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Long after the god-awful New York City pandemic spring of 2020, Dr. Lindsay Lief would remember the excruciating morning the alternate universe came calling. Death was everywhere. It was April 3—a Friday, and one of the worst days at the height of the surge. The New York Times’ banner headline ran the width of the front page: “Unrivaled Job Losses Accelerate Across US.” Underneath, a travel map of the United States was mottled with coronavirus red.
At dawn, Lief rushed through the beige halls of the fifth floor of the billion-dollar Greenberg Pavilion at New York’s Weill Cornell Medical Center and pushed through the swinging doors of her ICU to find a message relayed from Steven Corwin, the president and CEO of NewYork-Presbyterian. Lief tried to process the gist of an e-mail sent to all the ICUs and their nursing supervisors: “Corwin wants to do video rounds with you later if you are around.”
Everything about that sentence had been unimaginable to her just weeks before. It was almost unheard of for the CEO of the hospital to reach out and down to critical-care teams; it was like—well, it was hard to think what it was like. The head of NASA asking to sit in on the weekly meeting of a high-school astronomy club? The boss of a Hollywood studio calling a theater in Fargo and asking to speak with the manager at a concession stand? Before the pandemic hit New York, Lief had only the faintest sense of Corwin’s background; he was at the helm of the hospital mother ship, far removed from patient care. Over the years, they had met briefly at hospital dinners when Lief was being handed yet another award, but her seat was definitely not at his table.
Lief is the director of the medical intensive care unit on 5 South, one of six ICUs at NewYork-Presbyterian/Weill Cornell. The original hospital was created by royal charter in 1771, and it is still considered the Emerald City of medical care in the great metropolis. She oversees a team of eleven critical-care physicians (the attendings) and dozens of highly trained nurses, respiratory therapists, pharmacists, X-ray techs, and housekeepers (“environmental services,” in hospital-speak), all of whose task is to help heal the sickest of the sick, to conjure miracles amid the breakdown of the body’s systems.
On a normal day, back before all of this, Lief would have awakened and taken her children from their home in Greenpoint (the northernmost neighborhood in Brooklyn) to school in Williamsburg, joining the throng of hip Brooklyn moms and clusters of heder boys in their yarmulkes and payos navigating for space on the sidewalks, before going to work. Now her normal days involved waking up when it was still dark, after far too little sleep. She was often the only person on the road as she crossed the deserted Queensboro Bridge. She would reach Weill Cornell at 6:00 a.m. The atmosphere inside the hospital was surreal. The marble entrance halls, once jammed with crowds of visitors, were desolate; the gift shop shuttered; the Au Bon Pain in the lobby, where in the old days she’d bought croissants for her team, completely dark. Lief could hear the deafening noise from the jerry-rigged HEPA filter systems a few floors away, and as she headed to her office she saw her colleagues and the scurrying shadows of doctors and nurses and respiratory therapists and accountants working as patient transporters rushing up and down the stairs wearing frayed N95s and plastic shields or scuba goggles retrieved from their childhood basements, not waiting for an elevator for fear of the very air they might breathe.
Video rounds? What could Steve Corwin possibly see on his iPad? He couldn’t see the fear on the faces of the nurses who worked in rooms where aerosolized droplets escaped from clogged ventilator tubes but who had to wear masks they had used for days, long after they should have been discarded and replaced, as there were no replacements. The iPad would show, but not show, Weill Cornell’s beloved emergency department doctor Chris Belardi struggling for his life on a vent after the first weeks of frontline duty. Same with two close friends who had contracted COVID at a party; the entertainer who had just had a birthday and seemed unlikely to make it to his next birthday; the critically ill twenty-eight-year-old months away from his wedding; and on and on and on. Lief had already decided that she didn’t care about the “no visitors during COVID” rule—she would allow the twenty-eight-year-old’s fiancée to be by his side when he died.
The truth was that you had to be there on 5 South—had to have been there—to understand what was going on, and yet Corwin, because of the hospital’s legal policies, was forced to resort to a brief FaceTime tour of the floor. Corwin felt caught between the fierce tug of his calling as a doctor and his responsibilities as head of the hospital. For years, he had been a cardiologist most at home in the ICU and had run ICUs at Columbia-Presbyterian.
In a blur, Lief heard Anthony Sabatino, her nurse manager, announce, “Lindsay, Steve wants to hear from you.”
