The Daily - 24 Hours Inside a Brooklyn Hospital

Episode Date: April 15, 2020

Note: This episode contains strong language. More than a month since the onset of the coronavirus crisis, the majority of patients — some of whom are doctors themselves — in Brooklyn Hospital Center’s critical care unit have Covid-19. With permission from staff, patients and their families, we shadowed one doctor for a day to get a sense of what it is like on the front lines of the pandemic.Guest: Sheri Fink, a correspondent for The New York Times covering public health, who spoke with Dr. Josh Rosenberg and his colleagues at Brooklyn Hospital Center’s intensive care unit.For more information on today’s episode, visit nytimes.com/thedaily. Background reading: Test kits and protective gear have been in short supply, doctors are falling sick, and every day gets more difficult. But the staff at Brooklyn Hospital Center keeps showing up.On their shifts, medical workers throughout the hospital face unrelenting chaos. At one point while our reporter shadowed, three “codes” — emergency interventions when someone is on the brink of death — occurred at once.

So every morning in the intensive care unit at the Brooklyn Hospital Center, the doctors gather for something called morning report. The people who were on overnight, they stand around and the head doctor is there and they kind of give a report of what happened. And then the new doctors who are coming on, they get that information. When she was at rest this morning, she was breathing 23. She's very comfortable, thumbs up. They talk about, you know, who was admitted, who got critically ill. The overnight patient is not doing well, so she had to be re-intubated almost immediately.

And one recent morning report was particularly intense. Okay, all right, okay, next patient. There were patients in their 80s and patients in their 30s. A female, 30 weeks pregnant, asthma, obesity, MSDSU. She was intubated yesterday evening. All right, good, next. There were patients from nursing homes and patients who were homeless. She was intubated overnight. She's on azithromycin, flaconil, and triaxone. Okay, next. Patients with asthma and diabetes and patients with no underlying conditions at all.

But most of them can pass medical history here for a few hypoxic respiratory failure. patients with no underlying conditions at all. But as the doctors raced to get through the cases, they all shared a nearly identical description. He was upgraded for acute hypoxic respiratory failure. Okay, next. Male with acute hypoxic respiratory failure, secondary confirmed COVID. All right, next. Admitted for acute hypoxic respiratory failure with confirmed COVID- next. Next. Acute hypoxic respiratory failure, secondary to COVID-19.

All right, next. From The New York Times, I'm Michael Barbaro. This is The Daily. Today. It's been more than a month since the coronavirus descended on New York City's hospitals and on Brooklyn Hospital Center, where the vast majority of patients in critical care have the virus. My colleague Sherry Fink has been reporting from the hospital with the permission of staff, patients, and their families, and brings us the story of a single day there.

It's Wednesday, April 15th. Wednesday, April 15th. Morning, everybody. Josh, do you want to spend a little... This is Sharon. She's with the New York Times. And she's going to spend some time here a little bit. Pleasure. It's up to you. I'm fine with...

A physician and a... She's going to spend some time here a little bit. Pleasure. It's up to you. I'm fine with a physician. So for the past few weeks, I've been embedded in the Brooklyn Hospital Center. I'm going to finish rounding here, and then I'm going to go downstairs and cover SI. And what I've been able to see there is incredibly unique. What's happening? What is it like inside a hospital during a pandemic? And then we'll figure out the rest. Okay.

Do you want to give him your mic or are you willing to wear a... And there was one doctor I met who really embodied that transparency. Does it beep every time I say a four-letter word like South Park? Dr. Josh Rosenberg. I am mildly inappropriate. I am just warning you. An attending physician in the intensive care unit. How are you, Peter? I didn't see you hiding over there, my friend. There are people from all over the hospital recruited to work in the ICU.

So it's not just like ICU doctors and nurses who are used to intensive care treatment, but in fact. She's one of the podiatry residents. So all people who are good with knives and big needles. When I was there that day, there was a podiatry doctor in two of her residents. Those are doctors who work on the feet. No, no, no. What I would like to do is that as much as possible, we're going to try to get all the COVIDs on one side, and then the whole area is a dirty area.

