24 Hours Inside a Brooklyn Hospital: An Update

Hey, it’s Michael. Starting today, The Daily is revisiting our favorite episodes of the year, listening back and hearing what’s happened in the time since they first ran. Up first: A story from this spring, when New York City was the epicenter of the pandemic.

So every morning in the Intensive Care Unit at the Brooklyn Hospital Center, the doctors gather for something called morning report.

The people who were on overnight, they stand around and the head doctor is there, and they kind of give a report of what happened. And then, the new doctors who are coming on, they get that information.

They talk about, you know, who was admitted, who got critically ill.

And one recent morning report was particularly intense.

doctor

OK. All right. OK. Next patient.

There were patients in their 80s and patients in their 30s.

There were patients from nursing homes and patients who were homeless.

Patients with asthma and diabetes, and patients with no underlying conditions at all.

But as the doctors race to get through the cases —

— they all shared a nearly identical description.

Acute hypoxic respiratory failure secondary to Covid-19.

From The New York Times, I’m Michael Barbaro. This is “The Daily.”

It’s been more than a month since the coronavirus descended on New York City’s hospitals and on Brooklyn Medical Center, where the vast majority of patients in critical care have the virus. My colleague, Sheri Fink, followed one doctor through a single day there. It’s Wednesday, April 15.

So for the past few weeks, I’ve been embedded in the Brooklyn Hospital Center.

And what I’ve been able to see there is incredibly unique — what’s happening? What is it like inside a hospital during a pandemic?

And there was one doctor I met who really embodied that transparency.

Dr. Josh Rosenberg.

An attending physician in the Intensive Care Unit.

There are people from all over the hospital recruited to work in the I.C.U., so it’s not just, like, I.C.U. doctors and nurses who are used to intensive care treatment, but in fact —

When I was there that day, there was a podiatry doctor and two of her residents. Those are doctors who work on the feet.

And the I.C.U. had actually effectively doubled in size, so it was completely full. And they had to turn to other areas of the hospital to turn them into Intensive Care Units. In fact, a big part of the I.C.U. is now in a place that just a few weeks ago was where patients would come for outpatient chemotherapy treatments. That’s now in I.C.U..

It was also a bit of an obstacle course.

There were cords everywhere.

They had pulled apart the ventilators. They had the control — parts of the ventilators that were helping people breathe, those were in the hallways so that nurses and respiratory therapists didn’t have to go in and out as much and expose themselves to risk.

And the nurses were doing the same thing with IVs, with the tubing that the medicine flows through. So they had pulled the IV pumps out of the room so that they can not have to go in and out and use up the personal protective equipment.

You all have to be very careful.

So now, Dr. Rosenberg is taking over for the doctors who were working the night before, and he’s beginning to make his rounds.

So nearly all the patients in the I.C.U. are on ventilators.

Some have asthma. Some have diabetes.

But a lot of these patients don’t have any underlying conditions at all.

So Josh and the other doctors are kind of confounded by some of the patients. They don’t understand why, if they don’t have a lot of underlying health issues, why their lungs look so bad.

And they also just don’t have that much to offer.

So, I mean, for most patients, they’re trying this thing called the Covid cocktail, which is that hydroxychloroquine and azithromycin. That’s that combination the President talks about a lot.

But there’s really very little evidence, and Dr. Rosenberg in particular is very unsure that those drugs really help.

So they start talking about other possibilities. There’s this experimental drug called remdesivir that you have to apply to the manufacturer for each patient, and they have to meet certain criteria. You have to have a test result. They can’t have certain complications.

There’s another drug called Kaletra that doctors think might have some effect.

So they kind of toss this around.

There was another Covid patient in the Intensive Care Unit on a ventilator, and she was pregnant, which adds a whole layer of complexity.

And they actually decided to deliver the baby by c-section two months before the due date. They had to give a couple of doses of steroid medication to help mature the baby’s lungs. The whole goal was to save the mother’s life, because I think part of it is that it gives more space for the lungs to expand once the baby is taken out.

So far what’s known is it tends to be quite rare that a baby would be born with Covid if the mom has it. At least that’s what the early studies say.

It might be surprising how enthusiastic Dr. Rosenberg sounds while discussing these patients, but he’s leading this team. He’s trying to keep morale up.

