A New York City ER doctor who served in Iraq says the coronavirus has turned his hospital into 'a war zone'

• ER doctor Cleavon Gilman works at a New York City hospital, where "everyone's COVID" right now.
• Gilman, who was previously a marine medic in Iraq, says being surrounded by death in the city feels "a lot harder" than being in Iraq because "there are no boundaries of a war zone" for COVID-19.
• Gilman said it's fairly common for two or three patients to die on every shift he works right now. "It's really hard to be that person who gives that bad news over and over and over again," he said.
• Here's what a typical day in the ER is like for Gilman right now.
• Visit Business Insider's homepage for more stories.

Dr. Cleavon Gilman knows what it feels like to work in a war zone.

He was dispatched to Iraq as a marine medic in 2004, treating battle-wounded soldiers.

But now, he has been dispatched to the front lines of a different war, one he says has "no boundaries."

Gilman is a doctor of emergency medicine in New York City, where more than 29,500 people have been hospitalized with COVID-19 so far.

"When I was was in Iraq, I knew I was in Iraq, I was on a cot, it was 140 degrees, I had a flack jacket, I had a pistol," Gilman told Business Insider on a recent Saturday, while resting at home. "Here, I'm in my house, I have my family in the other room, and I actually walk into the war zone."

Working in a crowded ER, Gilman faces constant reminders that 'I'm in a war zone'

It doesn't take long for Gilman to walk to the battlefield.

His apartment is a block away from the hospital where he works, "in the Heights" of upper Manhattan.

Arriving for his shift, which may range anywhere from eight to 12 hours a day, he puts on a fresh N95 mask, goggles, and a face shield.

"It used to be hard to breathe with those on, however it's not anymore, it's almost a piece of me," he said.

Now, he's ready to meet some patients. And there are a lot of patients.

"Usually, I'm walking into a very crowded ED," he said. "There's probably a patient who's being intubated at that time, and it's just high volume, high acuity. We have lots of ambulances that line up outside."

Operating rooms in the ED have been transformed into makeshift intensive care units to make room for more critical COVID-19 patients, but it's still not enough space for everyone who arrives.

Gilman walks past gurneys lining the hallways, stretchers parked "back to back to back," and hooked up to monitors beeping "endlessly, over and over again." The patients on these beds, whether 20 or 80 years old, are the most fragile cases in the city, and many have severe pneumonia.

Gilman often tries to get some of the younger patients up to walk around, and see if they might be ready to be discharged, but usually "they're just very short of breath, and they crash."

They're "too sick to even talk," he said. "I used to walk in, and patients would be like, 'Where's my sandwich at? Where's my doctor?' And they don't even talk now. They're just laying there, ill, looking up at the ceiling."

Everyone in the ER right now is COVID

It's a frustrating scenario and, often, Gilman can't help but feel a little helpless.

"We really don't have a great drug to treat this, we don't have a vaccine, we're just treating patients with oxygen," he said.

As new critical patients stream into the hospital, other bodies prepare to leave.

"It's not unusual to walk into a shift and there's a corpse or something like that from an hour prior that has tags on the sheets," Gilman said. "That's just a constant reminder that I'm in a war zone."

There's no room to deal with any other crises right now.

"Everyone's COVID," Gilman said. "Everyone. Even if you're not, if you come to the hospital, you are COVID."

Such was the case with one 93-year-old "sweet gentleman" Gilman met recently in the ER, who did not have COVID-19 when he arrived, but "he ended up getting it in the hospital, and died a week later."

"That's what's very hard about it," Gilman said. "It's a very predatory virus. If you seek treatment, it will attack you, and it attacks the vulnerable populations."

Calling families of the dead every day is heartbreaking

Gilman is used to dealing with death and devastation in the ER, but not on this scale.

"We see drug overdoses, we see suicides," he said, but the volume of death is now completely staggering. "I'm calling two to three families a day now, whereas it would be common to call them like once or twice a month."

Younger patients are often outfitted with a non-rebreather mask in the ER, and "just oxygen and oxygen and oxygen," Cleavon said, with most recovering and leaving the hospital in four to five days. Other cases are not so simple, requiring invasive intubation, and weeks of care.

"People are under the impression that, if I put you on a breathing machine, it's going to do everything for you," he said. "That's not true, you have to tell the machine how many times to breathe, how large are the breaths going to be, how much oxygen? Even putting in a breathing tube is hard, you've gotta paralyze a person."

One day, as Gilman was intubating a man in his 60s, he listened in horror as a woman lying nearby shouted out: "That's my husband! Oh my God. What are you doing? What are you doing!?"

"She saw the whole thing," Gilman said.

Many patients in that couple's age group, 60-plus, are "just not doing very well on the ventilator at all," he said, and a large majority of the deaths he sees right now are among the elderly, a trend that's being mirrored around his city, and around the world.

"I get very attached to the patients," he said. "I'm not sure if that's really a good thing to do, but I do it. I have to, I'm a human being, I tuck them in, I'll get them a blanket. I get them something to drink if they ask for it, and when they crash and when they die, you know, I take it very, very hard."

Making things even more emotionally taxing, families can no longer be in the emergency room with their loved ones in their last moments of life.

"I'm trying to honor their wishes," Gilman said. "I try to do these small gestures, as much as I can."

In what's become a bit of a trend among healthcare workers, he's been sharing messages families relay over text, sending one grandmother a message from her grandson about barbecuing and watching birds again, moments before she died, at other moments pressing his phone up to the face of sick patients, so they can hear from their next of kin just one more time.

"I've done that with three patients, and they've all passed away," he said. "Even the younger patients, who were pretty healthy."

'It's really hard to be that person who gives that bad news over and over and over again'

After six weeks of battling the coronavirus in the ER, Gilman's developed a sense of when things aren't going to turn out so well.

"I can see into the future," he said. "It's just like, 'I don't think they're gonna make it.' And they don't make it. And it still hurts every time."

After each shift, the doctor walks the single block back to his home, where, standing alone, he pauses before stepping through the door of his apartment. Here, he must be careful to place his scrubs and his sneakers from the hospital in a special bag, to keep any virus particles that may be on those items away from his fiancée and his two girls, aged 10 and 12.

He's also started journaling after every shift, using his Facebook page and his website to process some of the grief. The doctor is also a musician, and he's written before about the pain of resident burnout. He even created a rap song about the COVID-19 pandemic, and says he might write another yet, about what it's like dealing with so much coronavirus bad news, day in and day out.

"I was in Iraq, I've seen people die, you know, 18-year-olds, very traumatic out there," he said. "But this is harder in the sense that it's people in my own community. These are people that I see on the streets. These are people that work in the grocery stores, and I'm doing this on a daily basis, and it's really hard to be that person who gives that bad news over and over and over again."

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