‘I’m gonna die, right? Tell me!’
Meliseanna Gibbons suited up in PPE, walked into the ICU at Wyckoff Heights Medical Centre and bravely faced the unknown. It was March 14 and in a special, pressurised room lay an 82-year-old woman with Covid-19. Medical staff believed that she had died but, because of conflicting vital signs on the Brooklyn hospital's telemonitors, someone had to physically check.
“This was actually my first time to go into a Covid patient's room and, I'll be very honest with you, I was very scared,” said Dr Gibbons, a resident physician at Wyckoff, who returned home to Bermuda last week to visit family. “I didn't know what I was dealing with at the time. You don't know whether or not as soon as you go into the room you will be infected — that could have been the case.
“I went to the patient and she had passed. I remember the doctor talking to me from Northwell Health [Wyckoff's hospital partner] and she said, ‘The reason why we need you to go in here, this is a very important case. This will be the first Covid death case in the state of New York.'
“It was a very emotional, out-of-body experience. I realised how huge this was. And I myself, before the rest of the state, knew what was coming.”
New York has since recorded more than 32,000 deaths as a result of the coronavirus pandemic. For two months straight, while the disease was at its peak, Dr Gibbons worked on the front line.
As the numbers rose, people would come into the Emergency Room terrified by the symptoms they had come to associate with death.
“They knew that there was no cure and they would say, ‘Doc, I'm gonna die, right? Tell me! I'm gonna die.' And that would break my heart every time because, at that time, the odds were so high that we probably couldn't save them.”
Like most hospitals, Wyckoff was ill-prepared for the onslaught: more than 2,000 patients were treated for Covid-19; almost 300 died and nearly 200 staff were infected.
For Dr Gibbons, it was like “a massive wave that hit us out of nowhere”.
She said: “When we got our first case, everyone at that point realised maybe we should start talking about this. And then it got to the point where the Emergency Room was flooded with people and everybody looked the same. Everybody came in short of breath, with chills and fever. Everybody.”
The entire hospital was converted into an ICU facility. Material similar to “a plastic curtain” with zippers was used to create triage areas to keep people in the Emergency Room separate until staff could figure out who had Covid-19 and who did not.
“Everyone, we could assume, had the virus,” Dr Gibbons said. “We became flooded with patients out of nowhere. Where it was at one point just the ICU having these Covid patients, it became the entire hospital. And the thing about it, these patients were just deteriorating so fast. So they would come in and, three or four days later, they're on a ventilator machine. Just like that.”
Most frustrating was knowing there was nothing she could do to help.
“They were like, ‘Doc, please help us. We're drowning, we're drowning, we're drowning.' I just can't overemphasise the fact that we had no idea what we were dealing with.
“There was no real research. There was, of course, no medication to offer. All we saw were patients who couldn't breathe. So all we could offer them was oxygen. That's it.”
A nasal cannula was initially used, with the oxygen level increased until it reached the maximum amount. Patients were then moved on to a high-flow nasal cannula, a more pressurised device that gives a higher percentage of oxygen.
When that proved insufficient, they were given non-rebreathers, masks that covered the entire face and gave an even greater concentration of oxygen.
A ventilator was the final hope.
“What became devastating was when we realised the breathing machine was not saving lives. That's when it became horrible to us as doctors because we realised we literally had nothing to offer these patients. They were coming in by the fifties every day, and we had nothing to offer them.”
Through X-rays and CT scans it soon became obvious that Covid looked the same in everyone.
According to Dr Gibbons, it was like a “really, really, really bad pneumonia” that took over both lungs entirely, where it was usually just the upper or lower lobe.
“Everyone's CT scan looked like that. My attending physician who is in the ICU — he's been working there for 20, 30 years, so he's experienced with critical care — he was floored. He said, ‘In all my years, I've never seen anything close to this'.”
With so little understood, personal protective equipment became mandatory from the very first case. Strict procedure had to be followed for its removal, with it all done “very carefully”.
Dr Gibbons said: “They warned you — don't touch anything else in the room because you could contaminate yourself; don't take off the mask because that's really the biggest protection that you have from the virus right now.
“Make sure not to let that come against your face. Don't touch your skin at all because that's the way you're going to be contaminated.”
On March 14, as she left the room of the elderly woman, worried about having to tell her family of her death, the importance of following procedure also played on her mind.
“It was just a lot of pressure, a lot of things to think about,” she said.
Wyckoff, a 350-bed teaching facility that cares for an “ethnically diverse residential neighbourhood”, usually operates with 1,800 “physicians, nurses and support personnel”.
Amid the pandemic, those numbers fell as some took ill and others were just too terrified to come to work.
“As resident physicians, I think that we just kind of stood up to the plate,” Dr Gibbons said. “The staff were scared. So, not only were we dealing with masses of patients, we were dealing with them on a shortage from our end.”
In her eyes, the “heroes” were the ones who showed up knowing that they could contaminate their loved ones.
