COVID-19: A Dispatch from NYC, Part 1
Envision Healthcare anesthesiologist John S. Jones, MD, shares his experiences from a deployment to the the frontlines of the COVID-19 pandemic in New York City in May of 2020.
Greetings! I wanted to let you know how things are going here and, hopefully, answer some of the questions that many of you have been asking. Overall, the mood is cautiously optimistic. We all know how much work remains to be done, but we’re ready for the challenges to come. Incidentally, I was assigned to a hospital in the same neighborhood as Columbia University, where I graduated from college. The entire area is filled with fond memories of those formative years. I feel grateful to have the opportunity to come back and serve in a place that had a major influence on my family and me.
The hospital I am working in was built in 1952 and serves an aging and relatively low-income community. These residents tend to have multiple comorbidities and are particularly susceptible to complications associated with COVID-19. By the time I arrived, the majority of the hospital population had tested positive for the virus. Despite hearing news reports and other accounts, the numbers and severity of the patients took me by surprise.
Since I’ve been deployed to New York, I’ve been working the night shift. I spend most of my time either admitting new patients, rounding on existing intensive care unit (ICU) patients, or taking care of emergencies on the floor and in the ICUs. The residents and nurses I’m working with are outstanding. We are on our feet most of the 12-hour shift, even with their help. There are two attendings per shift, one of the hospital’s house attendings and me. I am extremely appreciative of the fact that they have welcomed me here and made me feel at home.
Most of the patients admitted to the hospital are COVID-19-positive. All the surgical services have essentially shut down, and the surgical and cardiac ICU’s are filled with Covid-19-positive, mostly ventilated patients. Treating COVID-19 patients is different than other types of care. We are forced to minimize direct interaction with the patient. We make all necessary interventions at one time if possible, e.g., ventilator changes, lab draws, positioning, etc. If a patient is on infusions, the pumps are left outside the room, and we run extension tubing underneath the door to the patient.
Many of these patients are sedated, which consists of any combination of propofol, dexmedetomidine, midazolam and hydromorphone. Fentanyl is in short supply and rarely used. I am part of the intubation team, which consists of an anesthesiologist and an anesthesia resident.
Each time a patient is intubated, we try to minimize the number of people who enter the ICU. The facility doesn’t have as many respiratory therapists, so the certified registered nurse anesthetists who have come are invaluable.
We operate under the assumption that everything in the hospital is contaminated, so we wear N95 masks and face shields all day long, which tears up your face after 12 hours. And, contrary to what is often reported on the news, we have an adequate supply of PPE and ventilators.
When I’m not working, I’m either sleeping, eating or just resting in my room getting ready for the next shift. I wear a mask anytime I leave the room. Most people outside are wearing some kind of mask. The streets of New York are eerily quiet. I have pictures of Broadway at Times Square at rush hour that are completely empty, which is unheard of. I took them while standing in the middle of the street, where normally, I would have been run over. Businesses, in general, are all closed, with the exception of some pharmacies, and some restaurants that have take-out-only services
Sometimes, the little things make a difference. There are drivers assigned to take us to and from the hospital, so we don’t have to take public transportation. Breakfast and dinner at the hotel are free. The meals are placed in a take-out bag that we can eat in our room. Wifi and laundry services are also provided. I recently sent five days’ worth of laundry to be cleaned, which I have never done at a hotel before!
I hope I have given all of you some idea of how things are going. The people of New York have a history of coming together in times of crisis, and this time is no different. I’m humbled and honored to have the chance to return to a place I called home for many years and contribute a small measure of support to people who have worked so hard to overcome a tremendous hardship.
I am grateful for the support I have received from so many of you who have helped make my being here possible.
Be safe, and I look forward to sharing more experiences with you in the weeks ahead.
Editor's Note: This is the first article in a three-part series. Click here to read Part 2. Click here to read Part 3.