Dr. Josh Mugele is an emergency room physician who practices in Gainesville at Northeast Georgia Health System. He volunteered to go to New York City, free of charge, to help with its surge of coronavirus patients, calculating he could return in time for the surge in Gainesville. In several conversations, he spoke to the Atlanta Journal-Constitution about his time there and his return home. His comments are edited for length and clarity. He worked from April 8 to May 4 at Metropolitan Hospital in East Harlem, slightly after the peak of the city’s surge.
One of the things I had to learn was which patients are sick and which patients aren’t sick. I hadn’t seen as many COVID patients as some of the people who’d worked there already.
One of my first patients there was kind of a borderline patient. His oxygen sats weren’t bad but they weren’t perfect, and he had some co-morbidities. He wasn’t young but he wasn’t super old, either. And I kind of had to make a decision. And I ended up sending him home and discharging him. For the next three shifts I was checking on him. And really making sure he didn’t come back or anything. And he didn’t. So I was like, OK, I’m relieved, I made the right decision. He’s doing OK.
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Then 10 days later he came back in, while I was working. And he was really, really sick. Probably was the sickest patient I’ve seen so far. His lungs were just filled with fluid. If you looked at his chest X-ray on one side it was almost pure white. We put him on a ventilator and sent him up to the ICU, and I was fairly convinced he was going to die. But he didn’t, he actually survived.
It makes me feel like somehow I didn’t do the right thing for the patient. Even if there was nothing else I could have done. It makes me feel bad, like I failed him somehow.
New York, empty
I think the actual work was manageable from my end. I think what was more difficult or more of a shock was actually living in New York for a month while this was going on. It was really, really empty.
It was really bizarre standing in the middle of Times Square with all these lights and billboards. It was eerie. There were a lot more rats in the street. I rode the subway to work every day and it was completely empty.
Credit: Courtesy of Josh Mugele
Credit: Courtesy of Josh Mugele
There were cops, homeless people and then cabs just kind of waiting in a line. For most of the time, those were the only people I saw.
I planned to go running every day. That probably turned into I was running once every five days. I was just in a head space. I think I started getting depressed. I was sleeping a lot more.
Actually, halfway through there I switched hotels. They were putting COVID-19 patients up in the same hotels as I was staying in. Then not in my hotel but right around the corner from me, they found three dead bodies.
People started banging on my door like three times in one day doing a welfare check. I was sleeping after a late night shift. The first one was at 10 a.m. and I didn’t answer my door — so they kind of broke in.
I was like, “What in the world?”
Help and hurt
One of the best things about the trip was, basically through Twitter a ton of people offered me help.
Someone I didn’t even know deposited $20 in my Venmo (a digital wallet). A screenwriter offered me his apartment, though the co-op board said no, they didn’t want a COVID doctor staying there. Then somebody bought me a cocktail through this collective. An out-of-work bartender set this up.
At about one week in, I ran out of scrubs. My scrubs were all dirty and I didn’t want to wear them two times in a row. I ended up texting a previous coworker who had a friend, basically a friend of a friend, who had an apartment who was living in New York, and they were quarantined. They invited me over to their apartment to do laundry, and I had dinner and had drinks on their rooftop.
That was actually my first time hearing the New York cheer.
At 7 p.m. the entire city opens their windows and honks their horns and bangs pots and pans, and cheers. So I got to hear that sitting up on a rooftop drinking whiskey.
I actually cried. It lasts for a good minute to two. It’s not just this tiny thing.
While Mugele was in New York, news broke that a New York City emergency doctor who had treated the COVID-19 wave, then contracted the disease, and then gone back to work again, had committed suicide.
That one – that was devastating. You could just see yourself in her. I think we all get to a point where we’re physically exhausted, or emotionally exhausted, can see ourselves quitting the job or running off to south America. Or even killing ourselves. I think most of us can be in a head space where we realize that’s temporary.
Credit: Courtesy of Josh Mugele
Credit: Courtesy of Josh Mugele
I try not to get wrapped up in a case. It’s the emotions that always come afterward. You’re kind of in a professional mode while it’s happening and then it hits you later. A week later, or that night, or a month later.
People are dying from this disease. I think there’s a lot of emotions and frustrations and anger wrapped up in the governmental response, the state response, or the brokenness of the system that you see. How poor people are getting this more, or undocumented workers are getting this more, or the homeless people are getting this more.
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I think that’s frustrating and angering. I think that is the predominant emotion a lot of us are feeling around this.
It waxes and wanes.
I think what I’m feeling a little bit right now is – I’m almost a little defeated. Maybe resignation is a better word. Do I wish I had more N95 masks? Of course I do. Should I have more? Of course I should. But this is the situation I’m in. I’m going to show up to work and do the best I can.
Back home
When I flew back to the airport in Atlanta it was, I wouldn’t say packed, but it was pretty busy and not a lot of people were wearing masks. Everybody in New York was wearing masks.
I was a little dumbfounded honestly. It’s frustrating. Again my hope is that as we open up the state, people will take it on themselves to be as careful as they can, whether that’s wearing masks or maintaining social distancing or not going out too much unless it’s absolutely necessary. But I know how people are.
I was talking to a person recently who has COVID-19. And he decided that, reading the government’s guidelines for opening the state up, he could go shopping as long as he wore a mask and kept social distance. So he went out shopping. He told them he was positive. And he got thrown out and refused to leave and they called the cops for trespassing.
In northeast Georgia, we’ve been seeing a decent number of COVID cases for the duration. Now, I feel like I’m seeing more potential COVID patients in Georgia than I was seeing at the end of my time in New York.
This week one of our ICU nurses died from COVID. This is affecting my coworkers.
When people, or the system, are going out more without wearing their mask, or opening back up, it’s not just affecting the patients, it’s leading back directly to health care workers. Because we’re the ones who are going to end up being either overwhelmed but also be secondarily affected and infected by it. I think it just has a higher potential of hurting, either making ill or even killing, some of my coworkers.
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I just hope that people are sensible enough that as we open up they don’t go too crazy with it. That’s my hope.
I’m happy to be back. It’s a sense of normalcy.
I learned a few things. In New York it was kind of common knowledge that a lot of COVID patients were presenting with diabetic ketoacidosis. Yesterday we had a patient with that, and I said, “Better test for COVID.” And every time I have a stroke patient, or a patient with chest pain where I’m concerned about heart attack.
I think more than anything just the act of going and the act of volunteering hopefully was a good example. Hopefully it can show people that there are people willing to help out, there are people willing to travel up there. And I think a lot of the doctors I worked with expressed that to me. They were just in shock that somebody would come up all the way from Georgia.
I think it’s more of a a sense of community and a sense of camaraderie and just a way to help. A way to be there and be present. To show people that the rest of the country is caring about them.
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