A Journal of the Plague Year: A physician's first-hand account of the COVID-19 pandemic Week 1
Updated: Apr 25, 2020
The whole thing seems like science fiction. I’m a big fan of science fiction: Arthur C. Clarke, Isaac Asimov, Ray Bradbury, all classic purveyors of the craft.
But this isn’t fiction.
It’s Friday the 13th (of March), and I’m preparing to take inpatient GI service call at Memorial Hospital in Savannah for a week. The coronavirus outbreak that I wrote about in this newspaper three weeks ago when it was on the other side of the world, in China, has hit home. It’s officially a pandemic now. As a result, our lives have changed. The NBA, NCAA, MLB and NHL are all done for the season. Springtime staples like March Madness, Georgia’s spring football game, the Savannah Music Festival and the St. Patrick’s Day parade have all been cancelled. Those of us in the medical profession knew this had to happen in order to contain this thing. The alternative could be an unmitigated medical disaster, overwhelming our health care system just like we see happening in Northern Italy right now.
Still, it all feels surreal.
We have all become overly accustomed to medical miracles. In the era of antibiotics, we forget that infections killed millions in the not-too-distant past. We debate over the merits and perceived shortcomings of vaccines as if that really makes any sense at all, failing to recall the catastrophic outcomes during the pre-vaccination era for diseases like smallpox, measles, polio and even influenza. The ready availability of CT scans, minimally-invasive surgery and numerous advanced diagnostic and therapeutic techniques have spoiled us, making us all too complacent, too trusting—and too naïve.
So now we are dealing with a novel coronavirus, a pathogen no human being had ever seen before December of 2019. Let’s call it by its formal name even as we curse its very existence: SARS-CoV-2. It causes a disease known as COVID-19 that is highly contagious and is very often lethal. Thousands have died from it so far. Thousands more will likely die in the months to come.
In 1722, Daniel Dafoe (the author of Robinson Crusoe) published the novel “A Journal of the Plague Year.” It was a story about one man’s experience during the 1665 Great Plague of London. That was the last year that the bubonic plague (aka the “Black Death”) had a severe outbreak in Europe. The Great Plague killed over 100,000 Londoners, or about a quarter of the city’s population at the time.
I have been a doctor for 32 years now. My father practiced medicine another 26 years before that. In our combined six decades of medical practice, neither of us has ever seen anything even remotely like the current COVID-19 epidemic. We are deep in uncharted territory, and it’s scary as hell.
Being a writer, I decided to write all of this down as it happens, warts and all. So here’s the first entry in my own personal “Journal of the Plague Year.”
I was awakened by an ICU nurse at 2:30 A.M. about an unstable GI bleeder and could not go back to sleep, so I looked over my patient list, checked the fit of my N95 respirator, and prepared to go in.
It was still black as pitch outside when I left my home. The night sky was bejeweled with stars. I listened to NPR, as usual, but all they talked about was the coronavirus.
I could not get away from the damned thing.
There was a snafu when I got to the hospital. The patient I was supposed to perform endoscopy on that morning had an unexpected cardiac arrest during the night and was now on a ventilator and medication to keep up her blood pressure. As a result, she was too unstable for the procedure. Nobody had bothered to tell me.
While conversing with the respiratory therapist in the preop area, I was struck by one comment he made.
“We have three ventilators left,” he said.
Three total ventilators—and the COVID-19 epidemic has not even hit yet.
After I left the OR, I went by the Emergency Room to see a patient who was anemic. She was on 7 liters of supplemental oxygen and was still having trouble breathing. She had been tested for the coronavirus the day before. The results were still pending.
“What’s wrong with me, Doc?” she asked. “I can barely walk across the room without losing my breath.”
How do you explain interstitial pneumonia to a layperson?
How do you tell that person you just met that if their COVID 19 testing comes back positive, they have a 1 in 8 chance of never leaving the hospital alive?
Memorial is running out of N95 respirators already. Those are the only face masks that will really protect the wearer against the virus. That means that health care workers are more likely to get sick.
I have my own small supply of N95s, though. I bought them a month ago. I’m giving them out to our doctors as they go onto the inpatient hospital services, since that’s when they are at the highest risk for exposure. Mine is clipped to my name tag—just another piece of necessary medical equipment in this strange new world we live in.
