip them ourselves and keep them flipped we in this field are pretty much all assuming that we will all get covid19 we will all at some point be infectious if we're not already so believe it or not we are actually running what's called a skeleton crew there are actually fewer doctors and residents and fellows and staff in the hospital than there normally would be so that when the rise and crest of this pandemic does hit our hospital we'll have people who are home and well and healthy and ready to go it is friday march 20th it's 5 50 in the morning getting ready to go to work today is my first trauma call since the shelter and place order in los angeles started and since all these crazy measures and and since the outbreak really hit los angeles so usually you know in my day-to-day life i'm an icu doctor but today i have my trauma surgery hat on so uh we'll see how things are different today from a from a trauma perspective let you guys know i hope that i have continued to stay positive and keep my head up all right it's just scary you just have to um you just have to go to work every day and you have to wash your hands and and do your best and listen for the plans and and and speak up if you see something that's fixable and and just you know take care of the patients today on trauma call it has been q u i e d which is a word we don't usually use around here one thing i hadn't thought about until the last couple days is what happens if my hospital is full of coveted patients and i don't have an icu bed or an operating room or space or resources for a trauma patient that comes in you know stretching the system means it affects everybody whether you have covert or not and that's not really something i hadn't thought about until today on trauma call i will talk to you guys next time bye good morning it is i don't even know what day it is it's the 24th of march i just wrapped up a 24-hour shift we were really busy with non-covered patients so again it was like another normal kind of regular day for me i've noticed i am starting to have something that feels a little bit like survivor's guilt when i hear from my friends back in new york who are working at hospitals where they're out of ventilators and they're starting to turn operating rooms into icu pods and i feel bad because i'm not like directly helping with the covid patients and and with this national or worldwide crisis and i i still have other patients to help so try to focus on helping them and try to stay positive and wash my hands and stay home when i'm not at work that's about where we are today remember when i was complaining about not being busy it's one o'clock in the morning and we've been operating non-stop on gunshot wounds go figure hey everyone it is friday march 27th it is my quarantine day my day home and away from the hospital i have applied for emergency privileges back at a large hospital system in new york so that in the event that um things don't get super busy here in la i can go back and help be it mop the floors or adjust ventilator settings who knows but yeah that's where we are today just still watching and waiting and you know who knows what's going to come in la if obviously my first priority is my patients and my colleagues here but if it gets to the point where it's clear that more help is needed elsewhere then i'm ready to do that um that's where we're at today it is saturday march 28th and i'm on trauma call we did one gallbladder this morning um i've had a couple of non-urgent trauma consults it's been pretty slow again and it feels really frustrating and it feels um terrible to have a skill set and know i could help but um but i'm not physically there right now and we why can't we organize a better way to to get resources where they're needed when they're needed so that's what's on my mind today just waiting waiting waiting it is thursday april 2nd and it's been really busy and i realized i hadn't made a little entry in a few days so i thought i would take a few minutes and give you guys an update about what's been happening there are a fair number of intubated patients with covalent in my hospital now you know they're taking up all the negative pressure rooms first and then sort of spreading from there i will say the first time i walked past a patient who i knew had covered in my icu it felt pretty surreal because this is something we've been preparing for and worrying about and waiting for and then finally one day here was a regular person who was minding their own business and got this horrible disease and now they're here in our unit the wave is here it's it's starting up it's still been exhausting it feels like we've been doing this for years but it's only been a couple of weeks and it hasn't even really hit us yet a couple things that have changed uh i sit here now our little call room this is like normally just where we sleep on call it's kind of like just this depressing bed normally i would sit in our trauma office but i'm trying to socially distance so i sit in here all day and hide that's about it it's friday april 3rd it's about 1 pm in the afternoon today at my hospital the medical icu is completely full we got our first patient who's coepositive who i am now primarily responsible for i'm the main doctor for the covid patient it was a pleasure to meet this man he is a nice man middle-aged otherwise completely normal completely healthy but just got sick about a week ago and couldn't breathe and came to the emergency room and his oxygen levels were really really low right now he's on a little bit of extra oxygen therapy but his breathing rate is very fast so it makes us worried that he's may at some point need a breathing tube so that's why he's here in the intensive care unit probably more where that's coming from so from now on the code patients who come in through the ed who need icu care are gonna come to my unit so that's where we are this particular patient came to the er with a week of symptoms of shortness of breath actually he had a lot of gi complaints so diarrhea nausea vomiting taking care of this guy is definitely different than taking care of my other typical trauma or surgical icu patients who need stuff done to them this guy just needs supportive care and monitoring close monitoring it is april 8th wednesday a week's worth of night shift so i got my schedule pretty well flipped at this point leading that nocturnal life trauma has been steadily busy i've had a couple of big trauma cases this week including a young man who got shot directly in the heart who saved him so that was a pretty good case and mickey's still been full