A ‘duty to warn’: An ER doctor, shaped by war and hardship, chronicles the searing realities of Covid-19

As a Marine combat medic in Iraq’s Al-Anbar province, Cleavon Gilman saw bodies torn apart by IEDs. He heard agonizing screams, saw burned flesh and penetrating trauma. He stood in pools of blood, tending to fellow Marines with severed spinal cords, missing limbs, and intestines bulging through gaping wounds. He emptied the pockets of the dead, collecting baby pictures and ultrasound photos, removed dog tags, and stacked bodies, sometimes two and three at a time, into refrigerated trailers. He still has PTSD, though he returned from the war 16 years ago. Even so, that experience did not prepare him for the coronavirus.

“Seeing this kind of death is not normal,” said Gilman, an emergency room physician who cared for an onslaught of Covid-19 patients in New York as the virus killed 20,000 people over a matter of weeks this spring. He’s now working in his second hot spot, Yuma, Ariz., which has nearly four times the nation’s rate of new coronavirus cases per capita, a major outbreak in its prison, and a hospital overflowing with patients.

“I’ve trained for this. I’ve been in war, and this is absolutely worse,” Gilman said. “There are no borders in this war. There is no date when I know I’m going home.”

You may have pandemic fatigue, but Gilman is flat-out exhausted. Whether it was this spring at NewYork-Presbyterian Hospital, when choruses of ambulance sirens pierced the nights, or his current work in rural Arizona where he often struggles to find open ICU beds, he’s treated Covid patients for 10 solid months. And as he sweats to save the lives of the farm workers, prison guards, and snowbirds who are his patients, he’s fighting what may be an even harder battle: to persuade people in his state, including a governor who refuses to order a mask mandate, to take the virus seriously.

“After you treat patients, intubate them, see people watch their loved ones die, you get to drive home, past the gym that’s crowded with people, past the people who are eating at restaurants inside, maskless,” he said. “It’s just a slap in the face, over and over again.”

At first through a daily diary of Facebook posts, and now through a relentless Twitter streamwith almost 100,000 followers, Gilman has emerged as a vocal leader speaking out on behalf of health care workers and a voice of outrage railing against the virus’ steep toll and the politicians who aren’t working harder to contain it. It’s a surprising platform for a man who dropped out of high school because he was teased mercilessly for a crippling speech impediment, and who escaped a grim upbringing to become a physician trained at some of the nation’s most elite institutions.

“Whenever we had to present in medical school, Cleavon would always go first, to get it over with because of his stutter. He has what some would see as a disability or vulnerability, but his way of dealing with it is not to shy away from it, but to confront it head on,” said Yakira Teitel, a former classmate and a family physician with the San Francisco Department of Health. “Cleavon has learned how to use his voice, and clearly, he has put it to good use.”

That voice got him into trouble late last month, after he sent out a tweet about the lack of ICU beds in Arizona. He was fired, he said, despite severe staff shortages at his hospital, Yuma Regional Medical Center. “I’ve been sidelined for three weeks while many of my colleagues have been ill,” he told STAT. “I’ve been risking my life here since July and for this to happen is inexcusable.”

Once it became public, Gilman’s apparent dismissal provoked outrage on social media from both Yuma residents and physicians around the nation — even Oprah chimed in to offer Gilman and his family an all-expense-paid vacation for his service. Afterward, the hospital released a statement saying Gilman had not been fired, and his not being scheduled to work was a “misunderstanding.”

“News to me,” Gilman said. But the coronavirus was still burning through Yuma. More than 650 new cases in inmates had surfaced in recent weeks at the state prison complex in town. When the hospital called last week, Gilman suited up and returned to work.

The fact that Gilman became a doctor at all was unlikely.

Born to a white single mother, with a Black father he never knew, Gilman, 41, grew up in some of northern New Jersey’s rougher sections, towns hit hard by the twin epidemics of black tar heroin and AIDS during the 1990s. He lost his stepfather, Edgar Rodriguez, the only father figure he’d ever known, to a heroin overdose. His mother’s parents never acknowledged their Black grandson.

He didn’t have many prospects. “I could have been a bouncer at a strip club, or a drug dealer, those were the opportunities,” he said. Had he stayed, he added, “I’d be locked up, or probably dead.”

Gilman dropped out of high school because he couldn’t read aloud or speak in class without getting teased for his stutter. He eventually returned and graduated, but was turned down for job after job. Like many Black teens he grew up with, he was hassled by police, once at gunpoint. It was during one of those encounters that Gilman, literally, saw his path out. He’d been stopped while carrying license plates — his own, the police discovered — and was sitting on a curb waiting to be released when he looked up at a billboard looming overhead. “Join the Navy and see the world,” it said. He enlisted.

A high score on a military vocational test gave Gilman a wide choice of career paths. He chose medical and was assigned as a medical corpsman to Walter Reed National Military Medical Center in Bethesda, Md., with duties that included emptying bedpans. He was caring for a stroke patient one day, when he glanced at a TV and saw a plane flying into the Twin Towers. “After that, I knew I’d be deployed,” he said.

