By Pravin George, DO, assistant professor of Neurology, Cleveland Clinic Lerner School of Medicine; staff, Neurointensive Care, Cerebrovascular Center, Cleveland Clinic
More than three months ago, New York City experienced the largest reported metropolitan surge of COVID-19 patients in the entire country, possibly in the entire world. In the blink of an eye, every NYC hospital census took an unprecedented upswing, and ICU teams were all swamped with a single, common, unknown adversary. At several hospitals, no longer was there a division between ICU specialty; every ICU became a COVID ICU. Horror stories of inadequate staffing ratios, personal protective equipment and medication shortages blazed the news media, and every nurse, physician and allied healthcare provider became a “hero” overnight.
Unlike many communities and major cities throughout the country, Northeastern Ohio was not as badly affected during the mid-March surge. Maybe it was the effect of an early shutdown and stay-at-home order, or perhaps it was simply the geographic profile of the area, but the cities and counties were relatively spared. As stroke, intracerebral hemorrhage and subarachnoid hemorrhage numbers plummeted, and the number of COVID admissions remained for the most part very contained, I remember at one point having a census of about four to seven primary neuro ICU patients. The “surge” for us in Ohio seemed to be largely averted.
That’s when a memo was released from my institution, Cleveland Clinic, asking for volunteers to assist with the healthcare workers at the frontlines in NYC and Detroit. Should I leave the comforts of my ICU off weeks and leave my wife, three daughters and three-month-old son? Would there be enough PPE? What happens if I get sick? So many thoughts and questions ran through my head in the following days, but coming off the sidelines was something I felt I had to do.
Although much of the NYC experience is a blur in my memories, I vividly remember the first step onto United flight 3011, a flight serviced by a completely volunteer staff. The pilot mentioned that his daughter was a nurse and that this mission to NYC was something very personally important to him. I also remember landing at Newark Airport to signs from the grounds crew welcoming us and a transport taking us to the hospitals in the center of Queens, Brooklyn and Manhattan. As we stepped into the COVID epicenter, we were just a group of 25 people. We didn't bring much, but what likely helped more than anything else was some sense of hope that they weren’t alone in this fight.
As intensivists and intensive care nurses, we weren't naive to sickness and death, but the atmosphere was different. Anyone reading this who has worked on the front lines of this disease would tell you the same. Each person had their own way of processing the experience. For me, NYC was my native community, it was the place I grew up and the place where my parents lived. There was some sense of home being only blocks away from the street that my entire family immigrated to and seeing our old house from the hospital windows while working at the same place where my grandfather went when he suffered a stroke many years ago.
Our time in the hospital was extremely busy. The patients, like in all other COVID centers, were suffering from complex respiratory and coagulopathic issues. In my first hours on the unit, I remember being more concerned about how carefully I was donning and doffing my PPE and about how anxious I was with interacting or coming into contact with any of our patients. However, by the end of my shift on the first day, I learned how to remain cautious but comfortable while working and examining the patients. So comfortable I began aiding our proning team. The residents I worked with were outstanding, and the skills and medicine that they were learning was incredible. These were experiences they will carry with them for their entire lives. Data on what was beneficial for the disease was sparse, and together with the team of intensivists, we were coming up with therapies in real-time.
Between shifts, we would exchange ideas in the recharge areas of the hospital and talk about what similarities and differences we were noticing. Working together as a team we were able to help bring the ICU census down to numbers that were more manageable, and eventually able to close some of the makeshift ICU floors. I couldn’t help but stop and think back; silently reflecting to thank all of my teachers, mentors, nurses, respiratory therapists and other colleagues for all the clinical pearls given to me throughout training. My closest neuro ICU colleagues and I formed a texting group to share some of the latest COVID-19 research and information with each other. We were rapidly coming to the realization that COVID-19 was not simply a severe respiratory disease but more of a multi-systemic and complex interplay between a virus and its host, with a multitude of neurological implications emerging.
I left NYC a few weeks later much more knowledgeable about the disease but with mixed emotions. In the empty airport, I had my first chance to reflect on the entire experience alone for the first time. Most prior evenings, we decompressed together as a group. I remember feeling an element of survivor's guilt and wondering if I could have done more. Every aspect of the experience had its pluses and minuses, but I had little, if any, regrets in the decisions I made.
I am humbled and honored to have been able to work with everyone in New York City. In the days ahead and especially for those facing the “second surge,” please stay safe and know that our ICU community supports you.