Early in the coronavirus crisis, before New York shut down and the schools closed, when people still shared opinions about Marie Kondo and the timing of the Iowa caucuses, Elmhurst Hospital, in Queens, began rearranging its emergency room. The section for less acutely ill patients became a screening room for patients with symptoms of COVID-19. Within days, a new wall had been built. The critical-care area was doubled, then tripled. A triage tent soon went up outside. And the family room—where doctors and families can have difficult conversations in relative privacy—was turned into a place for the distribution of personal protective equipment, a transition from a “cold zone” to a “hot zone.” “You walk into your shift and are handed a bag with your P.P.E. for the day, like it’s your lunch box when you show up to school,” Hashem Zikry, an E.R. doctor, told me, adding, “It’s a little bit surreal. We all have perspective for a moment on how truly insane what’s going on is. That our life is picking up this P.P.E. and changing into it, and that everyone out there is so sick.”
At the beginning of a recent shift at Elmhurst, Zikry took over the care of a forty-five-year-old man who had a wife and four children. Although the man was on high levels of oxygen, he was short of breath. He had written out several paragraphs in Spanish specifying that he did not want to be intubated or resuscitated. “Normally, I don’t push back on that too much, because I think people don’t understand the futility of those efforts in most cases,” Zikry said. “I pushed back on him, though. Because he was only forty-five.” The man reiterated his wishes. “When he came in, he was well enough to speak in full sentences,” Zikry said. “Two hours later, when he was at the point where we would have intubated him, I asked him again.” Too breathless to speak, the patient shook his head; he was resolute. Zikry called the man’s wife, who said that she trusted her husband to decide. “It was a horrendous shift,” Zikry said. “So many people were dying.” The man was visibly in agony, as is every patient struggling for air. Zikry and other doctors tried to help him find positions that might let more air into his lungs. The man rolled and bucked; eventually, he was still. By the end of the shift, he was dead. Zikry called the wife again. She didn’t shout; she thanked him and the other doctors and nurses. “It was very hard to hear someone thank you for standing there and watching her husband die,” Zikry said. “I felt very helpless.”
hg0088Zikry has been working as a doctor for nine months. He is twenty-nine years old, an intern in the emergency-medicine residency program at Mount Sinai Hospital. As part of his training, he rotates through different hospitals and specialties. In late February, he began a six-week rotation in the E.R. at Elmhurst Hospital, a place he loves and describes as the soul of medicine. The neighborhood around the hospital is one of the most diverse on the planet. Nearby blocks are crowded with Thai noodle shops, Colombian bakeries, and groceries that sell lotus and taro root. The neighborhood, which has a large working-class immigrant population, was hit earlier and harder by the pandemic than most of the rest of the city. “It’s become very clear to me what a socioeconomic disease this is,” Zikry told me. “People hear that term ‘essential workers.’ Short-order cooks, doormen, cleaners, deli workers—that is the patient population here. Other people were at home, but my patients were still working. A few weeks ago, when they were told to socially isolate, they still had to go back to an apartment with ten other people. Now they are in our cardiac room dying.” Zikry, whom I have spoken to regularly in the past month, has extraordinary resilience and good humor; on this day, he sounded despondent. “After my shift, I went for a run in Central Park, and I see these two women out in, like, full hazmat suits, basically, and gloves, screaming at people to keep six feet away while they’re power walking. And I’m thinking, You know what, you’re not the ones who are at risk.”
Before Zikry went to medical school, he had been in an E.R. only once. When he was thirteen, he shut his front door on his left middle finger. There was so much blood that his mother almost fainted, and Zikry remembers going to the E.R. with his younger brother. An orthopedic surgeon said that there was nothing to be done—he would lose the finger. By then, his mom had arrived, “like a mother on a mission,” and she said, “My son is a pianist, don’t tell me there’s nothing to be done!” A plastic surgeon was brought in—Jess Ting, who had studied music at Juilliard. Zikry had never played piano in his life. He told Ting that his parents were the worst people in the world, and liars. (“I was very . . . hormonal.”) Zikry recalled, “Then Ting said to me—and he became my mentor, he’s the one who kept encouraging me to go to medical school over the years—‘Well, I’m here now, let’s see if I can help.’ ”
hg0088Zikry went to Hamilton College, where he studied English and ran cross-country, before going to Mount Sinai’s Icahn Medical School. He loves Jane Austen. He still reads before bed, and trains for and runs marathons—his favorite is Grandma’s Marathon, in Minnesota. Through the majority of the pandemic, Zikry worked an average of six days a week at Elmhurst. His shifts often lasted thirteen hours, an exhausting schedule that is typical for a first-year physician.
Even after New York’s schools were closed, on March 16th, many hospitals in the city were at the eerie stage of preparing and waiting for a surge in COVID patients. “I would say our E.R. looks, well, more orderly than usual,” Jolion McGreevy, who directs Mount Sinai Hospital’s E.R., told me, on March 18th. Elaine Rabin, the head of the hospital’s emergency-medicine residency program, recalled being an intern during 9/11, and said, “This is different from that. It very much feels like a tsunami is about to hit us.” But, for the time being, the patient volume at Sinai was down. The non-corona cases—the broken bones, the belly pains, even the chest pains—were not turning up in their usual numbers. (Telemedicine had off-loaded some of those patients, but people were also afraid of the hospital, as evidenced later in the dramatic increase of deaths at home.) Elmhurst Hospital, however, was already four people deep into its sick-call list for staffing. It had many COVID patients, but they were accompanied by the usual load of “normal” cases. “The drunk falls, the chest pains—those numbers have been inelastic here,” Zikry told me, in late March.
hg0088The P.P.E. bags that Elmhurst doctors received at the start of their shifts contained a papery yellow gown, blue gloves, a face shield, and an N95 mask. The mask had to suffice for a whole day, although as recently as February the C.D.C. recommended putting on a new one for each patient. An N95 mask fits the face more tightly than a regular surgical mask, and has a metal strip on top to hold it in place. “The bridge of my nose is bleeding from wearing it all day,” Zikry told me. “I tried to MacGyver it with a Band-Aid, but it’s not working.” The P.P.E. that E.R. doctors in New York have been wearing more closely resembles a poor man’s welding gear than the astronaut-like outfits seen in photos of medical workers in South Korea.