It may have been the best, and hardest, medical training he could have received. “The things I saw. Full body burns from mortar attacks, head injuries in people in Humvees that hit IEDs, penetrating trauma, abdominal eviscerations, amputations,” he said. “But a lot of these people survived.”

The memories are still painful. “You have nightmares that it’s your loved ones,” he said. “The PTSD was real for many years. I still can’t hear fireworks.”

In the military, Gilman saw something else he’d never seen before: Black dentists. Black officers. Black doctors. “I had never seen a Black person in a position of power like that,” he said. “Growing up, I didn’t think that was possible. I didn’t know any physicians.”

A few of the medical officers had taken notice of Gilman as he helped stabilize wounded Marines. They encouraged him to pursue a medical degree. “They saw something in me that I didn’t see in myself,” he said.

Gilman had none of the advantages that most people who go to med school have — not only had he not graduated from a prestigious college, he hadn’t gone to college at all. No one in his family had even earned a bachelor’s degree. But he had uncommon determination — he’s still not sure where it stems from. It didn’t matter that he was older than the other students. It didn’t matter that he stuttered. Gilman decided he was going to make himself a doctor.

“He has willed his way to this point,” Teitel said.

Gilman started his post-military life in San Diego, enrolling in Southwestern College. He promptly got an F in algebra. A fellow student told him he should study with the solution sets to homework problems that were available at the bookstore. He’d had no idea such resources existed. “After that, I got all A’s,” he said. Gilman left his apartment each morning with a gallon of water and some cooked chicken and rice and spent his entire day either in class or the library. “I was on campus 12 hours a day,” he said. “I deployed.”

After earning his associate degree, Gilman was admitted to several four-year schools, including the University of California, Berkeley. He didn’t realize it was the state’s educational crown jewel. He told his chemistry professor he wasn’t sure where he’d enroll. “Go to Berkeley with all the Nobel Prize people,” the professor said. He did.

That early lack of sophistication about education pathways is something Gilman still thinks about when he mentors “little Cleavons” — youth from low-income families or underrepresented communities of color and in whom he sees his young self. “We have a dream of becoming a doctor, but we don’t know anyone who’s a doctor,” he said. “I had no Plan B.”

He didn’t need one. He was not only admitted into medical school at the University of California, San Francisco, but also chosen for the school’s selective five-year track, PRIME, for students committed to working with urban underserved communities. Teitel said she had no doubt he would succeed. “He works harder than almost anyone I know,” she said. “He saw what he wanted and was not shy about asking for help.”

It was in New York that Gilman started chronicling what he saw in the nation’s first coronavirus epicenter, on social media and on his own website. At first, he was postingto keep track of his experiences as a chief resident at NewYork-Presbyterian, something he’d regretted not doing when he was at war.

He wrote after each shift in the emergency department, exhausted and sometimes through tears, about the barbers, nannies, construction workers, bartenders, waitresses, and store clerks he was trying to keep alive. He wrote about patients’ gratitude when he’d bring them a cup of water, that he tried to treat them like family. “They are Black, Dominican, Puerto Rican and Mexican,” he wrote. “A lot of them don’t have enough money to pay for a subway ride home from the hospital.”

Quickly, his purpose shifted: “I really wanted to warn people,” he says now.

“At this rate of intubations we’re going to run out of ventilators,” he wrote in a post on March 20. Two nights later, when the city recorded 6,211 cases, he took a moment to look around as 80 patients waited for admission. “I guess this is what the pandemic will look like,” he wrote.

The onslaught of coronavirus patients at the hospital was so difficult, even veteran doctors were shaken. “I worked 9/11, the anthrax attacks in New York City, SARS, Ebola, and Hurricane Sandy, but this was different,” said Renu Chawal Mital, the senior associate attending physician who supervised Gilman at NewYork-Presbyterian. “During the 9/11 attacks, we tried to save as many patients as possible, but we were not putting our own lives at risk. With this, not only did we have an overwhelming number of patients infected, we saw our own colleagues falling down before our eyes. The fear and anxiety was real.”

This was no time to shield residents, Mital said. They were needed to help, as were colleagues in ophthalmology and dermatology. “The ER was drowning,” Mital said, “It’s a once-in-a-lifetime experience, and this is where you step up to the plate.”

Mital recalls meeting Gilman on his first shift as an intern in 2016. In her 23 years on the job, she’s trained more than a hundred young doctors, but Gilman’s difficult pathway stood out. She was also surprised to see someone choosing such an exhausting field of medicine at a relatively late age. “To do this residency in your late 30s, after all he’s been through — it is simply incredible,” said Mital, an assistant professor at Weill Cornell Medicine.

Gilman’s prose in his entries is crisp and precise. He had learned early on he could stop stumbling over a word by replacing it with a synonym. To arm himself with words, he read dictionaries from front to back. At 12, while attending a summer camp sponsored by the rapper LL Cool J, he discovered his stutter disappeared when he rhymed. Shortly before the pandemic, Gilman was gaining notice in medical societies by rapping about topics like clinician burnout and health insurance.

