Covid nurse who shared patient’s tragic last words shocked by US inaction

In a country where access to affordable healthcare is not guaranteed, New York City nurse Derrick Smith struck a nerve across the US after sharing the last words of a Covid-19 patient who minutes before being intubated asked: “Who’s going to pay for it?”

Trump in quarantine as Covid diagnosis throws US into fresh upheaval

Read more

His Facebook post went viral six months ago, when cases in the city were surging and the streets echoed with the constant sound of ambulance sirens.

Today, Smith is shocked about how little the US has done to address healthcare costs during a global pandemic. In part because he has seen Covid-19 patients fearful of the eventual price tag for care leave his hospital against doctors’ advice.

Smith told the Guardian the inaction was “probably the most upsetting part about it. I don’t know another critical healthcare event that could take place that would necessitate instituting some sort of measure to universalize access to healthcare.”

Congress ordered insurers to cover testing costs in March, but there is no such order in place for treatment. A program created to cover testing and treatment of uninsured people has been riddled with problems leaving people with tens of thousands of dollars in medical bills. At the same time, health insurer profits are double what they were last year.

A certified registered nurse anesthetist (CRNA), Smith has worked in healthcare for more than a decade, always in intensive care settings. But because the patients he usually treats have pre-scheduled procedures for which they know the cost, he had not been faced with such a horrific example of what it means to not guarantee healthcare to every citizen.

It didn’t help that the patient’s question wasn’t the only alarming collision of money and healthcare at his hospital during the pandemic.

Smith said Covid patients concerned about the cost of healthcare have left the hospital “against medical advice”, a situation known as an AMA. “Not only is that a problem for them in terms of their healthcare outcomes, but they are also going back into the community and possibly increasing spread,” he said.

Smith’s job normally involves preparing people for scheduled surgeries but when Covid-19 cases spiked in New York City in March and April, his job was moved to the intensive care unit and to a team which responded to emergencies in the hospital. They would quickly assess patients, then prepare them for intubation to be placed on a ventilator.

His first night on the quick response team involved at least 10 intubations and left no moment for pause. “During the peak it was back to back, sometimes almost simultaneously, so you’re running around,” Smith said.

Patients were out of breath, exhausted, with vital signs off and desaturating oxygen.

This included the patient who asked about the treatment costs. Smith said the patient showed signs of needing intubation sooner, rather than later, and Smith and his colleague focused on getting them on the phone with their spouse because it was their last moment to speak before being put on a ventilator. “The priority was to have them speak to someone briefly and then perform the clinical duties to help save their life at that moment,” he said.

Smith tucked the question in the back of his mind, unable to answer it or absorb its implications. “I work in a relatively underserved area, so I have some inclination of knowing about the socioeconomic status of my patients, but it was the most real I’ve experienced during this pandemic,” he said.

Smith stabilized the patient but does not know what happened next.

He posted on Facebook about it a few days later, in part to process a shocking moment he had compartmentalized while performing the duties of his job. “It was kind of traumatic and I’d been thinking about it a lot,” Smith said.

His page was fairly private and he only made the post public at the request of friends who wanted to share it with their network. It exploded shortly after.

Ever since, Smith has become more active on social media, sharing articles about the unequal healthcare system in the US.

“I’m not really one to frequently take a public platform, but I felt what it was highlighting was important to have a dialogue about and hopefully compel our legislatures to make some meaningful change going forward,” Smith said.

“Because in my opinion, it shouldn’t be happening in this country, which as we know is one of the richest countries in the world, but we are not allocating funds to where I think they should be.”