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In the middle of the night, Emily Wolfe slipped away from her patients and into the break room. She was aching to get out of her mask. The virus was probably everywhere in the break room, all over everything — on the locker Wolfe shared with two other doctors and the large conference table where the staff still shared meals. And she knew that every time she removed her PPE, she increased her exposure, no matter how carefully she washed and disrobed. “I have my helmet and other stuff, and I’m taking that off, but there’s nowhere to put it down. The whole room was not safe. If this were Ebola, we would all be dead in five seconds.” But the tight, heavy mask was compressing her nose and turning her cheeks purple. She needed air.
Wolfe is an attending physician in the emergency room at Elmhurst Hospital in Queens, where she’s worked for over 20 years, her whole professional life, but this night — March 29, as the number of cases in the city was turning sharply upward — was “unbelievable,” she said. “Absolutely unbelievable. It felt so out of control I could not physically help people fast enough.” Everyone had a fever. Everyone was out of breath, some unable to walk even ten steps without passing out; by the time she stabilized one person, two more were waiting. “A guy would walk in satting 37 percent” — an extremely low level of blood-oxygen saturation — “and you’d think, He’s terrible. He’s breathing so hard. I want to get ready to intubate him right away, and then someone else comes in and he looks even worse, so I give the first guy a little ketamine, maybe that will buy him a little time, and intubate the second guy.”
The large open area by the nurses’ station was crammed full of stretchers, 60 of them, all COVID-19 patients, three deep and a layer across, from head to toe to head to toe without an inch in between, like cars in a city parking garage, with the healthiest patients (also feverish and attached to oxygen tanks) seated off to one side on hard folding chairs. The sickest people, 40 of them, about a third on ventilators, occupied two more rooms in the ER, one recently converted into a makeshift ICU. There were visiting nurses on the floor, people who have come to help from Canada, from Georgia, and they regarded the packed ER with wonder. “Where I come from,” Wolfe overheard one of them saying, “we take care of all these other diseases, but here everyone has this!”
That night, the storerooms had run out of all but the largest-size masks for some of the breathing machines, so the masks kept slipping down the patients’ faces, increasing their annoyance and discomfort and causing the clinical staff extreme distress, because every loose or fallen mask meant more virus escaping into the treatment room and required a hands-on fix, an actual nurse or resident approaching a patient and touching the mask, the face, and the mask again. The alarms on many of the ventilators were sounding constantly, a glitch in the new, unfamiliar equipment — odd models arrive with almost no time to learn them — and no one had the bandwidth at that moment to fiddle with the settings to figure out why. So the alarms just rang, and everyone was yelling, because everyone was wearing masks, and it was impossible for anyone to hear, to understand, or be understood. “There’s something really ironic about the fact that the patients are suffering in these masks, and the doctors are suffering in these masks. And it’s so fucking annoying. You’re telling the patients, ‘You’ve got to keep your masks on,’ but we’re all suffocating.”
In the break room, Wolfe, with a naked face and ungloved hands, rooted around and found a cache of donated peanut–butter-and-jelly sandwiches, a favorite work snack. The bread was heftier than she usually liked — in normal times, she would have gotten one from a nearby deli on toasted wheat — but the ordinariness comforted her. “I can’t say the ratios were perfect. You needed a fatter sandwich to make the most of bread.” Still, “it was a 90 percent PB&J.”
On a recent evening, when Wolfe pulled into her suburban Long Island driveway on a day off, she found a sign planted on her front lawn. It said HERO IN SCRUBS. An anonymous admirer had put it here, which embarrassed her. At the beginning of her residency, Wolfe, who’s now 49, took something like a Myers-Briggs test and scored zero on all measures having to do with wanting status, visibility, or prestige. (Her name has been changed here to preserve her and her patients’ privacy.) She had thought she wanted to be an OB/GYN or a pediatrician, specialties dominated by women, but then she did a rotation in an emergency room. In college, she was the kind of student who habitually pulled all-nighters; she describes the movements of her own mind, even in ordinary times, as a tempest. “Picture an office with infinite stacks of paper and then put on a big fan that blows the papers around the room. I’m in the middle of the room, grasping at paper, paper, paper.” The emergency room meshed with her temperament; under pressure, she found, she became an expert prioritizer. In her first rotation at Elmhurst, she saw someone give birth and a stabbing victim with his chest wide open — “the whole anatomy of everything right there.” She watched as a drunk with a guitar took up a spot by the nurses’ station and serenaded everyone.