“Worst case scenario. There’s some things you gotta know,” Gilman rapped in a video he released on March 21 to raise awareness about the virus. “This is not your common cold … affects adults, not just the old.”

Gilman thinks health care workers have to shed the mantle of hero and be more open about their worries. He hasn’t been afraid to tell people how scared he is of catching the virus. “Did I infect myself while doing compressions on the patient that was pronounced dead?” he asked in a post on March 22.

As the spring wore on, there were moments of joy — patients and colleagues who were weaned off their ventilators and recovered. But mostly, there was a lot of death. Gilman started calling the chair he sat in to notify family members of a deceased patient “the bad news chair.” He sat in it often, each call chipping away at him. The PPE was protecting Gilman from the virus, but not from the pain.

“My heart hurts so much,” he wrote in an April post. “So many people are going to die and we can’t save them.”

On April 26, Lorna Breen, the ER medical director of New York-Presbyterian Allen Hospital, took her life. She’d survived Covid, but could not survive the emotional fallout. She had been one of Gilman’s mentors, and one of the best, and toughest, doctors he knew. Her death shook him to his core.

“I still don’t think people understand the severity of what we went through,” Gilman said. He thinks the isolation Breen suffered while off duty to recover from the virus and the mental strain it caused was her undoing.

“Health care workers, we like to be busy. It’s not good to be isolated when you’ve seen so much death,” he said. “From my experience in Iraq, the quiet times are the hardest.”

Gilman was still in New York when Arizona’s rising caseload, and lack of precautions, riled him up. He’d chosen a job in Yuma after completing his residency because it was close to California, would allow him to work in a medically underserved community, and paid well enough to help him start to chip away at his hefty medical school debt. But he was worried. He was leaving a city that had dramatically curbed the spread of the virus and moving to a state where businesses were reopening and the governor, Doug Ducey, refused to issue a statewide mask mandate.

He knew doctors were supposed to stay in their lane. He knew senior physicians that had been disciplined, or lost their jobs, for speaking out. He didn’t care.

“Gov Ducey if YOU don’t MANDATE face masks then people will NOT wear them,” he tweeted in mid-June. “It’s time to lead.”

When Ducey hosted a largely maskless rally for President Trump on June 23, Gilman went apoplectic. “Looks like a super spreader event by our super spreader commander-in-chief,” he wrote.

“I’m right out the frying pan of #NewYork into the fire of #Arizona,” he tweeted a week before his first ER shift in Yuma in mid-July. “We must keep being vocal.”

Gilman kept up a steady stream of commentary, warning about the rise in cases in Arizona, the lack of resources, the many, many young people suffering from Covid in his ER, and the need to wear masks and ban large gatherings.

While he no longer faces the crush of patients he saw in New York because Yuma’s population is under 100,000, Gilman said conditions in some ways are harder. “In New York, there were so many resources, doctors and nurses, you could make whole intubation teams,” he said. “Here, it’s the exact opposite.”

And because there are few restrictions on activities, his ER is still shouldering a full load of regular emergencies even as new coronavirus patients arrive day after day. “In New York everyone stayed home, so you were not having car accidents and trauma,” he said. “Today, a patient came in for hemorrhoids and I said, ‘Are you kidding me right now? Why are you here? This is not an emergency.’”

Sometimes out of beds to handle the influx of new Covid patients, Gilman said he has had to resort to treating patients in the ER waiting room. “You can’t move patients out of the ER because there’s no room upstairs, and you can’t move people from upstairs because there are no ICU beds,” he said. “With Covid patients, ICU beds only open when someone dies.”

While a mask mandate narrowly passed in his county, he remains stunned at the governor’s refusal to issue a stay-at-home order or statewide mask mandate. He’s been staying away from crowds, getting takeout only, and not seeing family; meanwhile in Phoenix, a massive soccer tournament that included more than 400 out-of-state teams was played over Thanksgiving. “That cannot be allowed to happen when I can’t find an ICU bed,” he said. “That threw me off the edge.”

More recently, Gilman has been using his platform to amplify the plight of health care workers who are penalized for speaking out and to highlight the deaths of young, previously healthy patients who were killed by the virus. One of those was his own cousin, Simon Press, a 27-year-old who was trying out for the NFL, who died on Dec. 7. Press had been sent home from his local ER in New Jersey twice, Gilman said, after being told his chest pains were just anxiety. He wasn’t swabbed for the virus until he reached the coroner’s office.

Gilman’s activism has not gone unnoticed. In November, he received a phone call from President-elect Biden, a fellow stutterer Gilman has long admired. The two bonded immediately. “He talked to me like I’m talking to you,” Gilman said. “Very down to earth, very casual.” They discussed Gilman’s service in Iraq, the pandemic response that Biden had started putting together last March, the potential of using the Defense Powers Act to increase production of N95 masks, and, of course, their stuttering.

For now, Gilman is happy to be back in the ER, where he returned last week. (The first patient he saw asked whether he was the doctor who’d been in the paper and thanked him for staying.) He has every intention, he said, of continuing his personal deployment against the virus, and continuing to speak out. “We should not be silencing the voices of health care workers,” he said. “I feel a duty to warn people.”

Read original article here