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At my hospital, we’re hearing a new COVID-19 tune

'Happy Code' gives us a few seconds of respite from the uncertainty, anxiety and sadness at our frontline New York medical center
Medical workers dance during a 'Happy Code.' Montage from a video shared on Instagram by Montefiore Health System.
Medical workers dance during a 'Happy Code.' Montage from a video shared on Instagram by Montefiore Health System.

Here in our New York hospital, my colleagues and I have been on all-hands-on-deck scheduling for a month – no vacation, no real weekends for the folks on inpatient service. It is arguably a better schedule than my non-COVID one (yeah, I know how sad that statement is). There are days off and I see my family. And very wisely, our maximum shift is 16 hours rather than the 26 hours I’m used to, which helps an enormous amount. So this schedule is pretty sustainable; which is good, because we just set it up for another month. We’re nowhere near the end of this thing. And I’m tired in my bones. I will keep going, but I’m tired.

It is a humane schedule, and we’re all adjusting to this new exhausted normal. When I talk to other staff on our labor and delivery units, in our N95 masks covered by a surgical mask, our welder eye shields, our surgical caps covered by a second surgical cap, we talk with the buzz of urgent calls going on above us all the time.

“Respiratory code, 11 South.”

“Cardiac arrest code, 9 North.”

It is the signal for teams from all over the hospital to converge on a patient who is, for lack of a better word, dying unless they get more help. And it has been, since the pandemic started, an almost constant blare.

And on labor and delivery where I work as a high risk pregnancy doctor, my coworkers and I keep having the same conversation. Our exposures are so strange: we have healthy patients, and COVID-19 patients, and we take tremendous precautions between them and between ourselves. But I don’t know what it means to protect yourself when the work requires that you spend long periods of time – hours sometimes – with a COVID patient; maybe one who who is pushing and then delivers, or one who had pneumonia and is on oxygen and needs a cesarean. Hours and hours and hours of exposure. What has that meant for us?

As the days and then the weeks go by, we start to say to each other: I must be one of those asymptomatic positives. I must have had it already. Is it possible to have been here and not to have caught the virus? And the truth is that we do see an enormous number of asymptomatic positive patients – it feels more and more likely. But I can’t tell if it’s just magical thinking. Maybe I am already across the river. Maybe I didn’t realize I got to the other side, safe and sound; and so did my husband and my four kids. Did we make it all the way over without noticing? Is it possible that could be true? Or is it more probable that my extensive hazmat procedures actually work? I can’t tell anymore.

What I will say has changed is this: my coworkers and I are settled in to our reality and looking for signs of the other side. And so has our system. My institution updates us daily with COVID hospitalization numbers: how many new cases, how many in the ICU. But in the last week, they’ve also started reporting other statistics: how many COVID discharged patients; how many recovered; how many home, safe. And that’s so good. We needed to remember that we win, a lot of the time.

And here’s what my hospital has also started doing. Whenever anyone with COVID-19 gets successfully extubated and is breathing on their own; or gets discharged from the hospital, a different announcement goes out. The overhead systems says: “Happy code. Happy code, 9 south.” And they play the chorus from Alicia Keys’ “Empire State of Mind,” the part that goes “New York, New Yooooooork.”

And do you know what all of us do, in our N95 masks and welder eye shields and bonnets? Doctors and nurses and cleaning crew and scrub techs? We stop everything and behind our masks we all grin. And for ten seconds, we dance: arms in the air, total joy.

And then we go back to work.

View this post on Instagram

We're in an #EmpireStateofMind at the Montefiore Health System! 2,638 #COVID19 patients have been discharged as of today! Celebrate the #HappyCode! #HealthcareHeroes #MontefioreProud #MonteHeroes

A post shared by Montefiore Health System (@montefiorehealthsystem) on


About the Author
Dr. Chavi Karkowsky is a high-risk pregnancy doctor who writes about medicine, women's health, policy and, occasionally, her kids. Her book "High Risk: A Doctor's Notes on Pregnancy, Birth, and the Unexpected" was published by Liveright (W.W. Norton & Company) in March 2020.
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