And the ICU had actually effectively doubled in size. So it was completely full, and they had to turn to other areas of the hospital to turn them into intensive care units. In fact, a big part of the ICU is now in a place that just a few weeks ago was where patients would come for outpatient chemotherapy treatments. That's now an ICU. Thank you. Watch out. Don't trip. Don't trip. Don't trip. Don't trip. It was also a bit of an obstacle course. Don't trip. There were cords. Don't trip. It was also a bit of an obstacle course. Don't trip.

There were cords everywhere. Please be careful. Do you have gloves? They had pulled apart the ventilators. They had the control parts of the ventilators that were helping people breathe. Those were in the hallways so that nurses and respiratory therapists didn't have to go in and out as much and expose themselves to risk. This is a disaster waiting to happen. Yes and no, though.

And the nurses were doing the same thing with IVs, with the tubing that the medicine flows through. So they had pulled the IV pumps out of the room so that they could not have to go in and out and use up the personal protective equipment. It's great. Yeah, I mean, you can trip over it. You just all have to be very careful.

You just have to be careful. It's making the best of what you can do. Yeah. Okay, guys, can we start with number two? Appreciate everybody being here and everybody's support massively. So now Dr. Rosenberg is taking over for the doctors who were working the night before, and he's beginning to make his rounds. Let's start with number two, and then just go around the unit, please.

All right, so, lucky number two. So nearly all the patients in the ICU are on ventilators. So do we have any history of smoking, shisha use, anything like that? Some have asthma, some have diabetes. All right.

What does he do for a living? Occupational exposure. But a lot of these patients don't have any underlying conditions at all. I'm just right because, I mean, listen, on some of these, you have a real reason why, you know, they may have bad lungs and that makes it worse. Sometimes it's just the disease. But if there's something we can do to them. So Josh and the other doctors are kind of confounded by some of the patients.

They don't understand why, if they don't have a lot of underlying health issues, why their lungs look so bad. Crap. Poor dude. Any asthma? And they also just don't have that much to offer. Okay, so what are we going to do with him? Right now, we're... Well, at this point, I'm not actually sure what we can do with him. We have... We tried... Right now, we're, well, at this point, I'm not actually sure what we can do with him. We have, we tried to... So what is he on drug-wise?

So, I mean, for most patients, they're trying this thing called the COVID cocktail, which is that hydroxychloroquine and azithromycin. That's that combination the president talks about a lot. I don't think it's doing much. But there's really very little evidence. And Dr. Rosenberg in particular is very unsure that those drugs really help. We'll see about remdesivir. We'll see if we can get some COVID results and see what we can do.

So they start talking about other possibilities. There's this experimental drug called remdesivir that you have to apply to the manufacturer for each patient, and they have to meet certain criteria. You have to have a test result. They can't have certain complications. How do you guys feel about Kaletra or other PIs? There's another drug called Kaletra that doctors think might have some effect. The data is very, I mean, I think the data is very weak all over the place. That's the basic problem. So I always look at it as where are you starting these drugs?

It's near the end of the sporting event. You're down by a lot. I don't care who you throw out there, right? Even freaking Jordan couldn't recover that basketball game outside of Space Jam when you're down by 100 points and starting the fourth quarter. That's why I don't think we should be giving a demonstration to a already in the area. So they kind of toss this around.

Yeah, and so we don't know. I mean, this is the problem. We really just don't know our data. But like, so looking at this, yeah, so we'll figure out, we'll see if we can get the Rindemsever, which I doubt we'll be able to. We'll try to get a positive test result.

Next, let's move on along. Okay, ICU 6. Going for C-section? Supposedly today, yeah. There was another COVID patient in the intensive care unit on a ventilator, and she was pregnant, which adds a whole layer of complexity. She needs another dose of decadron and then... Decadron? No, beclamacizone.

Oh, sorry, did I say decadron? Yes. And they actually decided to deliver the baby by C-section. Two months before the due date, they had to give a couple of doses of steroid medication to help mature the baby's lungs. The whole goal was to save the mother's life because I think part of it is that it gives more space for the lungs to expand once the baby is taken out. So if she's going for C-section, she won't be in her dustbin, right? I have no clue.

So far what's known is it tends to be quite rare that a baby would be born with COVID if the mom has it. At least that's what the early studies say. All right. Number four. Number four. How are we doing here? It might be surprising how enthusiastic Dr. Rosenberg sounds while discussing these patients. But he's leading this team. He's trying to keep morale up. All right, so I'm going to stop here and head downstairs. Evgeny is going to take 6, 7, 9.

