COVID-19 Tour Day #4

Another day on the COVID ward. My impression of Woodhull Hospital in Brooklyn: the hospital seems to serve a very diverse population of mostly poor people. The diversity here is staggering. There are very few white people (to put it crudely). There is a large Puerto Rican population, African American population, people from the islands (Jamaica, especially), Polish (many of whom speak no English though they are in the 60s and above). The doctors (including the residents) seem to come from all over the world. Hearing the nurses on the wards, one hears a number of accents -- several African ones too.


I have been impressed with the severity of illness in the patients here and COVID seems in most of them like the least of their problems. We took off 5.9 L of fluid (ascites) from a gentleman that had alcoholic liver cirrhosis and now hepatorenal syndrome. He needs a liver transplant. The resident (intern) did it with no hesitation. It seems they do so many paracenteses here that most of them are credentialed in the first half of the year. We have a diabetic (HbA1c of 13.6%) who has dry gangrene of a left foot due to occlusion of his distal popliteal artery. He shall be getting a below the knee amputation. Another female -- a 37 year old female came in with a magnesium level of 0.8, a calcium of 6, potassium of 2.8 in tetany. Etiology is uncertain but suspicious for poor nutrition and alcohol use. Another gentleman had bad hypertension that has remodeled his heart. His ejection fracture is 6%! We had a young lady (23 year old) been drinking since 18 who came in with a long QT syndrome (QTC 560 ms) due to taking too much Zofran for vomiting from withdrawals from alcohol. She refused all detox treatment and asked to be discharged in 2 days when we would not give her the sedative medication she wanted.


People come to our ward COVID-suspect. Some leave with their test results still pending, because they are medically well. We had one gentleman who came in with COVID with pneumonia and shortness of breath. He did okay. The time came for discharge -- as he was recovered, but he was still COVID-positive. His 70 year old mother did not want him to return home. He is an invalid (left below the knee amputation, right foot 2 toes amputated, obese, noncompliant with treatment. He refused to go to a hotel or inn or shelter (we would have made arrangements) and because he did not lack capacity to make decisions, we had to send him home.


Walking down the street, taking the subway, I see a dirty city with shoddy people. Yesterday, I saw a mouse pop up between the cement tiles of my hotel parking area? There is sewage visible in the sewer.


I have seen NYC. I know that every place is not like this. But it does make me sad to see how people are at least in this little part of town.


The hospital could use more staff, doctors, nurses, facilities. They are doing the best they can with what they have.