And then there he was on her iPad, the head of the hospital speaking to her from his apartment a few blocks from the hospital, himself ordered into quarantine by the board of trustees, who had been worried about his health, since someone in the corporate office had tested positive.
Though few on 5 South knew it, for weeks Corwin had been on Zoom call after Zoom call, from dawn to midnight, trying to get new equipment, parts for broken machines, and, especially, masks—one million of them—battling with the state and FEMA and the White House and the suppliers they had long relied on.
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All night Corwin and his wife, Ellen, a former ICU nurse he’d met when he was a resident, listened to the endless sirens of the ambulances screaming up and down the FDR Drive. He would get updated on the number of admissions, intubations, and deaths and try to deal with the fact that at its lowest point, his hospital system—number one among New York City hospitals in the U.S. News & World Report ratings—was down to two days’ worth of the personal protective equipment (PPE) without which doctors, nurses, and staff could not function. The hospital had gone from one COVID patient on March 3 to twenty-five hundred on March 31, and the rate was increasing. He often closed his eyes as he tried to absorb it all, overwhelmed and exhausted.
“Lindsay,” Corwin said now. “What can I do for you? How can I be helpful?”
Lief suddenly heard herself sobbing. “Dr. Corwin, we are not okay,” she replied. “We are breaking down. I am desperately worried about my staff. We are the ones who are having to make the ethical decisions about beds and ventilators, and we are putting our nurses in danger.”
Corwin took it in. He let her cry. “Whatever you decide, you have my full backing and the backing of the hospital,” he said. He added some general reassurance, but mostly he just listened.
Bradley Hayward, one of 5 South’s critical-care attendings, interrupted Lief—a patient was coding; the tubes of yet another garbage ventilator from the state had clogged with the horrible COVID mucus that congealed as hard as old chewing gum.
End of video rounds for Lief; she was on the run again.
For a moment, her fury evaporated, erased by the immediate urgency, the snap of tunneled focus that made her such a brilliant ICU doctor. Lief felt strangely reassured—they were proceeding the best they could in wartime conditions; 5 South was on it.
But there were only so many machines that worked, and there were so, so many patients, some with better chances than others. Day after day, hour after hour, as scores of desperately ill people rushed to the hospital, there were often three or four patients who needed ventilators at the same time and, on several occasions, only one or two that seemed to be available. Yes, Lief and Hayward would be told, as would the doctors in the other ICUs and in the emergency department, we have more somewhere, in this storage area or auxiliary hospital. Lief would be told constantly: They are going to show up. But when and how? And how to keep someone alive until they did? And so the calls to hospital ethicists and the agony of the need for triage decisions out of corporate lines with no state-sanctioned crisis rules in place. What am I going to do, Lief thought, write in the chart that Corwin says it is okay for the patient to die in the ICU?
Later, reflecting on Corwin’s outreach, Lief thought that, despite his empathic tone, Corwin was saying something between the lines. Oh, we are getting the policy—that they should trust the credo of William Osler, by many measures the father of modern medicine, who’d preached the need for Olympian detachment: Sometimes you had to cut your losses and move on.
Osler, who’d practiced in the late nineteenth and early twentieth centuries, had revolutionized medical training by taking his students into the public wards. Treatment options were limited then, so his instructions both allocated resources and reinforced the power of the doctor by virtue of distance. Emotions would be seen as revealing uncertainty, and for their own good, patients had to think of their doctors as rational and certain. Lief, however, was of a generation that believed in the need for radical transparency. She had long since stopped caring if a patient’s family saw her break down and cry.
Looking at the computer screen, she saw that one hundred ventilators were set to arrive—a miracle—but then saw that sixty of them were broken. They were potentially usable, but refurbishing them—finding parts; testing them, fingers crossed—would result in an immeasurable delay. One hundred ventilators in Lief’s new reality actually meant forty. And because of the hastily drawn-up rules of engagement, they would likely go to all the other pop-up ICUs and the emergency departments, or EDs. So she was left with the hard facts: Under New York State law, if she instructed her attendings not to try to resuscitate COVID patients, she could be accused of murder.
Hayward told her, “It’s hard to say to the head of the hospital, ‘This is all very nice, but from a practical point of view, when I am called to court a year from now, do I say that you would support us? Where are you?’ What are we going to say when we fill out the forms about the reason of death? ‘Corwin said it was okay to not put the patient on a vent’? Is Corwin going to testify in court for you?”
