Granted complete access to the New York Presbyterian/Weill Cornell hospital system (from the CEO to the maintenance crews) the author–a Vanity Fair writer-at-large–crafted a saga of bravery, ingenuity, and loyalty under horrific conditions at one of the world’s greatest hospitals as it battled COVID (from the first reported case in America to the tsunami that followed). In this adaptation from her new book The Desperate Hours, Brenner focuses on a legendary ICU doctor and her highly charged interactions with the head of hospital—himself frantically trying to save lives in his own way.
There were a lot of things Dr. Lindsay Lief, head of 5 South, was great at, but always following the rules was not one of them.
Lief was the beloved director of the medical intensive care unit on 5 South, one of six ICUs at New York-Presbyterian/Weill Cornell, a hospital system that is considered the Emerald City of medical care in the New York metropolitan area. She brilliantly oversaw a team of 11 critical-care physicians (the attendings) and dozens of highly trained nurses, respiratory therapists, pharmacists, X-ray techs, and housekeepers tasked to help heal the sickest of the sick, to conjure miracles amid the breakdown of the body’s systems. It was a unit that would be knocked down again and again and again during the first 18 months of the COVID pandemic. That it was still standing was a miracle—and while Lief never told anyone about it, one reason for that may have had to do with a six-year-old and his forbidden wish for a slice of pizza.
It had happened years before, when “coronavirus” was a term unknown among 99.99% of the American public. As an intern at Weill Cornell, Lief had loved the time she spent in the MICU—the medical intensive care unit—with its hourly calibrations of everything that was happening in the body. Later, as an attending, Lief would intoxicate her residents with her all-heart, take-no-prisoners approach to what she called “real medicine”—what mattered most of all was the human connection. She’d met the six-year-old battling leukemia during her training. He had a feeding tube, but his only wish was for a slice of pizza, forbidden by everything in his treatment plan. Endless debate ensued: Was giving him the pizza wise? How would his digestive tract react? “Get him the fucking pizza,” Lief said, before pumping him with painkillers for the possible agony that might follow the meal.
Was this medicine or something else? A few months later, she saw the boy on the pediatric floor. “And what about the day you had the pizza?” she asked, feeling guilty about this instance in which she broke the rule. Had she made the right choice? “It was the best day ever,” he told her. “The last time I ate anything.” A few weeks later, he was gone. So maybe it was medicine after all.
Now, in early April 2020, Lief was anxious, to put it mildly. She had an ICU full of extremely ill COVID patients, and word had come that the head of the entire hospital system, Steve Corwin, wanted to FaceTime into her morning rounds. Such long-range observation was, as far as anyone knew, unprecedented—and of all mornings, just as systems, equipment, and lack of supplies seemed to be getting worse, not better.
On a normal day, back before all of the pandemic, Lief would have awakened and, before going to work, taken her children from their home in Greenpoint 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. 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 (as this particular branch of the New York-Presbyterian system was generally referred to) 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 rushed 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.
What could Corwin possibly see during a FaceTime call? The patients, yes, but 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 screen 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 the entertainer who had just had a birthday and seemed unlikely to make it to his next; the critically ill 28-eight-year-old who was months away from his wedding; and on and on and on. Lief, whose understanding of the Hippocratic oath diverged from the more traditionally and reservedly clinical, had already decided to dispense with the “no visitors during COVID” rule. She would allow the 28-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 to understand what was going on, and 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. Yet, because of the hospital’s legal policies, he was no longer allowed on the floor. FaceTime was the best he could do.
In a blur, Lief heard Anthony Sabatino, her nurse manager, announce, “Lindsay, Steve wants to hear from you.” And then there was her boss on her iPad, speaking to her from his apartment a few blocks away, 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.
“Lindsay,” Corwin said. “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. She 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 constantly reassured: 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?