so we've also been emitting covetation so that's also been steady tonight the big to do will be right around 10 pm we'll have to flip the patients onto their stomachs so they spent a few hours this afternoon on their backs getting all the nursing care but they spend most of the night and most of the day on their stomachs so i have to sort of help out with that it's very labor intensive it involves about six or seven people and that's it it is friday april 10th and i'm about to go in for the night shift but i wanted to introduce everyone to my new orchid tony named obviously for dr anthony fauci a man of science and a hero for our time and tony was a gift from a very generous local florist who brought this morning's brought pallets and pallets and pallets of the most beautiful orchids you ever saw and they were giving them out to the nurses and doctors on the night shift leaving the hospital this morning was amazing we know that these small businesses are hurting right now they have to be and the people who own these businesses are taking time out of their day and money out of their budgets and who even knows where they're getting this money to try to help us and cheer us up and keep us positive and it's really amazing and it's an honor and a privilege to take care of patients and this is we're just doing our jobs that's how i feel at least i'm just doing my job so all the generosity that's been shown really feels above and beyond and um i really appreciate it first of all and i know uh i hope tony has a nice life here we'll see [Music] good morning it's friday april 17th and i just took my mask down just for a minute to say good morning and hello and heading into the hospital for a week in the icu and um i've heard it's been pretty busy and pretty crazy so much so that our trauma center was actually on diversion yesterday which means that ambulances and the firefighters were not bringing traumas to our hospital because our units were so full so that's a big difference from when i last rounded a week ago so we'll see how the day goes yeah that's it talk to you guys soon it is april 20th and today is a really awesome and really good day and i'm super happy a couple hours ago we extubated which means remove the breeding tube out from my first covey patient which i'm just looking at the chart now he was admitted to my icu on april 3rd he's had the breathing tube in for like almost that entire time and today we took out the reading tube and he looks amazing he looks like a million bucks so could not be happier feels like a really big win um we've had a rough couple of days with a bunch of really sick patients and some covid patients taking good steps forward and some uh just not making any progress whatsoever and that is incredibly frustrating as a as a doctor but he looks great and i'll take this big one and uh the first thing he asked for was a tamarindo jarito a type of soda that's very popular around here so if you guys told him if he does well and he continues to breathe nicely that i'll bring him on maybe a little later tonight or tomorrow so big win the three p's in taking care of these folks is uh proning paralysis and patience because you want to fix the numbers and you want the patient to get better but sometimes it just takes a long time and that's just really different from trauma and surgical critical care another code patient of mine is doing very very badly and pretty much failing every therapy that we have he has by definition ards the acute respiratory distress syndrome we have him paralyzed to relax all his muscles so the machine can breathe more efficiently for him and we have him prone which means he's lying on on his stomach and he's not doing well his oxygen levels are extremely low and there's blood coming out of his endotracheal tube and we consulted some of the cardiothoracic surgeons at our hospital for consideration for ecmotherapy ecmotherapy is a machine that basically replaces the work of your either your lungs or your heart and your lungs it's pretty much a last resort so the guy's not doing well it has been an absolute whirlwind and a real learning experience and pretty exhausting we're thinking about this patient tonight and hopefully he's doing better in the morning but we'll see [Music] i've been reasonably busy there are a couple of different national groups and bodies keeping track of how individual hospitals are doing taking care of the cove patients and so i got roped into being the person who goes through the charts and types in the lab values and the age and the birthday and the which medications were given on this day um so i'm i'm doing that it is taking forever it takes probably about an hour per patient you know it could be worse i should be grateful that um you know the the pandemic hasn't struck my city of los angeles so badly that i am able to stay home and do data entry as opposed to being working you know 24 7 in a crowded icu so i guess that's the silver lining and probably do another couple hours of data entry and then uh head back to the netflix coming to you live from my apartment you know i remember back in march i i sort of made the analogy of like a wave that's coming and that was probably true in a place like new york but here it's less of a wave more of like a slowly rising flood you just kind of stand here watching the numbers creep up and up and up the medical ic was full surgical icu is busy and we still have a handful maybe five or six um covered patients it's been this whole time it's been 15. but that's just going to go up as social distancing restrictions are lifting um which you know i i want the economy to get going and i want people to have their jobs and i i want to make moves forward but it's hard to justify that when i know that the testing in order to make this happen is not there the contact tracing in order to make this safe is not there it's a shitty situation and uh i'm feeling it and i'm looking forward to get back on service on monday um so this weekend probably just some more uh reading relaxing let me go for a run early in the morning with my face covering and just trying to stay positive [Music] today was my second day back on service in the surgical icu um i am tired already after two days on service which is not good for me i usually have a lot more stamina than that but just been running around like a damn headless chicken taking care of all these coveted patients they're really um they're very i'm they're they're high maintenance um the critically ill covered patients need a lot of uh tinkering lots of little adjustments here and there and then