The Daily - 24 Hours Inside a Brooklyn Hospital: An Update

Episode Date: December 24, 2020

This episode contains strong language.This week, The Daily is revisiting some of our favorite episodes of the year and checking in on what has happened in the time since they first ran.When New York City was the epicenter of the coronavirus crisis in the U.S., Sheri Fink, a public health correspondent for The Times, was embedded at the Brooklyn Hospital Center.In April, she brought us the story of a single day in its intensive care unit, where a majority of patients were sick with the virus.Today, we check back in with one of the doctors we heard from on the episode, the unflappable Dr. Josh Rosenberg.Guest: Sheri Fink, a correspondent covering public health for The New York Times.For an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. You can read the latest edition here.Background reading:“Covid will not win” — here are some portraits and interviews with the staff members powering the Brooklyn Hospital Center.For more information on today’s episode, visit nytimes.com/thedaily

Hey, it's Michael. Starting today, The Daily is revisiting our favorite episodes of the year, listening back, and hearing what's happened in the time since they first ran. Up first, a story from this spring, when New York City was the epicenter of the pandemic. It's Thursday, December 24th. It's Thursday, December 24th. Good morning, everyone. Hi. So every morning in the intensive care unit at the Brooklyn Hospital Center, the doctors gather for something called morning report. So now I want you all to present it. 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. They talk about, you know, who was admitted, who got critically ill. And one recent morning report was particularly intense. There were patients in their 80s and patients in their 30s. All right, good. Next. There were patients from nursing homes and patients who were homeless. She was intubated overnight. She's on azithromycin, clopidol, and subtraxone.

Okay, next. Patients with asthma and diabetes and patients with no underlying conditions at all. Male, with no significant past medical history, here for acute hypoxic respiratory failure. But as the doctors raced to get through the cases... Next patient. ...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. Okay, next. Male acute hypoxic respiratory failure, secondary confirmed COVID. All right, next. Admittance for acute hypoxic respiratory failure was confirmed COVID-19. Next. Acute hypoxic respiratory failure.

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 Thursday, December 24th. Morning, everybody. Josh, do you want to spend a little bit? 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. 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 there was one doctor I met who really embodied that transparency. 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 everywhere. Please be careful. Do you have gloves? They had pulled apart the ventilators. They had to 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. What? 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 have to be careful. It's making the best of what you can do.

Yep. 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 did 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 have bad lungs and that makes it worse. Sometimes it's just the disease, but if there's something we can do to... 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 to, so we're going to have... 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's very, I mean, I think the data's 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 10-recreation to an already in the RDA.

So they kind of tossed 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 Rindemsevir, 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 need her doctor, 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 six, seven, nine. Thank you. I will circle in with you guys. Good job. Thank you. Good job. But actually, 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. How are you doing, buddy? Best of care. One, shouldn't you be home? Shouldn't you be home? My mom's here.

Oh, fuck. I know. Which bed is she in that side? She's in 10. Okay, I'm rounding here now. May I 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 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? 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, for all the medical students that are coming through. And two, I hate to say it like this, I don't wanna 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 had 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. 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? of kin. He's a 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 consents, 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. OK. So his pulmonary prognosis is horrible, right? He's not getting better. Blood gas is... Not good at all. Not good, and he's on 100%.

So what does the family want us to do? The family wants us to continue treatment. They agreed to be in our day... 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 is down, he's out cardiovascular, he's 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. Which means that somebody needs to be resuscitated, that they are basically dying. Reza. Reza. Okay. Can we follow you? Yeah. 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 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. OK? Get her out. Get 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.

What's up? 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.

He doesn't feel like it, right? Yeah. He's one of our surgical residents. Bring him to the ICU. Bring him here. Don't dilly. I'm not saying that. I'm just saying. I think what was really striking to him or what sort of like like, shocked him,

was that this was another doctor. 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 from 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. Thank you for taking the time for being here today. 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 mean, 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. Jesus. Jeez. 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 am tired. We'll be right back. Last week, Daily producer Daniel Guimet called back Dr. Rosenberg for an update. Hello? Hi, Dr. Rosenberg. How are you doing? Good. Are you at the hospital right now? Oh, yes. I'm standing in the vaccine queue.

We're socially distanced, six feet apart. Employees and everybody are talking to each other, saying hi to one another. It does sound very jovial in the background, which is great to hear. I don't want to use the word jovial, but people are happy to get this vaccine. They want to get this vaccine. They want to protect themselves. They want to protect their patients. And the mood is not somber. Mood is that a lot of people are somewhat excited and somewhat nervous. It's a new vaccine. They know that.