The doctors on call met in the doctors’ lounge around lunchtime to commiserate. There was a lot of gallows humor, followed by a spate of nervous laughter. And then we all went our own separate ways, suddenly silent. Because we are all uncertain, and a little apprehensive, about what might be coming.
After rounds, I went home. Daphne and I went on a bike ride. The weather was sunny and beautiful. We walked out on the dock and looked out over the Vernon River, listening to the screes of the shorebirds as they wheeled above the marsh.
“You’d hardly know anything was going on at all,” I said wistfully. “Things look so normal.”
That night, I spoke to a friend of mine who is a gastroenterologist in Atlanta. He’d been on call at Emory the week before.
“COVID 19 is here,” he said. “We can’t test for it, of course, but it’s filling up our ERs and our ICUs. They’re cancelling elective surgeries next week. It’s just a matter of time now.”
I counted that I had washed or used alcohol gel on my hands 88 times on that first day on the inpatient service. My knuckles were red and raw.
I’ve decided that I need to invest in some hand lotion.
My son Josh and his wife Katie, who just celebrated their first anniversary, arrived with their two dogs about 4 AM today. They’d driven all the way from Seattle over a two-week span, making the final push from Katie’s parents’ home in Arkansas in a single 15-hour day of driving.
It was good to see them get back home. I’d be worried sick if they were still in Seattle, which has turned into Ground Zero for COVID 19 in America. King County, Washington now has 700 confirmed COVID 19 cases and 60 deaths—the most of any community in America.
The day at the hospital was relatively uneventful. I finished early enough to come home and eat dinner with my family. Daphne made spaghetti for the two of us, my father, Josh, Katie, my son Chris, his wife Abby, and granddaughter Violet. It was great family time, almost good enough to make us forget about the coronavirus pandemic.
And then we heard about two ER physicians who died of COVID 19 in Seattle. They likely picked it up at work. Later that night, the combined GI societies announced that we should start cancelling elective outpatient cases effective immediately.
Reality bites sometimes.
It’s biting pretty damn hard right now.
When I was five years old, I had a recurring nightmare. Three green, glowing ghosts (who looked a lot like Casper the Friendly Ghost’s mean brothers) were chasing me around the house. I knew if they touched me that I would die—but you could be saved from them if you submerged yourself in a tub of water. But all of our tubs were filled. There was no place for me to go—and the ghosts were closing in, gaining on me. Their eyes were bloodshot, their pupils dark and fathomless. I could feel their rotten breath against my skin. I had that dream maybe a hundred times. It always ended just as the ghosts had cornered me—and then, one day, it just went away, never to return.
I dreamt about the ghosts again last night, for the first time in over half a century.
It seemed more real this time.
It’s St. Patrick’s Day.
I dressed in green, but it doesn’t feel like the holiday we Savannahians have all come to expect. There’s no celebration, no garrulous interplay, no joking about my Irish surname. Everything is solemn, like we’re in a war zone, and the stark difference between this and a normal March 17 in Savannah only accentuates the grim situation we all find ourselves in.
I was supposed to be at the Hibernian Society dinner tonight in a tux, sitting with my old friend Peter Muller and former Georgia Coach Vince Dooley. But the Hibernian banquet was cancelled, of course, like everything else. Coach Dooley, who is 87 now, appropriately stayed in Athens. And we ate takeout pizza. Because there really wasn’t anything else to do.
The Index case—and Going Forward
Today, on March 20, the Coastal Empire had its first documented case of COVID-19.
As of this writing, there are over 220,000 cases of COVID 19 worldwide. A total of 9000 patients have died. There are nearly 10,000 cases in the U.S., and 155 deaths. In Georgia, we’ve seen 200 cases and three deaths—and that’s merely the tip of the iceberg. More are coming.
Life is altered now. Malls are shuttered, hotels are closing, restaurants are doing take-outs only, and businesses are shutting down. We cancelled the bulk of our elective outpatient procedures. Times are going to be lean for many Americans.
For the time being, at least, this is the new normal. The plague is upon us.
I always start each day with a prayer for my patients and for my family. It’s a habit I acquired a long time ago. Those prayers have taken on a greater urgency now. For we are living in an unprecedented time. Our lives will be altered. Our faith will be tested. Still, I’m a firm believer in the intrinsic resilience of humanity. It’s going to be a rough few months, but I am certain that we will survive this crisis and move on with our lives.
Quite frankly, there’s really no other choice.