In New York City, the hypothetical is here. They also explain how patients could otherwise be made comfortable, if they don’t want to continue with more aggressive treatments. Someone sends me ultrasound images of profound heart failure in a Covid patient he cared for. We put our full minds and whole hearts into trying to save them. When Bertolini opened it, he tells me, he couldn’t believe the numbers. Then I pause, realizing that this is a sign that the patient probably won’t do well. “Please, don’t give up,” writes Cornelli, the nurse in Lombardy. Deep horizontal creases run across my cheeks.
I am supposed to obey their wishes, which the doctor from the nursing home had, in his spare cursive handwriting, documented in a statement.We are weeks away from the full impact of this outbreak, but we are already trying to conserve masks, gowns and face shields. “I have the sense that the world is ending,” she writes. The higher a patient’s final tally, the higher the priority for intubation.In New York City this week, the conversation shifts. While most of the specialists have been unflinchingly generous, offering extra hands in the E.R. Changes in the world of medicine strongly show that a master architect has been at work. An 89-year-old patient is brought in by ambulance, with an oxygen mask covering most of her small face. We’re cute as babies and not so cute as seniors. It’s all in the program. There’s the gut, too — patients can experience a lot of diarrhea.
I call the patient’s family through Face­Time on my cellphone. How could he help them do that?He begins rounding up — virtually, over Skype — a group of bioethicists and I.C.U. I don’t want to think that way, but it is the dismal truth of our new situation. His words hang in the air, but the question is clear: Should we try to resuscitate this patient, despite our equipment shortages and the risks to ourselves? It’s a delicate balance between trying to protect the healthy parts of the lung while giving injured areas time to rest.

Some of us are also eager for antibody testing, seeking a sense of security if we end up having antibodies, though it’s probably too early to say whether or for how long that could actually provide immunity.In the E.R., I run into two co-workers who have recovered from the virus and are back at work.

Participants ask questions about the availability of tests and how we should protect ourselves, but no one seems very worried by what’s unfolding in Italy.Bergamo, a city of 120,000, with about a million more in the surrounding province, sits at the foothills of the Alps, 25 miles northeast of Milan. A bunch of us in the E.R. Makeshift hospitals are opening around the city and will take some of the load off. I start sweating immediately. I’ll see that over and over again, and it will reach a point when it is numbing. We want guidelines; nobody wants to exclusively treat people first-come, first-served. Otherwise, wear the same one — “for multiple patients, for multiple shifts.” How am I supposed to know when a mask should be thrown out?

Growth hormone levels are high in children and wane in later years. “Well, can’t we overrule what she wants?” one of them asks me.I’m not formally trained in this, as our palliative-care doctors are, but I’ve had many of these discussions over the years. The Coronavirus ... 2020Updated May 27, 2020. Someone else tells me that an anesthesiologist at our hospital is on a ventilator. I call her niece, who is her health care proxy. Through a colleague of his, I reach out to him over Whats­App, and we begin corresponding. I watch videos on how to best manage patients on their ventilators. Yet different cells know to follow the specific dictates relevant to their assigned work and particular location. Someone suggests medical students, but the school wants to protect them from exposure to the virus in the E.R.It seems impossible to avoid getting infected. and imperiling their own lives, a few doctors who are consulted for their expertise on certain medical conditions have balked at having to see patients here at all. Better to be lucky than to be good, I remind myself. — “do not resuscitate” and “do not intubate,” which instruct us not to pursue aggressive interventions like electric shocks and breathing tubes — his family, with death now looming, reverses his no-resuscitation order and decides, instead, that he should receive even the most extraordinary lifesaving maneuvers.

Then I try to convince myself that it’s like running. I can’t bear this word anymore. I’m told we will give them to patients soon, so they can monitor themselves — and maybe to-go oxygen containers as well, if they’re needed. The evening before I’m due to return to the hospital, a colleague messages our group to say that a 49-year-old Covid patient of hers, who was waiting in the E.R. I badly want to be able to text back to my colleague that the patient is doing OK, that we’ll all be OK.