There was no time to go to the supply area to get a new mask. Tsegaye was putting on her N95 mask to enter the patient’s room when its elastic snapped in two. She kept flashing back to a day when she was told that a ventilated patient’s endotracheal tube had fallen out, a situation that can be fatal for the patient and is also dangerous for the physician: Replacing it requires the doctor to come into close contact with the patient’s breath. She knew that she had never extended herself on behalf of her patients the way she had since March. In the days to come, whenever Tsegaye thought about what Spyropoulos said in that meeting, she felt appalled all over again. Relying on gut instinct rather than evidence, he told them, was essentially “witchcraft.” “I stressed to the group that we should not abandon this principle, even in the very stressful environment of a pandemic that was overwhelming our hospitals at Northwell,” he said. As Spyropoulos recalls, he talked to the group about the importance of high-quality, randomized trials in making scientific progress, and the risks of trying experimental treatments without them. ![]() Hahn’s colleagues, a tightknit unit who had seen one another through so much, sat together in the conference room, occasionally checking their phones or exchanging glances as the meeting went on. Dozens of doctors from the Northwell system videoconferenced in, including Spyropoulos, who was seated in his home in Westchester. The point of contention would be discussed at the May 13 meeting. How could researchers dictate care to a doctor right there at the bedside, especially when a patient’s condition was so dire? Hahn pushed back: She had to rely on her clinical judgment and believed that it was unethical to wait for more information. They exchanged heated words, as the colleague implored her to stay the course. Word made it back to a doctor working with Spyropoulos, and that doctor called Hahn to urge her to reconsider, or at least to get more tests before acting. The research was trying to determine whether a standard dose of an anticoagulant or a higher dose yielded better outcomes for Covid-19 patients who were already on oxygen or a ventilator and were at high risk of organ failure and clotting. The meeting’s agenda included time for remarks from Alex Spyropoulos, a lead researcher at the Feinstein Institutes for Medical Research - the research arm of Northwell - who was running a clinical trial. Adey Tsegaye, a pulmonary-critical-care doctor who was calling in remotely, shared some of Narasimhan’s concerns. Narasimhan, who was in charge of more than 20 I.C.U.s across the Northwell Health system, knew heading into the meeting that it might be tense. ![]() Long Island Jewish, in Queens, had, at the time, treated more Covid-19 patients than any other hospital in the country the doctors there were still weary, still battered, their energy and time in need of careful rationing. Narasimhan and her team now had fewer hands to oversee new patients coming in and the long-suffering ones on ventilators who were still in need of meticulous care. The throngs of out-of-town health care workers who had come to New York City to help were also diminishing, heading home to regions whose own times would come. ![]() By then, the surge of Covid-19 cases, the waves of suffering that had crashed down on her hospital for months, was beginning, miraculously, to recede. She wanted to get back to the unit, but instead she was sitting in a conference room with about a dozen colleagues. Mangala Narasimhan, an intensive-care-unit doctor, started feeling impatient soon after the start of a meeting she attended at Long Island Jewish Medical Center on May 13. To hear more audio stories from publishers like The New York Times, download Audm for iPhone or Android.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |