Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

Hi everyone. It's Emily recording from my bedroom again on lockdown, like many of you, I just finished a four-day stretch in the hospital, and I'm very grateful to be getting some rest.

For those of you who are tuning in for the first time, I am a doctor in San Francisco and the host and creator of The Nocturnists, a live show and podcast that shares stories from the world of medicine. Four years ago, I started up The Nocturnists because I desperately wanted to see a safe space where physicians and other health care workers could come together and open up and be real about the joys and the sorrows of our work.

And that was all before coronavirus. What's happened to health care workers in the last few weeks is unprecedented in our lifetime. The virus is spreading. There's a shortage of testing. There's a shortage of PPE. And this is forcing health care workers to face impossible choices. We're putting ourselves in harm's way. We're risking the health of our families. We're asking ourselves, “Is this what we signed up for? Going to work without appropriate protective gear? Having to choose who lives or dies due to a scarcity of resources?”

Around the middle of March, we put out a call for people who were interested in keeping an audio diary about their experience on the front lines, and we were really overwhelmed by the response. As of today, well over 150 health care workers have signed up to participate. The audio clips are pouring in. Every couple of hours, our team gets an email that somebody has uploaded a new clip. Our team has been listening to your audio really closely, and it's been hugely therapeutic for us.

Speaking for myself, it's definitely made me feel less alone and less scared.

In that vein, we realized how important it is to get this audio out so that other people can listen and benefit from the sense of comfort and community that this audio brings. As a team, we've decided to interrupt our regular podcast season and air some of this audio. There's a lot more audio than we have time to air on the podcast. So we're also in the process of putting together an interactive map where you can click and listen to audio diarists across the country.

We've talked a lot about how we wanted to do this podcast, and our first priority is to respect the immense trust that you've placed in us as The Nocturnists. We know it's a sensitive time, and so we just wanted to put out the disclaimer that some of our audio diarists are sharing their names, others are using pseudonyms, and others have decided to be completely anonymous. We're airing the stories with very minimal edits, and the only music that we'll be using in this podcast series is that created by you, our diarists.

It's a sort of guerrilla-style podcasting that we've never done before. And so with that, allow me to introduce The Nocturnists: Stories from a Pandemic. In this first episode, you'll hear the voices of a trauma nurse in San Francisco, a pediatric emergency doctor in New York City, a durable medical equipment truck driver in the southern U.S., a neonatologist in Pennsylvania, a neurosurgeon in Los Angeles, an emergency medicine doctor in Arizona, and a medical resident in New York City.

If you want to add your voice to our diary project, visit our website at thenocturnists.com and don't forget, stay safe, stay healthy.

With that, here is Episode One: “New World.”

Emergency Department Nurse, San Francisco

I just finished my first shift in the emergency department in two weeks, and I was really kind of freaked out going in, and it wasn't…it wasn't that bad. We haven't really seen a dramatic surge yet in San Francisco, and I think that the hardest part right now is the anxiety of feeling like there's this giant wave that's going to come crashing down on us at any time and we're not sure if we're ready for it.

I mean, the anxiety is real. People…people don't know what to do if we run out of personal protective equipment. We're already reusing masks and reusing gowns in situations where they don't get soiled. We're really trying to conserve in a mindful way. And I am always so impressed and so bolstered by the spirit of my coworkers. And they're still smiling, and they're still laughing, and they're still together, and they're always supporting one another.

The community has come out so strong in support of us. I think food got delivered three or four times today. The joke right now is, how are we all going to lose weight after this is over? Because we're inundated with food, so…

Oh, it's…it's not–not bad yet. It's a whole lot of unknown. We're not in that place yet that we're reading about in the newspaper, that we're hearing about on the TV. We're…we're doing our best to get as ready as we can, but…but today was okay.

Pediatric ER Doctor, New York

Here's my first diary entry. Well, we are a few days in…it is March 19th. I am a pediatric emergency room doctor.

I worked yesterday. I thankfully have a day off today to recover after working five out of seven days in the first week of this crisis, including three overnights in the emergency room. Our volumes are down right now in the pediatric ER as people are scared and staying home. We have very limited testing. I've already seen a couple of positive cases, but we're only allowed to test patients who will definitely be admitted, which is a nightmare because people should know when they're going home, and we're sending people home on the subway who probably have COVID and we can't confirm whether or not they do.

But at work, I actually have been feeling more in control, like it feels like my hospital is responding appropriately. They're adjusting staffing. They're adjusting beds. They're listening to our solutions. And what has been the worst for me is getting on the subway to go to work. It's almost an hour commute on the subway.

