In late March, as the COVID-19 pandemic's stranglehold on New York City strengthened, with cases totals doubling every couple of days, the city's wealthiest neighborhoods began to empty. By the tens of thousands, people sent mail-forwarding requests to the U.S. Post Office and left their homes in Manhattan or the Upper West and Upper East Sides and headed upstate, to New Jersey, the Hamptons or even Florida or California.
By March 22, New York had confirmed more than 15,000 COVID-19 cases and 76 deaths, and hospitals were quickly becoming overwhelmed, scrambling to convert operating rooms into intensive care units. The following day, Gov. Andrew Cuomo signed an executive order requiring hospitals to increase capacity by a minimum of 50 percent as the confirmed case count topped 20,875 and deaths had doubled to 157.
The day before Cuomo signed that order, on March 22, Myrna Dipert, a 65-year-old interventional radiology nurse at St. Joseph Hospital in Eureka got a phone call. It was from an administrator with Samaritan's Purse Disaster Assistance Response Team (DART), a program of the faith-based nonprofit that mobilizes teams of medical professionals to respond to humanitarian crises, from natural disasters and famine to war and disease. The organization was setting up a makeshift hospital in a park in New York City and wanted Dipert to help. She had two hours to decide.
Dipert says she spent stints of her career doing international healthcare work under adverse conditions in Papua New Guinea, African and Sri Lanka. It's something "near and dear" to her heart, she says, which is why she signed up for DART after returning stateside. She'd narrowly missed call-outs through the organization, one to go to Mosul, Iraq, and another to respond to an Ebola outbreak because the timing wasn't right. But this time she was ready.
"I had really felt so compassionate about the New York situation," she says, adding that she spent much of her career as an intensive care unit nurse. "I'd been watching it and just said, 'This is something I can do. This is something I was trained to do. I can help.'"
But Dipert also wasn't naïve to the risks inherent in making the trip, having read about healthcare workers in other parts of the world falling ill with COVID-19 at alarming rates, with many suffering critical outcomes.
"I will not say I'm fearless," she says. "I was afraid. I was nervous to some degree. But I also have a very strong faith. I don't believe that God magically takes care of me more than anyone else but I believe that if you're ever going to grow in your faith, you have to put yourself in a place where you have to trust. That was part of it. ... I'm also old, my kids are grown and it's not a huge tragedy if something should happen to me. Part of it was, I feel like I don't want to die — I want to live and do what I can — but if I do die, I've had a great life filled with wonderful experiences."
She called her husband, who's in Canada, and explained her thinking. He agreed she should go, so she set up a call with her children. Two of her sons were distraught and didn't want her to make the trip but her daughter was supportive.
"My daughter was nervous and anxious but she said, 'Mom, I know this is your heart. I know this is what moves you is helping and taking care of people," Dipert says.
She packed and the next day was on a plane to New York City. There's no way she could have been prepared for what she would encounter there.
The day after Dipert's arrival, DART and Ms. Siani Hospital opened a 70-bed field hospital in East Meadow in Central Park that would be staffed with volunteers like Dipert, doctors, nurses and other healthcare providers from around the country who, for nothing more than room, board, a small stipend and a desire to help, left their lives to meet the pandemic at its U.S. epicenter. Across Fifth Avenue, Mt. Sinai Hospital's 100-bed ICU was treating 160 patients as the worst of the city's surge still loomed.
The field hospital — the first DART had erected in the United States — comprised 14 tents.
"Each ward was a tent," Dipert recalls. "It was like a mash unit."
For the next 21 days straight, Dipert worked the ICU tent as one of four nurses there to treat 10 patients with the guidance of a 66-year-old retired doctor.
"We worked 14-hour days, seven days a week," Dipert says. "All of our patients were COVID patients. They came by ambulance, usually from Queens or Brooklyn, because there was no more room in hospitals there. One day I was told four patients died en route there. They were often very critical. They would try to manage them in the wards with supportive measures but quite often they would then come to the ICU."
Her voice trails off briefly: "It was incredibly difficult, probably the most difficult thing I've ever done. It was physically difficult. It was mentally difficult. It was emotionally difficult."
Dipert says her days would begin before dawn and stretch well past sundown. A shuttle bus would pick her and her team members up each morning from wherever they were staying — Dipert says she split time between a hostel in Hell's Kitchen and an older hotel near the park — in time to get them to the field hospital by 6 a.m. There, World Central Kitchen, the disaster hunger relief nonprofit founded by José Andrés, would provide breakfast — usually an egg sandwich and a cup of coffee — that Dipert and her cohorts would eat during briefing meetings before "going into the hot zone."
Because of the highly contagious nature of COVID-19, coupled with the need to keep providers both safe and healthy working on the front lines, Dipert says the makeshift facility had "excellent" safety protocols in place. But these made suiting up to enter the facility a lengthy process: First they'd put on rubber boots, followed by a pair of rubber gloves, then two gowns, a mask and a second pair of gloves, followed by a face shield. Phones then went into a Ziploc bag. Dipert says a monitor would watch the entire process and if at any point protocol wasn't followed, they'd have to start all over again. Coming out of the "hot zone" was even more intense, she says, as virtually every step of stripping off personal protective equipment was separated by a chlorine wash to decontaminate and vigorous hand washing. The protocol was so painstaking, she says, that she and most colleagues would only take a single break during their 14-hour shifts. But, she also notes, not a single one of her colleagues fell ill.
