“I think I’m infected,” Gabriela tells me with an astonishing calmness.
“Do you think so?” With the same composure, she explains that her symptoms match those of COVID-19: the cough, the fever. She also tells me that it isn’t just her either, her boyfriend, a Medicine student, also has these symptoms.
Why don’t they immediately get tested?
“Well, this would be the first problem here. There aren’t enough tests available and not all patients with symptoms are tested.
Gabriela Sanchez-Bravo left Cuba with her family in 2005, after finishing pre-university at the Lenin vocational pre-university. A friend of hers from those student days, kindly helped me to track her down. She has now received a degree from the Upstate Medical University and is studying the 1st year of her Family Medicine residency at the Institute for Family Health in New York.
She spends her practical experience between this institution and the Mount Sinai Hospital’s examination room. We speak for over 50 minutes. During this conversation, the calm in her voice at the beginning disappears on more than one occasion. Whenever she speaks about other people: the sick, her patients.
“Shocking”, “devastating”, “dismal”. This is how she describes the situation we are living right now. Although she calls it “interesting”, because of the professional challenge it has posed, with the great question mark that is still hanging over the planet when we talk about COVID-19.
She says that ever since the pandemic was announced, teams at her institute work a full week from 7 AM until 8 PM, and then they rest the same number of days, doing some work from home or seeing patients in the community.
“Another great problem in New York,” the young woman points out,” is that there isn’t enough space in hospitals to admit everyone with symptoms or even everyone who tests positive for SARS-CoV-2. Only people in critical condition with low oxygen levels are hospitalized. Those who are in better shape are sent home with instructions of how to quarantine themselves. However, this also presents a problem as families don’t quarantine properly a lot of the time, especially if the patient doesn’t feel ill. Remember that some people only develop mild symptoms.”
Similar situations have played out in Italy and Spain, countries where the national health system collapsed during the peak days of infection.
Even though she doesn’t directly work in the ICU, the doctor has already seen distress and signs of chaos in waiting rooms, images that bore into her brain at times. Knocking on wood, like a proper Cuban, she says that nobody with COVID-19 has died in front of her yet, but she does unfortunately know about packed-out morgues, cremation solutions some people have found and about burials in mass graves.
Families who can’t hold traditional funeral and burial ceremonies, not even getting to say goodbye to their loved ones, she says.
Amidst this situation, doctors and nurses have had to take initiative and make videocalls so that patients (who aren’t in an agonizing condition) can at least be connected with their loved ones for the last time. I think that it must be a great responsibility for medical staff: suddenly becoming the last relatives of every patient.
“I remember the story of a really old woman, who had survived the Holocaust, and different types of cancer, who told me: ‘I’ve been through a lot in my life and look, this is what is going to kill me.’ The last time I left the hospital, things weren’t looking very good for her. She might not be there anymore when I go back.”
Gabriela’s father is a psychiatrist, so he is seeing most of his patients online during this extraordinary time, except for the ones who are in critical condition and need to be tested or hospitalized. Her mother is a caregiver, who continues to work with an elderly woman, taking strict safety measures. She is the one in the family who is most exposed to the new Coronavirus, right now.
I ask Gabriela about Andrew Cuomo, the State governor, who has made more than one headline, recently. She confirms what others are saying, that the man has shown great leadership and taken the best action he could during this storm, even challenging president Donald Trump’s opinions; and that the awful situation in New York could have been a lot worse without a governor like him. At the time we spoke (April 24th), the US was already the global epicenter of the pandemic, and the “city that never sleeps” was the painful focal point in the northern giant.
Talking about the general atmosphere in the state, she believes that social distancing measures are being respected, generally-speaking. Supplies, except for one-off crises with a certain product – toilet paper, antibacterial gel – are on store shelves, and public transport circulates the famous city, empty.
“I work with a lot of people in the Bronx and Harlem, people with low incomes, who have been the hardest hit. The mortality rate amongst African-Americans and Latinos has been a lot higher than in other population groups. People knew about this inequality before, in a country where healthcare isn’t universal or free, but a crisis like this one pushes it into the spotlight. Poverty also doesn’t allow many people to stay at home,” she adds.
Something that has had quite a significant impact on her is that patients don’t feel safe in the hospital. “Doors of rooms (cubicles) are closed and without windows, and sometimes you have no idea what’s happening on the other side. I found some of them confused and with really low blood oxygen saturation levels. I went in and found that they weren’t wearing their oxygen masks. They were afraid. Sometimes, they didn’t even know if they had the virus. There was also a lack of human connection, because nurses are in protective gear and don’t go into rooms unless they really need to.”
As she speaks perfect Spanish, relatives of sick Latino patients who see her outside of the hospital, beg her to take special care of their loved ones. Nobody trusts what goes on inside. Not knowing makes sick people despair. “Treat my mom as if she were your grandmother, doctor, as if she were your grandmother,” they have told her. Widespread fear has become spine-tingling.
Gabriela doesn’t have children, but she understands the great anxiety parents have in situations like this one. Only two beautiful cats: Elisa and Hestia, live under her care, for now.
Before the deadly virus spread to the Americas, Gabriela had planned to go on holiday in Cuba. A trip that she would take with her mother to see her grandparents, uncles and aunts, cousins, even some relatives living in Europe. A real get-together to celebrate different birthdays together. When all of this is over, taking this trip is the first thing she wants to do. For now, she admits that it’ll probably be at least another month of things being shut down until Trump reopens the economy and gets things running, but she is really afraid of a second spike.
Almost before cutting off the call from Pinar del Rio to New York, she told me about a case that had really shocked her. “It was a 35-year-old pregnant woman. She had already been intubated and extubated. She was in a bad way one morning; she could barely breathe. I could see her suffering and I quickly told the nurse. Thinking it was nothing, she told me to give her a pill for anxiety. She suffered a heart attack, in the afternoon. She was 30 weeks pregnant. We were able to resuscitate her and the baby was born via an emergency C-section. They both made it… but I don’t know if they have been affected by it.”
I thanked her very much for our conversation. Even though it might sound super obvious, I told her to look after herself and said that I was sure that her and her boyfriend’s symptoms were probably nothing, just a common cold.
Smiling, the only thing she said was: “Let’s hope so”.
*The author would also like to thank colleagues Salvador Salazar and Maylin Guerrero, for their help in getting this interview.