Without delay, my body reacted the only way it knew how. The symphony was inaugurated by a brief gasp of astonishment, followed by the pounding of my exploding heart as it passionately intensified until it merged with the melody of my footsteps pacing furiously to reach the patient’s room. And when I was finally able to place my mask on correctly, my panting for breath took the spotlight and sang its solo piece. Until at last I approached the patient’s room and interrupted the concert with a soft whisper, “Please, not another one.”

At that point, my eyes locked in with my invisible enemy, COVID-19 himself, undoubtedly disguised in the face of the vulnerable, old gentleman struggling to breathe just before he lost his pulse. Automatically and mechanically, my fellow companions and I assumed our roles to wrestle with death. We worked diligently and in sync in the midst of the shouting, beeping, injecting, compressing, and bagging. Our willpower, at first relentless, gradually shifted at the passing of time. Alas, a feeling of disbelief took control of our bodies unanimously for we could not grasp the thought that regrettably, yet again, we had indeed lost another one. Almost hourly, a similar crisis took place within a twelve-hour period.

Until at last, my shift ended. Detached from all that had come to pass, I walked home defeated. Yet spring greeted me with its cool, soothing breeze, the ruffling of its recently sprouted leaves, the chirping away of its carefree birds, and the chaos from the hospital slowly faded away. But my numbness was short lived as the faces of everyone that passed away came crashing in like a haunting movie reel. And in that moment, I felt like both the doctor and the family, at first harshly questioning myself and the next, weeping unconsolably, broken all the same.

And as I pondered over my uncontrollable thoughts, I entered the threshold of my sanctuary, my home. There, I started to ease my mind, and tried to make peace with that which I could not change. In time, thoughts became quiet, tears stopped streaming, and the silence came. It was then that I began to heal.

Sofia Arango Mendoza MD

This could be the last goodbye, the last facetime, the last I love you

Right before he wants to call his family

It could be the last time he speaks with them

He hangs up and looks at us anxiously

“I don’t want to die” he says

We tell him we are here for him and we will take care of him

The ET tube is supposed to help him breathe easier

To let his muscles and lungs take a break

We hope and pray this works

In our minds we know this could be the last time he interacts with people

We try to ease his fear but there are no words to provide comfort

We tell him his family loves him

The breath we used to take for granted has been taken away for so many

Each breath is precious

Remember to breathe

Remember to breathe

Naomi Friedman MD

You hear that cry, that shriek, that uncontrollable sobbing from the widow.

The patient is actively dying. We are doing compressions.  We are giving medications.

There is still no pulse.  Compressions have stopped.  The patient is dead.

It is up to us to call the family.

We have to do it for the family

and for ourselves

It is up to us and no one else because we were his doctors.

We took care of him and we were with him until the very end.

We tried everything but nothing could save him.

You call the number and hear the ringing.

The phone call that will change their lives forever.

They pick up the phone almost immediately.

You hear the desperation in their voice wishing, hoping and praying for you to tell them good news.

But it is not the case.

You recognize its that last moment of normalcy and of hope that is completely shattered

You prepare them by saying unfortunately I have bad news to share.

You hear that cry, that shriek, that uncontrollable sobbing from the widow.

You give them time to process the enormity of their loss.

I wish it were different. I wish we could have saved him.

We are here for you and mourning with you during this time.

You are not alone – we are crying with you.

Naomi Friedman MD

As I saw another patient lose his battle

A man aged like my father

Whose life ended too soon, and too abruptly

I also saw my spirit break

As I walked out of his room

And despair invaded me

The world turned silent

While the voices in my head grew louder

How will we go through months of this?

Who will I become when this is all over?

Are we Davids ready for our fight against Golliath?

Or will our swords be useless against this Hydra?

As we ran through the scorched earth

Left behind by our foe

Into the future of uncertainty lying ahead of us

A silver lining shimmered

I looked to my right, and I found compassion

I looked to my left, and I saw hope

My brothers and sisters persevering in our war

Yes, they were broken too

But our pieces, when brought together

Formed a mosaic so magnificent

That it stood imposing as our war standard

Through this sign you shall conquer, it read

And conquer we shall

(Dedicated to all the JMC residents – thank you for carrying me through this)

Francisco Machiavello Roman MD

Let’s go back to the start.

