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NEWS | Aug. 3, 2020

The Night Shift

By Capt. Joseph Kochan, Executive Officer, Operational Health Support Unit Portsmouth, Va.

The Night Shift
SLIDESHOW | 2 images | The Night Shift A first-hand account from the front line of New York COVID-19 relief efforts.

As my group of 15 physicians and nurses began a half mile walk from our hotel to the Javits Center in the early evening of April 10 to catch a bus to Elmhurst Hospital, we discussed how empty New York City was. No people. No traffic. Just empty streets. My team had not only volunteered to be a part of the New York City coronavirus response, we had also raised our hands to go to Elmhurst, the epicenter of the disease. Once on the bus, we began the seven mile trip to the hospital where we would report for our first shift in the various New York hospital intensive care units. During the ride I reflected on the events of the previous five days.

It was late on April 2, when the deputy chief of staff, Naval Medical Forces Atlantic contacted Navy Reserve Operational Health Support Unit Portsmouth with a request for nurses and doctors willing to support the COVID-19 response efforts in New York City — and he needed the list of volunteers by the next morning.

The request started a cascade of events that landed 154 Navy Reserve medical and nurse corps officers in the heart of New York City on April 5 — 48 hours after the initial call and within 24 hours of receiving orders. Four days later we had all been in-processed into U.S. Northern Command’s joint reception, staging, onward movement and integration at Joint Base McGuire-Dix-Lakehurst. We received orientation with Joint Task Force COVID-19 Pandemic, New York City; obtained training and emergency privileging with New York Health and Hospitals; and received Intensive Care Unit introductory orientation.

My day job is as an anesthesiologist at a Level I trauma center in Lansing, Michigan and coverage at a community hospital in Owosso, Michigan. Although, I had critical care training in residency and helped care for patients in the community hospital intensive care unit, nothing could have prepared me for what I was about to encounter. I have been to Afghanistan as an advisor to the Afghan police and army hospitals and have seen terrible injuries in both U.S. and Afghan service members. COVID-19 was magnitudes worse.

We were now at the tip of the spear fighting COVID-19. Many in our group designated the hospital as the "Hot Zone." Arriving at Elmhurst, we were greeted by multiple New York City emergency response vehicles — sirens and horns blaring — with almost every person on the way in thanking us for coming to help. As we moved into the lobby, we were greeted by hospital administrators passing out dinner and bottled water to every employee including us. We moved to our locker room and put on our "battle-rattle" which included scrubs, an N-95 mask, a surgical mask over the N-95, two head covers, a clear face shield, surgical boot covers and a surgical gown. At this point, the team scattered across four different intensive care units.

My small team was assigned to A-4, which had been a regular ward until just about two weeks prior. I put on a second cover gown and medical gloves to enter through a newly constructed door with a sign posted, reading in all caps, "You are entering a Level 3 zone, must wear prescribed personal protective equipment and continuous hand washing after touching all doors and equipment."

This was no ordinary intensive care unit with individual rooms, where inside the room was considered contaminated and the hallway was clean. The entire floor was considered contaminated. Walking through the door all one could hear were alarms from ventilators, IV pumps and cardiac monitors. I joined the intensive care team of two attending physicians, two resident physicians and two physician assistants providing care to 40 unstable, intubated and ventilated patients.

This was nothing like I imagined; the reality was it was much, much worse. Much worse than what I had even seen on the news or read about online. This was just one of many wards in Elmhurst where 180 patients were exactly the same; suffering from an overwhelming illness that first attacked lungs, then caused kidney failure, strokes, blood clots and death. And to further stress the health system there were at least 400 patients in the hospital diagnosed with serious COVID-19 infections. The hospital was full of COVID-19 patients.

Not even in this newly constructed ICU for 20 minutes, the overhead speaker blared "Code Blue A-4, Code Blue A-4." One of our patient’s heart had just stopped. Our team entered the room along with a respiratory therapist, a laboratory technician and multiple nurses. We began advanced cardiac life support protocols to try to revive our patient. We performed CPR, gave multiple medications and gave multiple electrical shocks trying to restart the heart. What seemed like five minutes actually had been over 30 minutes with the patient never regaining a heartbeat — my first casualty of COVID-19.

Then it hit me. There were no family members who had seen our patient since being admitted two weeks prior. No one to hold their hand. No one to say I love you. No one to give them a hug. No one! This was due to the strict no visitor policy to try to stop the spread of the disease. But in the process, we had dehumanized care. A ray of humanity returned when the lead resident asked if we would all take a moment of silence for the patient. I teared up immediately as this simple gesture touched my heart.

I looked around and it was only 8 p.m., I had 11 more hours to go in this first shift and it had already been an emotional roller coaster. I looked at the team and you could see in their eyes that this was just as hard on them as me. I stood in the center of a 20-room, 40-patient ward manned by 20 nurses. Our gowned and masked team were caring for patients in a dire situation, fighting a virus that was so new that treatments were being developed as the disease progressed. We were not winning this war.

No time lapsed and a second Code Blue was called. For this patient, we were able to restart the heart after it had stopped three times. But it stopped for a fourth time and we were not able to restart it. A moment of silence to mourn the deceased patient, then on to care for our next patient. Out of a line of 40 patients we had actually only seen about five, and two hours had passed.

Two more Code Blues occurred as the night progressed and both patients died followed by two more moments of silence. I also witnessed as the resident doctors would go back to our workroom and call each deceased patient’s family. Many times they would speak fluent Spanish to the family explaining every aspect of care during the final minutes of their life. The resident would never rush the conversation and was always compassionate even though the conversation was often repeated from family to family.

The staff was incredibly respectful preparing the bodies of the deceased patients for the morgue. They quietly removed all IVs, breathing tubes, bladder catheters and other equipment. Then they thoroughly bathed the patient and placed them in a body bag. Another team would appear and transport the patient to the morgue.

Once the room was cleaned the next critically ill, intubated and ventilated patient was admitted. There were now over 20 patients in the emergency room needing ICU beds. It was after midnight when we finally completed evaluating each of the 40 patients. Now the work began to adjust medications, place special central access IV lines, hemodialysis catheters, adjust breathing tube placements and other tasks. This took all of our efforts for the remainder of the night.

As the clock reached 7 a.m. the next morning and my first 12-hour shift ended, I walked out of the same "Level 3" labeled door after doffing my outer layer of personal protective equipment. During the night I had changed gloves, sanitized my hands dozens of times, and changed my outer gown in between treating each patient.

It was time to go home, exhausted both mentally and physically. I met up with the Navy team in the locker room as they returned from their own ICU assignments. Every one of them had a similar experience that night and it was a quiet ride home to our hotel.

As I left Elmhurst that morning after my first night, I met Anthony. He was an administrator and our team’s supply chain manager. That morning he was handing out breakfast. He and I would meet almost every night and every morning in the lobby food line. He became my sanity check at the beginning and end of each shift for the next two month.

As a Navy team we were adopted into the Elmhurst healthcare team family from day one. We worked side-by-side with Elmhurst staff and contract nurses for 60 days straight. Our bonds of friendship and companionship ran deep with the staff and at the end they didn’t want us to leave. As we reached the 30-day mark, we started to see a definite decrease in the number of cases being admitted to the ICUs. We had started to see some patients improve enough to be removed from ventilators, have breathing tubes removed, and then "graduate" to normal hospital wards. The tides of the war were changing.

In 20 years of training and practice, this has been one of the toughest assignments of my career. But even in the darkest days, as a doctor and as a Navy Reserve Sailor, being part of a team dedicated to caring for others and serving our nation makes it all worth while.