April 27, 2020

Radiology on NYC’s Front Line

By Jeremy Ford, MD, MBA, a radiology resident at NewYork-Presbyterian/Weill Cornell Medical Center. Jeremy would like to thank Maria Mitry, MD also a radiology resident at NYP/Weill Cornell, for her contributions to this column. Jeremy would also like to thank all the intensivists, residents, nurses, and respiratory therapists continuing the fight.

Flashback to the beginning of the COVID-19 pandemic: I had been following the news coming out of Italy for several weeks. My Italian relatives were forwarding me stories of overrun hospitals, PPE shortages, and heart-wrenching moments. I was looking into my future.

Maria Mitry, MD, my co-resident, and I got the call from our program director, Dr. Andrew Schweitzer, at 7:37 p.m. on March 24th, around my son’s bedtime. I was being redeployed. After the call, I got the go-ahead from my wife. She said, “Do what you need to do. You are a doctor. This is your call to arms.” I got back to Dr. Schweitzer with my answer: “Tell me when and where.”

When I arrived at NewYork-Presbyterian Queens in Flushing, N.Y., I found a hospital in the midst of an unprecedented surge. A medicine resident handed me an N95. “Guard this with your life,” he said, “It may be a few days before you can get another one.” Fortunately, the PPE situation improved, with donations and bulk purchases pouring in from all over the world.

Maria and I were soon deployed to a brand new COVID ICU, repurposed from a former Cardiac Cath Recovery Unit. Maria, who was kind enough to take the night shift, arrived at the unit around midnight. “The unit was empty,” she says. “Various learning materials and posters for Cardiac Cath patients were strewn across the unit. There weren’t many supplies. It was a calm before the storm, but spirits were high at the time. Then we got three back-to-back admissions. By the following day, the unit was full.”

The following weeks were a lesson on what happens when the curve is not sufficiently flattened, and a hospital is stretched beyond its capacity. While ventilators were the bottleneck getting the most press, many ICU patients were into renal failure. Due to the hypercoagulable state of COVID patients, their dialysis machines would often clot. With a shortage of nurses, I was almost constantly drawing PTTs, often alongside an orthopedic surgeon who had also joined the fight.

In an attempt to uplift spirits, the hospital played Journey’s “Don’t Stop Believin’” every time a COVID patient was discharged. However, on our unit, most patients continued to decline regardless of our interventions. Hydroxychloroquine resembled a placebo. The “discharge song” was drowned out by the cacophony of monitor alarms and the far more frequent “C-A-T” (Code Activation Team) announcements, which I would often hear in the silence long after I returned home from my shift. The only thing that kept our waning morale afloat was the emerging sense of comradery among the residents and attendings, many of whom I will never forget.

I began to wonder if this was how medicine was practiced before the age of antibiotics, biologics, and gene therapy. What’s it like to be a doctor when the medicines stop working? We were all finding out.

I realized this is when our humanity as physicians must shine the brightest. I decided to call each patient’s family, every day. Given the grim course of severe COVID, I was often repeating myself. “There are slight improvements in your daughter’s lung function, but the kidneys are failing. Please know, this is a potentially deadly virus, but we are doing everything we can for them.” Since families could not see their loved ones in person, FaceTime sessions became paramount. They would often ask, “Can they hear me?” I would respond, “I don’t have scientific proof one way or the other, but I like to think that somehow, some way, they can hear you — or already know in their heart what you’re about to say.” Their shrieks of grief and devastated facial expressions are forever etched in my memory.

I understand the deep impact that “The Great Pause” has had on livelihoods. However, there is no equivalency between the temporary loss of livelihood and the permanent loss of life, including the hole it leaves in the fabric of communities and families. The scar COVID will leave on Queens and the broader NYC community will last for many years.

I sincerely hope we will all emerge from this stronger and better prepared, but I also hope we will emerge a little kinder. I am not quite the same person I was pre-COVID, but I hope it has made me a better doctor. Take care and stay safe. Also, after the social distancing recommendations are lifted, hold the people you love a little tighter.