“This disease has challenged everything that we believed was right six weeks ago.” “It’s different than anything we’ve seen before, and maybe the way we’ve taken care of things is not the right way of doing it.” “There is a lively and healthy debate, that I think is a good debate, about what the right thing to do here is.” “I’m concerned that if we continue on the path that we’re on, that hundreds of thousands of lives and lungs may be at risk.” “It’s actually kind of vital that we not deviate from those treatment protocols because we know that they reduce mortality.” “Low oxygen levels.” “They will tire out within a few hours. So what’s your next step?” “Before Covid-19, I would recommend putting you on a breathing machine.” “I would have rushed to intubate.” “Because that was probably the right thing to do.” “I know when to put in a breathing tube. I’ve worked long enough, and I’ve worked enough places with enough people. But in this disease, it is extremely confusing, you know, it just doesn’t make sense. Listen, I stocked up for the apocalypse, like most people. Now, I just can’t believe that I ever thought that I’d somehow be home to make all my frozen food. On a normal day in an I.C.U., you have very sick patients. Patients will — are dying, but this is just different. It’s just — you have a disease we don’t understand that is very deadly with patients that are scared and staff that are scared, and on top of that, it does not appear that we have a good treatment strategy other than a ventilator. And we don’t — we’re not sure when to put a breathing tube in. The crux of it is, we don’t want to put a breathing tube into someone who doesn’t need it knowing that there’s a 70 percent chance they’ll die, and then we don’t want to not put it into someone who would need it too late. When you go to the E.R., and there’s like 40 people that need oxygen, and they all look terrible, but they can all talk to you.” “And no apparent distress whatsoever.” “And then you get them on a monitor, and you look up, and you see this oxygen saturation of 45 percent or 50 percent.” “And telling myself this is impossible. This is not possible. How can this be?” “It’s just not compatible with life to have an oxygen saturation that low.” “You know, this is strange. It’s out of a horror movie.” “I’ve been unable to sleep because I’m trying to wrap my head around it. This goes against anything I’ve ever believed.” “The paradigm of ARDS is not matching with the patients that I’m seeing, so it’s like trying to fit a square peg into a round hole.” “The core of the core of the core — it is just, what disease are we treating? And are we treating something that is naturally ARDS, or are we not?” “We protect the lung against what we do to the lung. Protect it from what? From what we do in mechanical ventilation.” “So what he is saying is that we just have to be gentle. People will need a ventilator, and those that do need as high oxygen as possible, as little pressure as possible, in order to buy time until this demon virus stops.” “These patients have ARDS. I think the editorial has both been misinterpreted, and I think people have misunderstood that it’s just that. It’s an editorial. It’s not a study and it’s not a trial. I don’t doubt that people have seen some cases with some terrifyingly low oxygen numbers. On average, they’re as sick as prior cohorts with ARDS.” “I just think it’s important to say that it’s not a settled question. Every hospital in the world is probably solving its problems slightly differently.” “We’re using an early intubation strategy here, and of our first 66 patients, already a third of them have been extubated. I’m arguing for evidence-based medicine, which is something that we all purported to agree with before this outbreak hit. We have large, randomized, controlled trials. The patients in those trials had met the same diagnostic criteria that our current patients meet. We should apply the results of the trials.” “Today, we do not rush to intubate. Intubate shouldn’t — has become the last resort, and the protocol once they’re intubated has changed drastically.” “So within the last two weeks, I mean, what has been unacceptable has become very acceptable. Some of these patients don’t need to be intubated. You watch them carefully. You make sure their oxygenation is adequate, and they can recover.” “I am not saying we don’t need ventilators, but perhaps we need to think about how we’re using them. Somebody, and preferably people that are not taking care of patients every day, needs to look at the disease and figure out how we can treat it better.” “The truth will come out eventually. In the meantime, the question is: What do we do until that happens? And yes, I’m nervous. I’m scared everyday when I go into work, but I’m just trying to do the best I can.”