And I am just horrified by how many people are on the subway everyday still. And I am frantically looking around to see if anyone is sniffling and trying to move if they are, or coughing, which people are. And other people are like carrying a yoga mat on the subway to go God knows where. I don't think yoga studios are open. And that feels really scary because at least at work I can wear my full gear. On the subway, I just feel really scared just trying to get to work.

And yesterday I got kind of, like, harassed by some teenagers. And I know they're just kids, but... I’m really tired. Just like kids hanging around on the subway platform or like by the station …and 13, 14 year olds, really young kids–it’s not like they were going to hurt me. But one came up to me and put his hands all over my jacket. He was, like, touching me. I mean, like “Corona, Corona!” And they all ran away laughing.

I was really scared. (SIGH) But now I will sleep. And hopefully there will be fewer people on the subway tomorrow, and hopefully my work will have enough gowns and masks for us. And I'm trying not to get sick.

Delivery Driver, Southwestern US

So here we go. I work for a children's hospital system as a delivery driver. My job is to take supplies to patients’ homes and give them what they need. It can be anything from vent and trach supplies, to oxygen, to formula and diapers, to phototherapy equipment, to CPAPs and BiPAPs and…whatever they need.

But things have started to get a little weird. For the most part, I don't go to the hospital. I get the all-hands emails about their protocols, but it doesn't make a lot of sense to me because I'm not a medical professional, really. I'm not a doctor. I'm not a nurse. I'm not an RT. I just drive a truck. So I know that we have to inventory gloves and masks every day, and we're getting some blowback from patient families now because…because of the PPE shortage, we're no longer sending boxes of gloves or masks to families who need them. Instead, we're sending out gloves by the piece in a Ziploc bag.

Yesterday, I had my first family refuse to allow me into the house. They wanted me to leave their oxygen tanks on the porch and then back away slowly so that they didn't have to interact with me to sign the paperwork. That was a little weird.

Today, we got the directive that we no longer even have to have paperwork signed, and by the end of the week, they're supposed to do voice consents for new patients instead of having us do consent and financial paperwork, when we go out to the patient's house for the first time. We're considered essential, and at my office we’re several hands short, just without the crisis. But they sent me home early today because I'm getting too much overtime. Apparently being willing to make sure that our patients get their stuff is too expensive. So I don't know. We'll see what they have me do tomorrow.

I tried to make a delivery to a doctor's office yesterday. They wouldn't let me in the doctor's office either. I was greeted by nurses in the parking lot in full PPE. They're apparently keeping patients in the car until they're ready to go back to an exam room. They've closed the waiting room. So I don't know where it's going to go.

My suspicion is that it's going to get real bad in the next couple of weeks. And everybody's terrified. I went to the home of a new patient today…a newborn who needed phototherapy for newborn jaundice. And typically, I'm in the house for 30 to 45 minutes, and I clean my hands with hand sanitizer a couple of times–that's the protocol, that's always been the protocol. But the parents were nervous about even having me in the house.

And I have to demonstrate this equipment to them. It's this, or they go back to the emergency room. So they finally relented, but it was tough. I get that they have a five-day-old child who's, you know, got jaundice. And instead of getting a medical professional, they get a truck driver. I can see how it would be nerve-racking. So I don't know. We'll see what happens.

Pediatric ER Doctor, New York

It's March 19th, 2020, and this is my COVID-19 pandemic diary.

I can just kind of feel the impending doom of the lack of supplies coming upon us. We've been told there's no more Purell, so we're to soap in the water soon, unless there's more Purell made. So we'll see about that.

And as I said yesterday, we just don't have enough PPE. That keeps coming up every single day. The cases from the CDC are going up every single day. So it all looks pretty bleak. So I thought that instead of talking about being prepared to not be prepared, I would just tell a funny story.

So I have been altering my hygiene practices as a result of the COVID-19 outbreak, and I wear scrubs to work every day, and I take off my clothes when I come home first thing and put them in the wash. So it's not clothes that I would wear anywhere else but the hospital. And I take them off and I put them immediately in the laundry room in my basement and I walk into my house.

I was trying to be really good about, before going to work, leaving a pair of clothes in the guestroom that's like up the stairs. But I keep forgetting to do that. So I'll generally just go into the laundry room, strip down and be in my underwear as I go upstairs to play with my kids, and I'll try to shut all the blinds all over the house so that none of my neighbors could see me.

