Cannon Fodder: A doctor on the front lines

Abstract

106 essay Cannon Fodder A doctor on the front lines Laura Kolbe War and peace is making a comeback this spring, along with other great fat books, book clubbing in general, twelve-­ bean soups, and other projects meant to reac­ quaint us with a more glacial, less contemporary sense of time. When I think of War and Peace now, though, my mind strays from the Rostovs and Bezhukovs to Charles Joseph Minard’s graphs of Napoleon’s invasion of Russia. Minard was a nineteenth-­ century French civil engineer esteemed for his data-­ rich but immediately apprehensible diagrams of everything from commuter traffic to wine imports. His most famous and damning image, however, maps the progress of the Napoleonic army as it staggered west from Russia back to central Europe. Soldiers’ lives are initially a thick red band, a gash of enormous and emphatic force. Each mil­ limeter of red width stands for ten thousand men. As the march Cannon Fodder | 107 continues, the red band dwindles, etiolates. By the end of the cam­ paign only a small stream trickles back to safely held territory. As a child, I went to a somewhat old-­ fashioned Catholic school where history was largely understood as the study of military bat­ tles and their outcomes. This kind of education leaves much out, but helps me recognize a Minardian or Napoleonic situation when I see one. It’s becoming rapidly apparent that I, an internal medi­ cine doctor based at two academic hospitals in Manhattan, am part of the thick red band that’s about to be wrung threadbare. In the Trump administration’s United States, COVID-­ 19 has always been about commodities—that is, their scarcity. First there weren’t nearly enough tests, and the available tests were sporadi­ cally employed and sluggish to yield results. Then there were too many probable cases for it to be practicable to test widely, and besides, we somehow ran out of the swabs compatible with the test assays (just as there were finally almost enough of the latter). I’m speaking in the national “we,” and in particular the New York “we.” Here in New York City we’ve mostly stopped testing all but the severely ill sick enough to need a hospital bed—it would be a waste of precious swabs. While we worried about tests and swabs, we ran out of personal protective equipment (PPE) for health care workers. Over the last two weeks my hospital’s stock of gowns, gloves, masks, and face shields visibly dwindled in every cabinet. Eventually you had to know who to ask about secret cabinets, small locked stashes. It helped to whisper; it helped to have friends. My head was full of combination codes for various locked drawers and closets around the hospital. Then even the locked chambers started to empty. Every day we are told that a modest quantity of new supplies is almost here, but every day they’re not quite here. Ditto for ventilators. There is now a growing array of formal and informal protocols for cleaning, reusing, stretching, and sharing everything from masks to rooms and ventilators, all of them inge­ nious but admittedly not quite as good as the gold standards for worker safety or patient care. This is ubiquitous in all hospitals in our region, with mine in fact faring better than most. In addition 108 | Laura Kolbe to finding or reusing scarce equipment, new aspects of my job include lengthy and heartbreaking conversations about prognosis and “code status” (a patient’s wish for resuscitation and/or a ven­ tilator), determining which patients’ deaths are imminent enough that they can be allotted their single hour-­ long visit from the loved one of their choice (otherwise, no visitors allowed), and studying textbooks and videos so that I might serve as an ICU critical-­ care doctor should the need arise (which normally would require an extra two years of intensive training beyond the medical education I’ve had). Each day a portion of my list of patients is critically ill, and a portion are recovering. I quiz those who are recovering more extensively about their living conditions than I ever would have before. A single...