Wolfe is a crier. She has always cried easily at movies like Beaches or at news of a friend’s unexpected diagnosis, but now she cries frequently, sporadically — often in her car, on her drive home from work, and also during the two hours when she’s cleaning herself and every item of her clothing, including the zipped plastic bag where she keeps her cell phone, before she sees or touches her husband and kids. Over the past two weeks, I spoke with Wolfe numerous times, in marathon sessions, usually in the morning as she drove home, her stories pouring out in emotional torrents lasting more than an hour, telling me about dying patients, their extremities turning blue, and the images from the pandemic novel Station Eleven that come to her unbidden, and the generosity of strangers and friends, such as the hair colorist who made a house call, touching up gray roots in the backyard wearing gloves and a surgical mask. Before leaving Elmhurst, Wolfe washes her face “once with whatever disgusting thing is in the hospital soap. Then I put Purell all over my face and neck.” At home, she undresses in the laundry room and puts everything in the washing machine, “and then I have that blue Dial pump in my bathroom.” She has always talked easily to her family about her job — “Our mother ties up violent drunks for a living,” her kids used to tease her — but there are conversations now she won’t have; for instance, about the fact that in the chaos of one workday last week, no one knew what to do with all the bodies. “It’s so awful you don’t know what to do or how to handle it. I asked yesterday about the logistics. ‘How do families get the bodies?’ I didn’t get an answer. No one in my department seems to know.”
For the most part, Wolfe has been content to be a shift worker, to give more than 100 percent at the hospital and then leave it behind. But she sees that is no longer possible. What she’s going through now will change her in ways she cannot predict or plan for. “There will be an overwhelming amount of sadness and death and loss. I’m not emotional in my care of patients. But when I give bad news to families, when the game is over, I know this is their worst day. And now I’m carrying that kind of sadness with me on a massive scale.” Dozens of people die at Elmhurst every day. And as much as these feelings bring her involuntarily to tears, she knows the numbness is even worse. “When I’m just going through the motions — those times scare me more.”
Over the past ten days, Wolfe has noticed how patients inhabit her mind in a new way. The emergency room used to be a place for quick fixes. But now, with so many very sick patients and so few proper ICU beds, patients stay in the ER for at least two or three days, which means doctors leave work and come back again to find the same patients still there, so they get to know them well, not just their vitals and their oxygen saturation but the fact that they have families and jobs. Wolfe was watching TV at home one night, and a wedding scene reminded her of a patient she had seen earlier that day with fingers so swollen she knew his wedding ring would have to be cut off his hand, and this made her worry about the psychic toll on him. She describes the 65-year-old man sitting in one of the chairs, for days, with fever, unable to lie down or to sleep, thirsty for water and begging to leave. She hated to be the one to insist that he stay.
Wolfe is from a close-knit Jewish family, the kind where people show up for each other, and she found the period of her grandfather’s hospitalization in an ICU, when she was 19, surrounded by relatives and joking around, to be a meaningful and spiritual time. At Elmhurst, as at every other hospital, ventilated patients are usually sedated, paralyzed, and unable to communicate; to Wolfe, the additional fact that they are alone feels shocking and unnatural. “Here’s a 35-year-old guy in respiratory failure. I just intubated him. Does his family even know he’s here? What will his mother think when all of a sudden he stops texting?” (Only a fraction of those on ventilators survive.) Elmhurst is located in what’s been called the most ethnically diverse city neighborhood in the world, home to the waiters and cleaning people and Uber drivers and doormen and nannies who return from work at night to small apartments inhabited by generations, parents and grandparents and grandchildren all living together. In these neighborhoods, social distancing is both practically impossible and conceptually alien. That these patients have to be sick and suffer in the absence of family — even as they’re receiving crucial care — makes Wolfe constantly upset. “This is such an immigrant community. It’s exactly what Donald Trump wants: Oh, good, we’ll lose a third of these people, and it will help our undocumented problem. I don’t want this neighborhood sacrificed. It’s keeping me up at night.”
