diary of a hospital

The Doctor Holding the Camera

“Today, I was there for maybe five hours. In that time, five patients died.”

Monday, March 30: The ICU team resuscitates a patient with cardiac arrest. Photo: Patrick Schnell, M.D.
Monday, March 30: The ICU team resuscitates a patient with cardiac arrest. Photo: Patrick Schnell, M.D.
Monday, March 30: The ICU team resuscitates a patient with cardiac arrest. Photo: Patrick Schnell, M.D.

As the COVID-19 crisis continues to unfold, the medical staff at Mount Sinai Brooklyn is providing regular dispatches about their daily experience fighting the virus. Today we spoke to photographer Patrick Schnell, who is documenting the hospital for New York. Schnell is a pediatrician who worked in hospitals for 14 years before taking a job in drug safety in 2006. He also has a lifelong passion for photography, and his medical training allows him to capture moments that an untrained eye might never know to look for. Schnell has photographed inside Mt. Sinai Brooklyn on numerous occasions, for magazine features and hospital promotional materials. But Schnell, who has been visiting the hospital daily, says he has never seen anything like this. Here’s what his camera captured on Monday.

How did you feel taking on this assignment?

I worked in the ’90s here in pediatrics when many kids had AIDS, so the fact that there was a virus that was potentially life threatening wasn’t anything new, but coronavirus is much more easily transmitted. And you don’t know whether you’re going to get severely affected because everybody is playing roulette. I do think I’m not that old — even though I’m 55, which is kind of old. But I’m relatively healthy. You just hope that you’re going to survive if you catch it.

There’s so many sick people and so many patients who you basically already know have the virus, breathing in close proximity. I would almost be surprised that I wouldn’t get it, even though I’m wearing the mask at all time. To be honest, sometimes if something feels a little funny, you wonder if this may be the beginning — like, this funny feeling in my chest, is this how it starts?

Perfusion pumps placed accessibly outside of the ICU room in order to reduce the need to open the door, thus minimizing the risk of cross-contamination. Photo: Patrick Schnell, M.D.

What sort of protective gear do you wear?

Two years ago I bought my own N95 masks because I was going to go to Hanoi, and I knew the air quality was horrible there. So every day I come with my own mask and I feel at least a little bit good about not taking the hospital’s. Then I will try to get some scrubs, but that’s not easy because the hospital itself is a little bit short on that. So the first day I actually worked on in my regular clothes, which is bad for two reasons. Number one, I look like, totally silly with my cameras hanging around me, as if I’ve walked in from the street and just started taking photos in the ER. The other thing is that all my clothes are going to get contaminated.

Michael Cooke, RN, in his first day at the Brooklyn Mount Sinai ICU where he is helping out due to staff shortages, can be seen caring for an intubated patient in the ICU. Photo: Patrick Schnell, M.D.

How does it feel being trained as a doctor but not being out in the field at a time like this?

I felt that I have skills that would potentially be needed. And I think I would have volunteered but I can’t do that with my regular job. I also feel it’s important to complete this photography job now, because that’s how people know what’s going on. The advantage of doctor as photographer is that I can anticipate the next move in procedures and capture them. Plus I’m a lot less intimidated by everything.

I may still sign up to volunteer. Problem is that I’m a pediatrician and this is not a pediatric disease at all. But it may come to the point where even I can be useful. I worked as an EMS before studying medicine, in place of military service, which was compulsory in Germany at that time, so I learned how to intubate.

What do you hope to convey with your photos?

I just want to show what’s going on. I don’t want to make it look more or less pretty than it is. I just want to really reflect the reality and it’s a very brutal reality. If I can somehow show who these workers and nurses and doctors and cleaning staff are, that’s part of it too.

Solitary patient in ICU bed. Severe restriction are in place for visitors in order to limit the spread of SARS-CoV-2. Photo: Patrick Schnell, M.D.

Are there things that surprised you once you actually got there?

You hear this story in the news, everybody’s sick, everyone’s on the ventilator, everybody’s dying. And it’s hard to understand until you’re there and you see it. Watching CNN is not going to transmit that message. Today [Tuesday, March 31, the day after these photos were taken], I was there for maybe five hours. In that time, five patients died. It was like clockwork: boom, boom, the next one, boom, dead. It’s unbelievable.

Doors are kept closed as much as possible to minimize spreading infection with SARS-CoV-2 Photo: Patrick Schnell, M.D.

Tell me about the photo below with the traffic jam of stretchers.
What is happening here?

This was probably around 10 o’clock on Monday in the ER. What you see in the background is where the arriving patients come in from the ambulance-reception area. This is the area where all the EMS people congregate and try to get rid of their patients and they usually have to wait quite some time for that to happen. So they come up this corridor and that’s the patient you can see in the photo. And then there’s maybe another one in between and sometimes there might be one behind him. Apparently a couple of days ago there was a whole procession of maybe 12 patients just waiting on stretchers to even come into the ER. So they were just on this ramp forever.

It’s very noisy. There’s all sorts of alarms going off all the time. People talk over each other, the phone rings incessantly, the person who answers the phone never stops talking. He’s taking questions from relatives and trying to give information about the status of patients. Otherwise, the nurses, doctors, physicians assistants, and all these people are just running over each other, trying to get from A to B, to go from the computer screens to where they do blood draws to taking care of patients to doing histories to getting X-rays and making decisions about admitting patients or sending them home.

