The author was given full access to the New York Presbyterian/Weill Cornell hospital system (from the CEO to the maintenance crews) Vanity Fair writer-at-wide-has crafted a saga of courage, ingenuity, and loyalty under horrific conditions at one of the world’s largest hospitals as it battled COVID (from the first reported case in America to the tsunami that followed). In this adaptation of her new book The desperate hours, Brenner focuses on a legendary ICU doctor and her highly fraught interactions with the hospital’s head – who is frantically trying to save lives in his own way.
There were many things that Dr. Lindsay Lief, head of 5 South, was good at laundry, but always following the rules wasn’t one of them.
Lief was the beloved director of the medical intensive care unit at 5 South, one of six ICUs in New York-Presbyterian/Weill Cornell, a hospital system considered the Emerald City of medical care in the New York metropolitan area. She brilliantly led a team of 11 intensive care physicians (the nurses) and dozens of highly trained nurses, respiratory therapists, pharmacists, X-ray technicians and housekeepers tasked with helping to heal the sickest of the sick, to work miracles during the collapse of the body’s systems. It was a unit that would be brought down again and again during the first 18 months of the COVID pandemic. It was a miracle that it was still standing – and while Lief never told anyone about it, one reason may have had to do with a six-year-old and his forbidden desire for a slice of pizza.
It had happened years before, when “coronavirus” was a term unknown to 99.99% of the American public. As an intern at Weill Cornell, Lief had enjoyed the time she spent in the MICU — the medical intensive care unit — with its hourly calibrations of everything going on in the body. Later, as a counselor, Lief would intoxicate her residents with her genuine, non-prisoner approach to what she called “real medicine” – the most important thing was the human connection. She had met the six-year-old girl battling leukemia during her training. He had a feeding tube, but his only wish was a slice of pizza, forbidden by everything in his treatment plan. Endless debate ensued: was it wise to give him the pizza? How would his digestive tract react? “Give him the damn pizza,” Lief said, before pumping him with painkillers for the possible pain that could follow the meal.
Was this drug or something else? A few months later, she saw the boy in the pediatric ward. “And what about the day you ate the pizza?” she asked, feeling guilty about this case of breaking the rule. Had she made the right choice? “It was the best day ever,” he told her. “Last time I ate anything.” A few weeks later he was gone. So maybe it was a drug after all.
Now, in early April 2020, Lief was nervous to say the least. She had an ICU full of extremely sick COVID patients, and word had come that the head of the entire hospital system, Steve Corwin, wanted FaceTime on her morning rounds. Such long-range observation, as far as anyone knew, was unprecedented—and of all mornings, just as systems, equipment, and lack of supplies seemed to get worse, not better.
On a typical day, before all the pandemic, Lief would have woken up and, before going to work, taken her kids from their home in Greenpoint to school in Williamsburg, joining the crowd of hip Brooklyn moms and clusters of honour boys in their skullcaps and payos navigate to space on the sidewalks. Now her normal days were waking up when it was still dark after way too little sleep. She was often the only person on the road crossing the deserted Queensboro Bridge. She would reach Weill Cornell at six in the morning (as this particular branch of the New York-Presbyterian system was commonly called). The atmosphere in the hospital was surreal. The marble entrance halls, once crammed with crowds of visitors, were deserted; the gift shop closed; the Au Bon Pain in the lobby, where she used to buy croissants for her team, completely dark.
Lief heard the deafening noise of the jerrycan-rigged HEPA filter systems a few floors away, and as she walked to her office, she saw her colleagues and the hasty shadows of doctors and nurses and respiratory therapists and accountants at work as patient transporters arrived. upstairs and down the stairs, wearing frayed N95s and plastic shields or goggles they’d taken from their children’s basement, not waiting for an elevator for fear of the air they might breathe.
What could Corwin possibly see during a FaceTime call? The patients, yes, but he couldn’t see the fear on the faces of the nurses who worked in rooms where aerosolized droplets escaped from clogged breathing tubes, but who had to wear masks they’d used for days, long after they’d had to be thrown out and replaced. , as there were no substitutions. The iPad screen would show, but not showWeill Cornell’s beloved emergency room physician Chris Belardi struggled for his life on a ventilator after the first few weeks on the front line. The same was true for the entertainer who just had a birthday and probably wouldn’t make it to the next one; the seriously ill 28-eight-year-old who was months away from his wedding; and through and through and through. Lief, whose understanding of the Hippocratic Oath diverged from the more traditional and reserved clinical, had already decided to waive the “no visitors during COVID” rule. She would allow the 28-year-old’s fiancée to be by his side when he died.
The truth was that you had to be at 5 South to understand what was going on, and Corwin felt caught between the fierce tug of war of his calling as a doctor and his responsibilities as head of the hospital. For years, he had been a cardiologist most at home in the ICU, leading ICUs at Columbia-Presbyterian. But because of the hospital’s legal policy, he was no longer allowed on the floor. FaceTime was the best he could do.
In a blur, Lief heard Anthony Sabatino, her nurse manager, announce, “Lindsay, Steve wants to hear from you.” And then there was her boss on her iPad, who spoke to her from his apartment a few blocks away, who was himself quarantined by the board of trustees, who had been concerned about his health as someone at headquarters had tested positive. tested.
“Lindsay,” Corwin said. “What can I do for you? How can I be helpful?”
Lief heard himself sobbing suddenly. “Dr. Corwin, we’re not doing well,’ she replied. “We are going to break. I am very concerned about my staff. We’re the ones making the ethical decisions about beds and ventilators, and we’re putting our nurses at risk.”
Corwin took it in. He made her cry. “Whatever you decide, you have my full support and the support of the hospital,” he said. He added some general reassurance, but mostly he listened.
Bradley Hayward, one of five nurses in South’s intensive care unit, interrupted Lief – a patient was coding. The pipes of yet another state waste ventilator were clogged with the horrible COVID slime that solidified as hard as old chewing gum. End of video rounds for Lief; she was on the run again. For a moment her anger evaporated, swept away by the immediate urgency. She felt strangely reassured—they went as best they could in wartime; 5 South insisted.
But there were only so many machines that worked, and there were so, so many patients, some with better odds than others. Day after day, hour after hour, as dozens of desperately ill people rushed to the hospital, there were often three or four patients who needed ventilators at the same time, and on several occasions only one or two seemed to be available. Yes, Like the doctors in the other ICUs and the emergency room, Lief and Hayward would be told, we’ve got more somewhere, in this storage room or in the auxiliary hospital. Lief would be constantly reassured: They’re going to show up. But when and how? And how to keep someone alive until they did? And so the appeals to hospital ethicists and the pain of the need for triage decisions beyond company lines without state-sanctioned crisis rules. What am I going to do, Love thought, write on the card that Corwin says it’s okay for the patient to die in the ICU?