Death, Disease and Denial: Combating COVID in the ER
February 4, 2021
Doctors and nurses can feel as if they’re living in two worlds. One in which patients are getting sick and dying from the coronavirus, and another in which people deny the virus is real. Emergency room physician Mike Hunihan describes what it’s like to live and work with that dissonance.
Listen to the full episode, read the transcript below or scroll down for more information.
Dan Gorenstein: Last week, hospitalizations for COVID-19 fell below 110,000 for the first time since December 13th.
And the pace of vaccinations is ramping up. It’s good news for sure. But for frontline health care providers, relief is still a long way off.
And many of them are coming up on a full year of combatting COVID. Today, what one doctor has learned in that year about death, denial and this new disease.
From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.
Mike Hunihan: It was kinda like when the tornado sirens go off around here.
DG: Mike Hunihan is a 37-year-old emergency room physician in Tulsa, Oklahoma.
Mike remembers when COVID first appeared in the U.S. He was almost sure it was going to spread. Fast.
MH: Like the sky is black and the birds are quiet. It’s very spooky. And there’s just the loudest siren you’ve ever heard, and you just kind of brace.
DG: He was bracing for a wave of sickness and death. And he was bracing against his own fear, that people would fail to meet this moment.
MH: I was worried at the beginning of the pandemic that we would know exactly what to do, you know, wear masks and distance and not go to gatherings and stuff, but not have the courage to do it.
One of his first patients did have that courage. She was a woman in her 90s.
MH: And I told her that she had COVID and she said, “I don’t want a ventilator.” She said, she said, “I’ve had a good life. And you should give it to someone young.”
I mean, she didn’t even need a ventilator, but she didn’t know that. She saw the news, and I told her she had COVID and she said, “Give it to someone else.”
DG: Mike recognized a kindred spirit in that woman, a person devoted to the greater good.
It’s why Mike left a well-paid, hedge fund job in Connecticut, and took out loans to practice medicine.
It’s corny to say, he says, but it’s true. He wanted to make a difference.
MH: Just sort of been pursuing that ever since. I still feel exactly the same. Nothing has changed at all. I think it’s the best. It’s an amazing job.
DG: Six years in, he’s treated heart attacks, strokes, shortness of breath, and gunshot wounds. And he’s gotten pretty good at it.
Now, he’s doing his best to make a difference in a world overcome by COVID.
It’s been nearly a year since Mike saw that woman who declined the ventilator, and Mike’s fears have been realized. Too few people had sacrificed to protect others to slow down the pandemic.
As of early February, Oklahoma has had more than 380,000 COVID cases, more than 3,500 deaths.
The point? There’s a cost to people’s seeming indifference to the virus. Mike sees that cost almost every day.
In fact, he basically gets a tour of it every time he steps into the ER. First there’s the waiting room.
MH: It’s controlled chaos.
DG: Mike says he’s hit by the noise. Ambulance sirens. Dozens of conversations in many languages. People in pain. People packed in.
MH: I mean there’s people sitting in chairs, in the hallway wearing street clothes. They don’t have a gown, they don’t have a bed, getting IVs and oxygen. And that would never happen before.
DG: Nurses draw blood. Stable patients take a turn for the worse. An appendix ruptures.
MH: You got 20 pots on the stove and you just can’t let anything burn. You know, you just have to find anything bad happening and do that right away.
DG: Mike is careful to say that everyone in his hospital gets what they need. But the waiting is real.
Next up on the tour, phone calls. Mike makes lots of calls these days. Sometimes that has meant asking adult children to make urgent end of life decisions.
MH: And I said, like I have said 100 times, I’m sorry to wake you up, it’s Dr. Hunihan in the emergency room. I have your mother here.
DG: A semi-conscious woman in her 90s had just arrived in the middle of the night from a skilled nursing facility. She had COVID.
MH: She’s really sick. I think the best thing to do is to intubate her. Does she have a power of attorney or an advanced directive?
DG: The daughter started to cry.
MH: She said, “Do I have to do this now?” She kept saying that. “Do I have to decide right now?” I said, yeah, you do.
DG: But she couldn’t. She needed time. Thirty minutes later she called Mike back.
MH: And she said she wouldn’t want that. Do what you think is best, she would not want to be on a ventilator.
DG: Mike then broke the news; the woman’s mother didn’t need the ventilator after all.
And that was great, of course. A few simple interventions had actually stabilized her breathing. But the moment also revealed a simple truth: the uncertainty around COVID is always there even for doctors.
After the break, confrontations with patients, a letter-to-the-editor, and hope.
DG: We’re back, looking at how one ER doc has coped with COVID.
Like most ER docs, Mike prides himself on sizing up a patient’s symptoms fast and acting. He’s modeled himself after his mentors.
MH: I remember thinking the older doctors had superpowers, like when I started training, like, they could just hold so much information in their head and they never panicked, they were always calm and they could just figure stuff out so quickly
DG: But COVID is new.