At the end of their long days, around 8 p.m., Dipert says World Central Kitchen would provide another meal that they'd eat on site before a shuttle would take them back to where they were staying. Once back at the hotel or hostel, Dipert says she'd just shower and collapse into bed.
"We were just exhausted," she says, adding that the work was as taxing emotionally as it was physically.
Dipert stresses that this was a frantic effort to save people fighting a new, largely unknown disease in a makeshift hospital. For example, in a typical ICU, a patient on a ventilator is attended to by a respiratory technician. The field hospital didn't have those, so it was up for the ICU nurses to adjust ventilator settings and monitor them. Complicating matters, she says, was the fact that the field hospital had seven or so different brands of ventilator, each of which worked a bit differently. Staff also had to ration certain supplies and make do with makeshift versions of others. Then there was the fact that treatment protocols seemed to change almost every day, as providers learned more about the disease, what worked to treat it and what didn't. She watched as they experimented with drugs like hydroxychloroquine and erythromycin, and recommendations changed as to how much pressure a ventilator should apply to a patients' lungs.
"It's really, really stressful," she says, "and really, really sad."
In many patients, COVID-19 attacks their lungs and depletes the oxygen saturation levels in their blood. When those levels fall far enough, patients are intubated and placed on a ventilator with the hope that life support will keep them living long enough for their bodies to fight off the disease. But under the best of circumstances, outcomes for intubated patients aren't good. And in those early days on the front lines in Central Park, it sounds like they were dismal.
"The patients — it was just really sad," Dipert says. "In the ICU, I think we probably only had one or two in those three weeks who actually survived."
One of the hardest things, Dipert says, is how patients had to be separated from family. Some were able to communicate via video conferencing or phone calls, but that wasn't possible for patients who were unconscious and breathing through a ventilator.
"So many family members weren't able to see their loved ones before they died," she says. "The anxiety is incredible."
Throughout the experience, Dipert says little things buoyed her spirits and kept her going. There were the cowbells nurses would ring when a patient had recovered and was being discharged, leading to a cacophony of cowbells banging in response throughout the field hospital's other tent wards and claps and cheers from other patients. There were the 7 p.m. howls, when it seemed all of New York would venture to their stoops, balconies or windows to express their gratitude. And there were the texts and emails she got from family and friends, just telling Dipert she was in people's thoughts and prayers. "Those kinds of things kept me going," she says. "They really did."
There were also the people she was working with — from nurses in their early 30s who'd left young children at home to the doctor she worked closely with who came out of retirement to help.
"That doctor," she says, her voice trailing off briefly. "I'll never forget him. He was in there cleaning messes and diarrhea with us and turning patients. He just had such heart."
When her time in New York was up — at which point the state's caseload had ballooned to more than 195,000 confirmed, with more than 10,000 dead — Dipert says she spent two weeks self-isolating at home before returning to work. That's when she realized she was suffering from post-traumatic stress disorder, when the full toll of her experience came into focus. She went into a storage room at St. Joseph Hospital and became overwhelmed and panicked. She started having nightmares every night and would cry "at the drop of a hat."
She realized she still hadn't really talked about what she' seen and experienced.
"There's just so much," she says. "People who have gone through a very traumatic experience, they need to be able to speak about it. But the truth is a lot of people don't really want to hear about it."
It wasn't until Dipert talked to some fellow ICU nurses about all she'd seen and all she felt that some of the stress started to subside. She told them about how she was watching CNN one day and the names of people who'd died of COVID-19 started scrolling down the screen and she began crying, thinking about one patient whose oxygen levels had plummeted to the lowest she'd ever seen. She and her colleagues knew they only had two to three minutes to get him on a ventilator or he'd die, but he broke down, screaming, "I just want to go home, I just want to go home." Dipert thought, "Those are probably the last words he's going to say." Then there was the young woman — maybe in her early 50s — who suffered a stroke or a blood clot and stopped responding neurologically. Dipert had to call her daughter to break the news. She says the field hospital made an exception and broke protocol, allowing the daughter to don full PPE to come see her mom one last time. "It was so hard," she says. But talking about it made it easier to carry, plus she felt like she was helping her colleagues, giving them some idea of what they might see if the worst should come to pass at their hospitals.
Two months removed from the trip, Dipert describes it as life changing and says she's proud of the work she and her colleagues did there. And looking around at Humboldt County, she says she's grateful and hopeful — grateful that most people seem to be taking this very seriously and hopeful that the county's rural nature and relatively early action will spare it the kind of surge she saw in New York City. But she also has moments of intense frustration.
"It's very frustrating to me when people argue about masks and stuff like that when I've seen it first hand," she says. "It's a little bit like a kick in the teeth that you guys don't take it seriously. I do find it annoying ... I'm pretty passionate about it after seeing people take their last breaths and having to tell family members, 'This is going to be your last conversation before your loved one is intubated.' I still have nightmares...
"... But mostly, I just don't want to forget the lessons I learned, lessons about not complaining, that we are so blessed and can give back in so many ways because we have so much, that our faith can be greater than our fear," she says, pausing. "Those kinds of things have been huge for me. In a very stressful time like that, you just learn what is really important."
Thadeus Greenson is the Journal's news editor and prefers he/him. Reach him at 442-1400, extension 321, or firstname.lastname@example.org. Follow him on Twitter @thadeusgreenson.