Inside New Jersey intensive care units, frustrated and frightened frontline medical staff are taking on double their normal patient loads or working twice their usual hours, without the equipment they need.
From moment to moment, they face harrowing life-and-death encounters and constantly risk their own safety to help an overwhelming number of people of a variety of ages and backgrounds who are “effectively drowning on dry land” from Covid-19.
“Every single 12-hour shift I work is like nothing I’ve ever endured,” said Lynn, a nurse at Pascack Valley Medical Center in Westwood, northern New Jersey. She has worked in the field for more than three decades, and describes the current state of the ICU as “a war zone”. The patients are “sicker than I’ve ever seen”, she says. They can crash in the blink of an eye, then slip into multiple organ failure.
Like many other medical professionals across the US, she does not want her full name published. She is afraid of retaliation from the hospital where she works for speaking out on the conditions inside her unit. But she said she feels beat up from working so hard, and is alarmed by the grim outcomes for her patients.
“What you see on TV you can pretty much times by ten,” Lynn said. “And that’s exactly what’s going on.”
New York is the US state worst affected by the coronavirus outbreak so far, but its neighbour, New Jersey, is not far behind. The state had more than 51,000 cases and more than 1,700 people had died as of Thursday afternoon, a stunning toll on a population of less than 9 million people.
Coronavirus cases have been confirmed across New Jersey, but the north, where many New York city commuters live, has been particularly hard hit. That is especially true in Bergen county, which has seen the fourth-highest number of coronavirus deaths of any county in the US, according to Johns Hopkins, and is where Pascack Valley Medical Center is located.
New Jersey governor Phil Murphy has said he believes the state’s curve for new coronavirus cases has begun to flatten. Even so, “the fatalities are going up, and sadly will continue to go up”, he said Wednesday as he announced the deaths of New Jersey residents who were infected weeks ago.
Though there are signs of hope, New Jersey hospitals are still currently struggling. On Thursday, more than 7,360 people were hospitalized in the state because of Covid-19, and healthcare workers on the frontlines said the vast majority of their patients now have the disease.
Though hospital staff are coping to the best of their abilities, Lynn says just at her hospital alone, it would require hundreds more nurses as reinforcements to be able to deal properly with such dire need. Hackensack Meridian Health, which operates the Westwood facility, did not return repeated requests for a comment for this article.
An emergency room doctor in northern New Jersey, who also feared retaliation and asked to remain anonymous, said his hospital has a similar caseload to Elmhurst Hospital, one of the hardest hit in New York City.
Before the outbreak, it wasn’t unusual if one patient lost their pulse and needed chest compressions to stay alive. But during a recent shift, he was faced with three such situations, back-to-back.
“For whatever reason, folks are holding up, holding up, holding up, and then almost before your eyes over the course of minutes to an hour will suddenly decompensate in a way that few things that we deal with in the emergency room do,” he said.
He describes how one 48-year-old patient’s oxygen levels dropped catastrophically low. The doctor rushed in without full personal protective equipment (PPE) so he could insert a breathing tube into the man’s airway, even as his patient was coughing up the virus.
An hour later, the doctor was on the phone with his patient’s daughter to update her on her father’s condition. He was grateful he had avoided a much more difficult call by making the choice he did, regardless of personal risk.
“The choice is stop and put on all your PPE, which can take a minute or two, or get on the most important stuff, and get in there and save his life,” the doctor said. “Not to be dramatic about it, but that quite literally was the choice that I felt I was faced with.”
In another case, a 400-pound man with Covid symptoms started throwing punches at hospital staff as his breathing began to fail. His carbon dioxide levels were too high, and he likely didn’t know who he was or where he was, much less who other people around him were.
The doctor had no idea how he and other staff members would help the man without risking exposure to the disease themselves.
He said he thinks his hospital and New Jersey’s state government are doing the best they can in the circumstances, but is frustrated with the federal government, and especially Donald Trump, for minimizing the disease’s seriousness and creating what he believes are unrealistic expectations around available resources as well as how long this pandemic will last.
“All of that as an emergency room doctor has made my work harder, not easier, and it’s made it harder in ways that are very tangible,” he said.
He describes walking into a shift weeks ago, when he quickly realized that within two hours of the president going on television and saying testing was readily available – even though it wasn’t – somewhere between 40 and 60 patients had flooded into his emergency room looking for tests.
Tests haven’t been the only tools in short supply. Lynn said she and her colleagues have been using the same face shields for up to a week, and they’re out of bleach wipes to disinfect their once disposable equipment.
“They’re one time use, and up until a month ago, I would have been disciplined for using them more than once,” Lynn said.
Jane, another registered nurse who works in the ICU at Pascack Valley Medical Center and asked to only use a nickname, wrote in an email to the Guardian that nurses are “covered head to toe in whatever PPE they can find”, but there still isn’t enough. Jane said she and her peers use one N95 mask per 12-hour shift, and they’re putting the masks in paper bags to reuse even after they’re assumed contaminated.
Amid the scarcity, employees have started buying their own PPE, she said.
Jane described desolate hospital halls, juxtaposed with a “chaotic” ICU, where patient monitoring alarms blare, signaling another person’s decline. She laments the lack of staff and hazard pay, doubled patient loads and risk of infection. But after her shift is done, what stays with her is how many young, relatively healthy people are dying. And dying alone, because their loved ones are not allowed to visit, for fear of spreading this invisible killer.
“I feel defeated,” she wrote. “I also feel helpless because we are working so hard, trying every treatment modality that we can, and patients are still dying.
“Sometimes I cry driving home from work. I can’t help but think about patients and their family members who weren’t able to be with them or speak with them before they died.”