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COVID Crisis Post 24: Demographics & Education.


I began the day bothered. And I wasn't quite sure why.


I started the day off by arranging for my awesome friend Caroline to pick up some PPE donations I had received from a few of you awesome people - you know who you are.


Caroline is working with an organization called Masks for Docs/Med Supply Drive, where they collect donations of PPE from numerous generous souls, keep a master list of which hospitals need what type of PPE, and then set up deliveries to those hospitals based on those needs. I was happy to serve as a middleman for the donors, and it felt good knowing there are at least a few more people who will be safer even if just for a short period of time.


But I kept feeling antsy. And as the day progressed, I finally realized why that was.


It was because I felt I could be doing so much more during this crisis.


That may sound ridiculous to many of you, but hear me out. As I've said in the past, I am fortunate to work at an institution that has an abundance of resources when compared to almost any other hospital in all five boroughs. We have a strong team concept at work, especially in the ICUs, that allow everyone including intensivists, anesthesiologists, surgeons, residents, nurses, nurse practitioners, physicians assistants, respiratory therapists, etc, to work in incredible synchrony. We support one another and the whole is greater than the sum of its parts. And so no matter how bad things get, we all have one another's back. And that is a blessing.


But so many institutions are not so lucky, especially in all the boroughs not named Manhattan. And so I feel something akin to survivors guilt as a result.


Why am I so fortunate to work in the institution I do, but others are working, and suffering, in much more difficult situations? Why do I deserve to be safe, and not others? Why am I left to feel supported, only to see my counterparts in other hospitals feel like their hospital could give two shits about them?


We are spoiled in Manhattan relative to the other boroughs. And the statistics bear this out. Out of all the boroughs, Manhattan has the LOWEST number of cases per 100,000 people. This is likely multifactorial, and likely include differences in patient demographics including race and socioeconomic status and access to quality healthcare. Even given our density, we have fewer cases TOTAL in Manhattan than every other borough besides Staten Island - who has almost TWICE the number of positive cases per 100,000.


For NYC, the disparities between the races are stark. The age-adjusted death rate for Hispanics/Latinos and Blacks/African Americans is about 2-2.5x the amount for Whites or Asians. There are many factors that likely lead to this disparity, including a higher incidence of underlying health conditions and concern minorities may not be receiving adequate information regarding the disease and have less access to testing. As a result, there has been a push by NY state to shift resources to those hospitals caring for these minority populations to try and mitigate some of these sobering statistics.


One additional thought I've considered: the characteristics of Manhattan itself has contributed to the low number of cases relative to other boroughs.


The other boroughs have a more family-unit centered experience compared to Manhattan. The majority of larger families live outside of Manhattan, most likely due to cost and space limitations. Therefore, more people live together and/or live in tight-knit communities as a result. And speaking from an epidemiological standpoint, if even one family member in a unit ventures out and makes contact with someone outside of their unit, then effectively it is as if the entire unit did the same thing so practicing social distancing is even more essential in these communities.


But speaking to friends of mine who live in all of the boroughs, social distancing isn't being taken as seriously in their eyes compared to Manhattan. One friend stated she saw people packed in a park just this past weekend in Williamsburg. Another stated she saw many people walking out and about yesterday in Astoria due to the beautiful weather, many not practicing social distancing. And most frustrating of all, there continue to be large groups of people from certain religious communities who continue to have large funerals and other processions, even though many of their own fill the city's ICUs. It's a frustrating, and vicious, cycle.


And so, given these facts, I have been torn. And the question I kept asking myself today is what else can I do? How can I be of more help? I do not feel I am working as hard as I could be, and I want to ensure my skillset is maximized to do the most good. So how exactly do I do that?


I spoke to some of my friends and colleagues about this. And the overriding point was this: I cannot feel guilty for being in a better situation than most. I am doing a great job taking care of my patients here. And even if I was able to go to another hospital to help, if I'm not protected due to lack of PPE and poor working conditions, I am just putting myself at risk. There needs to be a balance.


And so I recentered myself and focused on how I can best give back each time I work:

Education.


I am a physician. An anesthesiologist, specifically. I have a unique set of skills which are very valuable in crisis situations. Anesthesiologists across the country are being lauded for our invaluable contributions during this crisis because of our incredible ability to adapt to ever-changing situations. If we don't have exactly what we need, we are able to improvise without missing a beat. We are experts in physiology and pathophysiology including hemodynamic management, pharmacology/sedation, airway management, vent management, invasive line placement including arterial and central venous lines, ultrasound, amongst many other things. All things absolutely essential in taking care of the sickest COVID-19 patients. This type of crisis utilizes our skillset to the extreme.


So we are uniquely positioned to served as excellent teachers during this crisis, especially in an ICU setting. In the midst of the chaos so many other hospitals are experiencing, many physicians are likely either too busy to teach or they are too tired to teach or they don't have any interest in teaching. I have received many kind comments from grateful non-anesthesia intensivists, fellows, nurses, NPs, PAs, and RTs who have all appreciated the time I've taken to teach during this crisis. One of the senior pulmonary critical care fellows told me how grateful she was to get a glimpse of how the anesthesiologists mind works when managing patients. And perhaps the best compliment I could receive came from a nurse tonight:


"I just appreciate how you keep it real."


It has been so extremely satisfying.


Tonight has been that kind of night. This post is going up so late (or early depending on your perspective) because I was busy helping to manage numerous sick patients while also ensuring education was a part of the process, even if this occurred after the controlled chaos subsided. I am also very fortunate to have downtime to decompress and write because our team has functioned like a machine all night long, and I have been a student as well during this process.


I feel fortunate to play a small part in (hopefully) saving some lives tonight and beyond. But what I hope the most for is the knowledge I and my colleagues impart on others will hopefully help save many more lives to come.


And that's a super cool and humbling thought.


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