Beyond the ethical and legal complications, the younger attendings were enraged that Corwin, once a “real doctor,” was not walking the halls in his PPE as they were but was instead at home, with all the comforts a large New York apartment provided. That he might have been sleepless too, that he might have been working frantically to help them in the ways that he could—well, when you were falling asleep in your chair or at a small table in a crowded break room, the idea of Corwin in a big bed with clean sheets seemed like a betrayal.
On 5 South, they could not see the effort being put in by Corwin and the hospital’s chief operating officer, Laura Forese. Her responsibilities were endless: How would she get enough equipment for the hospital when the governor insisted eighteen thousand ventilators would be needed by the state that very week? How would the hospital get thirty-seven thousand meals delivered to its employees four times a day? Forese and Corwin had to come up with solutions. Corwin understood that the cool blond former pediatric orthopedic surgeon—the only female resident in her class—hid the strain she was under with an imperiousness that could alienate staff. He considered it unfair that, even now, the few women running corporations in America were judged by outdated boys’ club standards; it was as if, to be allowed to succeed, they had to hide their at times fierce executive command.
Forese presided over her daily hospital briefings with anchorwoman detachment, a tone that, as the crisis grew, struck many as at odds with their reality. The more pressure that was on her, the more she tried to control every aspect of corporate communication. At the height of the surge, the CEO of one of the city’s most prestigious medical centers, Mount Sinai Hospital, decamped for Palm Beach, a story that broke in the tabloids and sent a frisson of fear through NewYork-Presbyterian. Was their corporate leadership, many wondered, similarly out of touch?
Lief’s own view was more nuanced: This is our job as well as our calling. Wasn’t that the whole point of spending years and years studying and training and going without sleep so you could study and train some more? Could Corwin help? Yes, he could, and yes, he should—the ice beneath 5 South was cracking. But when it seemed like your system was buckling, when it seemed clear that if the plague wasn’t halted in your city, the world itself would be ravaged, you just heeded the call as best you could.
Indeed, the day before Corwin tried to buck up Lief’s spirits, the son-in-law of the president of the United States, Jared Kushner, was busy infuriating every governor and hospital head in America by proclaiming that “the notion of the federal stockpile was, it’s supposed to be our stockpile, it’s not supposed to be the states’ stockpiles that they then use.” On a conference call later that week, Corwin tried to explain to Kushner how dire the situation was inside NewYork-Presbyterian, which provided 20 percent of all New York City’s hospital care. “Don’t give me anecdotes,” Kushner snapped at Corwin. “I just want facts.” Clearly revved up by his father-in-law’s public accusation that the New York hospitals “were selling masks out the back door,” Kushner challenged Corwin: “How can you use that many masks?”
“Are you kidding?” Corwin snapped back. “Do you have any idea how bad this is? Why don’t you come and see? No one is selling masks out the back door of my place. And the board members are not jumping the line to get into the ICU.”
Most of the board had shunned Donald Trump and his son-in-law for years, even before Trump became president, but now, however galling, they were in desperate need. That was the end of the outburst; Corwin knew the best way to deal with the arrogance of Jared Kushner was to fall silent, to try to win the match by losing the point.
Few who heard the story found it remarkable that Corwin could easily contact Kushner or, for that matter, the president; New York’s best nonprofit hospitals, with budgets in the billions and boards made up of Wall Street titans and the heads of tech and media companies, were implicitly, if not explicitly, linked to those in power. Corwin was paid many millions of dollars each year for not only his stellar managerial skills but also his ability to leverage the Favor Bank in New York City, the hardball capital of the world from the days of Tammany Hall to the halls of modern medicine.
Lief knew none of this—there hadn’t been even a moment to step back and wonder what was going on outside her wards. For her, the outside world had vanished; the only evidence of its existence was what seemed like a ceaseless avalanche of dying patients, all of them desperately hoping the Amazing Place would live up to its nickname.
