‘Is This When I Drop Dead?’

‘Is This When I Drop Dead?’

Two emergency room doctors, Dr. Tsion Firew in New York and Dr. Cedric Dark in Houston, discuss their cities’ coronavirus outbreaks — and responses. (Columbia University Irving Medical Center; Baylor College of Medicine)

Health workers across the country looked on in horror when New York became the global epicenter of the coronavirus. Now, as physicians in cities such as Houston, Phoenix and Miami face their own COVID-19 crises, they are looking to New York, where the caseload has since abated, for guidance.

The Guardian sat in on a conversation with two emergency room physicians — one in New York and the other in Houston — about what happened when COVID-19 arrived at their hospitals.

Dr. Cedric Dark, Houston: When did you start worrying about how COVID-19 would impact New York?

Dr. Tsion Firew, New York: Back in February, I traveled to Sweden and Ethiopia for work. There was some sort of screening for COVID-19 in both places. On Feb. 22, I came to New York City, and nothing — no screening. At that point, I thought, “I don’t think this country’s going to handle this well.”

Dark: On Feb. 26, at a department meeting, one of my colleagues put coronavirus on the agenda. I thought to myself, “Why do we even need to bother with this here in Houston? This is in China; maybe it’s in Europe?”

Firew: On March 1, we had our first case in New York City, which was at my hospital. Fast-forward 15 days and I get a call saying, “Hey, you were exposed to COVID-positive patients.” I was told to stay home.

Dark: My anxiety grew as I saw what was happening in Italy, a country I’ve visited several times. I remember seeing images of people dying in their homes and mass graves. I started to wonder, “Is this what we’ll see over here? Are my colleagues going to be dying? Is this something that’s going to get me or my wife, who’s also an ER doctor? Are we going to bring it home to our son?”

In March, we repurposed our urgent care pod, which has eight beds, into our coronavirus unit. And for a while, that was enough.

Firew: In late March, health workers without symptoms were told to come back to work. It felt like a tsunami hit. I’ve practiced in very low-resource settings and even in a war zone, and I couldn’t believe what I was witnessing in New York.

The emergency department was silent — there were no visitors, and patients were very sick. Many were on ventilators or getting oxygen. The usual human interactions were gone. Everybody was wearing a mask and gowns and there were so many people who came to help from different places that you didn’t know who was who. I spent a lot more time on the phone talking to family members about end-of-life care decisions, conversations you’d normally have face-to-face.

In New York, the severity of the crisis really depended on what hospital you were at. Columbia has two hospitals — one at 168th and one at 224th — and the difference was night and day. The one on 224th is smaller and just across the bridge from the Bronx, which was hit hard by the virus.

There, people were dying in ambulances while waiting for care. The emergency department was overwhelmed with patients who needed oxygen. Its hallways were crowded with patients on portable oxygen tanks. We ran out of monitors and oxygen for the portable tanks. Staff members succumbed to COVID-19, exacerbating shortages of nurses and doctors.

My friends who work in Lower Manhattan couldn’t believe some of the things we saw.

Dark: I went to medical school at NYU and have a lot of friends in New York I was checking in with at the time. I thought that in Houston, a city that’s almost as big, we had the conditions for a similar crisis: It’s a large city with an international airport, it attracts a lot of business travelers, and thousands of people come here each March for the rodeo.

In late March, a guy about my age came into the hospital. It was the first day we got coronavirus tests. A few days later, a nurse texted me that the patient had tested positive. He hadn’t traveled anywhere — it was proof to me that we had community transmission in Houston before any officials admitted it.

You became infected, right?

Firew: In early April, I became sick, along with my husband. I never imagined that in 2020 I would be writing out a living will detailing my life insurance policy to my family. Walking from my bed to the kitchen would make my heart race; I often wondered: Is this when I drop dead like my patient the other day?

A few days before I got sick, the president had said that anybody who wanted a test could get one. But then I was on the phone with my workplace and with the department of health begging for a test.

It was also around that time that a brown-skinned physician who was about my age died from COVID-19. So I knew being in my mid-30s wouldn’t protect me. I was even more worried when my husband became ill because, as a Black man, his chances of dying from this disease were much higher than mine. We both recovered, but I still have some fatigue and shortness of breath.

