A6| Wednesday, April 8, 2020 ** THE WALL STREET JOURNAL.
THE CORONAVIRUS PANDEMIC
for the devices, a spokes-
woman said Tuesday. The
agency said it would allow
emergency use if companies
applied for it. A Philips
spokesman declined to say if
the company had done so.
“This is an emergency,” Dr.
Jarrett said Monday. “We
need to do what we consider
safe to keep patients alive.”Nurse needs
Rosemarie Robinson, a
nurse, arrived last Monday at
Long Island Jewish Forest
Hills and wondered how much
worse it would be. She man-
ages the nursing staff in in-
tensive care and worried
about having enough help.
That day, close to 50 inten-
sive-care beds on two floors
were nearly full with patients
on ventilators and tethered to
six or more intravenous lines.
Ms. Robinson needed enough
nurses to check IVs, oxygen
levels and blood pressure. Pa-
tients also needed to be
turned to help them breathe, a
job that requires as many as
eight people.
Some Forest Hills nurses
couldn’t work that day be-
cause their exposure to the vi-
rus forced them into quaran-
tine. Others were already
working 16-hour shifts. Nurses
from Northwell hospitals ar-
rived to help, including a team
from pediatric intensive care,
but they needed training.
There were a few new nurses
from a temp agency.
Every wave of arrivals left
Ms. Robinson at risk of being
understaffed. The hospital was
transferring patients to help
make space. Ms. Robinson
identified patients able to be
moved, knowing empty beds
would quickly fill.
Shegotatextfromthe
hospital’s chief nurse execu-
tive: “Where are you?” Her
boss said the hospital needed
to open a third ICU. Ms. Rob-
inson wondered how that was
going to be possible.
Three days later, the hospi-
tal opened a 12-bed intensive-
care unit. Nurses from Califor-nia, Minnesota and Florida
arrived to work there.
“I have never seen quite
this many of the worst of the
worst,” said Helen Bloch, an
emergency room doctor of 35
years. Last Tuesday, she
scoured medical records and
vital signs to evaluate 40 pa-
tients stable enough to safely
transfer from Long Island
Jewish Forest Hills to other
hospitals. Over the previous
three days, the hospital had to
relocate more than 90.
It was Dr. Bloch’s first day
at the Northwell Health Cen-
ter for Emergency Medical
Services in Syosset, N.Y. Her
immediate task was to comb
through Forest Hills’ digital
medical records, evaluating
dozens of critically ill patients
for anyone who could be
safely moved.
Ambulances had over three
days moved an entire hospi-
tal’s worth of patients from
Forest Hills and a second hos-
pital to make room for more.too, was afraid of dying.
While poring over digital
medical records, Dr. Bloch ap-
proved moving one patient.
Two hours later, the patient’s
oxygen levels and vital signs
dropped. Even a 15-minute
drive was too risky. She can-
celed the transfer.
Then word came: Please
find another patient to trans-
fer.One win, please
Adey Tsegaye got to work
Thursday morning at Long Is-
land Jewish New Hyde Park.
Before she reached the eleva-
tor, the loudspeaker blared a
code for a patient in distress,
summoning doctors at the
Nassau County, N.Y., hospital.
Before the pandemic, hos-
pital loudspeakers blared such
codes around 100 times a
month. Now, there are more
than 100 a week.
Dr. Tsegaye met with the
doctor who had worked over-
night to review details about
each patient. The unit had one
empty bed left. The other 21
were occupied by patients on
ventilators.
One patient stood out. Doc-
tors had put a woman back on
a ventilator after taking her
off the device two days ear-
lier. So many patients had
made little progress, or had
gotten worse. Our one win,
and we slid all the way back,
she thought.
Dr. Tsegaye went to see
each patient with a team of
doctors and nurses, advance
care practitioners and a phar-
macist. As she sat later that
day, recording information
about her patients, her phone
buzzed with a text from an-
other doctor: He believed a
patient was well enough to
get off a ventilator.
Dr. Tsegaye ran through the
unit. Two doctors and a nurse
waited for her at the patient’s
bed. The doctors found in a
test given daily to every venti-
lated patient that the man
could breathe on his own. Dr.
Tsegaye had seen only one
other patient in three weekspass the test.
She peppered the doctors
and nurse with questions. “I’m
telling you, he’s going to be
OK,” the nurse said. “We’ve
gottotry.”
“Let’s do it,” Dr. Tsegaye
said. Another doctor removed
the breathing tube from the
patient’s throat. Dr. Tsegaye
told the patient where he was
and what had happened. Did
he understand? She asked.
He responded “OK,” and
gave a weak cough.
The doctors watched his
breath and oxygen levels. Min-
utes passed. Both remained
stable. Dr. Tsegaye walked
back to her unit, hopeful of a
win.Sudden goodbye
Physician Darryl Adler
ended a 12-hour shift Satur-
day at Long Island Jewish Val-
ley Stream at the bedside of
yet another patient whose
lungs had given out and
needed a ventilator. She was
89 years old.
In a short span, he had
seen many patients die on a
ventilator, sedated and sepa-
rated from family. Five had
died on Friday, five the day
before; four on Wednesday;
two on Tuesday; five Monday;
three on Sunday.
Dr. Adler asked the medical
team at the patient’s bedside
to give him a minute to call
the woman’s family. He told
Nicole Mitchell that her
mother, Victoria Gourdine,
very likely wouldn’t survive,
even with a ventilator.
Ms. Gourdine lived near her
daughter, but was indepen-
dent. She drove to the store
and sang in the church choir.
In August, Ms. Gourdine had
lost her husband of 50 years.
Ms. Mitchell tried to keep
her distance during the pan-
demic, and they mostly talked
by phone. She went to see her
mother Thursday. Her
mother’s breathing was heavy,
but Ms. Gourdine refused to
go to the hospital.
