‘Covid Will Not Win’: Meet the Force Powering Brooklyn Hospital

‘Covid Will Not Win’: Meet the Force Powering Brooklyn Hospital

‘Covid Will Not Win’: Meet the Force Powering Brooklyn HospitalBy Victor J. Blue, Sheri Fink and Catrin EinhornPhotographs by Victor J. BlueDuring the surge of Covid-19 cases this spring that filled Brooklyn Hospital’s emergency room and intensive care unit with the critically ill and the dying, the staff went in day after day, trying to save as many lives as they could. Now they are bracing for a second wave.These portraits of the hospital staff were taken during the grueling first wave. In interviews in recent months, the workers reflected on that period — what they had lived through and how they had coped, what they had learned and how it had changed them.From the doctors and nurses to the workers serving behind the scenes, each had a vital role to play, and each knew that playing it could be fatal. Fighting this disease required sacrifice and courage from the laundry room and the supply depot, the laboratory and the security desk — throughout the hospital, all the way to the chief executive’s office.The experience of so much death in such a short time was overwhelming. It seemed somehow impossible, so unbearably sad that it couldn’t be real. And still they went in.Many spoke in battle metaphors. The virus seemed to come from all sides, they said, and threatened to spare no one. They talked about the front line, and being called to duty, and “training for war.”The interviews, conducted between May and July, have been edited and condensed.The first day that I went into that truck, I went home and cried for about two hours.Alexis Gomez, patient transportAlexis Gomez, patient transportI say I’m the cab driver inside the hospital. I move people by bed, stretcher or wheelchair. I knock on their door, introduce myself, and try to crack a joke or something so they could smile, because they’re probably not having the best day if they’re in the hospital.With Covid, I became a mortician at the same time as a transporter. The amount of bodies that we had to move — it was probably the hardest thing I’ve ever had to do. My job would be: clock in, probably do one or two calls, and then get suited up to move about 15 bodies into a freezer truck, every single day. Dead weight is probably the heaviest thing that you could ever feel.The first day that I went into that truck, I went home and cried for about two hours. My wife had to hold me.The scary part is the next day, I was desensitized. I put my suit on. I sat down. I took a deep breath and just said, “Let’s go.”Then the pandemic took one of our transporters, somebody that was with us for almost 30 years. He was our delegate. He was a big brother. He was one of the most popular, important people in that building.Ever since he passed away, I truly feel everybody’s death.This was my time to be called to do this, you understand? There were six or seven of us that went on those trucks on a daily basis, and they all could tell you the same thing.I’m beyond proud.Coronavirus has made me probably even more aware of the value of human connection in treating illness, because we’re really deprived of that, the patients are deprived of that. It’s made me more vulnerable, more grateful to be there and be able to do something to help, to help those that I could help.Dr. Sylvie de Souza, chief of emergency medicineDr. Sylvie de Souza, chief of emergency medicineMy job is to oversee a team of E.R. physicians and residents in training. And to ensure the emergency department runs efficiently and provides quality care and efficient care and safe care.My favorite part of my job is the team, the E.R. team, my colleagues. My least favorite part of my job is situations where I feel that I am not able to help.Coronavirus has made me probably even more aware of the value of human connection in treating illness, because we’re really deprived of that, the patients are deprived of that. It’s made me more vulnerable, more grateful to be there and be able to do something to help, to help those that I could help.The fear of this coming back is the hardest part now, and thinking about those who we have lost that we weren’t able to help and really weren’t able to honor in the end, or their families weren’t able to honor in the manner they would have wanted to. That’s what I think about now.Facing the day brings a mixture of emotions. There is the anxiety of just returning to the scene of so much death and illness and pain and suffering. There’s the hope that we never have to see this again in our entire careers. It’s a mixture, it’s anxiety and fear, but as soon as we’re involved in the action of the day and the task at hand, it just dissipates.Definitely coming home is a different story. Then I think all of us have trouble sleeping, trouble resting. Even though it seems quiet now, I don’t think any of us are at peace.We had so many more happening per day, sometimes multiple patients crashing at the same time.Christine Ciaramella, emergency medicine clinical pharmacistChristine Ciaramella, emergency medicine clinical pharmacistThe public knows pharmacists in retail settings, but I work in an emergency department. I’m physically present at bedside with patients, working alongside the doctors to come up with the best medication regimen. I also prepare medications at the bedside.Normally I work with a team and respond to cardiac arrests and intubations. We had so many more happening per day, sometimes multiple patients crashing at the same time. We had to prioritize and run from person to person to try to keep up. It got to a point where I had a fanny pack