Things change quickly in a pandemic. I started interviewing people for this piece a little more than a week ago as a way to capture this moment for people on both sides of our health care crisis—a medical resident struggling to find protective gear for himself and other emergency room workers, a woman in federal prison with very little access to medical care, an unhoused street medic in an encampment, and a nursing student being sent home by her hospital. Each has their own fears and concerns about what it means to be vulnerable right now. Some anonymously shared with me what they’re seeing but feel they can’t say publicly themselves. Some are working in places where getting official answers is impossible. These, by necessity, are incomplete scenes from the first weeks of an American pandemic.
An emergency room resident in a New England hospital
It was a shift earlier this month that really sent me over the top. The guidelines about personal protective equipment and testing had just been released—including N95 masks for any patient with flulike symptoms or who came in with respiratory distress—but that equipment was still being stored in a locked area. That’s because of the shortages we’re facing, but in an emergency room context, which is the one I work in, there’s no time to tell a patient, Hang on a second while I go find this personal protective gear. So knowing that, I asked for some face masks in advance, and the people with the nursing administration just looked at me and said they didn’t really know where any of that stuff was. Then I raised the issue with the attending faculty, and they didn’t have a good answer, either. It sort of threw me for a loop.
Even more so because, you know, we had meetings between our hospital administrators for a week prior to this, and it was clear they had not considered the boots on the ground—residents and nurses—and their personal protection. I didn’t have options. I couldn’t go home. I couldn’t say, I’m not working here today.
We’re residents, which is a provisionally licensed physician. Things can’t run without our labor, but the hospital also views us as cheap—cheaper than attendings. When we first started considering what was going to happen, it became clear that if this came to America, residents could get pretty sick. My first question was: If I was exposed and had to go into quarantine, would I be paid? Would I have to take vacation time? Would it be unpaid? Would I have to extend my training? There were no clear answers to those questions, and it seemed entirely at the discretion of my program director. That seemed really scary to me, the idea that my job means I may come into contact with a potentially lethal virus and that any recovery or isolation I may need as a result of that could be unpaid and unprotected.
I remember some stories coming out years ago, around Iraq or Afghanistan, about the fact that a lot of our soldiers had inadequate protection in terms of body armor, or maybe their armored vehicles lacked the degree of protection that they needed. That was a political outrage, and it mobilized a lot of people. This feels like that.
We’ve never had an issue where we anticipated masks would be in short supply, so they’ve always been freely available. I think when things started happening in China, when a pandemic was anticipated as a possible issue, the hospital did a quick inventory and realized that we were going to run out real fast. Our hospital had a two-week supply, so they scrounged them up and put them under lock and key.
But by the end of my shift at the emergency room that day, we finally had a supply of all the equipment we needed that was easily accessible to us in the area where we work. But I had to ask for it. Without that, we would have been exposed—100 percent.
A woman in a federal prison on the East Coast
If you felt you were getting sick, you would place a sick call, which is a request through an email system to be seen by medical staff the next day. Usually, everything except for scabies and ringworm is diagnosed as “flulike symptoms” or “pneumonia.” Still, it is highly likely you will be accused of faking any symptoms you report and that you’ll be sent back to your unit without antibiotics or anything else you might need. Instead, you’ll be told to buy over-the-counter meds that are offered on commissary. Because the symptoms of coronavirus are very similar to the flu, it could easily be misdiagnosed.
Quarantines last three to seven days. Food is normally delivered by a member of staff and eaten in the cell. There is normally a 24-hour lockdown for quarantined individuals, but time out is allowed for showers once in the evening after 9 p.m. count, which is when the officers go around and check that everyone is there. But this also means that sick people can contaminate shared spaces, since no one disinfects or sprays those areas down after they return to the quarantine cell. Also, all visits are denied and video visits are canceled during a quarantine.
In most cases in a quarantine, a nurse will come through briefly to provide the pharmacy meds that are required to treat whatever illness you’ve been diagnosed with—if it’s even the correct diagnosis.
If you do not perish from your illness, like a woman I’m incarcerated with here recently did the other day, you might make it to outside medical. In the event that you are placed on quarantine, this would be after an initial diagnosis from staff—more than likely a nurse, a physician’s assistant, or phlebotomist who can take your blood. It is rare you will see the on-site doctor. Then, during the quarantine, you will only see a nurse when administering medications in the pill line or bringing prescriptions. There is limited-to-no medical staff here after 7 or 9 p.m.
The woman who died recently was sent to a hospital, and she perished on their property. But the people in her unit are saying that she was unresponsive and sallow—that she looked dead—when she left. Her bunkie is taking it hardest because she was not advised of her passing until she inquired about her belongings.
