Dr. Laura Evans hadn’t been gone long. Six months is all.
Yet when she returned to Bellevue Hospital in New York City, where she’d spent most of her career, she found it was both the same and foreign.
Evans is among the Seattle-area doctors who volunteered recently to treat patients in New York as it became the nation’s new epicenter of COVID-19, about a month after the first U.S. death was reported Feb. 29 in Kirkland.
She had been the head of critical care at Bellevue and is now the medical director for critical care at the University of Washington Medical Center. She had an idea of what to expect after seeing a surge of COVID-19 patients in Seattle earlier in the pandemic. But this was something else.
“Although we are quite used to critically ill patients, just the numbers and the acuity was really, really high,” Evans said. “You walk around this ICU space and there would be just patient, after patient, after patient, after patient, on a scale we definitely didn’t see here in Seattle.”
The national focus was initially on Washington state, which was the first to diagnose a case of COVID-19 in mid-January and reported the first death from the illness in the U.S. on Feb. 29. As the virus ripped through the Puget Sound region, hospitals were inundated with COVID-19 patients, forcing the state to ask for help.
Retired health-care workers returned to the front lines, and the state loosened requirements for doctors and nurses from other states to practice in Washington. The state Department of Health has approved more than 2,300 volunteers to work here, 43% of whom are from out of state.
Then, New York — particularly New York City — became a hot spot. New cases of the coronavirus known as SARS-CoV-2 began to explode there in the second half of March, quickly surpassing Washington’s numbers. And while new cases in New York City have recently been on a general decline, the nation’s most populous city still also has its greatest concentration of COVID-19, with more than 197,000 cases as of Sunday, including more than 20,000 deaths.
To bolster medical personnel in the city’s overwhelmed hospitals, New York state lawmakers also eased restrictions on doctors from other states. Health-care workers across the nation flocked there.
By mid-April, around the height of New York’s surge in diagnoses, about 2,000 health-care workers were volunteering at New York Health + Hospitals, the largest public hospital system in the nation, which includes Bellevue Hospital.
The situation was dire around that time, said Dr. Edward Rippe, a first-year resident at another New York Health + Hospitals facility, WoodHull Medical Center in Brooklyn.
Rippe, a 31-year-old from Shoreline, puts it bluntly: “It was hell.”
He was assigned to a makeshift ICU where patients were dying during every round he made. “Code Blue” calls for the resuscitation team rang out through the hospital’s intercoms hourly.
Rippe had come back to work after his own bout with COVID-19, diagnosed in the last week of March. He believes he contracted the virus after treating a patient with kidney issues, who divulged only after he treated her that she’d had a cough and fever a few days before. Rippe wasn’t wearing protective equipment, which was already in short supply.
He was away from work for only eight days. With so many patients coming in, and so many of his colleagues also getting sick, he says the need was too great for him to be gone for long.
Doctors from the Seattle area were able to travel to New York to help with the heavy caseloads only because the nation’s epicenter had shifted from here to there, said Dr. Vikram Padmanabhan, who works in pulmonary and respiratory care at UW Medicine’s Northwest Hospital.
Treating COVID-19 is “humbling,” Padmanabhan said. Evans, who worked on the same floor at Bellevue Hospital with Padmanabhan, said that while most doctors have thought about what pandemics might look like and what dealing with a surge of patients might be like, it’s different to be in it.
“Trying to figure out how to take the very best care of this volume of patients who are really sick and really in need of your help — and trying to very much do real-time, on-the-ground problem solving — was incredibly gratifying and incredibly challenging,” she said.
Because COVID-19 is unlike most other diseases, Padmanabhan said, doctors have to adjust how they care for people.
Typically, when treating gravely ill patients, a doctor can develop a relationship with them and their families. That isn’t easy with COVID-19. Patients on ventilators can’t speak with their doctors, who are hidden behind protective gear, and family members have to stay away to avoid exposure to the virus.
So, in New York, a volunteer nurse assigned to Padmanabhan’s ICU team would speak with every patient’s family daily to glean any information she could about their loved ones to share with the doctors.
From those conversations, Padmanabhan learned he was caring for a taxi driver, a jazz singer and a parent to four children.
“It made it easier to do the hard work, because this is more than physiology,” he said. “We were taking care of people.”
Those kinds of things draw humanity out of an inhumane situation, Rippe said.
“It is in times like this that we see how similar we all are,” Rippe said. “I’ve spoken to many family members over the phone who could not go into the hospital to see their loved ones. I’ve had to give bad news over the phone. I’ve arranged FaceTime visits for family to talk to loved ones whom they may never see again. Others had no one who called, and died alone. No one wants to die alone. We all desire to love and be loved.”