Battle-tested

Dr. Chris Sossou, a third-year internal medicine resident at Newark Beth Israel Medical Center, hadn’t seen his wife in three weeks. He had 30 seriously ill COVID-19 patients to treat in his unit, and his wife was working in a labor and delivery ward in Brooklyn, where they live. They decided to live apart because of his high risk of contracting the virus, and he wasn’t sure when they would reunite.

“She has to continue to work and I have to continue to work,” he said. “If we have good health, we’ll see each other the rest of our lives, so it will be OK.”

At this point, New York City was the epicenter of the COVID-19 pandemic, with 1,400 deaths as of the beginning of April. Experts don’t expect a peak in the cases in New York until the end of April. The Gates Foundation projects 16,000 deaths in New York—which would outstrip the number of deaths from Ebola in the West Africa outbreak in 2014.

Sossou on this day celebrated the discharge of one COVID-19 patient from his unit, but the others weren’t doing well. He has had colleagues stricken with the novel coronavirus in the ICU, and he expects more healthcare workers will fall ill in coming weeks.

“If they get sicker, who will take care of the sick?” he said. “The entire hospital is being overrun with patients who are critically ill. … Most of our supervising physicians have never lived through anything like this before.”

Sossou has. Growing up in Liberia in the midst of a civil war, and then spending part of his childhood in a refugee camp in the Ivory Coast, he experienced cholera and malaria outbreaks in healthcare systems without the resources to respond. He and others—like the Samaritan’s Purse doctors working in Central Park with years of experience fighting viruses in places with limited resources—are huge assets to a country experiencing an overwhelming pandemic, widespread medical shortages, and an incoming wave of suffering and grief.

AS NEW YORK HOSPITALS have barred visitors to limit virus spread, Sossou can identify with patients left alone to die. When he was a teenager living in a refugee camp, Sossou contracted cholera and stayed in a tent with other kids whom doctors determined wouldn’t make it. They decided not to give him IV fluid, but reserve it for stronger patients. In the “death tent,” as he called it, a friend died next to him. Somehow he became stronger and stopped having diarrhea, even though he only remembers having unsanitary water to drink.

“A miracle, I guess,” he said. Doctors transferred him to the “survival tent,” and he was able to get treatment. For seriously ill COVID-19 patients now who aren’t allowed to have visitors, isolated like he was, Sossou spends part of his day calling family members to keep them updated on their loved ones’ medical status.

Now Sossou thinks about that kind of rationing coming to U.S. hospitals, where doctors would have to determine whether someone is too sick to get a ventilator. He’s friends with the ethics chair at his hospital, and this week they discussed how they hoped their hospital wouldn’t reach the point where they have to make such decisions. But New York area hospitals are quickly burning through ventilators, and hospitals nationwide are concerned about a shortage in drugs to do intubation.

“These are not easy decisions and they’re very difficult for people who have never had to make them before,” said Dr. David Stevens, who worked for years at Tenwek Hospital, a rural mission hospital in Kenya. Doctors at Tenwek regularly had to make decisions about limited resources—which babies would get an incubator, or who would get oxygen.

Stevens remembered one night that several children died in the pediatrics ward at Tenwek, and one of the doctors burst into tears over their limitations. Stevens told the crying doctor that more children would die without the doctors, so the doctor needed to stay healthy and avoid working 24/7. Stevens advises doctors in such situations: Ration yourself, ration your equipment, but also don’t ever be satisfied with a rationing scenario. Find more resources for patients. Get input from others for decisions on scarce resources, and document how you make decisions in order to be transparent.

“As competent as we are, as excellent as we are with our craft and profession, we cannot meet every need that is out there, and God comes alongside,” said Stevens, who went on to serve as the longtime CEO of the Christian Medical & Dental Associations. “In the midst of this coronavirus epidemic, Christ is walking down the wards with healthcare professionals.”

In the meantime Sossou, working shifts six days a week from 6 a.m. to 9 p.m., is being creative in the face of shortages. He microwaves his N-95 mask every night to disinfect it and uses it for a full week before getting a new one.

Having faced worse situations in his childhood, Sossou approaches the virus with a calm.

“I’m not afraid of dying,” he said. “Even if I’m dead today, if God planned for me to come this early, then it is His plan, and I’m pleased with it. Most of the time we don’t understand His plan for us and we think it’s irrational, but that’s His plan. If I don’t understand, when I get to Him we’ll talk about it. But I’m not afraid.”