That said, they've all seen me breastfeeding and my boobs out. I know that because one neighbor across the street told the neighbor next door who told me that she was concerned that her son, who–I don't know how old is–had seen me breastfeeding.

I wish she had told me. And if she ever listens to this podcast, she’d know that I know that she knows that I know that she told my neighbor about my breastfeeding. And I've already lost the chain of thought on that…but anyway, so, you know, to be fair to my neighbor who saw me breastfeeding and has seen my boobs, you know, I am naked in the house, especially in the COVID-19 outbreak.

So–so in the time of COVID, for me, it's also been a time without clothing, and maybe we can just all be okay with that.

Neurosurgeon, Los Angeles

It's March 26th in the afternoon. I’m finally home after a fairly long day yesterday and today. Evacuated a subdural hematoma again today and another traumatized person on an anticoagulant. Spent the rest of the day today teaching in the ICUs, working through some in situ simulations where we run the nurses through simulated codes and other drills in the ICUs, focusing mostly on protective equipment.

Met with some of the ICU fellows to work on our preparedness…was up until midnight last night working on health system-wide ethics guidelines. So one of the privileges of this crisis is that I've been able to help with a number of different aspects of our institutional policy in our large public hospital, but also work on policies that are affecting our entire health system.

We're fortunate in a crisis like this to be able to get to do things that, frankly, we’ve often been meaning to do for a long time. And so we're–we're really starting to construct some ethical guidelines concerning resource allocation, planning for the worst, giving clear guidance to clinicians without tying their hands, but giving them support and giving them a framework for making decisions and establishing resources for deciding how to allocate scarce resources. And of course, all of this comes after our planning to never have resource scarcity.

It's just so painful and so hard to think about the scarcities that people are suffering in New Jersey and New York and Florida–seeing pictures of people using trash bags as personal protective equipment and rationing, running out of ventilators, connecting multiple patients to the same ventilator when we have quite literally rooms upon rooms full of ventilators here at our hospital. Although people are complaining about the restrictions on protective equipment, we have all the gear that we need for the most part.

There have been a couple oversights in the planning process, but those are being remedied. We have Hollywood movie stars dropping off equipment at our hospital. We have funding from various sources. We have disaster caches. I won't say that we could weather the storm by any means, but the fact is that both figuratively and literally, it's 70 degrees and sunny in Los Angeles today.

We have two confirmed positives in our hospital, but there is concern on the horizon.

Our county health system has reported four hundred new cases, taking us from six hundred to twelve hundred reported cases in almost two days. We haven't seen that on the inpatient side result in really any increased demand, but you can't help escape this feeling that there's something around the corner. And, you know, every day when I get to go to sleep, all I think about is... did we do enough? Were we ready enough? Did I help enough people?

That's really how I judge myself. And I'm never sure that we're doing enough, and I'm never sure that we can do enough, and we won't really know until after this is all over. But I don't think that I've worked harder at a hospital project that I can recall. And to our colleagues on the East Coast who've been hit first by this, I…I can only say that we're listening to you, that we support you with our thoughts and and hopefully with our deeds, and that we're…we're trying to learn everything that you're trying to teach us, and to be ready…to be as ready as we can be.

We'll see. We'll see. We probably have a few more days until we know for sure whether or not we'll catch up with New York, but…but we'll stay and watch. We're ready, as ready as we can be.

Emergency Department Doctor, AZ

Hey there. It's my birthday. Celebrating in self-isolation during a pandemic is not exactly what I had in mind. Another year older means another year closer to COVID having more of a risk on my health, and also feeling kind of frustrated and stressed out about the mask situation in our emergency department.

Last time I spoke was two days ago on Friday when I was coming off an 80-shift, at which point I was told we were out of N95 in the entire hospital system. I wasn't able to get one for our patient we were putting on CPAP or BiPAP, but it was okay, I stayed out of the room…

And then I was told after some masks were brought up, that was it. The hospital was out. Of course, I just heard this from nurses in the emergency department. I didn't hear it from any higher ups, but I assumed to be true. And it doesn't really matter, right? If I need a mask and I can't get one, then we’re effectively out in my mind. Furthermore, if someone has to go down to sterile supply to get the mask and if it's not available urgently when it's needed in the ED then, again, we are sort of out of masks in my mind. In the emergency department, we need to have a mask ready when someone's being wheeled in, sick, and emergently needs intubation or some kind of airway.

