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

published on July 2, 2020

– I'm Annie Onishi and
I am a trauma surgeon

and surgical critical care
doctor in Los Angeles,

California, and today
is Thursday March 19

Hello again it's may 19th, 2020,

For the past 10 weeks
I've been chronicling

what my life has been like
during the COVID-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

[suspenseful music]

As of today at 12 pm
there's, in Los Angeles County,

231 cases, two 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 what's gonna 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
gonna start to get admitted

to my unit the trauma 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,

like it's 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 the surgical ICU nurses

how to what's called prone, a patient,

when a patient needs to be proned,

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 prone the patient,

so flip them ourselves
and keep them flipped

We, in this field are
pretty much all assuming

that we will all get COVID-19,

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 in place
order in Los Angeles started

and since all these crazy measures,

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 had my trauma surgery hat on

So we'll see how things
are different today

from trauma perspective

I'll let you guys know

I hope that I have
continued to stay positive

and keep my head up

[quietly sobbing]

Sorry I

It's just scary

You just have to

You just have to go to work every day

and you have to wash your
hands and do your best,

and listen for the plans and speak up

if you see something that's
fixable and just, you know,

take care of the patients

Today on trauma call
it has been Q-U-I-E-T,

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's full COVID 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 COVID 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

[somber music]

Good morning, it is,

I don't even know what day it is

Is the 24th of March, I just
wrapped up a 24 hour shift

We're really busy with non-COVID patients,

so again it was like another normal,

kinda 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, 'cause I'm
not like directly helping

with the COVID patients
and with this national,

or worldwide crisis,

and 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 gun shot 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
things don't get super busy

here in LA I can go back and help,

be it mop 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 gonna come in LA,

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

That's where we're at today

It is Saturday March 28th,
and I'm on trauma call

We did one gallbladder this morning,

I've had a couple of non
urgent trauma consults,

it's been pretty slow again,

and it feels really frustrating

and it feels terrible to have a skill set

and know I couldn help but
but I'm not physically there,

right now, and we,

why can't we organize a
better way to get resources

where they're needed when they're needed?

So that's what's on my mind today,

just waiting, waiting,
waiting, and more waiting

[somber music]

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 COVID 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 head COVID in my
ICU, it felt pretty surreal,

'cause 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 on 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,

I sit here now, our little call room

This is like normally just
where we sleep on call,

it's kinda like, just this depressing bed

Normally I would sit in out 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
was COVID positive,

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 may at some point
need to breeding tube,

so that's why he's here in
the intensive care unit,

probably more of where that's coming from

So from now on, the COVID
patients who come in

through the EE who need ICU
care are gonna come to my unit

So that's where we are

[somber music]

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 8, Wednesday, a
week's worth of night shifts

so I've got my schedule pretty
well flipped at this point,

living 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,

we save them, so that
was a pretty big case

And MICU's still been full,

so we've also been
admitting COVID patients

so that's also been steady

Tonight the big to do will
be right around 10 pm,

we'll have to put the
patient's 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

That's it

It is Friday, April 10th,

and I'm about 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
just 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, it was amazing

We know that these small
businesses are hurting right now,

they have to be, and 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 I really appreciate it,
first of all, and I know,

I hope Tony has a nice life here

We'll see

[somber 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 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

[somber music]

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 removed the breeding tube out

from my first COVID 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 breathing tube

and he looks amazing, he
looks like a million bucks

So could not be happier,
feels like a really big win,

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 just not making
any progress whatsoever,

and that is incredibly
frustrating as a doctor

But he looks great, and
I'll take this big win,

and the first thing he asked
for was a tamarindo Jarrito,

a type of soda that's
very popular around here

So I 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

Three Ps in taking care of these folks is,

proning, paralisis, and patience

Because you wanna 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 COVID 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 proned which means

he's lying on his stomach,
but 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

that our hospital for
consideration for ECMO therapy

ECMO therapy's a machine that
basically replaces the work

of your either your lungs,
or your heart and your lungs,

it's pretty much of last resort,

so the guy's not doing well

It has been an absolute whirlwind,

and a real learning experience,
and pretty exhausting

I'll think about this patient tonight

and hopefully he's doing
better in the morning

but we'll see

[somber 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 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 birth date,

and the which medications
were given on this day

So 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 you know the 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 be working, you know,