of intubation medications, so I kept all the medications on me. I was pushed to my limit.As pharmacists, we also had to deal with drug shortages. All the hospitals were using certain medications, for example, sedatives to keep patients intubated on the breathing tubes. We would have to get creative and come up with alternatives very quickly. What would be the next best option to use?When I was in it, I was just in it. The days were flying by, I didn’t even know what day of the week it was. I was just on this marathon. And then once it slowed down, it caught up to me. I needed some time to myself. I got some rest, processed it. Now I feel back to normal.I live in the neighborhood. I was born in the community. I wake up every day more motivated, wanting to do the most I can to help my community.Lenny Singletary, senior vice president for external affairs, strategy and marketingLenny Singletary, senior vice president for external affairs, strategy and marketingI left Wall Street to take this job. The younger me would have been like: “What? A hospital? You?” I never thought as a younger me that I ever would have had a career in health care.The favorite part of my job really is the engagement. I love just hearing different stories about what people deal with and how you can help provide a solution for their issues and their concerns. The least favorite part of my job is going up to the I.C.U. That’s the floor where my mother died in 2013, the day after Thanksgiving.My job has changed due to coronavirus. In many ways it has expanded. I never imagined that I would be a person taking a leadership role with providing care for the community, through building a tent that provided screening and relief to over 2,000 community members.Generally when you’re in a job like external affairs or marketing or strategy I don’t know that you ever think that you would encounter the mass casualties. But nothing about the pandemic was normal. Some I knew, some were friends and family members, some were friends of friends. That was really intense.I live in the neighborhood. I was born in the community. I wake up every day more motivated, wanting to do the most I can to help my community. The folks most affected by this pandemic suffered socioeconomic disparities, which led to health disparities. They’re one and the same. I don’t know any billionaires or people who have access to capital who are also dealing with health disparities.The hardest thing about the job is how do we get people to come back. I don’t want someone to sit home and have what could be a routine illness grow to the point that it becomes really complex because you have fear of returning back to the hospital.There was one day I cleaned 10 beds, and from those 10 beds, six patients died.Maribel Sanchez, housekeeperMaribel Sanchez, housekeeperI started in data entry at a company that shut down. That’s when I had a year with no work, no job. My friends said, if anything comes just take it and then you can move on to whatever you like. It was 1992. My godmother used to do hair for a secretary from the hospital. She said they needed someone. I felt so comfortable doing it, it just rolled on, and 27 years later I’m still there.I clean the beds when the patient leaves, transfers or suddenly passes away. I do the floors, the dusting and the housekeeping stuff. I work for the I.C.U. units: mop the floor, take out the garbage, pick up a little piece here and there, fill up the paper towels, the soap sanitizer and all that stuff.My favorite part of my job is cleaning the bed, because as soon as I begin a bed I think in my mind, one of my family could be there or it could be me, so I have to do it right, like no cut corners.The hardest part during the pandemic was cleaning all those beds and you know those patients didn’t transfer, they died. There was one day I cleaned 10 beds, and from those 10 beds, six patients died. It was hard for me because I never saw in one day so many people die.I see life differently. It’s short. You love your family more than before, because you don’t know if you’re going to see them again or not. My mother in Boston is 77 years old, and she has dementia. I want to see her before she forgets about everybody.Sometimes I say I’m only a housekeeper. Other people come and tell me what I do and the role I do, that it’s important and stuff. I don’t think so much about it. I love what I’m doing.When they brought those refrigerator trailers, seeing those bodies rolled in there, that was overwhelming, you know? All those bodies. It’s hard to take.Louie Ortiz, electric shop foremanLouie Ortiz, electric shop foremanWe’re in the background. We maintain the hospital. We’re responsible for the generators, patient rooms, we’ve got to make sure the outlets and lights are all working.It’s something different every day.Now you have to be aware, wear a mask. There were some rooms that we had to change over to patient rooms. We had to put outlets in, make sure that everything was up and ready.When they brought those refrigerator trailers, seeing those bodies rolled in there, that was overwhelming, you know? All those bodies. It’s hard to take.We had, I think, four guys in the engineering department get sick from it. But they came out of it, they’re fine. We had other people, actually about five people, I think, pass away. One of them was my friend from patient-transfer, a good guy named Ed Becote.As soon as I get in the door my wife is spraying me up. She sprays my bags, clothes. She’s an asthmatic so she’s got to be careful, too.I wake up in the morning, I’m fine. But when I’m ready to go in I just don’t want to. I tell myself: “Let’s make it through