So in my mind, we were out. Then I got an email today saying that we do have PPE. We have plenty of it–it’s being monitored on a high level. But where is it? If we have it, where is it? Why don't we have it in the emergency department? Then I get a text from one of my former co-workers, one of my mentors, and he asked me, “Hey, is this true? I read this article in one of the local independent newspapers that said that your health system is limiting and rationing masks for health care providers–literally having administrators yanking masks off of workers faces.”

So then I start to get confused, okay, do we have masks? And it's just that admin is saying that I don't get them, that I can't have them? Putting me at risk, putting my family at risk, putting my patients at risk?

And I thought back to an account that happened last week when I worked on Monday, when the administrator did come. She saw during a surgical mask…the same one I'd been wearing all day, just wearing it on my face for every low risk patient, reusing the same mask so I don't, you know, run through them. And she told me I need to take it off, that it was hospital policy, I needed to remove my mask. Only if I were sick would I be allowed to wear one. And it infuriated me at the time. I didn't act how I thought I should. I didn’t act in the best way.

I kind of got upset and I told her there's no way I was taking it off until she could reassure me that there is no shortage of PPE. I thought it was just the individual. I didn't realize that this was the administration's plan to forbid us from wearing masks. And it's true…we're only supposed to wear masks when patients have been labeled at high risk. Otherwise, we're not supposed to wear one.

But we know that asymptomatic people are having COVID. We know that half of the people with COVID, or some percentage of them anyway, only have GI symptoms. So if our screening tools just identify them with respiratory distress or fever, then we're missing people, we're putting ourselves at risk! And then I just read ASAP’s clinical guideline saying that emergency physicians can consider wearing a face mask or surgical mask for their entire shift, and they can use them with the current shortages in place.

I mean, it's just crazy.

And then I see on social media that the CDC has said that we can wear bandanas. It's absolutely ridiculous. Bandanas are not safe. Why don't we have masks? Why are these recommendations putting us at risk? Why can't they at least be honest and say you should be wearing a mask? Of course, we don't have them. So, I just…it's scary. I didn't stockpile masks because I thought my hospital would protect me.

I don't have any laying around. I made a Facebook post and I immediately took it down because I felt too histrionic. And also, I'm sort of scared of the repercussions of saying this stuff publicly if my administration comes out against me. But a few friends saw my post before I deleted it and they brought over masks. They left them on my front porch. I'm so thankful for them. But it’s just crazy. It's crazy that the hospital isn’t taking care of us.

Also, the university affiliated with us is starting a PPE drive to provide PPE for the emergency department. You know, if we had so many masks, why would this be necessary? Why are we having to go to the community, to lay people, to get our masks?

Internal Medicine Resident

Residency has been really weird lately. Last week, I was called into the hospital to take care of COVID patients.

I spent two nights working on the floors and then spent four days in the ICU. I was supposed to spend more time there in the ICU, but on day four in the ICU, I developed a sore throat and some chest tightness. And I had also learned two days earlier that one of my co-residents I’d been working with closely had come down with symptoms as well. So our program is pretty strict about self isolating when you have symptoms to try to stop the spread of coronavirus within the hospital staff.

So I'm at home. I've been told I need to be home for seven days since the onset of symptoms. I went and got tested yesterday. They've made testing available to hospital staff where I work and it came back negative. That sounds like good news, but we know that the test isn't 100 percent sensitive, which is to say that people can have false negatives, and there's a decent chance I'm one of those. The co-resident that I mentioned before, who I was working with and came down with symptoms, tested positive.

We were sharing a small workroom, not wearing masks. We were sharing the same physical landline, our mouths up close to it, taking turns on the phone. So I'm still acting as if I had an infection, and I'm home. When my husband and I are in the same room, which is pretty often in a one bedroom apartment in New York, we both wear a mask so I can try to keep him safe. Fortunately, my symptoms are really mild.

I have a little sore throat and a little chest tightness and again, maybe it's just a regular cold. The thing with the negative test result is in some ways it is just more uncertainty. But anyways, I'm home and it feels like so much of life is just being on my phone and on computer, on the computer, and responding to friends, reaching out to family. So much of the physicality of life is kind of missing. You can't go outside and go out to eat.

So, I found myself wanting to take out my violin. Residency is way harder work than anything I've ever done and so my violin has been living in my closet collecting dust. But I've recently started to want to play it a little bit more and, and now is the perfect time that I'm home and have time to myself, and I'm feeling a bit more reflective.

Sometimes words feel inadequate and sometimes I just want a break from words. So I'm finding music, especially music written centuries ago, that spans time and spans languages is deeply comforting.

This is the melody from the second movement of Dvořák’s Symphony Number 9, the New World Symphony.

MUSIC