But the thought that Wolfe really can’t bear, the one that keeps nosing in as she pushes it back, that makes her voice break, is the certainty that at some point, soon, she will have to care for the colleagues she loves so much and that some members of her work family may die. The Emergency Department of Elmhurst is a special place, something she has struggled her whole career to describe. A public hospital with none of the VIP amenities of private hospitals with more name recognition, Elmhurst serves the poorest New Yorkers with a kind of dedication and teamwork that she has never experienced anywhere else. “No one ever calls in sick. No one doesn’t pull their weight. Everyone works their ass off, and no one asks for help.” But there’s another level to the loyalty, too. It’s personal, intimate, and invested. Everyone is in each other’s business, always. Wolfe has encouraged a favorite resident to get engaged; she offered her medical opinion on a colleague’s oncology report and then supported another one as she was dying. When another resident gave birth, the baby was instantly welcomed into the circle as a “work love child,” and Wolfe feels about the infant as a grandmother would. (When the baby’s father got sick with COVID-19, Wolfe half-fantasized about bringing the baby home to her house so his mother could go to work.)
Wolfe tries to be in control of her terror, but reality makes that hard. In Italy, health-care workers account for nearly one in ten COVID-19 cases; 100 doctors have died there since the outbreak began. One of her closest colleagues at work is in his 50s and has asthma: “His wife texted me. She is hysterical and rightly so,” while he keeps on “making jokes about his life insurance.” Another colleague is on immunosuppressants. A third is the main support for an elderly father and a daughter with anaphylaxis and a husband with cardiac disease. Wolfe has texted her bosses asking for dispensation for her colleagues, but it doesn’t matter because these friends wouldn’t accept special treatment even if it were given. “My work friends are the most quality human beings on the planet,” she says. “The thought of losing any one of them is absolutely horrifying. It’s stuff I don’t want to talk to my husband about. What’s coming is going to cross lines of things I don’t want to share. I live in fear. I just don’t want that to happen. That just can’t happen,” she says.
Her three children are home — the oldest from college, the middle one, 16, going out of her mind with boredom (“This is actual torture for her”), the youngest needing help with his online environmental-studies homework. Wolfe is married to another doctor, and, like many Americans of means, she is observing the routines of her comfortable life as if from a distance and wondering how much will survive. As parents, she and her husband never got stressed about small things; they always let their kids order whatever they wanted at restaurants. “We’re like, ‘You want that dessert and that dessert? Get it!’ Why say no and make someone unhappy over something stupid?” But now she’s thinking even about the paper napkins they use profligately at every meal. “We are so frivolous with napkins,” she says. “Is it going to come to a point where we say, ‘Remember when we used to just throw away napkins?’ ”
The emergency room has a very different new normal. Now 90 patients in the Elmhurst Emergency Department is unmanageable but manageable; admitting 20 used to be a busy night. What Wolfe does now when she gets to work is check first thing on the availability of ventilators and, if the ER is short, go to the basement and grab what’s there without going through official channels, because when the need for a ventilator arises, it does so suddenly and urgently. This can cause friction with other hospital staff, but honestly, Wolfe doesn’t have time for that. “I like to have at least one ventilator ready to go, because there’s going to be someone rolling in with a [blood-oxygen level] of 40 or 50 or 60.” She recently had a tense exchange about following protocols with a colleague in critical care. “And I was like, But don’t you understand? I have none. The first person who comes in, I’m not going to have one.”
As the virus has overwhelmed hospitals nationwide, and physicians teach each other better strategies for fighting it, best practices change by the day. Two weeks ago, the majority of patients in the ER needing more than six liters of oxygen were intubated; now, many of these same patients remain stable on CPAP settings, the standard intervention for snorers with sleep apnea. American doctors have learned from Italy that many ventilated COVID-19 patients do much better when prone, lying face down in their beds, and that patients on other types of breathing apparatuses need to be rotated every couple of hours to keep their oxygen sufficiently high. “It’s like cooking,” she says. “Someone at work called it a ‘pig roast’ or whatever. When you change their position, their oxygen changes completely. If you sit someone up, their oxygen gets better. You turn them to the side, it helps again.” This is arduous work when the patients are weak and the ER understaffed, requiring physical strength and constant attention, but Wolfe, who is a small woman, uses a common hack: If she mechanically tips the head of the bed down for a second, gravity helps the patient slide to the top, and then, when she raises the bed again, the patient is comfortably seated. The crazy thing “is that when you put these people upside down, they’ve got blood-oxygen saturation of 97,” she says.
