A New York nurse laments his coronavirus patient's last words before intubation: 'Who's going to pay for it?'

·7 min read
Derrick Smith

Derrick Smith.

Derrick Smith

  • Moments before being intubated and put on a ventilator, one of Derrick Smith's coronavirus patients asked, "Who's going to pay for it?" 

  • It's "profoundly sad that people are worried about their finances during even possibly their dying moments," Smith, 33, told Business Insider.

  • As a nurse anesthetist at a New York City hospital, Smith has been thrust into a "critical care" role that's rife with shortages in personal protective equipment, long work hours, and worry of contagion. 

  • Smith is disappointed by government containment measures, criticizing a failure to "protect and uphold its citizens."

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Video: How to Help Hospitals and Healthcare Workers Fighting the Coronavirus

In Derrick Smith's view, the coronavirus has turned the United States healthcare system's pockmarks into garish scars.

In a much-shared Facebook post on April 3, he described a COVID-19 patient's last words: "Who's going to pay for it?"

On the verge of being intubated and put on a ventilator, the person "gasped out" the question to their medical team between "labored breaths" before being put on a phone call to their spouse for likely the last time "as many patients do not recover once tubed," Smith wrote.

Smith, a Certified Registered Nurse Anesthetist at a New York City hospital — whose name he asked to be withheld, wrote that "this situation is by far the worst thing I've witnessed in my collective 12 years of critical care & anesthesia ... This country is truly a failed state, and it's so sickening to witness firsthand, more blatantly than ever."

Reflecting on the experience, Smith told Business Insider that it's "profoundly sad that people are worrying about their finances during even possibly their dying moments." He declined to share more information about the patient, citing privacy laws.

People struggled to grasp the full scope of the coronavirus amid the government's efforts to downplay it 

Smith, 33, recalled first hearing about the coronavirus in January as it raced across Wuhan, China, admitting that "it was hard to ascertain the severity of it back then."

The US reported its first case on January 21. But one day later, President Donald Trump told CNBC's Joe Kernen that he was "not at all" worried.

"It's one person coming in from China, and we have it under control. It's going to be just fine," Trump said.

Given that the federal government "didn't appear to take it very seriously" and was even comparing the disease to the common flu to downplay it, Smith said he only began to fully realize the scale of devastation caused by the coronavirus in late February.


He described being instantly worried about the impact that "any sort of viral, contagious pandemic" that progresses quickly would have on the US's "already fragile healthcare system."

And what an impact it's had. 

The US has the largest recorded COVID-19 outbreak on earth, with nearly 400,000 confirmed cases and over 12,900 deaths. New York is the hardest-hit state, with more than 140,300 people testing positive for the coronavirus and over 4,000 dying. Hospitals are overrun, morgues are filled to capacity, and medical workers, who lack sufficient personal protective equipment (PPE), are succumbing to the illness themselves. 

javits center

The Jacob K. Javits Convention Center has been transformed into a 2,500-bed field hospital to deal with the influx of coronavirus patients.

John Lamparski/Getty

The coronavirus has reshaped Smith's medical work. An influx of COVID-19 patients has flooded the various medical facilities where he works, with the exception of a surgical center, which is "no longer functioning" because it focuses on elective procedures, which are now scarce.

At the hospital too, his role has morphed. Before the pandemic, Smith's work was more predictable.

"Initially meeting the patient, doing a full interview and physical assessment, taking them to the procedure area, sedating or inducing them for general anesthesia, and then taking care of them up until the post-operative period," he said, describing his routine.

Since the coronavirus hit New York, however, elective surgeries have been nixed, so Smith finds himself in "more of a critical care role" that involves intensive care unit (ICU) work or responding to all sorts of emergencies throughout the hospital.

'I reused the same N95 mask throughout my entire shift'

No two days or cases are alike, Smith said.

"You have some people that come in who are in absolute respiratory distress that needs to be intubated relatively soon," he said. "Or you have someone who's just very, very ill with classic flu symptoms and upper respiratory problems and don't quite need to be intubated yet, but definitely needs hospitalization, fluids or antibiotics for pneumonia."

Coming off a 12-hour shift, during which he only had one N95 respirator mask, Smith said the hospital's PPE supply has improved, but there's still plenty more to be done to safeguard medical workers and staff.

"I reused the same N95 mask throughout my entire shift, just being careful not to remove it frequently," he said. This conservation of PPEs marks a dramatic shift from "pre-pandemic" times, Smith added, when N95s were used as the single-use masks they're designed to be.

Smith also expects his team's shifts to get longer, saying the hospital is "admitting more and more patients," increasing their workload.

new york city coronavirus

A hearse car backs into a refrigerated truck to pick up deceased bodies outside of the Brooklyn Hospital on April 1, 2020 in New York City.

ANGELA WEISS/AFP via Getty Images

Asked if he and his colleagues are worried about contracting the coronavirus, Smith simply replied, "Yes."

The coronavirus affects people in different ways. Some are asymptomatic carriers, while others have such severe symptoms that they require intubation in the ICU, Smith explained.

So Smith, like his friends and co-workers, is "just trying to stay as healthy as possible with diet, home routines, exercise, and adequate sleep to boost" his immunity so he can ward off a severe reaction if he does catch the virus, he said. It'd also be helpful, he said, if people adhere to social distancing guidelines to help flatten the curve.

That said, the coronavirus is taking a toll on Smith.

"I'm no stranger to death, illness and the American healthcare system because I've been in it for over a decade," he said, "but I've never seen what I've been seeing lately with the speed, intensity, and spread of the virus itself, and its impact on patients and the hospital system.

"It does take a toll, but, you know, there's not really any other option at this point," he added.

The government is failing people rather than safeguarding their health, Smith said

Smith said his frustration with the healthcare system's "sad" state of affairs "peaked" the day he took to Facebook.

His interaction with the patient underscored how worries about affording medical care "disincentivize people from wanting to even seek treatment," he said. That's "inherently problematic" in the context of a pandemic because patients put a heavier "burden on the system when they come in so acutely ill," according to Smith.

"[A] tertiary care setting where people come into the ED with or without insurance ... is, in my opinion, far from the best way to do it," he said. "There should be a better emphasis on primary prevention, public health, and also the ability to pay for [healthcare] regardless of your social or class status."

It doesn't compute to see thousands of people a year dying from lack of access to medical care in "one of the richest industrialized nations in the world" or being forced to crowdfund their treatment, Smith said, denouncing federal and state government responses to the crisis.

He called out Trump for not doing enough with the Defense Production Act to actually "pick up the pieces of this mess" and leaving it to state officials to cull together a "patchwork" of containment measures. He also criticized Wisconsin authorities for holding elections during a pandemic and forcing people to choose between their well-being and democracy, and the CDC shifting its guidelines about which face masks are safe to use.

"I believe the main purpose of a government is to protect and uphold its citizens, and I feel like that's clearly not what's taking place," he said.

Correction: The headline of this story originally referred to Smith as an anesthesiologist. He is a nurse anesthetist.

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