It’s harder to be sure what he’s seeing. Like with that woman from the nursing facility.
MH: A big thing that’s been really scary is that it seems like intubating these patients might not always be the right thing to do. And that was something that we always had a fall back on.
DG: Typically when a patient struggles for air on her own, doctors insert a tube into her airway. The tube is connected to a ventilator that pushes air into the lungs.
MH: If someone’s oxygen was super low from heart failure, COPD or some other pneumonia, you could put in a breathing tube, and feel pretty sure that you could fix it.
DG: But patients with COVID can be sick for weeks. And if she’s on a ventilator all that time, she can lose the ability to breathe on her own.
MH: It’s kind of like an astronaut, like if they’re in space not doing anything for a month, they’re weak. When you put someone on a ventilator and COVID is just ravaging their lungs, they’re going to be on the ventilator for three weeks, they can’t get strong enough again to come off the ventilator.
DG: Nearly a year into this thing, doctors are still figuring out the best way to care for their patients.
MH: People are surviving with low oxygen, not intubated, and people are getting intubated for low oxygen and dying on the ventilator. And just so much of it doesn’t make any sense.
DG: The next stop, patients rooms.
COVID has, on occasion, pitted patient against doctor. Mike’s seen patients in the hospital with COVID refuse to wear a mask.
MH: They don’t think it’s real, and you’re just watching all this carnage every day for a year. It’s like your brain is not built to understand it.
DG: Mike has lost his bearings a bit. He’s devoted his medical career to helping the common good.
He even wrote a letter to the editor in the Tulsa World last fall after he heard what President Trump had said in an October rally in Michigan.
Trump: “Our doctors get more money if somebody dies from COVID. You know that, right?”
MH: It was kind of death by a thousand cuts, and that was the worst, last, deepest one. I mean, like as if what we’re already doing isn’t hard enough, you know?
DG: A few days later, Mike went for a bike ride after a rough shift at the hospital.
MH: And I was just riding through this big park in town and almost no one had masks on. And it was this juxtaposition of leaving the hospital where all these people are just sick and dying. It’s like you walk into a different world.
DG: He didn’t know what to do. Everything was piling up. He was angry, sad, disappointed. And he couldn’t sleep.
So on one of those sleepless nights, he wrote the letter.
MH: We need every single person to become a hero because what’s true on the front lines is true everywhere: When you distance, wear a mask and wash your hands, you are saving someone’s life.
DG: Mike hoped his letter might make a difference. That his story as an ER doc serving his community might convince more people to wear masks.
But Mike knows his story didn’t work well enough. All he has to do is look around his ER.
With the vaccine here, Mike’s now worried about people feeling a false sense of security, just as more contagious variants are on the rise.
He worries a year in, people still don’t get how serious this is. How connected we all are. And that takes us to the final stop of this ER tour: his computer.
MH: I had a patient that needed surgery for his gallbladder. He didn’t have COVID. But I called 12 hospitals until I found one that had a bed where he could go. This guy had an emergency, and there are so many people with COVID, that he would die in America if that ruptured.
DG: Imagine, says Mike, a doctor trying to save a patient of an imminently curable condition by desperately Googling hospitals looking for anyone with enough capacity to take him in.
MH: Maybe that will hit home a little differently. Think about that, if you need your gallbladder cut out or you’re going to die, you’ll wish that everyone had worn masks. Maybe that’ll work.
DG: Mike still believes, in spite of everything, there’s no place he’d rather be.
On days when he struggles, he turns to moments from the past year that remind him of how good people can be to each other.
The anonymous thank-you note on his windshield. The neighbor who started mowing his lawn. The surprise parade in front of his house, friends honking and waving.
And the 90 year old woman who was willing to sacrifice for someone else.
I’m Dan Gorenstein, and this is Tradeoffs.
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Select reporting on health care providers coping with the pandemic:
A Parallel Pandemic Hits Health Care Workers: Trauma and Exhaustion (Andrew Jacobs, The New York Times, 2/4/2020)
Covid Combat Fatigue: “I Would Come Home With Tears in My Eyes” (Katherine J. Wu, The New York Times, 11/25/2020)
The Emotional Evolution of Coronavirus Doctors and Patients (Dhruv Khullar, The New Yorker, 7/7/2020)
‘We Carry That Burden.’ Medical Workers Fighting COVID-19 Are Facing a Mental Health Crisis (Tara Law, Time, 4/10/2020)
How Doctors and Nurses Manage Coronavirus Grief (Jillian Mock and Jen Schwartz, Scientific American)
Michael Hunihan, M.D.
The Tradeoffs theme song was composed by Ty Citerman. Additional music provided by Blue Dot Sessions.
This episode was produced and mixed by Christine Fennessy.
Additional thanks to the Tradeoffs Advisory Board and our stellar staff!