ICYMI: Faith Save

Editor's note: This blog was originally published June 3, 2020, and is being shared again while RheumNow is on vacation this week in case you missed it. 

For Jessica, an ICU nurse at Mt Sinai Morningside, 12-hour shifts were usually fast paced, challenging and productive. But all that changed mid-March when COVID-19 came to town.

It began with a series of admissions that were remarkably similar. One day the ICU had six empty beds, the next, everyone is fighting for an ICU bed. Overnight, the hospital became a complicated and frightful place. The unit was over its limit with sickies on respirators. Under staffed, under the gun and quickly running out of supplies made Jessica's job worse.

Amongst her many ICU admissions, there was one, "Larry", who was instantly interesting and forever memorable. He had contracted the coronavirus less than a week earlier and now he was under her care. He was a 60-ish yr. old man who tried to be humorous, but who was clearly distressed and worried. He was febrile, anxious, breathing hard and on the verge of being unstable. 

Although he tried to be engaging, or joking, he clearly needed help and reassurance; asking if he will be ok or worrrying aloud about his family. Behind his oxygen mask, Jessica sees fear. Larry, on the other hand, can only see her eyes and name badge, as she's covered in a space suit (gown/mask/gloves), her COVID shield.

By now she knows that COVID-19 is dangerous and contagious, but in Larry she realizes the fear that it brings. Jessica can only fight that fear with her words, eyes and faith.

Larry deteriorates, and within hours is intubated and put on a ventilator. That night and the next several days were a blur of testing, adjusting, consults and scans. It was all bad. Dropping vitals, spiking fevers, scary labs, and white-out lungs overtook this once vibrant man who walked into her unit but was now hypotensive, unconsciousness and unresponsive.

This was all so shocking.  He was an otherwise healthy, middle-aged man with no apparent reason to crash so quickly.  Equally worrisome were the gowned specialists who swarmed his bed in waves, looking for a next best solution. They were among Mt. Sinai's “A list” leaders, intensivists, pulmonologists, neurologists, cardiologists and infectious disease specialists. They, and their entourages of fellows and residents, struggled minute by minute, 24/7, to manage a sea of critical patients with this nasty infection, often relying unproven treatments. 

Jessica examined him hourly, flipped him like a pancake to work his lungs and hardly had time for breaks or eating. She worried and wondered who was going to talk to the family. The family suffered; unable to come to the hospital because of the COVID lockdown. So she and the doctors took turns communicating with the family. Larry’s personal physician would also call Jessica for updates and he would then communicate with the family about how dire the situation was. 

Jessica had been a nurse for 18 years and loved the ICU. It’s were she knew she could do the most good. She’d seen almost everything, but this pandemic was unlike any other.  This infection was relentless, non-discriminatory and deadly to the most vulnerable.  It was unnerving to see the best minds and best care just not making a difference in many of these COVID cases.

She and her coworkers would persevere. Faith, hope and doing the job might be enough for some to go home. If there is a pulse, there’s a plan. Complications and bad results would either kill the patient, or challenge the medical staff to do the right stuff and turn it around.  

Early on, it didn’t look like Larry would live. Every day she would come in and he would still there, alone in room 7, with the hum of the respirator. Apparently, this infection has no expiration date. Larry was living a very bad groundhog day, every day and did so for many weeks. After a while Jessica figured that the primary goal was to sustain Larry, while he weathered the COVID storm. 

During March and April there were incredible demands for ICU care and space. Not surprisingly, Larry was moved to another ICU unit where they would tend to his ventilator care, and the specialists could deal with his neurologic and pulmonary complications. 

On Jessica’s watch, Larry walked into her ICU, went into a coma, was on a respirator for nearly a month, and was then shipped out, still in a coma, still on a respirator and way too many medicines. It was crushing to watch, yet he still lived.

ICU admissions, ultimately end as wins or losses. The wins go home and resume their lives. The losses devastate the family and patient. 

Larry wasn’t a win and certainly wasn’t yet a loss. Larry was in limbo as he was managed elsewhere in the hospital. Jessica tried to get word of his progress, but was usually met with a “lack of progress”. As he was still out of it, it was hard to tell if his brain was damaged or was it all from the infection or the many meds used to keep him sedated and paralyzed. 

Jessica remembered when he came in. She reassured him we would take care of him. She and others did their best. Maybe keeping him alive, on a respirator, for so many weeks was a credible feat – but it didn’t feel like one. 

Gravely ill and hanging on, it was torture for the ICU staff; imagine how hard this was on his family and friends - it seems like Larry has alot of both. 

A few weeks later she lost track of Larry, where he went or what happened.  Not knowing may have been better than hearing of a bad ending, yet she still wanted to know.   In the days that followed, Jessica would speak of her COVID experience, thinking about Larry, a heart breaking patient with a horrible disease.

Yesterday, the ICU phone rang with a call for Jessica. She picked up, and it's Larry’s personal physician, asking "do you remember our patient, Larry"?  Hearing Larry's name, she inhaled with apprehension and hope. It's 10 weeks since he was admitted to the ICU, and nearly 5-6 weeks since she lost contact. 

“Of course I remember him, what’s happened? Is he alive”, she blurted.

“Oh yes” said the doctor. “He's alive, speaking, laughing, joking and wondering ‘what the hell happened’”. Seems he had been moved to Beth Israel (a long term acute care unit) downtown for ongoing medical and ventilator care and was just recently transferred to the Jewish Home for long term rehabilitation. He was no longer on a ventilator, but still had enough tubes to require expert care.

This was so overwhelming for her to hear. She could hardly speak and her eyes welled-up as the details came. He was on a respirator for over 51 days, he awoke in late April and now he’s asking for the remote control and Italian ice. His mentation, memory, and humor all fully present and now he is poised for a slow and steady rehab stint. 

Larry is not without some damage and some gaps. He is amazed at what happened to him, but also what has happened to his New York City, his family, friends and what - the Yankees aren't playing! 

Jessica thought, God had to dig down deep to save this fallen man and deliver him back to his family and NYC.  She wondered if they would meet someday to retell their stories.  Her wish was granted as his family quickly connected the nurse and patient so they could exchange tears, glee and thanks.

COVID has dominated the news with negativism.  Occasionally, we've seen TV reports where a COVID patient, against all odds, got to leave the hospital after months of ICU and illness.  

As they are wheeled out, through crowds of cheering doctors, staff, nurses and Jessica’s, you can't help but smile at that patient's good fortune.  But you should also watch the eyes and faces those Jessica’s - they are beaming; they are rejoicing; this is their win too. This is what hospital folk will forever remember about March and April during COVID-19 in NYC. 

Larry became Lazarus over Easter, when he answered the call to come out of the darkness. First with an open eye, then a blink and twitch. Now, he’s running away from the darkness and towards a loving family and very rich life. Larry is a recently retired NYC principal, with a long history in the theater. He is known as a master raconteur.  He had plans to travel, act and write.  It seems he has alot of new stories to tell. 

Hospitals and ICU's have their attendant heartaches and disappointments. Two months of COVID in NY were a horror that too many people had to endure and live through. Larry was a miracle, fostered by faith and delivered by angels.

Hospital folk go to work every day with hope, dedication and strong will to do good. They live for these singular victories that refuel their faith and propels them to believe that when given the chance, and against the odds, good people can deliver on hope.

Disclosure

Larry is everyones best friend; but he has been mine for 60 years. 

This was written out of tremendous respect for Jessica, and many like her, at Mt. Sinai Morningside, Mt. Sinai Beth Israel and the Jewish Home, who have endured and delivered.