I first read about the news from Wuhan on social media. My memory of it all was that there was an event where a few hundred people were thought to have become sick after being exposed to an unspecified (but heavily speculated) substance. I did not think much about it. After all, bouts of flu-like illnesses are not necessarily considered a strange event, in any case, I thought the whole thing would blow over, and the reports I had read seemed mostly unconfirmed. However, things quickly started to change. The reports changed. Suddenly, the number of infected individuals rose to the thousands. There was a novel coronavirus affecting humans. It wasn’t just a regular viral outbreak, it was a severe pneumonia causing Acute Respiratory Distress Syndrome and many people were dying. A young doctor was being censored by authorities for calling for international attention to what he was certain was a new health crisis.

The novel SARS-CoV-2 virus and the syndrome it created; COVID-19 felt to me like an interesting but singular occurrence, not something tangible that I would probably ever see up close. After all, when had I ever seen a case of SARS? At the time, every person affected seemed to have a direct connection to Wuhan or the main event. As scientists were rushing to make sense of it all, I saw reassuring posts about how there were no cases of ‘community transmission’ and put the whole thing on the back of my mind. All of this information was fragmented in bits and pieces of what I could gather while still being fully preoccupied with my day to day duties as a medical intern.  It’s hard to worry about something that’s happening 7000 miles away when there are sick patients in front of you and you’re scurrying to do everything that needs to be done in a day. My parents were more concerned than I was. But gradually the news started to become far more worrisome. The city of Wuhan was in an absolute lockdown, and the images and news were nothing short of horrifying. Community transmission was widespread. In what now feels like an instant, coronavirus exploded into our collective consciousness as the eyes of the world tracked its every move. Then came the wave of international surges. South Korea, Japan, Iran, Italy, Spain. On March 1st, New York State had its first case right here in New York City, by March 11th, the World Health Organization declared Coronavirus a pandemic.

I never thought it would hit us that hard or that fast. It’s difficult to overstate how scary those first few days felt. Guidelines appeared to be changing shift by shift, treatments were recommended, then avoided, or avoided then recommended, and we got mask upgrades. We didn’t have enough time to watch the news, and sometimes we found out, we were the news. The flow of patients was torrential. The information flow quickly overwhelmed even the fastest readers and yet, many times we felt that there was nothing we could do, we just didn’t know enough. This disease had broken through the barriers of age, race, and background. We feared for ourselves and our families wherever they were, and for each other.

Slowly, the first few of us started becoming sick, and there was little left to do other than to support each other and cover whatever shifts lay before us. It should not be overlooked that it took a certain amount of courage to rise to the challenge of filling someone else’s shoes, knowing we were possibly exposing ourselves to the same culprit. “Take your time. Get well soon. Don’t worry.” During those earlier days, it wasn’t uncommon to hear comments, sometimes jokingly, other times sincere, about whether or not all of us would make it through this crisis. We talked about advanced directives, some already making their wills. I heard a resident ask an attending if they would save some ventilators for staff (just in case). It all seemed somewhat exaggerated to me, except it wasn’t exaggerated at all and I knew it.

Yet even in such circumstances, nothing could distract us from the task at hand. We had patients to take care of, some of which were critically ill in non-monitored settings and all our efforts and vigilance had to be on them. We soldiered on.  Adapting quickly to a new normal; social distancing, WebEx meetings, daily PPE. Our goal was clear, minimize exposure, but provide the best care we possibly can.

New York became the worldwide epicenter of the pandemic, with an exponential growth and disproportionate amount of cases that still baffles experts and the public alike. Despite shutdowns and social distancing, it seemed that the number of cases was just going to continue to rise. Painfully, many lives were lost. Our morgues quickly backed up. On a particularly bad night, after two consecutive unsuccessful codes, I went to the bathroom and cried. Was this going to be the same for the rest of the year? The rest of residency? The cases just kept rising, it would not have been sustainable had it not been for the enormous amount of support we received from every corner of the hospital and beyond.

