- Moments before being intubated and put on a ventilator, one of Derrick Smith’s coronavirus patients asked, “Who’s going to pay for it?”
- It’s “profoundly sad that people are worrying about their finances during even possibly their dying moments,” Smith, 33, told Business Insider.
- As a nurse anesthetist at a New York City hospital, Smith has been thrust into a “critical-care role” that’s rife with shortages in personal protective equipment, long work hours, and worries about contagion.
- Smith said he was disappointed by government containment measures, describing a failure to “protect and uphold its citizens.”
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In Derrick Smith’s view, the coronavirus has turned the United States healthcare system’s pockmarks into garish scars.
In a widely shared Facebook post on Friday, he described a COVID-19 patient’s last words: “Who’s going to pay for it?”
On the verge of being intubated and put on a ventilator, the person “gasped out” the question to their medical team “between labored breaths” before calling their spouse for likely the last time, “as many patients do not recover once tubed,” Smith wrote.
Smith, a certified registered nurse anesthetist at a New York City hospital, whose name he asked be withheld, wrote that “this situation is by far the worst thing I’ve witnessed in my collective 12 years of critical care & anesthesia,” adding, “This country is truly a failed state, and it’s so sickening to witness firsthand, more blatantly than ever.”
Reflecting on the experience, Smith told Business Insider that it’s “profoundly sad that people are worrying about their finances during even possibly their dying moments.” He declined to share more information about the patient, citing privacy laws.
People struggled to grasp the full scope of the coronavirus outbreak while the government tried to downplay it
Smith, 33, recalled first hearing about the coronavirus in January as it raced across Wuhan, China, acknowledging that “it was hard to ascertain the severity of it back then.”
The US reported its first case on January 21. A day later, President Donald Trump told CNBC’s Joe Kernen that he was “not at all” worried.
“It’s one person coming in from China, and we have it under control,” Trump said. “It’s going to be just fine.”
Given that the federal government “didn’t appear to take it very seriously” and was even comparing the disease to the flu to downplay it, Smith said it was only in late February that he began to fully realize the devastation caused by the coronavirus.
He described being instantly worried about the impact that “any sort of viral, contagious pandemic” that progresses quickly would have on the US’s “already fragile healthcare system.”
And what an impact it’s had.
The US has the largest recorded COVID-19 outbreak, with nearly 400,000 confirmed cases and over 12,900 deaths as of Wednesday. New York is the hardest-hit state, with more than 140,300 cases and over 4,000 deaths. Hospitals are overrun, morgues are filled to capacity, and medical workers, who lack sufficient personal protective equipment, are succumbing to the illness themselves.
The coronavirus has reshaped Smith’s medical work. COVID-19 patients have flooded the various medical facilities where he works, except for a surgical center that is “no longer functioning” because it focuses on elective procedures, which are now scarce.
At the hospital too, his role has morphed. Before the pandemic, Smith’s work was more predictable.
He described his routine as “initially meeting the patient, doing a full interview and physical assessment, taking them to the procedure area, sedating or inducing them for general anesthesia, and then taking care of them up until the post-operative period.”
Since the coronavirus hit New York, however, elective surgeries have been nixed, so Smith has found himself in “more of a critical-care role” that involves working in the intensive care unit or responding to all sorts of emergencies throughout the hospital.
‘I reused the same N95 mask throughout my entire shift’
No two days or cases are alike, Smith said.
“You have some people that come in who are in absolute respiratory distress that need to be intubated relatively soon,” he said. “Or you have someone who’s just very, very ill with classic flu symptoms and upper respiratory problems and don’t quite need to be intubated yet but definitely needs hospitalization, fluids, or antibiotics for pneumonia.”
Coming off a 12-hour shift during which he had only one N95 respirator mask, Smith said that the hospital’s PPE supply had improved but that there was still plenty more to be done to safeguard medical workers and staff.
“I reused the same N95 mask throughout my entire shift, just being careful not to remove it frequently,” he said. This conservation of PPE marks a dramatic shift from “pre-pandemic” times, Smith added, when N95s were the single-use masks they’re designed to be.
Smith said he also expects his team’s shifts to get longer as the hospital is “admitting more and more patients,” increasing their workload.
Asked if he and his colleagues were worried about contracting the coronavirus, Smith simply replied, “Yes.”
The coronavirus affects people in different ways — some are asymptomatic carriers, while others have such severe symptoms that they require intubation in the ICU, Smith explained.
So Smith, like his friends and coworkers, is “just trying to stay as healthy as possible with diet, home routines, exercise, and adequate sleep to boost” his immunity so he can ward off a severe reaction if he does catch the virus, he said. It’d also be helpful, he said, if people adhere to social-distancing guidelines to help flatten the curve.
That said, the coronavirus pandemic is taking a toll on Smith.
“I’m no stranger to death, illness, and the American healthcare system, because I’ve been in it for over a decade,” he said. “But I’ve never seen what I’ve been seeing lately with the speed, intensity, and spread of the virus itself, and its impact on patients and the hospital system.
“It does take a toll,” he added, “but, you know, there’s not really any other option at this point.”
The government is failing people rather than safeguarding their health, Smith said
Smith said his frustration with the healthcare system’s “sad” state “peaked” the day he posted on Facebook.
His interaction with the patient underscored how worries about affording medical care “disincentivize people from wanting to even seek treatment,” he said. That’s “inherently problematic” in the context of a pandemic because people put a heavier “burden on the system when they come in so acutely ill,” Smith said.
He said he thinks that a “tertiary care setting, where people come into the ED with or without insurance,” was “far from the best way to do it.”
“There should be a better emphasis on primary prevention, public health, and also the ability to pay for [healthcare] regardless of your social or class status,” Smith added.
It doesn’t compute to see thousands of people a year dying from a lack of access to medical care in “one of the richest industrialized nations in the world” or being forced to crowdfund their treatment, Smith said, denouncing federal and state governments’ responses to the crisis.
He said President Donald Trump didn’t do enough with the Defense Production Act to actually “pick up the pieces of this mess” and left it to state officials to cull a “patchwork” of containment measures. He also criticized Wisconsin authorities for holding an election during a pandemic and forcing people to choose between their well-being and democracy, as well as the Centers for Disease Control and Prevention for shifting its guidelines about which face masks are safe to use.
“I believe the main purpose of a government is to protect and uphold its citizens, and I feel like that’s clearly not what’s taking place,” he said.
Correction: The headline of this story originally referred to Smith as an anesthesiologist. He is a nurse anesthetist.
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