checking to see whether your intervention had a good effect or not so our census right now is about 19 patients or 20 patients something like that um half of whom are half coveted and of those patients about half of them are intubated of those intubated patients uh two or three of them are i would classify as critically critically ill all the therapies that we're doing with the ventilator and all the medications are now working and their lungs are just impossible to to ventilate and uh their oxygen levels are insanely low and slowly but surely other organ systems start to fail so their heart starts to fail their kidneys start to fail and it's uh it is like an impossible spiral it's really frustrating the rest of our unit is sort of um sort of normal for us just your typical car crashes stab wounds gunshots just a year ago i thought that stuff was really hard and it took all my mental energy but now these days these trauma patients are like super easy been a crazy couple of days um hopefully things settle in a little bit this week i have some good help from all my colleagues and my co-workers and my co-fellows so yeah just hanging in there today is thursday may 14th it's five in the afternoon it has been a really hard couple of days we've had a couple of our copic patients get really sick and a couple trauma patients just be really really sick also and then everybody's been working really hard to take care of um you know like the three or four super super sick people in the unit and then today um three of them died it is just it just sucks and morales you can just i feel really bad for my nurses you just walk in and the body language is very defeated and it's quiet and um we help a lot of patients and um there's just some that we can't help and it's really it is very frustrating it's been tough and how can life go on when everything like that is still happening here that's today uh just taking a little break getting a little peace and quiet and uh have a few other things to check up on but just needed a minute before we get back out there doing god's work you know hello again it's may 19 2020. tony the orchid is looking amazing he's starting to drop the flowers which i'm told is a natural part of the process and most importantly these are very thick green roots so that's how you can really judge the um health of an orchid plant is by the roots i will be forever grateful that this happened in a certain way because i think that the silver lining of this is it's going to help me take care of patients going forward believe it or not today is thursday may 21st it's 6 30 p.m and i'm just waking up and having my coffee it has been insanely busy this week trauma-wise at night bonkers a couple nights ago um we had probably six or seven people all stabbed in separate unrelated incidents had a guy like he was like on drugs or something stabbed himself all over his body he got himself in the crowded got both eyeballs that guy was really messed up we had um two patients come in in full cardiac arrest one from a gunshot wound to the chest one from a stab wound to the chest and then not even an hour afterwards we had a lady come in who was apparently minding her own business and got shot and it took out one of her iliac arteries so we were operating on her operate all night long and then you go check on the the patients in the icu and you have your little quiet covet corner pocket and i think that that's just going to be the new normal here as society starts to reopen i think that's just what we're going to have to get used to in the hospital is just this new level of unpredictability paired with just the the long slow burn of always having a few of these patients around and you know i think we're just gonna have to roll the punches and and get used to it and uh yeah that's gonna be about it i think party on i think for the foreseeable future our hospital will continue to treat and manage these patients uh in my icu the average time of a that a cova patient spends on a ventilator is something like 19 or 20 days as you can see in this image the hospital has taken steps to convert certain pods of the icu into completely negative pressure areas it's hard to communicate with the nurse when you're in there and um so you end up shouting the hepa filters are really loud so that's hard you know you're knocking on the door and waving to get somebody to bring something to you we use a lot of white boards to write things down to ask for stuff or or communicate with each other i think the most surprising thing about the patients has been sometimes less is more when you're a surgical intensivist you really want to try to fix every little number but these patients are so sick and so delicate that you you can't and you will sacrifice other parts of their physiology to fix different parts of their physiology so you can't make their labs look perfect you can't make their numbers look perfect on the ventilator so you have to just settle for good enough and just go from there and take it day by day i really miss restaurants i love eating and i love going out to eat and trying new places i miss my husband i haven't seen him in a while the day-to-day surgical icu thing that i miss is like popping in and out of rooms to fuss with stuff and fix stuff and talk to the patient and we don't do that anymore like even our non-coveted patients like i just it's there's just something that changed and it doesn't feel right to pop into and out of a patient's room anymore i feel like a little bit like a typhoid mary because i have these known exposures so i i feel bad like seeing other people [Music] really tough death today one of our code players who'd been in the unit for a month to the day today and it just sucks i got home and then on the news it was announced that today we reached a hundred thousand death mark in america and that's just like i mean that's insane if you think about like if that is insane how shitty i feel right now and how she that family feels and how sad they were i mean his wife was just like she crumpled that's a hundred thousand of those right in the last three months it's an incomprehensible number everything's opening back up how can we be moving on how can these this be over this is it doesn't feel over uh in the icu and there's nothing really else to say or do hug your people and tell your people you love them and you know just try to pick yourself up and dust yourself off and get back to work tomorrow i will talk to you guys next time that's where we're at today that's about it that's it talk to you guys soon that's gonna be about it i think party on