When did cases pick up in Houston?

Dark: We saw a gradual increase in cases throughout April, but it stayed relatively calm because the city was shut down. The hospital was kind of a ghost town because no one was having elective procedures. Things were quiet until Texas reopened in May.

I remember when I lost my first COVID patient. He started to crash right in front of me. We started CPR and I ran the algorithms through my mind trying to think how we could bring him back, but kept ending up at the same conclusion: This is COVID and there’s nothing I can do.

It’s like serving on the front lines of a war. We initially struggled to find our own personal protective equipment while the hospitals worked to secure the supply chain. Although that situation has stabilized, a lot of patients who come in for non-COVID reasons wind up testing positive. COVID is everywhere.

Our patient population is heavily Latino and Black and, for a time, our hospital had some of the highest numbers of COVID cases among the nearly two dozen hospitals in the Texas Medical Center network. It’s revealed the fault lines of a preexisting issue in terms of inequities in health care.

As area hospitals fill up, they reallocate additional floors to COVID patients. Who knows, if we don’t get this under control, maybe one day the whole hospital will be COVID.

Firew: Now I’m just chronically angry. The negligence came from the top all the way down. Our leaders do not lead with evidence — we knew what was going to happen when states reopened so quickly.

Dark: Yeah, this was completely avoidable, had the governor [Texas Gov. Greg Abbott] decided not to open up the economy too fast.

How are things in New York now?

Firew: There have been several days where I’ve seen zero COVID cases. If I do see a case, it’s usually someone who has traveled from abroad or other states.

People are coming in for non-COVID reasons. Recently, a woman in her early 40s came in with a massive lesion on her breast. She’d started experiencing some pain three months ago, during the peak of the pandemic, and was too frightened to come to the hospital. To make matters worse, she didn’t have insurance and couldn’t afford the telehealth that many had access to.

By the time she made it to our hospital, the mass had metastasized to her spine and lungs. Even with aggressive treatment, she likely only has a few months to live. This is one of the many cases we’re seeing now that we are back to “normal” — complications of chronic illnesses and delayed diagnoses of cancer. The burden of the pandemic layered with a broken health care system.

Dr. Tsion Firew is an assistant professor of emergency medicine at Columbia University and special adviser to the minister of health of Ethiopia.

Dr. Cedric Dark is an assistant professor of emergency medicine at Baylor College of Medicine and a board member for Doctors for America.

This conversation was condensed and edited by Danielle Renwick.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

As a Black high school teacher — and a mother of sons — this is my urgent message

As a Black high school teacher — and a mother of sons — this is my urgent message

This article originally appeared on Chalkbeat Indiana


George Floyd’s senseless death has set my soul on fire.

I like to think that I am an objective, rational person. I never hitch rides on bandwagons, and I always want to know both sides of an issue before forming an opinion, and then I usually only share it with close friends and family.

But the death of George Floyd was so disgusting and incomprehensible to me that I feel compelled to use my voice, since his has been extinguished. His senseless death has set my soul on fire.

Courtesy Photo Nikia D. Garland

I am a Black educator, and I know that brutality against Black people by the police and the world at large is nothing new. In 1850, Congress passed the Fugitive Slave Act, which made the federal government accountable for locating, returning, and trying slaves that had successfully escaped. We may have been “free” since 1865, but we are still being hunted by bigots who feel obligated to return us to our “rightful” state of bondage or death.

It does not matter the perceived offense. Whether we are walking through a neighborhood where we live, selling cigarettes, watching birds, jogging, sleeping, playing with a toy gun, partying, getting a traffic ticket, lawfully carrying a weapon, shopping, reading, decorating for a party, relaxing at home, asking for help after being in a car accident, holding a cell phone, playing loud music, going to church, riding in a car, or breathing, our existence spurs the hate-mongers into action. It’s troubling and just plain sad.

There has never been a time in my life that I have not been aware of the color of my skin. During my freshman year at Broad Ripple High School, I was waiting outside — ironically, under the flag — for my stepfather to pick me up after ballet rehearsal. A car sped down the avenue, and a man screamed, “Go home, n—!” I graduated high school exactly 24 years ago, and I still recall that incident vividly.