Ms. Mitchell returned Fri-
day and called the ambulance.
Her mother, who always
dressed well, left for the hos-
pital wearing her jewelry.
On Saturday, Ms. Mitchell
learned her mother’s health
had worsened. A nurse used
her cellphone so Ms.
Gourdine, her daughter and
granddaughter could video
chat.
“I am going to see you
soon,” Ms. Gourdine said.
“I love you,” Ms. Mitchell
and her daughter said.
The hospital later called to
say Ms. Gourdine might need
a ventilator and that Ms.
Mitchell should prepare to
make a decision to use it or to
just keep her mother comfort-
able.
Then Dr. Adler called. Your
mother needs breathing sup-
port, he told Ms. Mitchell, and
she isn’t likely to survive. We
can keep her comfortable, he
said. Please just keep her
comfortable, Ms. Mitchell
said.
Dr. Adler relayed Ms.
Mitchell’s wishes to the
nurses and headed off to the
emergency room.
Ms. Mitchell stepped out-
side to call a friend. “It’s too
soon,” she said. “It’s too
soon.” Her mother would be
in a better place, she said, but
that didn’t make the decision
easier. Ms. Gourdine died
hours later.Dr. Rafael Barrera at Northwell Health's Long Island Jewish Medical Center. Below, Dr. Darryl Adler and critical-care nurse practitioner ChristinaCalgano.LEE WEISSMAN/NORTHWELL HEALTHDARRYL ADLERNorthwell Health employees erect a mobile hospital tent outside North Shore University Hospital.LEE WEISSMAN/NORTHWELL HEALTHWhile they worked, Ms.
Pollard’s cellphone rang from
one of the intensive-care
units. “I need one more,” the
caller said. No one ferrying
the finished ventilators had
returned. “I got you,” Ms. Pol-
lard said. She grabbed one of
the new ventilators and ran
for the elevator.
As the elevator doors
opened on the fifth floor, a
waiting respiratory therapist
took the machine from Ms.
Pollard’s hands. “Thank you,”
the therapist called out as she
ran off.
When Ms. Pollard returned
to assemble the remaining
ventilators, she repeated a
phrase, as she had many times
over the past days: “God is
good all the time. And all the
time God is good.”
At Northwell Health hospi-
tals in and around Queens,
N.Y., last week, the surge was
felt by doctors, nurses and
others disoriented by the
speed and scale at which the
pandemic became their sole,
urgent focus.
Theytriedtostayastep
ahead, tearful over deaths
they couldn’t prevent and
fearing for their own health.
By Monday afternoon, the in-
tensive-care units at three
Northwell hospitals had met
or surpassed full occupancy.
Some signs point to New
York reaching a plateau in the
pandemic. The number of cor-
onavirus patients needing in-
tensive care and placed on
ventilators dropped Monday.
“This is a projection,” Gov.
Andrew Cuomo said Tuesday
of a possible plateau.
This account from three
hospitals in the Northwell
Health system in Queens and
neighboring Nassau County,
N.Y., is based on interviews
with doctors, nurses and fam-
ily members over the past
seven days.
Breathing room
Dr. Hugh Cassiere said he
jolted awake on March 25
with the idea of modifying
breathing machines using 3-D
printed parts to convert them
to ventilators.
He and his colleague Stan-
ley John refined the idea for
the machines they pulled from
storage the next day, confirm-
ing that the devices came with
software to use them as venti-
lators. Dr. Cassiere thought
the emergency use would help
relieve the ventilator short-
age, but he didn’t know if doc-
tors would use the devices.
The U.S. Food and Drug Ad-
ministration approved such
use of the devices, manufac-
tured by Philips NV, but only
for less-critical patients, not
those with the worst symp-
toms of coronavirus disease.
The breathing machines—typ-
ically used as bi-level positive
airway pressure devices,
known as BiPAPs—are for pa-
tients who can still breathe on
their own. They work as a
face mask to deliver oxygen.
While acutely ill coronavi-
rus patients couldn’t use
them, Dr. Cassiere and Mr.
John believed some patients
could be switched to the
Philips device.
The two men worked with a
biomedical engineer to pro-
duce 3-D printed parts that
connected throat tubes to the
machines. Soon, at least 50
less-severely ill patients were
using them.
Northwell wanted to see if
the modified breathing ma-
chines could be used for pa-
tients who couldn’t breathe on
their own. The wife of a venti-
lated patient who wasn’t ex-
pected to survive agreed to
try the device on her husband,
before his life support was re-
moved. It worked.
Mark Jarrett, a doctor and
Northwell Health system’s
quality chief, announced on
April 1 the decision to expand
use of the Philips devices,
which also were modified to
prevent spread of the virus
into the air. He acknowledged
it could be used in an emer-
gency for coronavirus pa-
tients.
Within three days, doctors
at the Northwell hospitals had
used the machines for 70 cor-
onavirus patients and another
18 patients without the dis-
ease. That helped to limit ven-
tilator use at its 23 hospitals.
The FDA hasn’t issued an
emergency-use authorization
ContinuedfromPageOne
City Feels
Full Force
Of Crisis
Across the room from Dr.
Bloch, monitors flashed 911
calls and a digital map tracked
the locations of about 70 am-
bulances.
Emergency medical dis-
patcher Kelly Walters fielded
a call for a man who had been
to a hospital earlier in theweek and tested positive for
coronavirus. “We are sending
the paramedics to help you
now,” she said.
Dr. Bloch had worked most
of March in the emergency
room of Long Island Jewish
Medical Center in New Hyde
Park, and she was drained. So
many patients had died. She,A doctor was jolted
awake with an idea
to use 3D parts to
make ventilators.