Battling coronavirus is the new definition of a ‘team effort’. It simply is not possible unless people come together, and in more ways than not, we did. I am still in awe of all that we were able to accomplish and eternally grateful for everyone that stepped up to do their part during this crisis. I would never be able to say thank you to everyone who helped and encouraged us during this time, but I will make an effort now to name but a few; I’m thankful for the international medical community, and the way we shared medical information so quickly, I think back to when I had my first COVID patient, and already had a helpful one-page summary from an Intensive care doctor in Seattle. For all the donations we received, such as from our colleagues in South Korea and China who sent over N95 masks, to our friends and allies in the neighborhood who sent us encouraging posters, letters and food, not to mention the World Central Kitchen who provided 3 warm meals each day for every single worker in the hospital. I’m grateful to the nurses and doctors who came from all over the country to help with the pandemic. Including the critical care attendings who rounded with us remotely from North Carolina and Maryland, or the critical care fellow I met who came from Philadelphia to help during the surge.  More help also arrived on our doorstep when the U.S Army physicians and nurses were redeployed to Jacobi and helped carry the heavy workload alongside us.

I am thankful to the Einstein students who reached out to many of us and offered their time and help, and for the outpouring of love we received from different residency programs. I am especially thankful to our colleagues in other specialties who worked side by side with Internal Medicine residents so we could overcome this challenge together. I thank the chiefs and our attendings for their continued teaching and support, and our leadership for listening to our concerns and adjusting quickly to the changing landscape so that we felt heard, appreciated, and protected. I am most grateful to my fellow residents. Now more than ever I am blown away by their hard work, determination, and humanity. It is remarkable how during these difficult times we still managed to learn from and help each other, even more than before. I am proud to be part of your ranks.

One day, without even realizing it, we passed a turning point. Each day brought less cases than the day before. We could feel ourselves breathing easier. The overhead announcers started playing happy music instead of code alarms. Gradually we realized, we had passed the peak. At this moment in time, we can look back at where we were 2 months ago and cautiously say that things are slowly drifting back towards normal. In New York City the cases have been trending down for several weeks, and we are seeing ‘regular’ patients again. The city is slowly easing restrictions, and we are looking forward to a reopening. So what have I learned? That extraordinary circumstances bring extraordinary people together. Our ability to change, adapt and learn are greater than we could have imagined. It’s also to OK to cry. We are better and stronger today than we were three months ago. And while the world thanks healthcare workers, we should also thank each other and the world because there is not one person who could have faced this crisis alone. I do not know what the future holds, whether or not we will have a second, third or fourth wave, or if this is a one time fluke that will not happen again until 100 years from now. The only thing I know is that united we can overcome the challenge.

Melissa Elaine Berges Morales, MD From my early experience during the 2020 COVID-19 pandemic at Jacobi Medical Center and Jack D. Weiler Hospital.

It’s surreal how a doctor holds the control for what appears to be even the smallest choices of a patient’s hospitalization: out of bed at will versus strict bed rest, normal saline versus lactated ringer’s, regular diet versus restricted diet. But we make more crucial assessments also, “this patient needs higher level of care”. That very statement was uttered and lingered for a patient that I was meant to receive in the MICU in mid-march 2020.

At noon I was informed about the incoming admission and my shift ended at nine p.m. so I had plenty of time to do what we all do, prepare. I knew everything that there was to know on her. Her reason for coming in? She could not breathe. Her diagnosis? As if it needed to be explicitly written…COVID-19 pneumonia. Who was she? A lady in her 50s, Latin American, who had a loving family and her whole life ahead of her.

At four p.m. I was told by my senior that the patient needed to be intubated on the general wards because the physical act of contracting her muscles to breathe was too much to bear. I had already grown weary of waiting for her, my hands were desperate to care for her and my eyes longed to put a face to the name. Minutes passed, hours passed and she was still not in my unit. Countless times I asked the nurses to speed up the process, countless times I called ‘Admitting’ myself. The one thing I had not done was go up to her room and fetch her myself; boy, how I wish I’d have done that.