Thank you. I will circle in with you guys. Good job. Good job. But actually, when we were going from one part of the ICU to another... Let's go downstairs. when we were going from one part of the ICU to another. Let's go downstairs. I don't like taking the elevators. He runs into one of his medical students.

Hi, guys. How are you doing, buddy? Best of luck. Wouldn't you be home? Shouldn't she be home? Shouldn't she be home? My mom's here. Oh, fuck. I know.

Which bed is she in that side? She's in 10. She's in Q10. Okay, I'm rounding here now. Okay. I'll speak to you at some point today when you have a chance. Call me at any point, all right? Thanks, doc.

I'll see you later. Call me if you need anything, in all seriousness. You have my cell, right? Yeah. Perfect. He's one of our medical students. He's been here forever. So we sent home all the medical students that rotate with us very early in this crisis, because I kind of looked at this and I said,

one, we don't have enough PPE, you know, for all the medical students that are coming through. And two, you know, I hate to say it like this, but I don't want to expose them. They have enough time to get the living daylights scared out of them. Let them actually be students for a bit. Next patient, Santos. Yeah, so this is our, she's our 54-year-old female,

has a history of hypertension, came here with shortness of breath, fevers, admitted for acute hypothyroidism. She's the mom of our med student, right? Yes, she's confirmed positive COVID. And when we get to this medical student's mom, things are not looking good. Her FIO2 has been hovering between 100 to 80. Just want to make sure you know that she's not looking good. Her FIO2 has been hovering between 100 to 80. Just want to make sure you know that she's... She's not doing well.

I'll speak to the son. I know him pretty well. Is he the next of kin? Is he the next of kin? He's the decision maker? And Dr. Rosenberg wants to find out, is the son, is the medical student the one who will be making decisions about her further treatment, about even possibly end-of-life care. But is he giving us consent, or does she have a husband?

This is going to be hard. He knows. He's a smart kid. I mean, to me it sounded like he feels that this medical student, even though he's still a student, is enough of a doctor to understand that the prognosis isn't great, that perhaps his mom has some risk factors for this being more severe and for her to possibly not make it. He's a good dude. He's a very sweet man, so we'll figure it out. Of course, when it's your family member, it's not so simple. All right, here. There are many cases where the doctors and the patient's families

have very different views of how to proceed with treatment. COVID? Yeah. Well, it's pending, but most likely. Okay. So his pulmonary prognosis is horrible, right? He's not getting better. Blood gas is... Not good and he's on 100%.

So what does the family want us to do? Where the family still wants to press forward with all the intensive care available? So how many organ systems do we have down on him? We have our kidneys are down, our respiratory system's down, he's out, cardiovascular is bad. He's on multi-organ system failure, right? So I have three out of my systems down already. His prognosis at that point, given his disease state, is just poor, unfortunately. And where the doctors had come to a different conclusion and really felt like there wasn't much hope and that, in fact, the goals of care should shift away from trying to extend life and much more toward comfort and end of life, accepting that the patient was

likely going to die. And I hate to say it like this, but I don't know what I'm able really to offer in terms of getting him back to where he was before. Next. Suddenly we hear this announcement go out over the hospital loudspeaker saying, code blue. Code blue, 6B. Josh. which means that somebody needs to be resuscitated that they are basically dying Music So the code blue, it turned out, wasn't for a COVID patient, but for a patient who had other medical problems. And they did CPR and the patient survived. and they did CPR, and the patient survived.

And for me, the moment was really just highlighting the fact that in a hospital, that work goes on, that there are all these other patients, too, who have different medical problems, and people are still having other emergencies. So hospitals can't just stop being hospitals for everybody else. But it's hard because the number of patients with COVID is increasing. Usually if you have people with a scary infectious disease, you would put them in specific rooms in the hospital. But of course now there's many more patients than there are isolation rooms. So I think the doctors are very concerned about this possibility that somebody could come into the hospital for something else. Is COVID negative?