But they're excited to progress forward, move the health of the nation forward, and be sort of something that's larger than themselves. And so it's, you know, kind of monumentous to be part of this. To me, this harkens back to the 50s in certain ways, where you had the lines for polio vaccination have ended out. Well, here in the hospital, we have a long corridor, and you have this line of employees to get vaccinated, extending down this corridor, much like the old polio vaccine queues were. I'm next. So I'm on the phone currently with the Times. Okay.

So they want to hear you scream? Apparently. Scream like a little girl. Yeah. All right. Let's go. Do you have any questions, Seth? No, I'm good.

I think I should have read everything. All right. All right. Tell me what's going on. Little pinch. We're done. No pain from the vaccine whatsoever. All right. Tell me what's going on. Little pinch. We're done. No pain from the vaccine whatsoever. All right. Give me two seconds.

Let me just save something and go to someplace a little less loud. While you're doing that, let me ask you, in terms of COVID cases at the hospital, how are things going? It's calmed down a fair amount. We are seeing an increase in COVID cases specifically. Our ICU is almost full. We have a couple empty beds. As time has gone on, we've learned a lot more about the disease. Time has gone on. We've learned a lot more about the disease.

And the truth is, is we're now finally having some semblance of might work, might not work. And to be honest, a fair amount of we still don't have a solid idea. But we're months out and we've had time to develop some newer drugs and treatments. The vaccines are now coming right out of the box. vaccines are now coming right out of the blocks, means that there has been a fair amount of success in trying to slow this, although it may not be to the degree that we'd like. Is the death rate at your hospital different compared to the spring? It is. It is lower. We still, unfortunately, have some people in their 50s and 60s who have passed away from it during this time, this recent time. That being said, there are a fair number of patients who I think are recovering and going home who might not. Otherwise, there was one recent patient we had where their family members were

actually able to get one of the newer antibody treatments. And that's an option that just didn't exist back then. If anything, what do you still not have enough of? I mean, we're very good in terms of equipment. We're good in terms of medications because we don't have the same citywide crunch on medications that we did back then. What happened back then is that everybody suddenly needed a lot of everything and the supplies were limited. So hospitals got rationing, which was appropriate at the time, but we ran out of things. We have enough of the sedatives that we needed before. We have enough of the vasopressors that we occasionally ran out of before.

We're in very, very good shape. But if we have a surge like we did in April and it's as bad as it is, and it's that bad in other cities, I could definitely see a run on medication. So there's just a limited supply of those nationwide. So if everybody suddenly needs increased volumes, we'll be in trouble. Same thing with all the various types of PPE. We're in very good supply now, but if everybody across the nation suddenly needs a tremendous, tremendous amount of stuff, absolutely supply lines could get tight. So there's always those supply demand issues that can happen. That being said, I don't see a particular item that I think is going to be a problem point.

What about staffing? Staffing's always a, you know, always a question mark. And if you have a high index of sick calls, yes, staffing will become an issue again. There's just nothing you can do about that. If a third of your workforce is out sick, a third of your workforce is out sick. I guess, though, the fact of hospital staff getting vaccinated now should reduce the risk of people being sick. I was one of the lucky ones that was enabled to kind of be near the head of the line, which I greatly appreciate because I do have a daily exposure to patients who are COVID positive by the nature of the work. And so we tried to hit up those who work in those areas

where we have COVID positive patients, frequently in the emergency room, the ICUs, the medical floors, housekeeping slash environmental services, the floors where those people work where they tend to have exposures. And we got a good turnout for it. And I think vaccine acceptance has overall been very high. Okay. So with the hospital staff getting vaccinations, I guess I wonder, is there like a lighter mood or something at the hospital? Like do things like amongst the staff, is there just like a sort of a sense of relief or something?

This darkness, maybe, just maybe, the craziness and the utter insanity that was last winter and everything else, there's a light at the end of the tunnel. It's coming to an end. And the vaccine's that first step in really making the disease under control if people are willing to take it. Just as a doctor and a scientist, it's to me still mind-blowing that they could create an effective, safe vaccine in that little time and get it out to all of us. It's to me mind- blowing because I know how long it took to do all these other vaccines in history. And so it's really a sense of awe at that. And I'm, you know, kind of just taken aback by it. Listen, thank you so much for making some time and good luck with the rest of your day. Thank you so much.

Thank you so much. Bye-bye. Bye. Today's episode was produced by Annie Brown, Daniel Guimet, and Claire Tennesketter with help from Alexandra Lee Young and Sydney Harper. It was edited by Lisa Chow, Liz O'Balin, Lisa Tobin, and Paige Cowett,

and engineered by Chris Wood and Dan Powell. That's it for The Daily. I'm Michael Barbaro. See you on Monday, after the holiday.