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Begin here, on Manhattan’s Upper East Side, with the nearby East River and its parade of tugs and barges. Its filigree of streets are lined with town houses and apartment buildings, its avenues are clotted with restaurants, grocery stores, and boutiques. This is the neighborhood where today’s NewYork-Presbyterian/Weill Cornell Medical Center—the behemoth originally organized for the elite of the city and known for more than two centuries as New York Hospital—has resided for almost a hundred years. Its facilities and researchers have drawn presidents, prime ministers, and luminaries, from Jacqueline Kennedy Onassis to the shah of Iran, all seeking what has long been considered the best care in New York. It was, for many in the city, the cornerstone of NewYork-Presbyterian, created when New York Hospital and Presbyterian Hospital merged—managerially but not geographically—forming a sprawling, nine-billion-dollar ten-hospital empire with each affiliated Ivy League institution keeping its hallowed medical school as a separate fiefdom; the acquisition of Columbia gave NewYork-Presbyterian its deep-bench research cachet. (NewYork-Presbyterian is partnered with the medical schools of Columbia and Cornell, two Ivy League institutions, both located in New York State.) Some New Yorkers simply refer to the Upper East Side cornerstone as Cornell or Weill Cornell and to the uptown hospital renowned for its research as Columbia. The merger had not changed old habits.
If you look down from a helicopter flying over Manhattan, you can see the span of the hospital empire from south to north. NewYork-Presbyterian brackets Manhattan, from the Lower Manhattan campus on William Street near Chinatown all the way north to the Allen at 220th Street; it extends to Queens, Brooklyn, and three hospitals in Westchester. The ten hospital campuses require a team of over two thousand employees to maintain the hundreds of acres of real estate. All of those acres—as well as three million square feet of interiors.
The Lower Manhattan campus serves much of the Asian American population in a neighborhood near Chinatown that was badly damaged by the 9/11 terrorist attacks. To the north, on the East River close to Sixty-Eighth Street, is NewYork-Presbyterian/Weill Cornell and the medical school, in the same location since the 1930s. Hopscotch one hundred blocks north and a bit west and you are at the sprawl of NewYork-Presbyterian/Columbia University Irving Medical Center and its medical school, called “P and S.” Officially, it’s named Vagelos College of Physicians and Surgeons, an impossible mouthful of a name many in the city choose to ignore. That campus includes the Morgan Stanley Children’s Hospital and the Sloane Hospital for Women.
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At Weill Cornell, in the Edwardian era, when it was still called New York Hospital, there were Persian carpets in the private rooms and daily deliveries of flowers. There was an in-house hair salon, a barber, and a cleaner—some New Yorkers even arranged to live there full-time, as paying guests. (No longer, although the view of the river from the VIP suites remains splendid.) Well endowed by local billionaires, NewYork-Presbyterian is a nonprofit system, garnering billions of dollars in tax benefits. In exchange for its nonprofit status, the system does not turn away anyone—not asylum seekers, or the undocumented, or the homeless. All through the city, there are bus-stop ads with crimson billboards announcing THE AMAZING PLACE: #1 IN NEW YORK CITY. But the hospital isn’t just in New York City; it is New York City. Walk into the clamor of the crowd in the entry pavilion off East Sixty-Eighth Street and hear a babble of Hindi and Urdu, Farsi and Mandarin, Spanish and Russian. There are often knots of families sitting on low benches talking after seeing loved ones or waiting for taxis and Ubers to take them back to the land of the well. Standing in the entrance, they look toward Rockefeller University, hidden behind high walls. For decades, Nobel laureates and postdocs have strolled through its Philosophers Garden and around its sixteen private acres, landmark Founder’s Hall, and iconic geodesic dome. It was the first biomedical research center in America, funded by a Rockefeller who had lost a grandchild to scarlet fever at the turn of the century; the first to identify a virus as the cause of the Spanish flu. It was a true enclave of scientific academic privilege, and research doctors from the hospital would dash back and forth to its labs, but it was otherwise closed to the world outside its gates.
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At Weill Cornell, Lief’s small, windowless office is on the fifth floor, just off a corridor at the entrance of 5 South, the medical intensive care unit. There are twenty spacious beige patient rooms, glassed in for germ control, with state-of-the-art equipment. The cubicles circle a long island of desks for residents, nurses, respiratory therapists, and physician assistants. The building was constructed in the 1980s in a brutalist style, and many visitors wonder how the attendings put up with the tiny, airless shared cubicles, shoebox conference rooms, and cramped lounge, where, during the day, research scientists struggle to prop their laptops on a wobbly glass table, and those treating patients catch quick naps if they were on call the previous night. Not that long ago, they had battled to save the call room, where there were actual beds for the on-call physicians. That one they’d lost.
Copyright © 2022 by Marie Brenner