At eight p.m. the operator called a cardiac arrest code at the location where I recognized my patient was, it echoed in my mind and, in the pit of my stomach, I was sure it was her. I told my colleague to take care of the unit and I ran towards her. My thoughts reached her faster than my feet ever could. I took a glance at her and her stare was blank. Everyone had a job: compressions, medications, keeping time, running the code. So I did what needed to be done, I called the family. As a doctor, there’s one thing that is worse than telling someone their loved one has passed, it’s not knowing what the person died from. We had told the family hours prior that if she was not intubated, she would die. And here she was intubated and she still died. If only I had not waited for the execution of protocols and bureaucracy, I would have had her in the intensive care unit and monitored her more closely.

Guilt set in along with tears. Had I played a role in her passing that day? No one can convince me otherwise. She might have perished even while in the MICU, even if everything had been done right and timely. Or she might have lived. I guess I’ll never know the ulterior outcome but I trust stories like this will serve as a catalyst for me to grow as a healer.

Andrea Arango MD

Q: How to Dial in JMC ?
A:
From outside – Dial 718-918-Extension (Ex:  for extension 6910, Dial# 718-918-6910)
From Inside – Dial 3-Extension (Ex: for extension 6910, Dial# 3-6910)
Rare cases: Some extensions are preceded by 4.
For NCB dial 5 then extension

**see http://www.nbhn.net/phonebook/    menu on left for more numbers and faxes.

Floors:

3B/Onc:  6910
4A:  5693/5694  | 4B MICU:  7160
5A:  7018  |  5B CCU:  7150  |  5D:  5256
6A:  6926
Dialysis: 6931

Consult Services:

Renal:  4282;  5722
Onc fellows room: 5663
Psych ER: 4850, 4989, 4089
Psychiatric consult: 6790;  Stat Consult:  917-577-8129
Detox: 4492, 4795, 4478 (Mr. Caldwell)
GI consult pager: 917-956-7333
GI room (callback): 3-5020
ID approval: (917) 218-5755 from 9am to 5pm, Monday through Friday. 3-7635
ID consult: 917-956-2877
Cardiology Fellow Room 3-5906
Ortho *8-0890
Ortho nextel: 646-601-1066
Ortho office: 3-4922
Plastic office: 3-8272
Gen surg office: 4-1535
Trauma office: 3-4147; 3-4148

MISC.:

Cardiology Cath room: 7150
Cardiology Echo: 5911
Cardiology clinic appointment:  5900 (looking for Carmen)
Patient Escort:  5763
Kitchen: 7634
HHC Transfer center:  844 – 442 – 2337

SMR Pager *8-0636/SMR Room 6915
CCM Nextel:  917-557-9962
Bed board: 3364
Rehab consults: 8469/8470/5535
Telemetry room: 7157

ED Social Worker: 3-5834

Labs:

General: 5995
Hematology: 5925/5926
Chemistry:  5980
Serology: 5952
Microbiology: 5949
Blood bank: 5227
Hematology lab 3-5925, 3-5926

Conference Rooms

4A small (Pulmonary/Sign-Out) 8163/8132
4A big (ICU) 46210
5A White Team:  8129/8126
6A Blue Team: 8133
5E15 Purple Team: 7598/6063
5D Green Team: 6831
Resident Lounge 4E12  6246/6247
4E4 Fish Bowl (Orange Team) 6944/8439
Medicine Clinic 4A: 8662, 4B: 8662, 4C:  8634, 4D: 8052  DT 8622/8620

Day float room: 7944
Medicine consult phone in day float room: 7929

Radiology:

CT:  4950  |  ER CT: 35335
CT supervisor: 3166
MRI: 4795
MRI Fax: 7988
Pharmacy: 34646
Vascular lab/echo: 35575

Hospitals:

Jacobi 718-918-5000
Montefiore (Moses) 718-920-4321
Montefiore (Weiler) 718-904-2000
NCB 718-519-5000
Lincoln 718-579-5000
Monte North 718-920-9000
St. Barnabas 718-960-9000
Bronx Lebanon 718-590-1800
AECOM 718-430-2000
Westchester Sq Hosp 718-430-7300