another day. Be careful.”Even when I think about it right now, it gives me goosebumps. It was a very scary, very overwhelming experience. It was a nightmare. Dr. Kiran Zaman, critical care fellowDr. Kiran Zaman, critical care fellowEven when I think about it right now, it gives me goosebumps. It was a very scary, very overwhelming experience. It was a nightmare.Towards the end of the morning report almost every day there would be a rapid response or an unfortunate code blue and we would run over. And the day would just go on like this, running to these rooms finding Covid patients in extreme respiratory distress, gasping for air. Some of them made it. Unfortunately, some of them didn’t.I will never forget their faces, the things that they said right before they were at the verge of death or getting intubated. “Oh my God, Doctor, please make sure that I live,” or, “Tell my wife this: I love her.”There was a very sick, young Covid patient. He was actually looking at his daughter’s pictures right before he got intubated. He told me, “Tell my wife I’m going to come home.” And he was swiping his daughter’s pictures on the cellphone, he made a cross on his chest and kept his phone on his chest. And then he got intubated and unfortunately that same night he died. We did everything to save him, but we couldn’t.I used to watch doctor dramas or soaps on TV, see these people saving lives and wish I was like them someday. I don’t think anybody ever imagined to be in something as intense as this pandemic.This was a very humbling experience. I consider myself very lucky that I was part of this hospital. I learned from each and every experience, whether it was as a human being or as a physician.When your sickest patients start improving, there’s no match for that feeling. I don’t know how to explain it in words — it’s like magic.I think, ‘Aw man, it could be me there on the machine in that condition.’Chostene Phanord, linen serviceChostene Phanord, linen serviceI’ve been working at Brooklyn Hospital for 31 years. I came here from Haiti when I was only 20.For me, every day is the same thing. I start at 4 o’clock in the morning. I pick up the dirty laundry because the truck comes at 5 and we want to give him as much dirty linen as possible. The more dirty linen you give, the more clean you get back. Then we just push all the clean laundry upstairs and start making deliveries. I do half the hospital and my partner does half.We cover up very well to protect ourselves from the virus. Sometimes you see people on the machine and you feel sorry. Nobody’s supposed to go through that. I think, “Aw man, it could be me there on the machine in that condition.” I get scared and say, “Forget it, let me keep moving, let me keep going.” I make my delivery and try to leave the floor as soon as possible.You’re right in the middle of the storm and you don’t know whether you’ll get to the other side. It was a very intense moment for me. You couldn’t stop people from dying.Dr. Vasantha Kondamudi, executive vice president, chief medical officerDr. Vasantha Kondamudi, executive vice president, chief medical officerEverything we were before is one story. Covid taught us. It taught me how to be a vulnerable leader and resilient.When the peak came I had to reassure my front line, I had to deal with them in the tent, in the emergency department, the intensive care unit, talking to the nurses, talking to the doctors, making rounds when we didn’t have enough P.P.E. How do you protect your patients and your employees? Because that’s your responsibility. We had to be very innovative. For a week we had to wear all garbage bags.The guidance changed every week. It was such a dynamic situation. We had to quickly react to the information that we received rather than just sitting there and wondering, “I wish we had known that.” For this pandemic, none of the knowledge would help you. This pandemic, nobody knows anything. It’s brand new for everybody, for the entire world.When we had the peak of deaths and when we had to have the second morgue truck, a video came out, an outside person saying people are dying here. It just wakes you up and shows you where you are. You open your eyes and see. Oh my God, is it where I am? And you don’t know whether you’ll get out. You’re right in the middle of the storm and you don’t know whether you’ll get to the other side. It was a very intense moment for me. You couldn’t stop people from dying.There was a moment that a lot of health care workers were sick. There were patients dying, your colleagues are getting sick and there is bad news everywhere. So you don’t know whether we will ever get out of this pandemic as an institution and as a nation.Today is good for me. I can look back and say, “Really, did we go through that?” But in that time when that happened you needed to have a lot of strength and courage and hope and faith that you would get out of it. That was a scary moment emotionally.We lost a lot of our co-workers here, very close people. That really hurt us. We are still grieving.Elvin Cruz, security officerElvin Cruz, security officerI’ve been doing this about 20 years. My mom was sick and I’m the oldest so I just wanted to work.Security was the easiest job for me to get quick. You get your certification and you start working.The job is more or less policing the hospital. Safety issues, crowd control, making sure everything is OK.With the virus, it changed drastically. A lot of our co-workers were out, so a lot of us had to step up to different roles. I was helping the guys in transportation. We were bringing the bodies out in stretchers.We lost a lot of our co-workers here, very close people. That