Dr. Chiti Parikh is the co-director of Integrative Health at Weill Cornell Medicine. In early March, as the coronavirus outbreak was poised to hit New York City, she volunteered to work in the emergency room to help care for an increasing number of patients arriving in the ER with symptoms of COVID-19. The following is her account of those weeks working in the hospital, and contracting the coronavirus, as told to Rolling Stone staff writer Tessa Stuart.
My first patient in the ER was an elderly Asian gentleman who came in with fever and shortness of breath. I had to stop in to get an N95 mask. Before, the boxes of N-95 masks would just be sitting outside — you just grab one, see a patient, and you throw it out. Now, I had to actually go to the nursing manager’s office, show them my ID, sign in saying I received a mask, the size of the mask, the date of the mask. I got my one mask, I went down to put on the full PPE and go in to see the patient. I would wear an N95 and a surgical mask over it, with a face shield. It was just sort of suffocating. And trying to communicate with the patient, he couldn’t see my face, my body language. And there’s a language barrier — he only spoke Cantonese. I had to use a translator phone to communicate. It was such a surreal experience. Obviously, he was scared.
It was just sort of a rough introduction to what the next few weeks were going to look like and how we had to rethink every little thing we did. My first day on the hospital floor, it was just shocking: I thought you would have your heart attacks, strokes, infections, cancer, and then you have COVID. But the hospital turned into a COVID hospital so quickly — that was all we saw. The other patients simply just disappeared.
It was sort of like being thrown into the deep end because no one knew how to take care of COVID patients. I’m a doctor. I have years of training. I’ve been through this before, but this disease was very new. Everyone said, “It’s older folks, people with compromised immune systems.” Very early on, we figured out that that wasn’t always the case. We could have a 30-year-old patient who would walk in with really no medical issues and could potentially end up on a ventilator within a matter of hours. We could have a 85-year-old patient who would come in with some respiratory distress, shortness of breath, but they might not necessarily need a ventilator.
In medicine, for pretty much every disease, we have a good understanding of who is at the highest risk. If you say heart attack, I can tell you 10 different things that will make me think that that person is at a high risk of getting a heart attack in the next year, 5 years, 10 years. With something like this, we just didn’t have that. We had to pool our knowledge and our experience across the board to understand, what are these guidelines that we can come up with? It was a lot of communication and learning from each other and discussion with colleagues on a daily basis to figure out, “Hey, I found a trend that if this blood marker is high, if they have this disease, that that tends to be a bigger risk factor.” That was what we had to rely on.
What’s ironic is, in spite of having all the cutting-edge devices and blood testing and medications, it all boiled down to our clinical assessment: the way the person looked, the way they were breathing. It was all medicine 101 — what you learn about before we had fancy technology, CT scans, and blood tests, and things like that. Tapping into that clinical gestalt, and the feeling that you develop over years of experience.
Week two, I was called from the ER to examine a male in his 50s, a nurse. He presented with the typical story of fever, coughing, some shortness of breath. Because he was a nurse, he was keeping a very close eye on his fever and his oxygen saturation at home, but he decided to come in because he noticed that he was just having a little bit harder time getting around his apartment. When I looked at him — it was just something that made me nervous. On paper he was barely requiring any oxygen, no significant medical history, really no red flags, but the minute I met him — talking to him, looking at him — I knew that things were going to get pretty acute really quickly. I got the feeling that he knew that, too. Both of us are walking in with a feeling that something is just not right, something ominous is going to happen, yet neither of us are able to verbalize that because we kept focusing on the numbers and saying, “Hey, the numbers look good. We’ll keep a close eye on you.”
In a matter of hours, I got a call from the ER saying that his oxygen levels were dropping. We got him up to a room where we can monitor him more closely. I just had a very honest conversation with him. I said, “Listen. I am worried. There is a good chance that you might end up on a ventilator.” He became very tearful. He knew exactly what that meant. About an hour or two hours later, when I went back to check on him, he just started to appear more and more lethargic and wasn’t able to communicate with me the way he was just an hour ago.
I’d been in constant communication with his family; his sister was the main point person. She was very nervous herself because she had been staying with this patient and her other brother, who is also now developing symptoms of COVID. While I was telling her that her brother is being put on a ventilator, she was telling me that her other brother is now about to come to the ER with the same symptoms. I just could not imagine what she was feeling: one brother is about to get intubated, another is about to come to the ER. She knew that very well could be the last time she saw either. Both of them ended up on ventilators in the ICU for several weeks. Luckily, both of them made it. I just cannot imagine the panic and the anxiety of the whole family.
There were so many instances where it was family members. I had another couple — an older Chinese couple in their 80s — where the wife came in first, who was slightly sicker, then the husband came in three days later. Both of them were pretty sick. They, unfortunately, would not do well on a ventilator, and the family, collectively, made the decision. That was just heartbreaking — this family was going to lose their parents in a matter of just a few days. We tried everything we can. We tried to make sure that both of them were in the same room together. They actually did a little bit better just being able to be in the same room. Just imagine being married for 60 plus years and ending up in the hospital. I get emotional talking about this.