More recently, we had a town hall and were assured that new inmates are being screened for coronavirus upon arrival to the Federal Bureau of Prisons. They also said there are no reported cases in the FBOP. I’m not sure if that is true, being as though everything is diagnosed as flu or pneumonia.
Update: Three people incarcerated in federal prison tested positive for the coronavirus over the weekend. “Two tested positive at FCC Oakdale, Louisiana, and one at MDC [Metropolitan Detention Center], New York,” ABC News reports.
A nursing student in a major city
Nursing students weren’t wearing masks out in public at all, we were just washing our hands. But seeing people in the city wearing these masks pointlessly or putting scarves over their face made me realize that people are aware that something is going on. No one is prepared for this, though. No one is doing all the right things. That was kind of a wake-up call.
Friends I have at other hospitals are saying that patients’ family members are taking masks home with them and filling up their own hand sanitizer from the hospital’s sanitizer dispensers. This is stuff I keep hearing, and it’s not that people are evil and horrible, it’s that people are freaking out and they don’t have any kind of guidance on this.
A couple of weeks ago, the hospital I’m doing my program at sent out an email that my instructor interpreted as meaning we shouldn’t be at clinical—which is where we learn in the hospital as opposed to the classroom—so we all got pulled out. The rationale was, I think, about conserving protective gear. One less person to dress.
I know that no one knows what’s going on—regardless of what industry you’re in, regardless of what you do for a living. Everyone’s in the dark. But it’s very difficult to know that I have skills as a nursing student that can be helpful but that I have nowhere to apply them. And no matter where someone is in any medical program, everybody’s got some kind of skills. Even the first-year nursing students who are with patients for the first time, they can still take people’s vitals.
I didn’t see any patients who had it, although some of my friends have. The nurses on the floor that I’m on were so professional—they didn’t talk about it anywhere but the break room. No one was freaking out, and that should instill confidence in people. Health care professionals are ready for this.
You build really intense relationships in nursing school because you see things no one sees. And now we just have text messages where we talk to each other. I’m bringing a friend who is under quarantine food tonight and just talk to her through the window. I know I have to get ready for this as the new reality. It’s like, all of a sudden I’ve been drafted. You get this, like, military mentality, and it’s not the kind of person I am at all. It’s really strange.
There’s also a lot of grief. I have to reassess and change my expectations to be real about that. I know this is horrible, and I don’t go telling my parents this or anything, but I’m trying to come to terms with the fact that I might die or have my life shortened by this. I’m trying to steady myself for the real possibility that one of my friends dies. I feel like I sound dramatic by saying it, but it’s not. I can’t even believe this is real, but I better get used to it. It’s real as shit.
An unhoused street medic living in an encampment
The police are down the street. They’re not supposed to be taking tents—it’s stated in this memorandum that they’re not supposed to take the tents because of the shelter-in-place order. If they take your tent, you have nowhere to go. So they’re taking everything around the tents. Like they’re being crybabies about not being able to take the tents, so they had a dump truck out here this morning, and whatever’s left outside, they’re just taking it and throwing it in the trash.
Cops said, “Anything that’s left on the street, it’s fair game!” No, it’s not. That’s people’s stuff. So that’s what I was doing just now—just reminding the cops of what policies are in place right now, so they can check themselves. I’m constantly having to talk to these guys. And most times they don’t listen. And the cops aren’t even coming out of their vehicles, they’re talking to me over a loudspeaker … they’re not even rolling the windows down.
That’s what I’m doing right now. There’s people out here in the encampments who have jobs—several people have jobs—and they leave their tents to go to work. Can you imagine returning back home, and your stuff is gone?
At the press conference announcing the shelter-in-place order, city leaders were like, Homeless people need to find shelter. Well, how? The things they’re saying, they’re just not logical. Why would you say that?
Out here, there’s only one case I know about where the person is quarantined right now. And the city has purchased 30 R.V.s for unhoused people if you do get sick, but those are set up about an hour from downtown. I think that they take you out there. You get three meals a day, and they deliver the food. But here’s the rub in all that: When you’re done being sick, you’re homeless again. They yank it away from you.
We survive off of Purell and baby wipes out here. A lot of places won’t let us in to use the restroom even in normal times. I get hand sanitizer and wipes when I volunteer with the harm-reduction outreach, and then I can bring them out here. Hand sanitizer is hard to come by, but alcohol pads are easier to get right now.
The city just leaves people to guess and suffer for themselves. Especially if they’re homeless. The only difference between them and us is they have a roof over their head. We’re all citizens of this city. We shouldn’t be treated any different.