really hurt us. We are still grieving.The mind plays with you. Working in the hospital, you don’t know whether you are exposed or not. God forbid something happens and you come home and one of your family members ends up going to the hospital, and then you feel like it’s your fault.You know what I think is one of the biggest things that you learn from this? You discover that you have a heart. Some people seem like they have no emotions. They don’t care about nothing. Through this ordeal, you’ve seen people change. They learned that they have something that they could give, that they could make a difference. During this time, people got to see how good you feel about yourself when you let the good come out of you.It was a bad experience, but at the same time it was one of the greatest learning experiences that I’ve had. I’m still learning every day.I saw it all — tears, exhaustion, sorrow, anger, helplessness, regrets. Many times I went home and cried because I saw the anguish in their faces and their hearts.Donna Mosley, clerk, emergency department Donna Mosley, 64, clerk, emergency departmentI’m the heart of the E.D. I started in 1982 as a registrar in the emergency room, then a unit manager. And then I started with E.M.S. as an E.M.T., and then a medic.I come in here every day with an up attitude because we’re around a lot of sick people, lot of negative energy, and so I keep people up. It makes a big difference for a lot of them.I think being a part of 9/11 prepared me for this, because I saw that tragedy, that I had experienced the trauma of it, I was able to handle it a little better.P.P.E. equipment was very scarce. I had to make sure that these doctors on every shift had N95s so that they can effectively do what they have to do. Because if the front line is not well, we’re in trouble, inside and out.The families not being able to communicate with their relatives, that was really hard.I would take the family member’s name and phone number and make sure that that doctor reached that family. That was the least that I could do to give them the information that they needed.We could have been exposed at any time. Nobody knew what it really does — if it lingers in the air, if it doesn’t, we didn’t know. We were just as blind as everybody else. The thing that frightens us the most is: What happens if this flares up again? Are we going to be equipped to really handle it, since the whole country is in a crisis?I saw it all — tears, exhaustion, sorrow, anger, helplessness, regrets. Many times I went home and cried because I saw the anguish in their faces and their hearts.Sometimes it just felt a little out of control, but the doctors kept everything together. There was great leadership — from the doctors to the nurses, to the clerks, to transport, to building service. So even though we were overwhelmed with patients, we had to be there for each other.Now for me it’s hitting a little bit more. I have time to think a little bit more, which is not necessarily wonderful.Judy McLaughlin, senior vice president and chief nurse executiveJudy McLaughlin, senior vice president and chief nurse executiveWe had our patient zero the first weekend in March, and then within two weeks the escalation was rapid. I didn’t know where I was going to put the patients. I can open up units, but I need staff to cover them.Normally in a nondisaster mode, because of union contracts, you can’t really float R.N.s out of their assignment areas. When you call a disaster, you have to put people where you must. So we had to do a lot of on-the-spot training, redeployment, education, and have people be there to support nurses on the unit, rounding to make sure they knew what they were doing.You were just working, coming home, falling asleep, getting up and doing the whole thing again. Even the weekends, if I wasn’t in the hospital I was on the phone all weekend trying to oversee things.The hardest part now is reassuring patients it’s safe to come back. I think there’s still fear of the fall, is it going to come back again? Are we going to be better prepared with, maybe not a vaccine, but treatment for it at least?I’ve been trying to get healthy again, because all that went by the wayside. Now for me it’s hitting a little bit more. I have time to think a little bit more, which is not necessarily wonderful.We are a safety-net hospital. We’re not rich. We don’t have a lot, so we have to make things work sometimes with a little bit less, which makes it more challenging.I was very proud of us. I think we did a great job considering the normal challenges we have. A lot of that was a lot of key people, the teamwork, rising to the occasion. I don’t think anybody did it any better than we did.I call it the little engine that could. You have this community hospital that stands tall against the big systems.Gary G. Terrinoni, president and chief executiveGary G. Terrinoni, president and chief executiveI call it the little engine that could. You have this community hospital that stands tall against the big systems. I do think we’re a gem.The most frustrating part is really dealing with the issues that surround equity. Covid has highlighted, even more, disparities and problems in Medicaid reimbursement. It’s the drum I’ve been beating for four and a half years. We’re a safety-net hospital. We get about 70 percent on the dollar for Medicaid patients, meaning the reimbursement is not covering our cost.Prior to Covid, we were not being state-subsidized and not being city-subsidized. We were actually holding our own, but marginal at best.We’re sitting on a billion dollars of real estate. I know a big system would pick us up. We’re fighting