The Growing Chaos Inside New Yorks Hospitals
By Lizzie Widdicombe
March 23, 2020
Health-care workers in New York face a looming shortage of personal protective equipment. If we dont get the proper equipment soon, were going to get sick, one I.C.U. nurse said. Photograph by Misha Friedman / Getty
Matthew Morrison is a thirty-six-year-old E.R. doctor at BronxCare, a hospital in the South Bronx, which has a large Dominican population. He speaks medical Spanish, he told me. Fiebre. Dolor. Náusea. Vómito. On Wednesday, he treated a woman in her mid-sixties with telltale signs of COVID-19: fever, shortness of breath, coughing up blood. She was terrified. She told Morrison, with tears in her eyes, Doctor, no me siento bien. Before admitting her, Morrison gave her the same speech hed been giving all his patients: Youve come to the right place. Were here for you. Unfortunately, we dont have a specific treatment for COVID, but were able to offer all sorts of supportive care. People were anxious. Another likely COVID-19 patient, an older African-American man, had taken a cocktail of medicationPercocet, Benadryl, an antibioticto treat his aches and fever, before arriving, disoriented, at the E.R.
New York City has become an epicenter of the crisis, with more than ninety-six hundred confirmed cases as of Sunday, and hospitals are struggling to keep pace. BronxCare workers were in the process of setting up a separate triage tent, to manage COVID-19 patients. Until then, the E.R.s waiting room would be crowded with the worried well, or, in this case, the worried sickpeople with coughs and flulike symptoms that might or might not be signs of COVID-19, whod come because they wanted to get tested. Most were sent back home, with orders to self-quarantine. Tests were being reserved for people sick enough to be hospitalized.
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Its challenging, Morrison said. Nobody has any experience with this at all, because theres been nothing like this since 1918. We can all read the Wikipedia page on the Spanish flu, but that doesnt show what it was like or describe the experience of people who had actual responsibility. He was avoiding news stories about health-care workers whod died of the virus: the doctor in Wuhan, the one in Seattle. But it was hard not to think about them as he donned and doffed his personal protective equipment and pictured all the things that could go wrong, the ways he could inadvertently touch a mask or a glove and become exposed. The biggest fear is realizing that youre probably going to get coronavirus no matter what you do.
Jessica van Voorhees, a forty-three-year-old E.R. doctor at Methodist Hospital, in Park Slope, Brooklyn, found herself watching the disaster with morbid curiosity. There is something thats sort of fascinating about watching a pandemic unfold in real time, and seeing the exponential curve, she said. She was working night shifts on March 8th, 9th, and 10th, when the first patients started trickling in. At first, it was a big deal. Like, I think we just had a COVID patient! Then we had three. And every day it more than doubled. When I spoke to her on Thursday, the E.R. was getting hundreds of patients with coughs, fevers, and sore throatsmost of whom just wanted to be tested for the virus. As in the Bronx, they were being sent home, with orders to self-quarantine. Testing had to be reserved for the very sick. For that reason, van Voorhees had concluded that the official numbers are totally off. Way off! She went on, I think were probably testing a small percentage of people who come in here and are clearly positive.
They were starting to see bounce-backs: people who came to the E.R. with a mild illness and returned days later, having swiftly deteriorated. A forty-two-year-old schoolteacher came in, with the usual symptoms: fever, body aches, sore throat, cough. He was super fit, healthy, and worked out all the time. Never smoked, van Voorhees said. We said, Look, we think you have the virus. Go home and self-quarantine. The man returned three days later, weak and disoriented. He walked into triage and then fell out of his chair, van Voorhees said. X-rays revealed a severe viral infection in both lungs. He was hospitalized and put on oxygen. Its so weird to see these people who are basically healthy struck down by it, van Voorhees said.
And it was troubling to see sick patients getting worse. Normally, when a patient has pneumonia, you hospitalize them and give them antibiotics. As the antibiotics start to work, they get better. But, with COVID-19, theres no direct therapy, just supportive care, so they get worse. Patients were often admitted to the hospital needing oxygen. I check on them the next day, and theyre a lot worse. The day after that, theyve been intubated and moved to the I.C.U.