I was supposed to get married this Saturday. Ironically, the first day I went into the hospital to work on the COVID unit was the day I was supposed to leave for my bachelorette party. We had a big Jewish-Hindu wedding planned. We postponed knowing that this was obviously not a good time, but we still wanted to do something because, unfortunately, my fiance’s mom is battling brain cancer. She’s restarting chemotherapy soon. It was very important to make sure that she could see us get married. We decided to go ahead with the ceremony even if it was just our parents because we just wanted her to be present. That’s what we’re doing this Saturday at her apartment. My family lives in New Jersey, so they’re driving in. Our rabbi’s joining through Zoom.
This whole time that I was working in the hospital, I stayed in a hotel. I didn’t come home because I was worried about infecting my fiance, but also my fiance’s mom. That was challenging — to not be able to see him and not be able to come home. When I made the preparation to go move into the hotel for God knows how many weeks, I was very cautious about what I brought with me: just scrubs, a couple of pairs of yoga pants, a microwave, and a lot of gloves and Purell.
The hotel, in downtown Manhattan, is 30 stories. At that time, there were only six guests. I had this whole routine: I would take my scrubs and everything off in the hotel room’s foyer, put it in a plastic bag, wipe everything down, and then I would enter the room, and shower first before I entered the bed area. A typical New York City hotel room is barely 150 square feet. That was my home. Luckily, I had a window. It was looking out to another office building, but I could see a reflection of Brooklyn Bridge in certain times of the evening. I could not tell you how many hours I probably stared at that.
I got sick with COVID in early April. It was about a couple of weeks after I started working in the hospital. At the end of my shift, I just had a terrible headache. I thought I didn’t drink enough water, missed a meal, or something like that. I went home and the headache just wouldn’t go away. It wasn’t one of the symptoms we had heard of. I didn’t have any coughing, shortness of breath. Then I took my temperature — I didn’t feel like I had a temperature, but I always kept a thermometer with me just in case. It was 102. I called my colleagues and let them know that I potentially have it in case they were developing symptoms. I ended up getting tested, and I did test positive. Luckily, the fever — 102 was just the first day, the rest of the time, it was very low-grade. I had a lot of weakness and muscle aches, but I was fine otherwise.
Those eight days were very tough. Out the window, I could see the reflection of the FDR, Brooklyn Bridge and some people walking. That was my only sort of outlet — that, and FaceTime with friends, family. I just couldn’t stand watching the news anymore. I would leave NatGeo nature documentaries on in the background. I just wanted some sound — just didn’t want complete silence.
That was probably the first time I was afraid — knowing that there’s just no way to predict. The day or two before I moved to the hotel, before I started working in the hospital, I made my living will. It seemed crazy, but at the same time, completely reasonable. I had colleagues who were my age who ended up in the ICU, and several doctors and nurses who lost their lives over the last few months. Having that conversation even with my fiancé and my family — I didn’t want to freak them out, but I thought it’s necessary. If things went south, that was probably the last time I would have seen my family. If I got sick, and ended up back in the hospital as a patient, that would potentially be the last time.
When I was a resident, I spent a couple of months working at a hospital in Tanzania. It was just surreal at that time to see how limited resources were — to see people die of things that you would never think about. I still distinctly remember a patient in his 30s dying of tetanus — something you never hear or you would never see in this country. The shot costs a few dollars, less than what I paid for lunch today, probably. He was working on a farm, didn’t have shoes on, stepped on a rusty nail and got tetanus. We literally watched this man die in front of us of tetanus over the course of several days. It’s probably one of the most horrifying ways you can imagine someone dying. It still haunts me to this day.
When we got to a point where ICU beds were in short supply, we didn’t have enough ventilators and stuff, it just brought me back to those memories of working in limited situations and how challenging it was. I never would have thought that this would happen in this country — the fact that I had to reuse the same N95 mask for 10 days. The fact that we have to move mountains to figure out how many ICU beds we had, and [use] makeshift ICU rooms, and everything we were doing. It just brought back a lot of memories. It just also laid out how fragile our health care system is and how fragile everything is in life — how quickly it can change. You always feel secure in your reality, in your bubble, being in America, that this would never happen here. You never have to ration things. We’ve been privileged. It’s always been happening in other parts of the world, but we were sort of immune to it, and are sort of not anymore.
People always ask me: Was it worth all the sacrifice? Would you do it again? I know the macho, the brave response is, “Yes, absolutely.” I would say that for many reasons. I’m not afraid of getting sick, or dying, or anything like that. That wouldn’t keep me from going back to the hospital. I 100 percent would. To be perfectly honest, what’s been most disheartening is when I watch the news, and what’s going on in our own country. When people don’t take this seriously, when people forget, that they have to be reminded that more than 100,000 people lost their lives in just the last few months, it just makes me angry and it makes me very sort of disheartened to see the sacrifices that so many people have made. So much effort that has gone into this over the last few months can all be negated just by the actions of a few people who refuse to take this seriously. That’s been the hardest part of healing – knowing that this is very well going to happen again, and more people will die in spite of my best effort, in spite of your best effort. That’s been the hardest part: knowing that the trauma is not over, that this might just be the first chapter.