like heck for that not to happen.We had to figure out a way to test for something that didn’t exist before. We did about four months of work in about four days.Wade Winchell, laboratory administrative directorWade Winchell, laboratory administrative directorI originally was a respiratory therapy major. I had to give CPR to someone when I was in that program, and I realized quickly that direct patient care was not something I could handle. My professor said, “What do you think about laboratory?” Laboratory is something that contributes to care in a really great way, but it doesn’t involve directly facing a patient.I became director of administration the day before the outbreak. Our previous administrator had passed away. Charline Falletta. She was a huge mentor. We have about 70 employees total. And we have a laboratory information system that integrates about 200 pieces of technology.We had to figure out a way to test for something that didn’t exist before. We did about four months of work in about four days. I was there with my microbiology supervisor, Shakeela [Jones], and her team for that whole weekend, from 9 a.m. until probably about midnight just crunching the data getting everyone trained. It was pretty wild.Every day seeing the data jump and not knowing if today would be the day it would be the biggest number was really taxing, just not knowing when it would stop.The hardest part is falling asleep, but once I get asleep it’s really hard to wake up. After I wake up I’m usually just exhausted. The emotion is kind of different every day. Some days I feel ready to face the challenge and go into this, and other days it feels like I just could sleep until it’s over.I remember just panicking. Like, how are we going to get through this? How can we do this every single day?Janmeet Purewal, clinical pharmacy managerJanmeet Purewal, clinical pharmacy managerWe ended up having several pharmacists that fell sick. It was very humbling. You never expect something like this to happen and you really realize the impact that your job makes. It’s very easy to get burned out, but it really helped us to remember that at the end of the day, what matters is the patient. It’s not how we’re feeling. It’s much bigger than us, and we have a larger role to play and we just need to do our best to take care in the things that we do day to day.There were times when so many patients were on the same medications and we were running out and I was like: What are we going to do? Things are on back order. Things weren’t coming in. You’d hear, “Code blue, code blue,” then the orders flood in. I remember just panicking. Like, how are we going to get through this? How can we do this every single day?It was really intense for a couple of weeks and you just expected it to be like this for months. All of a sudden it just flattened out. We’re still kind of on edge.I’m an Indian and it’s always been something pushed on you: Ooh, become a doctor. A pharmacist, it’s not as prestigious. That’s how it is always with our parents, our families. But now, I’m very happy to be in this field. I do think that the work we do goes unnoticed, and that’s OK. As long as we know the work that we’re putting in and how we are making an impact.Sometimes I catch it. They’re outside, ringing the bells. Yesterday they had E.M.S. services and people from the community just dancing outside. And then the N.Y.P.D. comes and they all have their sirens wailing. It’s a nice feeling to see that happen. It’s such a unifying moment for the community.Whenever a patient is being discharged, we would all hoot and holler together. Here we play Bob Marley.There’s new challenges ahead and I’m preparing myself and my team for the next wave. Covid will not win.Dr. James Gasperino, chairman of the department of medicineDr. James Gasperino, chairman of the department of medicineI go from bedside to boardroom. But I always value the front-line position role. I still go to every rapid response and cardiac arrest in the hospital. And during Covid I wanted to let people know that I’m right by their side every step of the way. We’re a team, and I’m going to lead you through this.It’s the oldest hospital in Brooklyn, a team of people that has a commitment to patient care and helping the community. We did it for a safety-net community, meaning that the social determinants of health play a big role in their outcomes, and puts them at a significant disadvantage if they get sick. And I’m really proud that when they hit the door we did a great job for them.I want to be able to handle anything, anywhere, anytime. In essence, training for war. I personally underestimated Covid. There is really nothing that I hadn’t seen. I felt that this is going to be a bad flu situation, this is what we do. I think it was a very complicated war.I recall one night — it was one patient after another, after another. And they were so sick. I said to myself, if this keeps up, we’re going to be overwhelmed here. Because I hadn’t seen anything like this before.After one of my night shifts, one of my close colleagues who I really trust said, “Listen, you’ve got to go home.” I was tired, I must’ve looked different, I was working 30-hour shifts.And then it hit me. My taste changed, and that was a sign that I was coming down.I went to get up and I just collapsed, I thought I broke my jaw. That’s when I knew, this thing is for real. It was close. There were a few dark moments there.A lot of people said, “Oh, you’ve changed a lot, you seem happier.” I’m grateful that I’m alive, because a lot of people didn’t make it. And, you know, it could’ve been me.

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