AS WE TALKED, New York’s nightly 7 p.m. cheer for healthcare workers went up in the background: people banging pans out their windows and hollering their thanks. In Central Park, New Yorkers lined up on the crest of a grassy hill overlooking the recently opened Samaritan’s Purse field hospital, clapped, and cheered.

Mt. Sinai had requested the Christian humanitarian group’s help when its hospital system was overwhelmed, and on April 1, Samaritan’s Purse (SP) doctors were busy treating their first seriously ill COVID-19 patients in the tents. SP leaders were already in discussions with Mt. Sinai about the possibility of setting up an additional field hospital to handle overflow.

SP brought more than beds and supplies to Manhattan. It brought experience from limited resource settings. SP’s Dr. Elliott Tenpenny, who is overseeing the Central Park field hospital, served as chief resident in emergency medicine at the Mayo Clinic and worked for years in the Democratic Republic of Congo, including during the recent Ebola outbreak.

The first day the field hospital had patients from Mt. Sinai, Tenpenny put his head together with SP’s Dr. Lance Plyler, who oversaw Ebola treatment in Liberia. At one point in the 2014 outbreak, Plyler had to make an agonizing decision: who between two sick medical staffers would get the one course of a limited experimental drug to treat Ebola. Plyler and Tenpenny know shortages, and they were working to make sure they had the right supplies and staff in place as patients were arriving in ambulances, pulling in from Fifth Avenue.

The design of the COVID-only hospital, which went from a grassy field to a complex with a functioning intensive care unit in 72 hours, comes from SP’s experience working in war zones and in epidemics. The complex has an Ebola-inspired water tank filled with chlorinated water that pumps into sinks around the hospital for decontamination. Staff built wooden troughs where they can push supplies with a cue stick from the cold “safe” zone through to the hot zone, which they presume to be contaminated with the virus and where everyone must wear full personal protective equipment. Mt. Sinai staff liked the trough design.

According to SP head of international relief Ken Isaacs, Spain and Canada had requested another one of the field hospitals, but he said, “our shelves are empty. … [W]e want to do more, but we’re maxed out.” Many SP staff members are stuck in countries around the world with travel restrictions, and other vetted medical personnel are already responding to the virus in their own communities.

Isaacs, at devotions outside in Central Park the morning before patients arrived, talked to staff about the possibility that some of them might get sick, or some might die. “They trust the Lord. They’re smart. … These people have put their lives on the lines, in cholera and cyclones and earthquakes.” He thinks New York overall, though, isn’t prepared for the loss that’s coming: “The city is going to be shocked.”

Across town, ICU nurse K.J. Rackley was reporting for her night shift at one of the city’s top hospitals, in an ICU that was full with 21 COVID-19 patients. Two of those seriously sick patients were top doctors from the hospital. (WORLD is withholding the name of the hospital due to media restrictions on staff). The hospital was one of the earliest to stop elective surgeries, a decision that cost the hospital financially but allowed it to be one of the better-prepared hospitals in the city. The hospital converted almost all of its operating rooms to ICUs for virus patients.

Rackley became a nurse because she hoped to serve overseas in resource-limited places, but she hadn’t served in such a setting, until now. “People get frustrated about simple things being available to us, because we’re used to having everything we need right away,” she said. “I have been loving this in a weird way, because it feels like a taste of what I want to do, having to be creative, having to come up with other things that can be used for something else. That spurs me on.”

She’s also found it to be an opportunity to encourage her co-workers. During her night shift, her church sent pizza for the staff. She was happy to be able to tell her co-workers that her church cared about them and was praying for them.

In Staten Island, Dr. Janet Kim of Beacon Christian Community Health Center was checking in on patients with the virus (Beacon is one of the few outpatient clinics offering COVID-19 testing) as well as the clinic’s usual patients with hypertension or pregnancies. Most of her telemedicine visits now are with people who have COVID-19 symptoms.

The clinic works in an ethnically diverse, lower-income community, and is helping local hospitals overloaded with patients. Kim thought back to 9/11, when she was in medical school in the city and her husband was working as a doctor. In that stressful moment, some people turned to God, but she noticed a lot of others became “very cynical and hardened.” She worries that might happen now among New York medical staff, faced with the shock of having patients they can’t help.

“They can’t do anything because there’s no treatment, no intervention that’s been proven to work. They’ve risked everything including their own life,” she said. “If you don’t go into that with the right perspective, it’s going to make you very bitter. … I pray that people will see that there is still a good God above all this.”