Even today, as someone with several degrees, I am never quite certain if I am viewed as credible by white counterparts. I recently declined a position at a primarily white and affluent school to avoid dealing with racist attitudes. I understood that I would be challenged more than my white colleagues on pedagogical style and content knowledge, and I did not wish to fight that battle daily.

I have to fight as a parent, too. I have two sons, ages 21 and 10, and I have explicitly taught them how to interact with law enforcement. My older son knows to always remain calm, keep quiet unless addressed, and to be compliant. The objective for him is to leave any encounter with the police alive.

When my older son initially received his driver’s license, he did not come to a complete halt at a stop sign and received a hefty ticket. When I reviewed the ticket, I noticed it had him listed as white. I couldn’t help but wonder if that mistake had spared him harm. This is why we discuss high-profile murders and systemic racism: so that they both may understand the severity of what they are facing as Black men in America.

Each death highlights the urgency of my message. That doesn’t mean I teach that all police officers are dangerous. One of our neighbors, a white male police officer, is friendly and kind. But my sons cannot count on such treatment in America.

My daily response to this violence is to tie social justice into every facet of my high school English curriculum. My students have read about the murder of Emmett Till, responding in disbelief when I displayed the photograph of his grotesque corpse for a stream-of-consciousness writing session. We have read the story of Amadou Diallo, watched William Bonilla perform his poem “41 Shots,” and listened to the Springsteen song “American Skin.” We have read articles and watched “Fruitvale Station” to process the life and untimely demise of Oscar Grant. We used the New York Times’ 1619 Project as a prelude to reading “Kindred.” We have also combed through Brent Staples’ profound personal essay, “Just Walk On By,” which outlines his brushes with racism and how he has chosen to cope.

As an educator, I simply cannot ignore my civic duty to address current events relevant to my students. My Black students have to be taught how to “read” the world in order to navigate its mainly hostile terrain. They need to know who they are historically and culturally. And my students have truly appreciated my willingness to set aside “traditional” topics and tackle ones that matter to them and their futures.

Not having an opportunity for a face-to-face discussion with my students now, because of the coronavirus, is painful. No matter how school takes place in the fall, whether it be in the traditional setting, online, or a hybrid, this will be a first priority.

As we move forward, it would be wise to remember the words of the Holocaust and writer Elie Wiesel, who said, “We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented. The opposite of love is not hate; it’s indifference.”

Sometimes we ignore what is taking place in our society no matter how vile and overt it is merely because it is uncomfortable to take action, and we “have no skin in the game.” My two precious Black sons, my Black family members and friends, and all the Black students that I teach are my skin in the game. And there is no denying that our skin, Black skin, is simply the most dangerous skin in the game.

But we all have skin in the game as Americans, and this is a fight that Black people cannot win alone. We need all our white allies to stand alongside us. White friends and colleagues, I challenge you to speak up. Use any platform you have, whether it be posting on social media, writing letters to the editor, contacting your members of Congress, participating in peaceful protests, organizing protests, informing yourself on the issues at hand, creating petitions, or talking with your children.

Enough is enough. It’s time to refuse to be silent in the face of injustice.

Nikia D. Garland is an English teacher and an adjunct professor who resides in Indianapolis.

Chalkbeat is a nonprofit news site covering educational change in public schools.

As a Black high school teacher — and a mother of sons — this is my urgent message

As a Black high school teacher — and a mother of sons — this is my urgent message

This article originally appeared on Chalkbeat Indiana


George Floyd’s senseless death has set my soul on fire.

I like to think that I am an objective, rational person. I never hitch rides on bandwagons, and I always want to know both sides of an issue before forming an opinion, and then I usually only share it with close friends and family.

But the death of George Floyd was so disgusting and incomprehensible to me that I feel compelled to use my voice, since his has been extinguished. His senseless death has set my soul on fire.

Courtesy Photo Nikia D. Garland

I am a Black educator, and I know that brutality against Black people by the police and the world at large is nothing new. In 1850, Congress passed the Fugitive Slave Act, which made the federal government accountable for locating, returning, and trying slaves that had successfully escaped. We may have been “free” since 1865, but we are still being hunted by bigots who feel obligated to return us to our “rightful” state of bondage or death.