24 seven in a crowded ICU,

so I guess that's the silver lining

and probably do another
couple hours of data entry

and then head back to the Netflix

Coming to live from my apartment

You know I remember back in
March 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 ICU is full,
surgical ICU is busy,

and we still have a
handful, maybe five or six

COVID patients, this
whole time it's been 15,

but that's just gonna go up,

as social distancing
restrictions are lifting,

which, you know, I want
economy to get going

and I want people to have their jobs

and I wanna 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 the
order to make this safe

is not there, it's a [beep] situation,

and I'm feeling it,
and I'm looking forward

to get back on service on Monday

So this weekend probably just
some more reading, relaxing,

maybe go for a run early in the morning

with my face covering, and
just trying to stay positive

[somber music]

Today was my second day back
on service in surgical ICU,

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 run around
like a damn headless chicken

taking care of all these COVID
patients, they're really,

they're very, they're high maintenance

The critically ill COVID
patients need a lot of 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,
half of whom have COVID,

and of those patients about
half of them are intubated

Of those intubated patients,
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 not working

and their lungs are just
impossible to ventilate,

and 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 is like an impossible spiral,

it's really frustrating

The rest of our unit is
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,

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
COVID patients get really sick,

and couple trauma patients just
be really really sick also,

and then everybody's
been working really hard

to take care of you know the three or four

super, super sick people in the unit

And then today three of
them died, it just sucks,

and morale, you can just, it
feel really bad for my nurses,

and you just walk in the body
language is very defeated,

and it's quiet

We help a lot of patients
and there's just some

that we can't help, 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, taking a little break,

getting a little peace and quiet,

and I have few other things check up on

but just needed a minute
before we get back out there

doing God's work, you know

[upbeat music]

Hello again it's May 19th, 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 health

of an orchid plant, it's 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 gonna help me take
care of patients going forward,

believe it or not

Today is Thursday May 21st at 6:30 pm,

and I'm just waking up
and having my coffee,

it has been insanely busy
this week trauma wise

at night, bonkers

Couple nights ago, we had
probably six or seven people

all stabbed in separate
unrelated incidents

Had a guy like, he was
like on drugs or something,

stab himself all over his body,

he got himself in the
carotid, got both eyeballs,

that guy was really messed up

We had 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 patients

in the ICU and you have your little,

quiet COVID corner pocket and I think

that that's just gonna
be a new normal here,

as society starts to reopen,

I think that's just what we're
gonna have to get used to

in the hospital, is just this
new level of unpredictability

paired with just 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 with the punches
and get used to it and yeah,

that's gonna be about it I think

Party on

[upbeat music]

I think for the foreseeable future

our hospital will continue to treat

and manage these patients

In my ICU, the average time
that a COVID patient spends

on a ventilator is something
like 19 or 20 days

[somber music]

As you can see in this image,

the hospital has taken steps
to convert certain pods,

of the ICU until completely
negative pressure areas,

it's hard to communicate with the nurse

when you're in there

And 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,

and we use a lot of whiteboards
to write things down

to ask for stuff, 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 wanna try to
fix every little number,

but these patients are
so sick and so delicate

that 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

[somber music]

The day to day surgical
ICU thing that I miss

is like popping in and out
of rooms to futz with stuff,

and fix stuff, and talk to the patient,

and we don't do that anymore,

like even our non-COVID
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

'cause I have these known exposures,

so I feel bad, like, seeing other people

Really tough death today,
one of our COVID players

who'd been in the unit for
a month to the day today,

and it just [beep] sucks

I got home and then on the news,

it was announced that today
we reached 100,000 death mark

in America, and that's just like,

I mean that's insane
if you think about it,

like it is insane how
[beep] I feel right now

and how [beep] that family
feels and how sad they were

I mean, his wife was
just, like, she crumbled

That's 100,000 of those, right?

In the last three months

It's an incomprehensible number,

everything's opening back
up, how can we moving on?

How can this be over?

It doesn't feel over in 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

[somber music]

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