Intubation itself is hazardous to physicians to perform because the spray from the patient’s throat goes everywhere, like a sprinkler, creating an invisible infectious cloud. In an ideal world, intubation for highly infectious diseases would occur in a negative-pressure room, where contagious microorganisms are sucked out of the air, but in the context of the current reality, it’s impossible for every pop-up treatment room to be outfitted this way. So Wolfe started looking around for plastic sheets that she might place over a patient’s face and chest to provide at least a protective shield during the procedure. But no such sheets existed in hospital supply. So with the thick plastic bags normally used to hold patient belongings, she invented a work-around. “I figured out that there’s a sharp spot where the metal pole of the patient’s stretcher meets the arm of the stretcher, and I ginned this maneuver.” Before each intubation, Wolfe slices the thick string on the laundry bag on the joint and then peels the bag open, creating a flat sheet. “That’s the general state of affairs. If the whole big picture weren’t so sad, figuring these things out might be kind of fun, like a scavenger hunt.”
One night, she received a warning from the hospital about possible ventilator shortages. Immediately, Wolfe went online and learned a method for creating a CPAP apparatus from a mask, a length of tubing, a wall oxygen tank, and something called a peep valve, which provides additional breathing pressure. But the hospital had almost no peep valves in stock, and Wolfe panicked: “I’m having to learn this Third World way on the fly, and I’m not even going to be able to MacGyver it. It was extremely anxiety-provoking.” So she called an OB/GYN friend who knew an outpatient anesthesiologist who has connections at a medical-supply company and could, as the friend said, “get you things.” So Wolfe texted the anesthesiologist, who asked her for a list of the six to eight items most urgently needed.
“I text him the list. I feel like I’m in a spy movie. Suddenly, the peep valves are getting delivered, and I called my boss. I said, ‘Is this working? Should I keep giving this guy lists?’ It’s not clear. Still, I pass him lists of things we need: ventilators, CPAP masks, laryngoscope blades. I said, ‘We need fentanyl,’ and he was like, ‘I can’t get that, but I can get propofol.’ On the back end, somebody is making some kind of arrangements and checking in whatever we’re getting, but I don’t know. When we get new stuff, I wonder if it’s from my secret source, and I think, This is fucked up. Who’s selling? Who’s buying? But in the end, it’s not my problem. If it’s coming, it’s coming.” (“Lots of people are reaching out offering lots of things, but for things like ventilators or medicines, all requests go through the hospital,” said Stuart Kessler, the director of the Elmhurst Emergency Department, adding that, in spite of the scarcity, the hospital has not run out of ventilators.)
Already, COVID-19 is creeping into her circle of friends. During residency, Wolfe and her husband became close with two other couples, all of them living in Mount Sinai housing, eating dinner with whoever was off that night. The couples had babies at around the same time and started spending New Year’s Eve together, first in an unheated house in Woodstock. Last week, when the father of one of the men in the group died of COVID-19, the man — a surgeon whose father was a surgeon — had to go to the funeral alone because it was limited to ten people. Wolfe was on the phone with the wife that day, who was sobbing uncontrollably after watching her husband put on a suit and get in the car all by himself. Wolfe is telling this story quietly, in her house on her day off, but apart from her family. She goes on to talk about another friend from residency whose husband just died. And in the same short period, she heard about a man from a nearby neighborhood who died while out on an errand. He had a heart attack and crashed the car. This last was not COVID-19 related, just random tragedy in the midst of catastrophe and another family sitting around waiting for news.
Wolfe is still sleeping in the same bed as her husband, although many colleagues on the front lines are making different choices: to live in a separate bedroom or in a rental or a hotel; to wear a mask even at home; to install high-tech air filters. At the beginning of all this, she and her husband made a plan. “If I felt sick at all, I would go to the basement. If my husband got sick, we could be in the basement together.” There is a little quaver in her voice. “I’ve felt completely fine. I’m not worried about myself. It would suck for the people who love me; it would be sad for them if something happened. But I don’t feel too freaked out. If there’s one person I’m worried about, it’s my husband. Men do worse, and it’s more common in them. He’s our main grocery shopper, and he doesn’t seem too concerned about it.”