It does not matter the perceived offense. Whether we are walking through a neighborhood where we live, selling cigarettes, watching birds, jogging, sleeping, playing with a toy gun, partying, getting a traffic ticket, lawfully carrying a weapon, shopping, reading, decorating for a party, relaxing at home, asking for help after being in a car accident, holding a cell phone, playing loud music, going to church, riding in a car, or breathing, our existence spurs the hate-mongers into action. It’s troubling and just plain sad.

There has never been a time in my life that I have not been aware of the color of my skin. During my freshman year at Broad Ripple High School, I was waiting outside — ironically, under the flag — for my stepfather to pick me up after ballet rehearsal. A car sped down the avenue, and a man screamed, “Go home, n—!” I graduated high school exactly 24 years ago, and I still recall that incident vividly.

Even today, as someone with several degrees, I am never quite certain if I am viewed as credible by white counterparts. I recently declined a position at a primarily white and affluent school to avoid dealing with racist attitudes. I understood that I would be challenged more than my white colleagues on pedagogical style and content knowledge, and I did not wish to fight that battle daily.

I have to fight as a parent, too. I have two sons, ages 21 and 10, and I have explicitly taught them how to interact with law enforcement. My older son knows to always remain calm, keep quiet unless addressed, and to be compliant. The objective for him is to leave any encounter with the police alive.

When my older son initially received his driver’s license, he did not come to a complete halt at a stop sign and received a hefty ticket. When I reviewed the ticket, I noticed it had him listed as white. I couldn’t help but wonder if that mistake had spared him harm. This is why we discuss high-profile murders and systemic racism: so that they both may understand the severity of what they are facing as Black men in America.

Each death highlights the urgency of my message. That doesn’t mean I teach that all police officers are dangerous. One of our neighbors, a white male police officer, is friendly and kind. But my sons cannot count on such treatment in America.

My daily response to this violence is to tie social justice into every facet of my high school English curriculum. My students have read about the murder of Emmett Till, responding in disbelief when I displayed the photograph of his grotesque corpse for a stream-of-consciousness writing session. We have read the story of Amadou Diallo, watched William Bonilla perform his poem “41 Shots,” and listened to the Springsteen song “American Skin.” We have read articles and watched “Fruitvale Station” to process the life and untimely demise of Oscar Grant. We used the New York Times’ 1619 Project as a prelude to reading “Kindred.” We have also combed through Brent Staples’ profound personal essay, “Just Walk On By,” which outlines his brushes with racism and how he has chosen to cope.

As an educator, I simply cannot ignore my civic duty to address current events relevant to my students. My Black students have to be taught how to “read” the world in order to navigate its mainly hostile terrain. They need to know who they are historically and culturally. And my students have truly appreciated my willingness to set aside “traditional” topics and tackle ones that matter to them and their futures.

Not having an opportunity for a face-to-face discussion with my students now, because of the coronavirus, is painful. No matter how school takes place in the fall, whether it be in the traditional setting, online, or a hybrid, this will be a first priority.

As we move forward, it would be wise to remember the words of the Holocaust and writer Elie Wiesel, who said, “We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented. The opposite of love is not hate; it’s indifference.”

Sometimes we ignore what is taking place in our society no matter how vile and overt it is merely because it is uncomfortable to take action, and we “have no skin in the game.” My two precious Black sons, my Black family members and friends, and all the Black students that I teach are my skin in the game. And there is no denying that our skin, Black skin, is simply the most dangerous skin in the game.

But we all have skin in the game as Americans, and this is a fight that Black people cannot win alone. We need all our white allies to stand alongside us. White friends and colleagues, I challenge you to speak up. Use any platform you have, whether it be posting on social media, writing letters to the editor, contacting your members of Congress, participating in peaceful protests, organizing protests, informing yourself on the issues at hand, creating petitions, or talking with your children.

Enough is enough. It’s time to refuse to be silent in the face of injustice.

Nikia D. Garland is an English teacher and an adjunct professor who resides in Indianapolis.

Chalkbeat is a nonprofit news site covering educational change in public schools.