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As the COVID-19 crisis continues to unfold, the medical staff at Mount Sinai Brooklyn is providing regular dispatches about the daily experience fighting the virus. As the small Brooklyn community hospital quickly became engulfed during the peak of the crisis, doctors from around the city and country were brought in to help. One of these doctors was Dan Herron, the chief of bariatric surgery at Mount Sinai in Manhattan. Used to commanding a team and teaching surgical fellows at the flagship uptown hospital, he found himself on the front lines deep in Brooklyn, doing whatever needed to be done — from performing blood draws and wheeling gurneys to changing bedsheets.
Surgeons are very good at doing tasks. We’re very good at getting jobs done. But when you’re sent out to an unfamiliar hospital, where you don’t know any of the staff, to come down and staff an ER that has been inundated with infectious-disease patients who are dying on a daily basis — that’s something very unfamiliar to us.
I work at Mount Sinai Manhattan, where I’m a laparoscopic-bariatric surgeon, and I run the laparoscopic-surgery fellowship, so I have a lot of responsibilities in terms of education. Mike Marin, who is the chief surgeon for the entire Mount Sinai health system and also my boss, was tasked by the upper leadership of Mount Sinai to create a command structure that would send surgeons to help in the outside hospitals. I was sent with a team I had never worked with to Mount Sinai Brooklyn, where I had only been a couple times.
Mount Sinai Manhattan is a 1,100-plus-bed hospital in the middle of Manhattan. It’s essentially what’s called a quaternary care facility, which means that it provides the highest level of academic medical care and is used to accepting patients from other more community-focused hospitals. You’re used to having pretty much every type of technology, every type of consultant, every benefit of the latest medical advance at your fingertips. Mount Sinai Brooklyn is a 200-something-bed community hospital. So it’s focused on providing high-quality, but lower-acuity care to a much smaller number of patients. That being said, they were forced to operate at a much higher level of acuity than I think they’d ever seen before.
Our initial deployment was to go to the emergency room. This was about three weeks ago, though it feels like forever ago. That was really in the period when the Mount Sinai Brooklyn ER was really getting hit hard. There might have been 10- or 15-plus intubated patients who were all as critically ill as a patient can be. Patients have alarms on their EKG monitors and oxygen-level monitors, so in normal times the alarm goes off and a nurse will go over and see what’s happening. But now everyone’s alarm was constantly going off because everyone had a low oxygen level in the emergency room. It was physically impossible for the nurses to respond to all these alarms going off nonstop.
The worst day was on my first week there. We would get into the emergency room at the beginning of our shift, and we would start off by walking around and checking in on all the patients in the unit. On one of those days, we made rounds and two of the patients were dead. Their alarms had been going off, but there were also another 20 patients’ alarms going off. And the nurses were just so overwhelmed going from one bed to the next to the next that these patients had died between rounds. That’s not something that anyone is used to finding out. Just going on rounds and checking up on a patient and you realize that they don’t have a pulse? It really takes you aback.
We also had a couple who were both very ill and were in separate beds in the ER. The plan had been made to make sure that they both went up to the same room so that they could be together in the hospital. It turns out that one of them was a little sicker than the other and ended up getting intubated, so they couldn’t go into the same room because the one who was intubated needed to go to the intensive-care unit. Watching the one spouse getting their breathing tube put in was about the most painful thing to watch, because you just had a sense that this might be the last time they’d ever see each other.
There were huge numbers of situations like that where people would come in and they would be talking to you one moment and then, 15 minutes later, they’d be gasping for air and getting intubated and getting rolled up to the intensive-care unit. It’s interesting the speed with which this disease progresses. Patients can have a very, very low oxygen level with COVID-19 and not have much of a sense of oxygen starvation. So while certainly many people are short of breath and very, very uncomfortable, other people have very low oxygen levels and it doesn’t really seem to bother them until it gets to a critical level and then they just conk out completely and need to get intubated. It was almost like they would be doing okay and then they would fall off a cliff.
I was in the ER for the first couple of weeks before we went up to work on the intensive-care unit on the second floor. Traditionally, in a hospital that’s operating within its normal capacities, everyone has clearly defined roles, but there were kind of no boundaries in my time there. Instead of having such an organized, regimented approach to taking care of patients, everybody just did what needed to be done. I was doing everything from transporting patients, rolling their gurneys down the hall, to doing respiratory-therapy work, adjusting ventilators, disconnecting oxygen tanks, carrying out old oxygen tanks and bringing in new ones, doing blood draws, doing nursing tasks. Patients would be stuck in the ER for 24 to 36 hours, and they would have soiled sheets, and I’d be working with the rest of the team to change the sheets. Everyone did everything.
It was heartwarming seeing everyone rising to the occasion and figure out what needed to be done and doing it. It’s such an awful situation and yet it was also an extraordinary learning experience. There were times you would introduce yourself and ask someone where the lab is, and often the response you’d get is, “Oh, I just showed up today from Minnesota.” The fact that people were coming from halfway across the country to help out was really something that you would only see in a wartime situation. You very much had the sense of a battleground with people from all different areas, geography, and levels of experience being brought together to fight the same battle.
Working in that kind of a situation, there’s such an incredible intensity of emotion. At the end of the day, you would be completely physically and emotionally exhausted. Surgeons are used to working hard, but you’re used to working hard in the controlled environment of an operating room, where you have all the tools you need, you know exactly what the command structure is, and you know that the family is going to be down in the surgical waiting area waiting for you to talk to them after the end of the operation. Here, all that structure was taken away. Plus, as surgeons, we’re used to being able to make a direct intervention for our patients, to help them to get better. In this situation, our skills as surgeons are limited against an infection like COVID. There’s no definitive treatment; everything is supportive. So it forced us out of our standard thinking. We’re throwing all these different medications and all these different interventions at our patients and hoping to support them as best we can and that their own bodies will be able to recover from this disease. It’s humbling.
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