On the night of March 30, just before 7 p.m., Dr. Ray Lorenzoni put on his face mask, walked across the street from the Bronx apartment he shares with his wife and started his shift at the Children's Hospital at Montefiore Medical Center.
Lorenzoni, 35, is in his second year of a pediatric cardiology fellowship at the hospital. But this night, the patients would be different: It was his first shift treating adult coronavirus patients — the first adults he's treated in the hospital since medical school six years before.
"Coming into the hospital, it was a little bit unreal," he says. "The whole floor was filled with adult patients."
By then, COVID-19 cases systemwide at Montefiore Medical Center had gone from just two cases a little over two weeks earlier to more than 700. In response, Montefiore transformed part of the children's hospital into a 40-bed adult COVID unit. All around the city, other hospitals were making similar adjustments. Medical students graduated early. Operating rooms were converted into ICUs. A field hospital went up in Central Park.
But the surge in New York City has done much more than simply rearrange space and upend protocol. More than 15,000 people have died of COVID-19 there, and that enormous toll will profoundly impact the city's tens of thousands of health care workers for years to come. Lorenzoni is one of them.
A little over a month ago, Lorenzoni answered a request from NPR for hospital workers to describe what work was like at the epicenter of the crisis. Lorenzoni began recording his reflections for NPR after his shifts, sitting at the desk in his bedroom, speaking into his iPhone in a slow, measured voice.
Just a few weeks earlier, Lorenzoni had watched — along with many other Americans — how the Italian medical system had been brought to its knees. It seemed likely it was only a matter of when, not if, the coronavirus would arrive in the U.S. And of course, by then, it already had.
"I knew I could be involved because of what happened in Italy," Lorenzoni says, and adds, "a pediatric physician needing to take care of critical adult patients is unheard of."
Still, he was surprised he was recruited so early.
"They filled us up pretty quickly and the patients were very sick. I remember in the first couple shifts we were putting breathing tubes in patients on a floor that doesn't usually do that," he says.
Treating adults hit him hard, he says. He's used to working with kids.
"Pediatrics is a career where most of your patients get better," he says. "But these were very with-it adults who were scared. They knew what the risk was."
It felt important to him, he says, to be honest about what was happening, even when the news wasn't good.
"One of my main mantras is to sit down with somebody. And that was very tough in this environment because our protective equipment didn't surround us," he says. "So we were discouraged from sitting down on the bed next to a patient to have a deep discussion or sitting down in a chair and being at eye level with the patient."
Instead, he says he would do his best to give his patient a sense of comfort by leaning against the wall, trying not to stand over or talk down to them.
"I think patients can see right through a physician when they try to dance around a difficult conversation," he says. "You can be honest with a person and they appreciate that honesty."
One patient, a man in his mid-forties, kept asking how bad his condition was. As the man's health deteriorated, Lorenzoni was open with him, aware that those hard conversations — like what it means to be put on a ventilator — are sometimes the last a patient will ever have.
"I remember that he asked me, 'doc, I know I'm not getting better, what else can we do?' and unfortunately I had to answer that we'd been doing everything we could. And he broke down. And I broke down a little bit in tears," he says.
In his recordings, Lorenzoni lingered on the quieter moments. He spoke about why it was important to take time with his patients, especially because visitors were not allowed. One woman, in her early 30s, often wanted staff to check in on her, beyond the usual rounds that doctors and nurses make.
"I feel like she knew she wasn't doing well, and she wanted the company," Lorenzoni says.
When he would leave for the day, he'd check in on her to make sure she was okay, but he worried that she would take a turn for the worse by the time he returned.
Eventually, that's what happened. She needed to be placed on a ventilator to breathe.
"One of the things I remember before the breathing tube was placed was simply sitting by her side and telling her what was going to happen. And what we could and couldn't do to help," he remembers. "She was scared about how little control she had or even the doctors had in how she did."
Lorenzoni transferred her to an ICU, an operating room that had been converted. His shift was ending, and he signed out his other patients, but he stayed on to be with this one during the intubation.
"When her body didn't respond well to that, because it was so weak, I was there doing chest compressions on her," he says. "And I signed her death certificate afterwards. It was a tough day."
She was the first of his patients to die.
"Although she passed away without her family by her side, she wasn't alone," he says. "I hope that even this small amount of company that she had at the end was comforting for her. And it's going to be one of the things that sticks with me for the rest of my career."
Many of the people who have died from COVID-19 in New York had underlying health conditions, like diabetes and high blood pressure, and that's true in Lorenzoni's experience as well. But he says conditions that put someone at a higher risk are much more common than people realize.
"These are people that we know. These are people that we're related to," he says. "It's either yourself, or your neighbor, or people that you work with."
Hospitalizations and deaths from COVID-19 have been decreasing for a few weeks now in New York, and Lorenzoni is back on pediatrics. It's a welcome relief for now, but he says if there's another surge, he could be called back.
MICHEL MARTIN, HOST:
By now, most people surely know how badly New Yorkers have suffered because of the coronavirus outbreak. There've been more than 15,000 confirmed deaths from COVID-19 in the city. And because of safety concerns, many could not have loved ones close by. And that has taken an enormous toll, not just on patients and their families, but also on the city's health care workers, who are often the last people the sickest patients are able to see.