Channel: WIRED

Views: 793,796

Rating: 4.9479399 out of 5

Keywords: covid doctor, covid 19, covid-19, covid-19 doctor, covid-19 surgeon, covid-19 seattle, covid-19 interview, covid-19 annie onishi, annie onishi, wired annie onishi, wired surgeon, wired surgeon explains, surgical resident, wired surgical resident, coronavirus doctor, diary of a covid-19 nurse, covid-19 diary, covid, annie onishi wired video, doctor wired, surgeon wired, surgeon reacts, surgical resident reacts, covid 19 diary, covid diary, wired

Id: AfOa3cvwyPg

Length: 23min 22sec (1402 seconds)

Published: Thu Jun 18 2020

Reddit Comments

[u/ChillN808]

It's a really long video so let me save you some time. The surgeon seemed only tangentially involved in care of Covid patients. Shares a few anecdotes about patients with Covid and screenshots of text messages with her friends in NYC hospitals and "how crazy everything is". I fast forward a few parts but never saw her doing any surgery or any footage of the hospital she works in. Honestly it sounded like a fairly boring couple of months for a trauma surgeon.

[u/jitatime]

Having been in the ER for the months of march and april...it was a ghost town, like half capacity. Sure their were cases but it wasnt crazy. Sure has it picked up? Yes. Is it going to get much worse? Probably. But we ain't at that true crazy point yet.

[u/tgeten]

Pure drama

[u/oddella]

Woah bro, honest legend in the workforce. Thanks for sharing this, and fuck man i could never do for an hour what she does for a living, major props. Maybe the paperwork but id probably get fired for being slow haha