I don’t normally wake up in tears, but this piece I received is too important, too beautifully written and too painful not to share.
“Friends,
I think most of you know that I write from Washington Heights, on the island of Manhattan in the City of New York. People don’t seem to ask very often why this neighborhood is called Washington Heights, probably because we don’t like to be reminded of our defeats, and in this place we once were defeated. It was right here, where now looms the city within the city that is The Columbia University Irving Medical Center, that the young nation was nearly snuffed out. In this place, George Washington was on the run, his Army in open mutiny, his soldiers deserting him by the dozen. It’s called Washington Heights because quite close to where I write this letter Washington holed up in desperate consul for a few nights before surrendering New York for good. Lin-Manuel Miranda in his musical “Hamilton” tells the story best, through the voice of Washington who raps:
Can I be real a second?
For just a millisecond?
Let down my guard and tell the people how I feel a second?
Now I’m the model of a modern major general
But the elephant is in the room
The truth is in ya face when ya hear the British cannons go
BOOM!
Goes the cannon, watch the blood and the shit spray and
BOOM!
Goes the cannon, we’re abandonin’ Kips Bay and
BOOM!
There’s another ship and
BOOM!
We just lost the southern tip and
BOOM!
We gotta run to Harlem quick, we can’t afford another slip
Guns and horses giddyup
I decide to divvy up
My forces, they’re skittish as the British cut the city up
This close to giving up, facing mad scrutiny
I scream in the face of this mass mutiny
“Are these the men with which I am to defend America?”
It was a devastating defeat, the first of many this nation would know. Some of the military sort, others of the soul. The Missouri Compromise, Bull Run (twice). The horror of the Peninsula campaign, the rise of Jim Crow, Guadalcanal, McCarthyism, Chosin Reservoir, Siagon, children torn from their parents on the Southern border. Our ideals and our sons torn to pieces, bleeding out in mud.
I wish that I could tell you otherwise, but we are losing again. The truth is in our face, we hear the cannons go boom. The extubation rate in my combined ICU Cores is less than 5%, Average time on the ventilator is 22 days with no end in sight as the tracheostomy teams are called in. This virus has us beat, its pathomechics inscrutable. We are doing what we can but we are simply unable to get patients off the vents. They lay in their beds angelic and trusting as we thrust and parry with the inevitable complications of long-term ICU care. Renal failure, CVVH, superimposed pneumonias, sacral decubs, line infections, We all try not to look at the snapshots scotch taped over the beds, silly selfies, a group in front of a cathedral somewhere, hikers on a summit. It’s just too painful, we look away and put our heads down back to the task of keeping the patients alive, 12 hours at a time.
Meanwhile, outside the hospital walls a strategic retreat is being carried out using the only method we have right now against this virus, hiding from it. Every one of you is doing just as much to actually help us get through this as we in the ICU. Your selflessness and patience is paying off, though at cost that challenges comprehension. Still, the curve has flattened, lives are being saved and we have bought dear what any Army in retreat needs most.
Time.
We will use this time. Don’t for a moment underestimate the power of the unbridled energies of this nation, so varied and free. No one soldier wins a war, nor does a nurse or a doctor or a hospital or Health System. What will bring us off our backs and take us out of hiding will be the slow, inexorable crush of science. Industry and Academia, chemists and epidemiologists, family practitioners and virologists with tenacity and rigor will rise up and push back. It will not be a column march or a top down directive, and fortunately it’s an effort nimble enough to avoid the occasional odd fellow in a leadership position. It will be a kaleidoscope of energies that prevails against this virus, energies as varied as those of the nation itself.
I saw these energies just today. Taking a walk following an ICU night shift. I crossed Washington Heights on a diagonal from 168th down St. Nickolas to 141st. A walk from the Medical Center to the mansion where Washington organized America’s first great retreat and then on to the graceful house Alexander Hamilton built for his family after the war was over and won.
I wish you all could have seen the neighborhood that I walked through, I wish Washington could have seen it, God how both me and Lin-Manuel wish Alexander Hamilton could have seen this slice of the nation he built. He would have looked out the front from porch of his house and heard the varied carol of America singing, even in this retreat. Dominican men playing dominoes in masks they occasionally slipped off for a drink of something, Africans in dakshe and latex gloves hawking bimbada from sidewalk blankets, hipsters wearing plastic gloves selling wildly overpriced coffee, and a big rapper dude, wearing gold chains and a leopard print face mask who, if you squinted, looked exactly like the actor from the musical, the one who played George Washington, returned again to this battlefield in The Heights.