NPR's Meg Anderson spoke with one doctor in the Bronx about what his hospital was like during the peak of the pandemic and about the patients he can't forget.
MEG ANDERSON, BYLINE: A little over a month ago, I asked Dr. Ray Lorenzoni. to start recording an audio diary after his shifts.
RAY LORENZONI: Hey, Meg. This is Ray, just doing another voice recording.
ANDERSON: I wanted to understand what it felt like to be at the epicenter of this crisis.
LORENZONI: I have a couple stories I'd like to share about patients who I've interacted with.
ANDERSON: I had put out a request asking hospital workers to send me some reflections on what work is like now. Ray's recordings caught my attention.
LORENZONI: First is a story of death.
ANDERSON: He was at a hospital in New York, and I expected his stories to be about chaos and overcrowding.
LORENZONI: There is - or there was a patient I was caring for who was the same age that I am, in her mid-30s.
ANDERSON: But as I listened to his recordings, I realized the moments that stuck with him were the quieter ones. He talked a lot about sitting with his patients.
LORENZONI: And so I would do my best to, you know, lean against the wall or do something to give, you know, my patient a sense of comfort and ease with what we were about to talk about.
ANDERSON: Telling them what might happen, helping them reach their loved ones.
LORENZONI: And we had the patient call her mother and her family because we knew that this could be the last time that they spoke.
ANDERSON: Ray is at the very start of his career, and he's actually not meant to be treating adults at all. After hearing his recordings, I started talking with him, too, to help me fill in the gaps of what he was telling me. He's in his second year of a pediatric cardiology fellowship at the Children's Hospital at Montefiore, which is in the Bronx. Ray knew he might get recruited to see adults since kids aren't hit as hard by the virus.
LORENZONI: A pediatric physician needing to take care of critical adult patients is unheard of.
ANDERSON: But just in case, he started rereading about how to care for really sick adults, how to manage ventilators. And on March 30, he worked his first shift - a night shift on a new adult COVID unit at the Children's Hospital.
LORENZONI: Coming into the hospital, it was a little bit unreal. The whole floor was basically filled with adult patients.
ANDERSON: By then, COVID cases system-wide at Montefiore had gone from just two cases two weeks earlier to more than 700. And Ray says treating adults hit him hard. He's used to working with kids.
LORENZONI: Pediatrics is a career where most of your patients get better. But these were, you know, very with-it adults who were scared. They knew what the risk was.
ANDERSON: So it felt really important to him to be honest about what was happening, even when the news wasn't good.
LORENZONI: I think patients can see right through a physician when they try to dance around a difficult conversation.
ANDERSON: There was one man in his mid-40s who kept asking how he was doing.
LORENZONI: When I first took care of him, he asked me, you know, doc, how bad is it? And I was honest with him because I honestly didn't know how he would do.
ANDERSON: Ray would go in and out of his room over the next few days, and the man's condition kept getting worse.
LORENZONI: And I remember that he asked me, doc, I know I'm not getting better. What else can we do? And unfortunately, I had to answer that we have - we'd been doing everything that we could. He broke down, and I broke down a little bit in tears.
ANDERSON: In his recordings, Ray was very aware that those hard conversations, like what it means to be put on a ventilator, are sometimes the last conversation many patients ever have. He felt like it was important to take that time to be with them. There was one young woman in her early 30s.
LORENZONI: One thing that really stood out to me was that she kept asking for the doctors to check in on her specifically. I feel like she knew that she wasn't doing well, and she wanted the company.
ANDERSON: When he would leave for the day, he'd check in on her to make sure she was OK.
LORENZONI: But I still, you know, spent nights worrying that she'd be the one to get sick, you know, by the time I came back the next day.
ANDERSON: And that's what happened. Her oxygen levels got too low, and she needed a ventilator to breathe.
LORENZONI: One of the things that I remember before the breathing tube was placed was simply sitting by her side and telling her about what was going to happen and what we could and couldn't do to help - that kind of stuff. And she was often scared. She was scared about how little control, you know, she had or even the doctors had in how she did.
ANDERSON: Ray transferred her to an ICU. It was an operating room that had been converted. He remembers it being cold. His shift was ending.
LORENZONI: And so after I signed out the rest of the patients, I stayed to be there as her doctor, you know? I was there for the intubation. When her body didn't respond well to that because it was so weak, I was there doing chest compressions on her. And I signed her death certificate afterwards. It was a tough day.
ANDERSON: She was the first of his patients to die.
LORENZONI: And although she passed away without her family by her side, she wasn't alone. I hope that even this small amount of company that she had at the end was comforting for her. And it's going to be one of the things that sticks with me for the rest of my career.
ANDERSON: Hospitalizations and deaths from COVID-19 are decreasing in New York, and Ray is back on pediatrics. It's a welcome relief for now. But he says if there's a second surge, he could be called back again.
Meg Anderson, NPR News. Transcript provided by NPR, Copyright NPR.