Traffic jam of newly arrived patients on stretchers. Photo: Patrick Schnell, M.D.

What’s happening with the next patient we see, in the orange?

This patient had to hang out for quite a while in the ER on the stretcher like everyone else. I asked him if it would be okay if I took these photos of him and he said yes and signed a consent form.

Patient in respiratory distress arriving via ambulance in an already overcrowded ER. Photo: Patrick Schnell, M.D.

Because his breathing was pretty labored he was wheeled into the first available room. Somebody like this who is having a hard time breathing, everyone almost knows that he is infected. Later on he gets a masked placed on him to help with his oxygenation. But he wasn’t at a point where he was decompensating [experiencing organ or system failure resulting in an urgent change in vital signs]. There were other patients I saw in the ER that were breathing so hard that maybe they would survive like this for another hour and then they would turn blue and die. He wasn’t quite there yet. But he certainly was having a hard time.

The patient I believe was Russian and his English was very limited. And so there’s an interpreter to help the doctor take a medical history. I don’t know what happened to him, but he wasn’t going to be sent home.

A patient in respiratory distress is being interviewed by Dr. Makini Chisolm-Straker with the help of a live online interpreter Photo: Patrick Schnell, M.D.

What are some of the ethical challenges of photographing patients who you can’t get consent from?

I don’t really take pictures of them because neither a magazine nor Mount Sinai would ever publish the face of a patient [without consent] — that’s against regulations. In the process of taking photos, you still have to be respectful of the patients that are potentially in the photograph. But my challenge is basically just to keep any identifying features out of the frame.

A patient with respiratory distress is having his blood drawn in the ER. Photo: Patrick Schnell, M.D.

What about the next sequence?

The next two sets of photos are all of the same patient. He has COVID and is unconscious on a ventilator.

Preparing to reposition an intubated ICU patient with severe respiratory compromise. Photo: Patrick Schnell, M.D.

I think frequently patients have been turned into the prone position, which supposedly helps with this particular illness a little bit, or at least potentially could help with it.

Preparing to reposition an intubated ICU patient with severe respiratory compromise. Photo: Patrick Schnell, M.D.

Here they’re just trying to sort out all the tubing that he has; they need to be rearranged properly so that if you turn the patient 180 degrees around from the back to the belly, that these lines don’t get yanked out of the patient.

Placing an ICU patient with severe respiratory compromise into a prone position. Photo: Patrick Schnell, M.D.
Making sure intravenous lines are not compromised when repositioning an intubated patient in ICU. Photo: Patrick Schnell, M.D.

Then what?

So the photos below are are of the same patient about 15-20 minutes after they repositioned him. He actually ended up having a cardiac arrest, which is what you see here.

Medications are rushed to the bedside of a patient who has just suffered a cardiac arrest. Photo: Patrick Schnell, M.D.

Resuscitating him took I would say 20 to 25 minutes, and it wasn’t an easy process. Multiple rounds of medications had to be given to resuscitate the patient, chest compressions were applied.

The ICU team during a resuscitation of a patient who has suffered a cardiac arrest. Photo: Patrick Schnell, M.D.
The ICU team during a resuscitation of a patient who has suffered a cardiac arrest. Photo: Patrick Schnell, M.D.

What happened to him after that?

This morning when I came in, he wasn’t there anymore. He had died. I was sad to hear that this morning. Even though I don’t know the person and have no direct contact with him, the fact that I’ve actually taken photographs of him, and saw how hard the physicians worked to resuscitate him. It was a temporary success, I suppose. To not see him today was a bit of a blow.

The ICU team continues to try to resuscitate the patient with cardiac arrest. Photo: Patrick Schnell, M.D.

That’s awful.

The respect I have for the people that work there just goes up every time I go there. It’s just really quite amazing what they do. Everybody says it’s a war zone. It really is. It’s horrible. What they have to go through now, this whole reality that you suddenly get thrown into … I worked for 14 years, all in hospitals. This is not unfamiliar territory to me. But being there now is still totally unfamiliar.

The ICU team successfully resuscitates the patient. Photo: Patrick Schnell, M.D.
After successfully resuscitating the patient using chest compressions and various drugs, ICU staff check the cardiac monitor to make sure that the patient’s heart rhythm remains stable. Photo: Patrick Schnell, M.D.

I spoke just now with the person involved in bringing the corpses into the morgue truck that’s parked outside of the hospital. And they were even saying: Man, this is tough, this is gonna stay with me, and I don’t know if a year from now this is going to really hit me. They’re just really having a hard time with it. One can tell that health-care providers are suffering. They are doing one resuscitation after another and you can tell that it takes a toll on them. In the last few days, I have seen physicians make not just one call to families informing them that their relative has died, but one after another, after another. After several unsuccessful resuscitation attempts over just a couple of hours, a sense of unreality sets in, and it seems that the nurses and doctors almost don’t quite know what to make of this experience. They are affected, but perhaps they don’t quite yet know how. There is no time to figure this out either. They have to carry on and just keep working.

I think there may be major mental PTSD-like health issues resulting from this. Nobody has ever seen anything like it. And I would never have had any idea had I not gotten this photo job.

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The Doctor Holding the Camera