When Sarah Levine, a senior staff nurse at NYU’s Langone Hospital, arrived on March 23 at the Kimmel Pavilion’s 16th floor — a space usually dedicated to patients requiring neurological attention — a lot had changed.
Two days earlier the floor was “converted into a COVID-ICU, and on March 22 we got our first patient,” said the Levine, who grew up in Squirrel Hill.
During the prior week, New York City’s historically heavily populated streets were vacant. Images of a deserted Times Square or shuttered Radio City Music Hall circulated online, along with information about a rising pandemic. On March 15, the NYC Health Department reported 1,028 new cases of COVID-19. A day later, the office counted 2,116. By March 20, the tally was 3,985.
When Levine began her shift on March 23, the patients no longer included those hospitalized due to strokes, brain surgeries or spinal procedures. Instead, they were oxygen depleted patients being attended to by a corps of advanced medical professionals.
“I saw all the providers literally just standing in a circle with their iPhones out looking on Google and reading up on the news about Italy,” said Levine, 29. “They were just bouncing ideas off one another, like, ‘OK, well they tried this. What about this? Oh no, no, that didn’t work here so let’s try that.’ It was just like a process of elimination. And, yeah, it was just wild. It was really wild.”
Prior to that night, the Kimmel Pavilion’s 16th floor was a specialized territory where Levine and colleagues tended to patients’ lumbar drains or spoke with individuals whose loved ones required neurological care. In mid-March, Levine was told the floor’s patients were being relocated and that her responsibilities were changing.
“The first time I walked in I honestly didn’t know what to expect,” she said.
It wasn’t as though Levine was new to nursing. She received her bachelor’s degree from Robert Morris University in 2015 and took a job at NYU Langone shortly thereafter, but her professional focus was not pulmonary. She was a neuro-ICU nurse and had grown familiar with the work.
“Usually, when you get assigned to a patient, the doctor gives you all these orders and a plan of care. You see how the night’s going to go,” she said. During that first shift under the new paradigm, it was difficult to grasp that “that wasn’t happening,” she said. “You look up to all these advanced medical practice professionals, and if they don’t have the answer who does?”
The situation was unlike any Levine had seen. “As a nurse, you’re like, ‘OK, what do I need to do?’ And you kind of don’t know. So you only do what you do know, which is hanging the next medication, you look at the patient’s vital signs and you make sure they’re OK. I think that’s what everybody was trying to do, just doing what we know and just going from there.”
In the weeks that followed there were “successful extubations, and we were happy about that, but we still lost a lot of people,” Levine said.
As of May 8, 14,162 individuals had died due to COVID-19 in New York City, according to the city’s health department.
New cases, hospitalizations and deaths are declining, but the period has taken its toll, said Levine.
Beforehand, conversations about morbidity “were more expected from the family,” she said. “Either the patient was transitioning into comfort care or transitioning” into code status. “As many family members that wanted to were able to come up and be with the patient. It was more of a healing environment.”
Addressing mortality in a COVID-19 setting “has been really tough,” said Levine. “I think the family members just aren’t expecting this. They don’t know what to do.”
During the past two months, Levine’s end-of-life discussions have typically occurred after a doctor has called and asked the patient’s loved ones to come to the hospital.
When the family arrives, they “see the nurse first, they don’t see the doctor, and they ask me, ‘Well, how is he really doing? What does it really mean?’ And I just don’t know what to say, because it’s just bad. I don’t want to say that usually the doctor is calling you because your loved one is going to die in an hour. So I try to say, ‘He probably called you just because the medications that we’ve been using are maxed out. We’re doing what we can, but the doctor wanted you to be here just in case something happened, and we wanted you to talk with your loved one in case he passes. We didn’t want you not to see him, or not to be able to say goodbye.’”
With COVID-19, the difficulty is that many family members “still don’t realize” what’s happening, she said. “It’s different from when patients pass in the neuro-ICU. I don’t know what it is, but family members seem to be more aggressive with end-of-life care with COVID patients. They want to do a lot more. They don’t feel like it was these patients’ time, like it came too soon, like one day they were fine and the next day they’re dying. So it’s just very difficult to explain to them what is actually happening.”
Levine works three 12-hour night shifts per week. To get to work, the Hillel Academy of Pittsburgh graduate takes the subway from Washington Heights. In April, the commute was easier, as Hertz provided free vehicle rentals to New York City health care workers.
Once the Hertz program ended on April 30, Levine returned to her regular mode of travel, “which was actually really scary,” she said. “It was just me, by myself, which was good. It was nice to see nobody on the subway.”
But there was something unnerving, she said, about coming to “the Times Square stop and it’s completely empty.”
In recent days, there have been more “people on the subway and I want to tell them to go home, stay home, it’s not over yet, but people are getting antsy,” she said.
Levine stays grounded by phoning her family frequently.
“I used to call them maybe once a week,” she said. “I call them every day now. I speak to my sister (in Israel) a lot. I Zoom with my nieces and nephews as much as I can. I try to schedule FaceTiming with my friends, and I work out when I can. I’m just doing a lot of self-care.”
Levine said she understands that quarantining is difficult, especially in a city like New York where many people lack large residential spaces like those in Pittsburgh, but it’s important to practice social distancing.
The recommendations are challenging, but if two months of caring for 18- to 90-year-olds, some of whom were otherwise healthy prior to COVID-19, has proven anything, it’s that perseverance and responsibility are the ways forward, she explained.
“We still have people coming in. COVID is still here. We still don’t know exactly the pathophysiology of it all,” said Levine. “People think that they’re untouchable for whatever reason, and they can’t get it, but everybody can get it. We just need to hang in there. Everybody’s in the same boat.” PJC
Adam Reinherz can be reached at email@example.com.