But actually, when we were going from one part of the I.C.U. to another —

He runs into one of his medical students.

[AMBIENT VOICES]

And when we get to this medical student’s mom, things are not looking good.

And Dr. Rosenberg wants to find out, is the son — is the medical student — the one who will be making decisions about her further treatment, about even possibly end of life care.

I mean, to me it sounded like he feels that this medical student, even though he’s still a student, is enough of a doctor to understand that the prognosis isn’t great — that perhaps his mom has some risk factors for this being more severe, and for her to possibly not make it.

Of course, when it’s your family member, it’s not so simple.

There are many cases where the doctors and the patient’s families have very different views of how to proceed with treatment.

Where the family still wants to press forward with all the intensive care available.

And where the doctors had come to a different conclusion and really felt like there wasn’t much hope, and that in fact the goals of care should shift away from trying to extend life and much more toward comfort and end of life — accepting that the patient was likely going to die.

Check vitals from there too —

Suddenly, we hear this announcement go out over the hospital loudspeaker saying, code blue —

— which means that somebody needs to be resuscitated, that they are basically dying.

[AMBIENT CHATTER]

So the code blue, it turned out, wasn’t for a Covid patient, but for a patient who had other medical problems.

And they did CPR, and the patient survived.

And for me, the moment was really just highlighting the fact that, in a hospital, that that work goes on — that there are all these other patients, too, who have different medical problems, and people are still having other emergencies. So hospitals can’t just stop being hospitals for everybody else. I But it’s hard, because the number of patients with Covid is increasing. Usually, if you have people with a scary, infectious disease you would put them in specific rooms in the hospital, but, of course now there’s many more patients than there are isolation rooms. So I think the doctors are very concerned about this possibility that somebody could come into the hospital for something else —

But of course, one of the big risks is to be a person who is walking into that hospital every day to work there.

And in fact, at one point —

Dr. Rosenberg gets word that one of his residents —

— tested positive for Covid and is in the emergency room downstairs.

Someone pulls up an X-ray of the resident’s lungs for him to look at, and he peels off his Personal Protective Equipment, which in this case includes his own ski goggles, and he looks at the X-ray. And immediately, the tone shifts.

What he sees on the X-ray is something that looks bad to him.

I think what was really striking to him, or what sort of, like, shocked him was that this was another doctor.

And close to his age, and somebody who’s been doing the same kind of work that he’s doing every day. And I think that shatters that sense of invulnerability.

I actually found out partway through that day that Dr. Rosenberg, himself, had been out the previous week with symptoms of Covid. He actually didn’t get a test until his symptoms had resolved, and it turned out to be negative, but he’s pretty sure he had Covid.

And this is a huge problem. A third of the doctors and nurses were out sick. A number of them had tested positive for Covid and were critically ill. And it’s not just a problem for this hospital. It’s a problem all over New York City, that as the hospitals are overwhelmed with Covid patients, you have high numbers of health staff out sick.

The day that I was at the hospital, New York Governor Cuomo pleaded for doctors and nurses and health care staff from around the U.S. to come to New York —

— in part to help fill in for the workers who are falling ill across the state.

We’ll be right back.

Last week, Daily producer Daniel Guillemette called back Dr. Rosenberg for an update. [PHONE RINGING]

Hello.

Hi, Dr. Rosenberg. How are you doing?

Good.

Are you at the hospital right now? Oh, yes.

So I’m standing in the vaccine queue,

Oh wow.

We are socially distant, six feet apart, and employees and everybody are talking to each other saying hi to one another.

It does sound very, very jovial in the background, which is great to hear.

I wouldn’t use the word jovial, but people are happy to get this vaccine. They want to get this vaccine. They want to protect themselves. They want to protect their patients. And the mood is not somber. The Mood is that a lot of people are somewhat excited and somewhat nervous. It’s a new vaccine, they know that. But they’re excited to move progress forward, move the health of the nation forward, and be start of something that’s larger than themselves. And so it’s kind of monuments to be part of this. To me this harkens back to the ‘50s in certain ways, where you had the lines for polio vaccination extended out. Well, here in the hospital, we have a long corridor, and you have this line of employees to get vaccinated, extending down this corridor, much like the old polio vaccine queues were.

