Home Ventilation system COVID’s Ground Zero, Spring 2020: A doctor, a hospital, and a traumatized New York

COVID’s Ground Zero, Spring 2020: A doctor, a hospital, and a traumatized New York


Granted full access to the New York Presbyterian/Weill Cornell hospital system (from CEO to maintenance teams), the author – a vanity lounge writer at large – crafted a saga of bravery, ingenuity and loyalty amid horrific conditions in one of the world’s greatest hospitals as he battled COVID (from America’s first reported case to the ensuing tsunami ). In this adaptation of his new book The desperate hours, Brenner centers on a legendary intensive care doctor and his highly charged interactions with the head of the hospital, himself frantically trying to save lives in his own way.

There were a lot of things that Dr. Lindsay Lief, leader of 5 South, was great at, but always following the rules wasn’t one of them.

Lief was the beloved director of the medical intensive care unit at 5 South, one of six intensive care units at New York-Presbyterian/Weill Cornell, a hospital system considered the emerald city of medical care in the New York metropolitan area. She brilliantly supervised a team of 11 intensive care physicians (the assistants) and dozens of highly trained nurses, respiratory therapists, pharmacists, X-ray technicians and housekeepers responsible for helping to heal the sickest. of the sick, to conjure up miracles in the midst of a breakdown. body systems. It was a unit that would be knocked down again and again and again during the first 18 months of the COVID pandemic. That he was still standing was a miracle – and although Lief never told anyone, one of the reasons for this may have had to do with a six-year-old child and his forbidden wish to have a piece of pizza.

This had happened years before, when “coronavirus” was a term unfamiliar to 99.99% of the American public. As an intern at Weill Cornell, Lief had loved the time she spent in the MICU – the medical intensive care unit – with her time calibrations of everything going on in the body. Later, as a participant, Lief intoxicated her residents with her wholehearted approach to what she called “real medicine” – what mattered most was the human connection. She had met the six-year-old who was battling leukemia during her training. He had a feeding tube, but his only wish was a slice of pizza, forbidden by everything in his treatment plan. A never-ending debate ensued: Was giving him the pizza wise? How would his digestive tract react? “Bring him the fucking pizza,” Lief said, before pumping him with painkillers for the possible agony that could follow the meal.

Was it a drug or something else? A few months later, she saw the boy on the pediatric floor. “And the day you got the pizza?” she asked, feeling guilty for that case where she had broken the rule. Did she make the right choice? “It was the best day of my life,” he told her. “The last time I ate something.” A few weeks later he was gone. So maybe it was medicine after all.

Now, in early April 2020, Lief was anxious, to say the least. She had an intensive care unit full of extremely sick COVID patients, and word had come that the head of the entire hospital system, Steve Corwin, wanted FaceTime on his morning rounds. Such long-range sighting was, as far as anyone knew, unprecedented – and every morning, just as systems, equipment and lack of supplies seemed to be getting worse, not better.

Dr. Lindsay LiefCourtesy of Dr. Lindsay Lief.

On a normal day, before the whole pandemic, Lief would have woken up and, before going to work, whisked her kids from their Greenpoint home to school in Williamsburg, joining the crowds of hip Brooklyn moms and bands. heder boys in their yarmulkes and payments look for space on the sidewalks. Now his normal days involved waking up when it was still dark, after far too little sleep. She was often the only person on the road crossing the deserted Queensboro Bridge. She would reach Weill Cornell (as that particular branch of the New York-Presbyterian system was generally referred to) at 6 a.m. The atmosphere inside the hospital was surreal. The marble entrance halls, once crowded with throngs of visitors, were desolate; the gift shop has closed; the Au Bon Pain in the lobby, where she once bought croissants for her team, is pitch black.

Lief could hear the deafening noise of HEPA filter systems mounted on jerrys a few floors away, and as she walked to her office she saw her colleagues and the rushing shadows of doctors and nurses, respiratory therapists and accountants working as patient transporters rushing up and down the stairs, wearing frayed N95s and plastic shields or diving goggles scavenged from childhood basements, not waiting for an elevator for fear of the very air they could breathe.

What could Corwin possibly see during a FaceTime call? The patients, yes, but he couldn’t see the fear on the faces of the nurses who worked in rooms where aerosolized droplets leaked from clogged ventilator tubes but had to wear masks they had used for days, long after they should have been discarded and replaced, as there were no replacements. The iPad screen would show up, but not To display, Weill Cornell’s beloved ER doctor, Chris Belardi, fighting for his life after the first few weeks of frontline service. Same with the artist who just had a birthday and seemed unlikely to make it to the next one; the critically ill 28-year-old who was months away from his wedding; And so on. Lief, whose understanding of the Hippocratic Oath deviated from the more traditional and reserved clinic, had already decided to waive the “no visitors during COVID” rule. She would allow the 28-year-old’s fiancée to be by his side when he dies.

The truth was, you had to be out there on 5 South to figure out what was going on, and Corwin felt caught between the fierce tug of his calling as a doctor and his responsibilities as head of the hospital. For years, he had been the most comfortable cardiologist in intensive care and led critical care at Columbia-Presbyterian. Yet, due to the hospital’s legal policies, he was no longer allowed on the floor. FaceTime was the best he could do.

In a blur, Lief overheard Anthony Sabatino, her nurse manager, say, “Lindsay, Steve wants to hear from you. And then there was his boss on his iPad, talking to him from his apartment a few blocks away, himself quarantined by the board, who had worried about his health because someone at headquarters social had tested positive.

“Lindsay,” Corwin said. “What can I do for you? How can I help?”

Lief suddenly heard himself sobbing. “Dr. Corwin, we disagree,” she replied. “We are down. I am desperately worried about my staff. ventilators, and we put our nurses at risk.”

Corwin got it. He let her cry. “Whatever you decide, you have my full support and that of the hospital,” he said. He added some general reassurance, but most of the time he just listened.

Bradley Hayward, one of 5 South’s critical care assistants, interrupted Lief – a patient was coding. The tubes of another state garbage ventilator had become clogged with the horrible COVID mucus that congealed as hard as old chewing gum. End of video tours for Lief; she was on the run again. For a moment, his fury evaporated, obliterated by the immediate urgency. She felt strangely reassured: they were doing the best they could in times of war; 5 South was on it.

But there were only so many machines working, and there were so, so many patients, some with better odds than others. Day after day, hour after hour, as dozens of desperately ill people rushed to the hospital, there were often three or four patients who needed ventilators at the same time and, on many occasions, only one or two who seemed to be available. Yes, Lief and Hayward would be informed, as would doctors in other intensive care units and the emergency department, we have more somewhere, in this storage area or auxiliary hospital. Lief would be constantly reassured: They will show themselves. But when and how? And how do you keep someone alive until they do? And so the appeals to hospital ethicists and the agony of needing triage decisions out of corporate lines without state-sanctioned crisis rules in place. What am I going to do, thought Lief, write in the chart that Corwin says it is okay for the patient to die in ICU?