“They were washing the patients down, giving the medications with the same N-95 that they'd been using for the last week, the same bunny suit that they'd been using for the last week, no idea if it's even working. They were showing up to work and caring for the patients until literally their final breath. Literally.
“I saw the janitors come in after a patient had passed and wipe down the room thoroughly — mop it, clean it, take out the trash.
“Everything in that room was contaminated with the virus. [Just as brave were] the custodians, the people who give out food. When you sign up to be a doctor, of course you don't expect to work through a pandemic, but you know you're dealing with sickness.
“To see the janitors, to see these people come in with their trays, drop the food off, talk to the patients and leave — that was heroic, in my opinion. And for months, we worked through that.”
Although the hospital later brought in tiny TVs so patients could speak with family members, initially they were dying alone. The fear was that visitors would spread the virus even further into the community.
“It got so bad where we just had to think that the entire hospital was full of Covid,” Dr Gibbons said. “There was no way to contain it any more. It just got to the point where, once we got on our shift, the first thing we would do was go downstairs to the basement to get our gear — a bunny suit, goggles or shields, an N-95 mask and bootees. We would go to our on-call room, put the entire gear on and stay in that for our 12-hour shift.
“I would call my parents and just cry and just cry and just cry because it was scary. It was scary, it was sad, it was heartbreaking, it was hopeless — every day. You just felt completely defeated as a doctor.
“I'm waking up every day to face something that I have no control over, that I have no answer to. And every day it's masses of it. There's nothing we can offer, there's nothing we can do to help and we are being exposed to it over and over again.”
The breaking point for her, and many of her colleagues, was when massive freezer trucks were set up outside Wyckoff to store the overflow of corpses.
“My hospital, during the peak of Covid, had three of them. So every day I had to wake up to go to work and walk past the trailer trucks knowing that it was full of people who had come into the Emergency Room looking for help but ended up in the back.
“And that broke me. It broke all of us.”
Added to that, staff were getting sick.
“That's when it became really scary. We didn't know if they were going to come back, we didn't know how they were doing, we didn't know if we were going to be next.
“We didn't know, but every day we showed up to work — and it was exhausting. I wanted to go home and cry, I wanted to think about what was actually happening. But at the end of the day, I had to show up to work and make decisions.
“I remember one day I was walking through the Emergency Room and tears just started to fall down my face. I just allowed myself to feel it. And then my phone went off. And I was like, ‘Meliseanna, you've got to go to work. You're on shift, you're the only [doctor] on this floor. The nurses are gonna come to you, they're gonna ask you questions, you need to get back into go mode'. So it was bouncing back and forth between ‘I want to feel this because I'm human, but I've got to get a grip because I'm the doctor'.”
She believes it was only with God's help that she managed to stay healthy. At her last blood test, there was no evidence of antibodies indicating she had been exposed to the disease.
What caused her to celebrate, however, was seeing patients start to recover.
“People were coming into the hospital, but they were leaving on oxygen. [It had been] war. Every day we were just praying: make it stop, make it stop. Everyone was passing away.
“It got to that point where we would applaud when a patient was discharged home because it was such a beautiful, rare thing to see. Then it got to the point where most people were being discharged home. Some were going home on oxygen, some were going home just fine and not coming back.”
Her colleagues started coming back to work. The hospital reopened its clinics; medical students returned and visitors were allowed inside. Bill de Blasio, the New York mayor, publicly commended the hospital for its efforts.
Dr Gibbons said: “Slowly but surely we saw Wyckoff as we had always known it — except for the fact that everyone wears masks, we wear shields, we wear goggles. But people are testing negative.
“I think the last Covid patient I saw was weeks ago. It's almost like it came and it hit those it was going to hit and they didn't make it, and the ones that recovered for whatever reason, we still don't know.”
Throughout the ordeal she longed for her parents, Sydney and Katherina Gibbons, and was thrilled to return home and see for herself just how shielded Bermuda had been from the disease.
“I've never wanted to come home and see my family and to see familiarity as much as I did these past few months.”
Now back in the US, Dr Gibbons is hoping New York doesn't experience the second wave of Covid-19 that much of the country is bracing for.
“I don't want to think about it,” she said. “But it's a virus. It could happen again. That's why I needed to come home. In case I have to face that again.”
In her final year of residency at Wyckoff, Dr Gibbons is planning to specialise in gastroenterology and endocrinology and is now applying for fellowships.
With much of the horror of Covid-19 past, she is finally able to see the positives.
“The rewarding part is it just gives you so much confidence. You go through something like that and you learn to think on your feet, to make decisions, but you also learn as a doctor to remember that you're human.
“Those were the positive things that came up. You hear of the measles, of Spanish flu and all these vaccines that they have come up with, but Covid is going to go down in the medical books. As a pandemic, it's going to be a monumental part of medical history and the fact that I could be a resident during this monumental time — it's not something every doctor can say.
“I think this generation of doctors will be different. What we have to offer going forward in our career will be different. This is something we will never forget.”