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E.R. doctors pride themselves on being able to flex and surge, she saidto adapt to the rush of patients on holiday weekends, or during a normal flu and cold season. So far, the emergency room had managed to adapt: the hospital had transformed an outpatient surgical clinic into a COVID unit, and built temporary walls in an exam area to create more private rooms. But the makeshift facilities were starting to fill up. And anxiety was building around the supply of personal protective equipmentmasks, gowns, goggles. Van Voorhees had started to think about the prospect of being overwhelmed. Whats it going to feel like? she wondered, as she contemplated running out of I.C.U. beds, choosing which patient to intubate and which to let die. She went on, The vibe at work is this feeling of impending doom.
Health-care workers faced an additional threat: a looming shortage of personal protective equipment. Last Thursday, the New York State Nurses Association wrote in a letter to Governor Andrew Cuomo that it was painfully obvious that their forty-two thousand nurses did not have the equipment necessary to protect themselves from the virus. It goes without saying that if our nurses, physicians and other workers are exposed and taken out of commission (because they are on quarantine or themselves sickened) that the hospitals will cease to function, the letter reads. At Montefiore Medical Center, in the Bronx, Michelle Gonzalez, a thirty-year-old intensive-care nurse, was monitoring several COVID-19 patients, who were critically ill and on ventilators. The hospital has multiple I.C.U.s, and hers specializes in respiratory issues, making her unit a hot spot. She was already feeling burned out. When you sign up for nursing, you sign up for the possibility of being exposed to certain thingsH.I.V., AIDS, a handful of bacterias and viruses. But I never thought Id signed up for a pandemic that were not prepared for, she said. Hospital authorities hadnt provided information about the supply of items like protective masks and gloves, but the gear was clearly being rationed. If we dont get the proper equipment soon, were going to get sick, she said.
Since the first week of March, when the virus arrived in the city, there had been confusion and chaos around safety protocols, she said. At first, the hospital mandated that COVID-19 patients be put in negative-pressure rooms, which keep contaminated air from circulating. Then word came down that regular rooms were O.K. Nurses were told to use only N95 masks, which more efficiently filter out airborne particles. Then they said on Sunday we no longer need N95 masks, Gonzalez said. Were going to switch to surgical masks and a face shield. It didnt seem likely that the surgical masks had become safer overnight; it was the hospitals way of managing the equipment shortage.
In a donning and doffing class, in which nurses were shown how to put on personal protective equipment, an instructor introduced a new rule: store your used mask in a plastic bag, so you can reuse it later. Gonzalez pushed back. I said, What kind of infection control is this? Isnt that just incubating germs? The instructor seemed embarrassed. He said, Listen, Im only telling you what the hospital is recommending. And he added, kind of under his breath, Doesnt mean I agree with it.
Gonzalez was scared. My manager told me, Michelle, youre fineyoure thirty. You dont have anything to worry about. But I live with my ninety-year-old grandmother, and my dad, who is sixty-two, diabetic, and immunocompromised. I want to be able to go home and sleep at night, knowing I didnt give it to them. She decided to take matters into her own hands, along with her fellow I.C.U. nurses. I started organizing us early, she said. They obtained a stash of N95 masks and devised a system of working in pairs, so that they could better conserve them. She began to acquire a reputation. Medical doctors from different specialties, and my own doctors, keep coming by and asking me for protective gear, because they have nowhere else to get it.
She was most concerned about colleagues in the emergency room, which was short-staffed even before the outbreak. Its always overpacked, she said. Nurses there have sixteen patients. A new screening tent had been set up, and suspected COVID patients were being shuffled to a waiting area along one wall, where they sat on stretchers, shivering and coughing into the open air. An E.R. nurse had told Gonzalez that she was still wearing a surgical mask. None of the hospital staff had been tested for the virus. They were supposed to be monitoring themselves for symptoms. Its almost like were desensitized to it, Gonzalez said.
She told me that shes a good nurse. I love my job. I love when I clean a little eighty-year-old person and they tell me, Thank you. I love providing care not just to a patient but to their family. But, in the past week, shes been having regrets about her choice of career. Im so in debt because of nursing, she said. Ive paid thousands of dollars for my education, and Ive felt abused throughout this whole pandemic. Its like my life and my jobmy well-being and my jobare in conflict. She knew it was about to get worse. Right now, its the calm before the storm. Just watch. Shits really going to hit the fan.
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Lizzie Widdicombe is a staff writer at The New Yorker.
I went for a treatment today at hospital up north. The nurses were wearing full surgical gowns and gloves. They must be scared of this virus thing too.