Craig Spencer is director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center.

NEW YORK — There are tents outside our hospitals. Every time I see them, I stop, startled. Their drab and dirty flaps seem so out of place against the grand facades of world-class hospitals. Desperate times, desperate measures. The last time I worked in a tent was West Africa in 2014, during the Ebola outbreak.

In those same tents, I saw too much pain, loneliness and death. People dying alone. I never thought I’d have to see or experience that ever again. I never wanted to. Once was painful enough.

There's no way to describe what we're seeing. Our new reality is unreal. The people and places we've known so long and so well have been transformed. Our ERs are ICUs. Everything looks, sounds and feels different. Just one week and it's a whole different world.

The patients I normally see are nowhere to be found. Every single patient I see has covid-19. Every single patient. Working in the ER means walking through a corridor of coughing. Each a slightly different pitch and different frequency but all caused by the exact same thing.

It’s not just the volume of patients that’s hitting us. It’s the severity. Respiratory arrest. Respiratory arrest. Respiratory arrest. Each takes six to eight professionals: nurses, respiratory techs, ER docs, anesthesiologists. Each takes an hour or more. Back to back. All shift long.

And it’s not just the unrelenting severity. We’re being asked to do things we’ve never done before. Run a code as your goggles fog and you can’t decipher the vital signs on the monitor. Try to predict which covid patient will crash if you send them home, and which won’t.

Talk to palliative care. Talk to family members. Long discussions about likely outcomes. Listen as family members sob. They can’t be here when they ask to withdraw care. We FaceTime so they can say goodbye. We stop the drips. Turn off the ventilator. And wait.

Your hands upon theirs. You think of their family, at home, sobbing. Someone starts saying a prayer. You can’t help but cry. This isn’t what we do. You stand by. You wait. This isn’t what we do. You stand by. You wait. Time of death: 7:19 p.m.

In West Africa, I saw too many people die. Have a long talk with them in the morning. Go have lunch. Come back and they’re dead. This isn’t what we do. We signed up to save lives. Not stand by as they pass.

In West Africa, I learned that even if death comes easy, you never get used to it. Today our patients are dying. Our colleagues are dying.

After my return from West Africa, I spent 19 days in a New York City hospital battling Ebola as a patient. Every day I thought of my patients who died. Alone. In a tent. I knew Ebola took whomever it wanted. Whenever it wanted. There was nothing I could do for them. Now there was nothing I could do for me. Just hope. And wait. And worry.

I know what my colleagues are feeling. I see it on their faces. We are exhausted. Hours in goggles, gowns and masks feel like days. But we are only at the beginning. The mental exhaustion is only starting to set in. The things we do, the things we see. This isn’t what we do.

I worry about my colleagues. Every day someone calls me crying. How long will they hold? How long will I hold? I remember how this anxiety gnawed at me every day in Guinea during Ebola. Would today be the day I got infected? Won’t know for a week. The days add up. The worry adds up.

I’ve never seen my colleagues so afraid, so unsettled. But I’ve also never seen them all work so well together. I’ve never seen us more unified, more focused, more sincere. Yes, we worry about PPE. Yes, we worry about lack of medications. Yes, we worry about one another.

But I’ve never seen so much sense of purpose. So much honor to do this job. We didn’t sign up for this, but we will show up for this. Every day.

I think of this when I finally get home. Clothes in a bag. Hot shower. Look in the mirror. Indentations of goggles still deep in my face. Blisters on the bridge of my nose.

How long will we hold?

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