All right, tell me what’s going on.

Little pinch, we’re done. No pain from the vaccine whatsoever. All right. Give me two seconds. Let me just go someplace a little less loud.

OK, well, while you’re doing that, let me ask you, in terms of Covid cases at the hospital, how are you, how are things going?

It’s calmed down a fair amount. We are seeing an increase in Covid cases specifically. Our I.C.U. is almost full. We have a couple of empty beds. As time has gone on, we’ve learned a lot more about the disease. And the truth is, we’re now finally having some semblance of might work, might not work. And to be honest, a fair amount of we still don’t have a solid idea. But we’re months out and we’ve had time to develop some newer drugs and treatments. And the vaccines are now coming right out of the block, which means that there has been a fair amount of success in trying to slow this, although it may not be to the degree that we would like.

Is the death rate at your hospital different compared to the spring?

It is. It is lower still. We still, unfortunately, have some people in their 50s and 60s who have passed away from it during this time, this recent time. That being said, there are a fair number of patients who I think are recovering and going home, who might not otherwise. There was one recent patient we had where their family members were actually able to get one of the newer antibody treatments. And that’s an option that just didn’t exist back then.

If anything, what what do you still not have enough of?

I mean, we’re very good in terms of equipment, we’re good in terms of medications, because we don’t have the same citywide crunch on medications that we did back then. What happened back then is that everybody suddenly needed a lot of everything, and the supplies were limited. So hospitals got rationing, which was appropriate at the time, but we ran out of things. We have enough of the sedatives that we needed before. We have enough the vasopressors that we occasionally ran out of before. We’re in very, very good shape. But, if we have a surge like we did in April, and it’s as bad as it is, and it’s that bad in other cities, I could definitely see a run out of medications. So there’s just a limited supply of those nationwide. So if everybody suddenly needs increased volumes, we’ll be in trouble. Same thing with all the various types of P.P.E. We’re in very good supply now, but if everybody across the nation suddenly needs a tremendous, tremendous amount of stuff, absolutely – supply lines could get tight. There’s still a so there’s always the supply demand issues that can happen. That being said, I don’t see a particular item that I think is going to be a problem point.

What about staffing?

Staffing is always a question mark. If you have a high [INAUDIBLE] call, yes, staffing will become an issue again. There’s just nothing you can do about that. If a third of your workforce is out sick, a third of your workforce is out sick.

I guess, though, the fact of hospital staff getting vaccinated now should reduce the risk of people being sick.

I was one of the lucky ones that was enabled to kind of be near the head of the line, which I greatly appreciate, because I do have a daily exposure to patients who are Covid positive by the nature of the work. And so we tried to hit up those who work in those areas where we have Covid positive patients frequently: in the emergency room, the ICU, the medical floors, housekeeping, slash environmental services, the floors where those people work where they tend to have exposures. And we got a good turnout for it. And I think vaccine acceptance has overall been very high.

Okay, so with the hospital staff getting vaccinations, I guess I wonder, is there like a lighter mood or something at the hospital? Like among the staff, is there just like a sort of a sense of relief or something?

Yeah, there is a light, yes. There is a sense of relief that this may finally be coming to an end, this darkness. Maybe, just maybe the craziness and the utter insanity that was last winter and everything else, there’s a light at the end of the tunnel. And it’s coming to the end. And the vaccine’s that first step in really bringing the disease under control, if people are willing to take it. And just as a doctor and a scientist, it’s to me still mind-blowing that they could create an effective, safe vaccine in that little time and get it out to all of us. It is to me mind-blowing, because I know how long it took to do all these other vaccines in history. And so it’s really a sense of awe at that. And I’m, you know, kind of just taken aback by it.

Listen, thank you so much for taking some time. And, you know, good luck with the rest of your day.

OK. Thank you so much.

Bye.

Today’s episode was produced by Annie Brown, Daniel Guillemette and Clare Toeniskoetter, with help from Alexandra Leigh Young and Sydney Harper. It was edited by Lisa Chow, Liz O. Baylen, Lisa Tobin and Paige Cowett, and engineered by Chris Wood and Dan Powell. That’s it for The Daily. See you on Monday after the holiday.