Q&A: New York Emergency Room Doctor Says It’s Just Getting ‘Worse and Worse’

Nineteen shifts in 22 days.

That’s what New York City emergency room (ER) doctor Calvin Sun has worked since the Covid-19 outbreak began in the city.

As a per-diem doctor, Sun works on something like a freelance basis, picking up shifts at whichever hospital in the city has a 10- to 12-hour hole to fill in its ER schedule. This experience has given him a broad perspective about the state of the city’s emergency rooms as New York has become the epicenter of the U.S. outbreak. On Thursday, the day Sun spoke with Caixin, the state of New York recorded 562 deaths from Covid-19.

Sun described the increasingly desperate-looking situation at New York City ERs, as younger, sicker patients seek treatment in droves even as the local health care system strains under the pressure. Some hospitals are setting up tents outside to handle surging patient numbers, while personal protective equipment (PPE) is in short supply that Sun has been taking donations to keep himself kitted out in “cobbled together” gear.

This interview has been edited for length and clarity.

Caixin: When did you start dealing with Covid-19?

Dr. Calvin Sun: I started working at exactly 7 a.m. on March 8. I was co-leading a trip in Angola up until March 7 at 6 p.m. And then my first shift was 7 a.m. the next morning. So, once I landed, I got immediately straight to work and I haven’t stopped since.

I think I’ve worked 19 shifts in the last 22 days. So tomorrow will be my 20th shift — I just picked it up five minutes ago because a doctor just got reinfected with Covid-19. And Saturday, I just picked up another shift for another doctor that got infected with Covid-19.

How many hours can you rest in between shifts?

I’m a per-diem, so I work however much as I want. I usually do 10- to 12-hour shifts — tomorrow’s is 10 hours, Saturday is nine hours, yesterday’s was 12 hours. But when I go home, I go home — you know, go to sleep.

How has the situation changed in the past month or so?

It has just been getting worse and worse. The patients are coming in sicker. They are coming in younger. More patients are coming in. The volume is higher. And more field tents are being set out outside the hospitals to manage the surge capacity. And we’re running low on resources. It was already understaffed and difficult before this pandemic.

There have been reports of shortages of PPE and medical workers. Have you seen improvement on these fronts?

Everything is a sign of progress in terms of effort, and trying to fill in the holes … We need to fight this pandemic as a warlike effort, but it’s just that I think there was a difficulty in the supply chain in getting us equipment because the other countries that were (producing) this personal protective equipment were shut down because they were also fighting this pandemic … We’re just doing our best right now by the ingenuity of the people who are staying at home, who are not working. They’re creating masks. They’re trying to give donations. They donating to the right people. And I’m accepting personal private donations. I’m distributing to my friends if I have too much of anything. And yeah, we’re just making a huge effort right now to make sure everyone is adequately protected.

My PPE is cobbled together for the many different emergency rooms that I work in. I’m lucky — if that’s even a word I can use nowadays — to be per diem, so I have access to different emergency rooms and their equipment. But every emergency room is always lacking something. It’s always something different. But I put something together for myself and have been getting by until my family and loved ones were able to donate something that was a little more comprehensive.

Are many medical workers getting sick?

It’s part of the nature of our work that we get sick … Every patient that we take care of — we’re exposed to what they have, and sometimes we get sick.

This is a little scarier because we’re getting sick with a virus that we know very little about. And it kills people very quickly. Unlike cancer or heart attacks — more people die from those — but people die in a more drawn out setting — a few heart attacks a day. But with Covid-19, you get infected really, really quickly because it is so contagious … It’s like, McDonald’s sells 2.5-3 billion hamburgers every year. That’s a lot, but they can handle it, right? But imagine you drive up to a McDonald’s and ask for 50,000 burgers in one day. That’s going to overwhelm the system, and that’s what we’re dealing with right now.

How are the emergency rooms operating right now?

Just because you have a quarantine doesn’t mean the rates of heart attacks are less. Maybe (there is) less trauma because there are fewer people outside, but every now and then I still get the occasional motor vehicle accident that comes into the emergency room, and we have to take care of them too. And when they come in, they may get exposed to Covid-19 just simply because a lot of our emergency rooms are structured as one giant room where patients are separated by curtains. Instead of every patient getting their own rooms. We just don’t have that space in a place like New York City.

What are you thinking every time you go to a shift?

It is scary. You’re battling a virus that you don’t know, that’s an invisible enemy, that’s very infectious — and you can bring that home.

I can imagine it being daunting for anyone in our shoes to rush, you know, into a burning building, fighting a fire that you cannot see. Inhaling all that smoke. Not adequately protected — naked — as the building is about to collapse on you. And your job is to try to get everyone outside of this burning building before it completely collapses, but you’re also trapped inside. That’s how I usually feel.

But personally, I’m trained for this … Disaster medicine is my thing … But I can’t speak on behalf of my colleagues who may not have signed up for things like that and may not be interested in that area of emergency medicine. So, it is something that a lot of us are adjusting to.

Have any of the emergency rooms that you’ve been to run out of ICU beds or ventilators?

Well, we would run out of (medical) beds and ICU beds even before this pandemic. It’s a known fact that the ICU is always 80% to 100% full in every hospital (in New York City). It was like that before and now it’s guaranteed that it’s going to be always full.

There are medical floors being converted into ICU beds. And then we have tents to create more beds. It is a sign that beds are in short supply. I don’t know any hospital that’s rationing ventilators right now. But they are forming committees so that a single doctor doesn’t have to make a unilateral decision to ration a ventilator.

As a medical worker, what do you need most right now?

Stay home. That’s it … If you stay home, you will not get infected. If you leave your home for any reason and it’s not necessary, you’re increasing your chance of death … The more people that have it, then there’s more patients for us, and you’re going to collapse the system. If everyone stays home, then fewer people get sick, fewer people come to the emergency room, and you help flatten the curve. That’s all we need from you. We don’t need anything else. We appreciate donations; we appreciate that you recognize us and see us. And that means a lot to us in this wartime effort. But sometimes the simplest thing is the best thing, right?

Contact reporter Michael Bellart (michaelbellart@caixin.com)