But she has been avoiding her mother and has delegated to her daughters the job of keeping their grandmother up to date. Wolfe is an only child, and she is close with her mother, who lives nearby. Their interactions throughout this epidemic have been mostly superficial: “She’s remarkably upbeat and positive and she hasn’t hocked me at all,” Wolfe says, deploying a Yiddishism for “insistent annoyance.” She sees how much self-control that must take, and she credits her father for helping rein her mother in. “No one has more questions than my mom, and not in the typical Jewish-mother way. She has such a curious mind. She always thinks of the next question. You leave something out, and she smells it.” The anxious and terrified way Wolfe feels about her friends at work is, she knows, how her mother feels about her “times a billion,” she says. “I totally can see it from a mother’s perspective. You don’t want the police or the military knocking on your door, saying your child is a hero — fuck that. So I kind of can’t deal with that feeling of her worrying about me. I’ve completely walled it off. I can’t hear it. I don’t want to hear it.”
On her days off, Wolfe tries to maintain normalcy. She takes walks with her family, often driving to a different suburb so she can evade the obligation of others’ gratitude and awe. “I could do without 6,000 people saying, ‘You’re a hero.’ ” If her parents come along, she makes them wear masks and walk on the opposite side of the street. Her kids recently prepared a parent-appreciation brunch with avocado toast on fiber crackers and bagels and lox, and the other day she made fajitas for lunch, which was unexpected. “I’m not a cook! I’m not a motherly mother.” Her 16-year-old is learning to drive, and together they log hours and hours — sometimes driving into the city to check out the dark and abandoned streets — gratified that they’ve found a good reason to get out of the house, even as a quiet voice in Wolfe’s head worries about squandering gas.
Wolfe’s anxiety about work has been escalating lately, an unfamiliar feeling, like having too much coffee. In part, it’s because protocols change every day. To reduce the contagion risk in the break room (among other places), the hospital has recently initiated a new protocol in which staff are required to don and doff PPE in a trailer outside. But the new routine meant new logistics, requiring the obtaining of keys and access to the ER by the back door. And all this would be fine, if it were regular and habitual, but all of it — the trailer, the keys, the back door — is novel and a work-in-progress, requiring so many extra steps and layers of thinking that the doctors who usually do this job with equanimity are sometimes snapping at each other. “I had to climb over barricades to get to the ambulance bay to get to the back door to get the key to the door to get to the trailer. You just start to feel insecure. The places I used to go — how am I going to get there?”
As Passover approached, there was a family debate about gefilte fish, because the kind everyone liked the best came from a store that felt too risky to visit. And Wolfe kept thinking of all the people who weren’t there. The previous year had been a brutal one: Her grandmother passed away in January 2019; her sister-in-law died of pancreatic cancer in May; two friends from work died, one of them leaving young children behind. It was the kind of year you want to put behind you, but for Wolfe, it has amplified the present-tense horror, increasing for her the understanding of what each individual death means for widening circles of people. Wolfe reflects a lot on the emotional distance between data points and human lives. “I keep wondering what the dead people are thinking. Glad I got out before this, or, What the hell is going on? I hate that Johns Hopkins number of 1.27 million [worldwide cases]. It was 400,000 a week and half ago. You know it’s exponential. You know, intellectually, what that means.”
Wolfe refuses to project how long this will last. “I’m kind of hoping it will not be so much longer, but I don’t have any basis for guessing that. I’d rather not even know. I’d rather think, There’s no end, and then one day be like, You know what? This is over.” And as the stress rises, her beloved colleagues try to keep it light, adapting and adapting yet again, continuing to post photos of themselves on Facebook with captions that say work family love! and teasing one another about how “hot” they look in their Tyvek suits. In her layers and layers of PPE — scrubs, gown, gloves, goggles, helmet — Wolfe knows that on some level she must look comic. In one 24-hour period, colleagues at work compared her to a garden gnome, the Pillsbury Doughboy, a character from The Handmaid’s Tale, and a snow cone. In a text, she conveyed these insults to her mother. It was a dark effort to make her laugh.
*This article appears in the April 13, 2020, issue of New York Magazine. Subscribe Now!