I remember as I boarded my flight from a picturesque vacation in Hawaii with family back to New York, I felt a sense of concern as I watched the news reports in the terminal. Weeks before, the first cases had been detected in the New York area. An attorney, who traversed Grand Central Station on his daily commute from work in Manhattan to his home in Westchester County, was one of the first reported cases of the novel coronavirus in early March. This station was blocks away from my apartment. There was little anyone knew about how this virus would affect us.
Upon arrival to my residency hospital the next day for call, the hospital had been eerily quiet. Elective surgeries had just been cancelled and the daily news conferences with the exponential increase in cases and hospitalizations created an ominous atmosphere. Within two weeks, all oncologic surgeries were cancelled and calls for our acute care and trauma/surgical intensive care service to begin staffing Covid-19 patients were answered. We traded our sterile gowns and electrocautery for face shields, goggles, and Tyvek suits. Soon the hospital was at capacity and essentially every ward in the hospital was caring for these patients, including the entirety of our trauma and surgical ICUs. A batch of 6 residents and myself volunteered to assist our surgical intensivist staff in caring for these patients each day for the first month. Our schedule involved alternating teams of 2 residents: 24 hours on duty and 48 hours off duty each day for the month of April. Ventilator and hemodynamic management were the priorities. Many patients required prone-positioning which necessitated a choreographed series of events to ensure the ventilator circuit was not broken – thus aerosolizing a potentially deadly pathogen and exposing everyone in the room. Each day PaO2/FiO2 ratios were tracked. Patients arrived to our ICU on minimal supplemental oxygen and, within a matter of hours, required emergent intubation and ever-escalating ventilator settings and vasopressive medications to remain alive.
Perhaps, the most challenging of tasks during this time was to update each family daily by phone. Since the beginning of the pandemic in New York, all visitors were restricted from seeing family members. As such, contact between a patient and their loved ones was relegated to a distant voice on a speaker phone or a short Facetime wave. Each day, the residents and fellows would split up the list of phone calls. Often, these phone calls were merely updates regarding the ventilator or vasopressor drip settings; the family members had all become accustomed to this very medical description of their loved one’s status. Unfortunately, much more difficult phone calls had to be made too often. “I know I updated you earlier that your husband was improving. I am so sorry to say this, but he has now taken a turn for the worst and his condition is very grave. He will likely not survive the night.” The reactions were varied but all traumatic. It was a feeling of paralyzing hopelessness from the other end of the phone. Even more distressing in these situations, each nurse, respiratory therapist, resident, fellow, and attending physician felt powerless to battle this unseen enemy. Every potential treatment, even experimental, was tried. Maximal support with extracorporeal membrane oxygenation, while carrying some patients, proved to be the last stop to keep the sickest patients alive, even the youngest.
Many of us had never experienced the level of morbidity and mortality over those few months. Some deaths were expected but many others were so sudden that there was little to do to prepare families, friends, and even ourselves. Throughout the most difficult days, the camaraderie that we felt as a team was truly what carried us. The conversations we had on rounds, while doing procedures, and outside of the ICU, served to educate us on so much more than the nuanced care that these patients required. It was an education in humility and humanity.
Since then, the curve has flattened in the New York metropolitan area and many successful discharges to rehabilitation and home were celebrated. What will stay with all of us moving forward is that sense of unity. No matter what your title was, when you walked into a hospital, you were going to battle. Every staff member stood by your side: from the person who fed and sustained us in the cafeteria, the respiratory therapist who drew countless blood gases, the physicians, nurses, and advanced practice nursing staff who tended to every need. Each team in the hospital felt the same call to arms and the same drive to support every life around them, whether patients or staff. In the end, that unity was stronger than the fear that we faced each day.