Behind the front lines of the pandemic

Originally published at

I’m a software engineer and so I usually fill this space with software and systems engineering topics. It’s what I do and love, and I enjoy writing about it, but not today. Instead I’m going to talk about what my wife does, and loves doing, and how the times we are living through have affected her job and our lives together. In many ways we’re among the lucky ones: we both have incomes and health insurance, and I already worked from home. In other ways we’re not so fortunate. The current crisis facing the world is like nothing any of us have seen in a generation or more. It’s impacting every single segment of our population and economy, and everyone has a story. This is what ours looks like, almost four weeks into lock-down.

My wife is a registered nurse. She works at a regional hospital in northern New Jersey, about 30 miles from our home. She has been there more than a decade. Her current role is as clinical coordinator on a cardiac critical care unit. You can think of it as sort of the captain of the care team. Some weeks ago, in preparation for what was obviously coming, her unit was converted into a negative pressure floor for the care of Covid-19 cases. This means that a lot of work was done to seal the floor off and provide ventilation to lower the air pressure within to prevent the escape of infectious material. The same was done to one other unit in the hospital, and a lot of work was also done to prepare to provide intensive respiratory care for patients in those units.

Today the hospital has something on the order of 50 Covid-19 patients. They have discharged some patients who have recovered. I don’t know if they have had any deaths. I don’t ask my wife about that. The very first patient to be cared for in her unit was on a ventilator, sedated and in intensive care for around four weeks. In order to provide that care doctors and nurses must practice a strict protocol when entering and leaving the patient’s room. I’m not going to try to list all the steps but it involves multiple hand washings, donning gown, mask, gloves and face shield in a specific order, and then reversing it all on the way out. Since the beginning of this event the hospital has struggled to find the right personal protective equipment and even today they are using gear that would not normally be used, and sometimes reusing gear they shouldn’t have to reuse.

The other scarce resource is people. Pretty much every hospital struggles to employ enough qualified nurses. In the current crisis critical care nurses are in short supply. The typical patient to nurse ratio should be something like 2 to 1, but it is now closer to 4 or 6 to 1. Doctors and nurses are working longer hours, caring for more patients, and at the same time trying to stay abreast of the fast moving medical detective work that is being done every day to defeat this thing. All of the treatments you’ve heard talked about are being tried at my wife’s hospital and at many others, and they are gathering data and sharing patient outcomes with professionals at other hospitals and organizations. All of this takes time, and has to be balanced with the actual care that afflicted people need to survive.

My wife normally works days, leaving the house by 5:30 AM. Sometimes she is asked to work nights to cover a resource gap, and these adjustments can be difficult and disruptive to sleep schedules. We don’t talk often when she is at work, even by text, because they are too busy. Her day ends around 7 or 8 PM if things don’t go completely off the rails. She lets me know when she’s on her way home because the fact that she has to drive 30 miles over mostly two-lane roads when she is very tired is something that’s always worried me. It’s a relief when I hear the garage door go up. She is very careful when she comes into the house. We’re both in our 50’s and an infection of the Coronavirus is not something we’re guaranteed to shake off. First the clothes come off and go into the washer. Then hands get scrubbed and sanitized, then she heads upstairs and showers.

When she comes back down we may touch each other’s arms. We haven’t kissed in a month, and I don’t know when we will again. She sleeps in a separate bedroom, and we don’t know when that will change either. We’re both very aware that if something goes wrong at the hospital and she is exposed it could be days before she develops symptoms and we know about it. It’s the thought of it getting both of us and leaving our kids alone that terrifies, drives sleep away, and makes it hard to work sometimes. Two of our daughters live here in New Jersey, both far closer to Manhattan than we’d like. Still it’s not certain that being close to New York is riskier than visiting a person who works daily with infected patients, so they adhere to guidelines and don’t come here to visit.

My wife misses seeing the girls, and I know she thinks about the same things and has the same fears I do, but there has never been any talk of whether or not this is a thing she should continue doing. It’s what she does, just as software is what I do. We both take comfort in the careful protocols they employ at the hospital to prevent staff from getting infected, but as an engineer I don’t believe in infallible processes. Perhaps in the end it will prove to be safer for me to be around her than to be around members of the general public, because the overall behavior of the general public is sometimes less comforting. Even now with over 600,000 infections and nearly 30,000 deaths in the U.S. a lot of people aren’t taking it seriously. From the President on down they seem to want to wish it away and transport us all back in time to how things used to be… a month ago.

“The cure is worse than the disease” is a refrain we’re starting to hear a lot now, always from the people who don’t have to provide the care or try to cure the disease. Everyone wishes we could go back to normal. For some that is a desire to go back to the job and health care benefits they used to have; to eat in a restaurant or attend a ballgame. For others it’s a wish to see their small businesses survive. Still others feel a longing to have their hotels and golf courses filled and their portfolios stabilized, or perhaps a better shot at reelection to high office. These are all fine reasons to wish this thing hadn’t happened. It’s just that wishing it hadn’t happened serves nobody, and acting like it’s over because the infection rates have started to level is the tail wagging the dog, if the tail could wag the dog so hard it died.

If we make the wrong moves here, and try to send people back into close proximity before we have the defenses we need, then the consequences of that decision are going to fall hardest on people like my wife and her colleagues. There won’t be enough beds, nurses, doctors, masks, ventilators, drugs, or any of the other things intensive care requires. The cascading effects of that will raise the mortality rate for this and other causes of death because the whole system will strain. Nurses and doctors will have to struggle to care for patients, because that’s what they do, and in the process will be exposed to even higher risk of infection than they already are. If hospital staff start getting sick at greater rates than they have already then the whole thing may come tumbling down. That is an outcome that nobody wants, least of all care-givers and their families.

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