And then, you know, catch COVID there. That's the real worst case scenario. She's not a COVID issue? Not really, no. Let's try to get her the heck out of this unit, please. Okay? Get her out. But, of course, one of the big risks is to be a person who is walking into that hospital every day to work there. Hello, Dr. Rosenberg speaking. I was paged. And in fact, at one point, Dr. Rosenberg gets word that one of his residents He has COVID.

tested positive for COVID and is in the emergency room downstairs. Thanks. All right. What's up? You have his x-ray out? Okay, I'll look at it in two seconds. Someone pulls up an x-ray of the resident's lungs for him to look at, and he peels off his personal protective equipment, which in this case includes his own ski goggles, and he looks at the x-ray.

And immediately, the tone shifts. That's shitty. I don't like that. I want him here. He is one to come up. He comes right up because he's high risk for getting intubated. What he sees on the x-ray is something that looks bad to him. That's what I'm worried about. Because his x-ray looks crappy. No.

He's one of our surgical residents. Bring him to the ICU. Bring him here. Don't dilly. I think what was really striking to him or what sort of like shocked him was that this was another doctor. That is ours.

That is ours. That is one of us. And close to his age and somebody who's been doing the same kind of work that he's doing every day. And I think that shatters that sense of invulnerability. This is insanity. For my first day of out after being back from a week in this crap, holy shit. I actually found out partway through that day that Dr. Rosenberg

himself had been out the previous week with symptoms of COVID. He actually didn't get a test until his symptoms had resolved, and it turned out to be negative. But he's pretty sure he had COVID. Well, one of the things we'll discuss at nurse, honey, we need more nurses. And this is a huge problem. A third of the doctors and nurses were out sick. A number of them had tested positive for COVID and were critically ill. And it's not just a problem for this hospital. It's a problem all over New York City, that as the hospitals are overwhelmed with COVID patients, you have high numbers of health staff out sick. As governor of New York, I am asking health care professionals across the country,

if you don't have a health care crisis in your community, please come help us in New York now. The day that I was at the hospital, New York Governor Cuomo pleaded for doctors and nurses and health care staff from around the U.S. to come to New York. We need relief. We need relief for doctors. We need relief for attendants. In part to help fill in for the workers who are falling ill across the state. So if you're not busy, come help us, please. Hey. Hey, he's going to be in ICU 12, okay? No, not yet. They're about to bring him out shortly, but we're getting everything done. I know.

I know. Trust me, it's freaky. I'm giving you this only five years younger than me. You know? I'm 45. He's only five years younger than me. You know? I'm 45. Like half of our patients upstairs, we have 40-year-olds who are intubated.

Jesus. Jeez. Oh. And this is brutal. All right, good. I just want to let you know where it would be, all right? You got it. I'll speak to you later.

Bye. I'll see you later, bye. I am tired. A few days ago, as the daily death toll in New York began to decline, state officials said it appeared that the pandemic was approaching its peak and that the worst was over. But on Monday, New York's daily death toll spiked again to 778. So far, nearly 11,000 people in the state have died from the coronavirus. Among them was the mother of Dr. Rosenberg's medical student, who died the day after Sherry visited the hospital. We'll be right back.

Here's what else you need to know today. Well, yesterday, the president at his news conference, and this is his quote, he said he has the power. He says when someone is president of the United States, the authority is total. And he said the governors know that. Do you know that? Nope. I don't know what the president is talking about. Frankly, we have a constitution. On Tuesday, governors on the East and West Coast, led by Andrew Cuomo of New York, rejected President Trump's claim that he has the legal authority to reopen the American economy by himself once he determines that the pandemic is over.

The federal government does not have absolute power. It's the exact opposite that the president said. It says that would be a king. We would have had King George Washington. We didn't have King George Washington and we don't have King Trump. We have President Trump. Appearing on NBC and MSNBC, Cuomo said that if Trump prematurely instructed states to end their lockdowns, many governors would disregard the order.

If he says to me, I declare it open and that is a public health risk or it's reckless with the welfare of the people of my state, I will oppose it. And then we will have a constitutional crisis like you haven't seen in decades, where states tell the federal government we're not going to follow your order. where states tell the federal government, we're not going to follow your order. And. As the organization's leading sponsor, the United States has a duty to insist on full accountability. President Trump said that he planned to end U.S. funding of the World Health Organization, the international group responsible for monitoring the pandemic, over what he said were its failures to properly manage the crisis. Trump singled out the WHO's opposition to banning travel from China,

a position that he said has proven disastrous for the countries that followed. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.