NEW YORK - Janett Perez sings to her patients, though few can hear her. They are sedated, intubated, pushed to the brink of death by covid-19. They lie unconscious in their beds as she tends to them.
"They can still hear you," the intensive care nurse at Brooklyn's Maimonides Medical Center said. Besides, she is all they have.
"They don't have family around. So we have to be their family."
The pandemic that has disrupted everything about the way people live has mercilessly altered the way they convalesce and die. Like every hospital in New York state, Maimonides has banned almost all visitors until the final hours before death, when a single family member is allowed to witness the passing.
The hospital is frantically expanding for the coming surge of covid-19 patients, although officials acknowledge it will almost certainly overwhelm their efforts. Before that happens, its leaders allowed The Washington Post access to some of the hospital's intensive care units and other floors last week, on the condition that patient privacy be protected.
Eighty percent of the approximately 600 adult patients in the hospital Wednesday were infected with the new coronavirus. That proportion will surely increase until nearly every bed is filled with its victims, officials said.
Everyone at Maimonides is working harder, under more dangerous conditions, than ever before. In addition to mastering unfamiliar medical responsibilities, nurses like Perez stand in as spouse, child, sibling or parent to their patients.
Perez bustles between patients, some now two to a room meant for one. She moves quickly but purposefully, checking a monitor, gently rearranging limbs and tubing. And keeping up her chatter: The weather. The Lakers. Last week's television show.
"I talk to them like I would talk to my family or my friends," she said. "Positivity goes such a long way. Positivity can heal a person. Positivity, good energy can just take away all the bad and infuse someone with goodness. That's really what nursing is about."
It is a remarkable perspective. There is little reason for optimism on Tower 8, the surgical ICU floor where just a few weeks ago Perez saw people after strokes, car crashes and major operations. Most of the patients who reach this floor will die, often after lingering for two or even three weeks on ventilators, the desperately needed machines that force oxygen into clogged and inflamed lungs.
"Many covid patients pass away," Perez said. "But you can't determine that others won't do well. . . . That's what we have to hold on to, is that hope that people will do better. And we have to treat them with the expectation that they will."
The overworked health-care workers are now the only bridge between patients and their family outside. At perhaps the worst moment of their lives, relatives crave every scrap of information, good or bad. It must substitute for being there themselves. Only women in labor and children are allowed to have one person with them.
"I talk about the ventilator," said Cheryl Martines, a nurse in the medical ICU, a floor below Perez on Tower 7. She explains to heartsick families how much work the machine is doing, why it's important to wean the patient off the breathing device. She speaks in layman's terms.
"I let them know we're here for them," Martines said. "Their family member is not alone, that we're with them. We talk to them. We encourage them. And we're praying for them."
But there is no denying the bleak prognosis for most. "It's breaking our hearts to see people dying, without having, really, anything to help them," said Monica Ghitan, associate director for infectious disease.
"One of the reasons that always attracted me to (infectious disease) is the fact that we cure people. We make people better. We give them medication, and they go home and enjoy their lives.
"And now we have very little, if anything, to give."
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An independent teaching hospital in Brooklyn's Borough Park neighborhood, Maimonides is named for a 12th-century Jewish philosopher and physician. Its ethnically diverse staff serves a patient population that speaks more than 70 languages, including Urdu, Arabic, Mandarin, Cantonese, Spanish, Yiddish, Creole and Russian.
As the virus approached, the hospital's leadership began building, staffing and equipping the equivalent of a second hospital on the fly, inside and outside its walls. Maimonides's official capacity is 711 beds. In a week or two, officials intend to have 1,400.
An enormous tent outside the hospital's front lobby will hold 80 to 100 beds. There are beds in a rehab gym. The number of beds in an older, smaller cardiothoracic ICU were more than doubled.
Like most major medical centers, Maimonides had separate intensive care floors for heart patients, children and others. But in effect, they are all covid-19 ICUs now. Nearly everyone else has been discharged to make room for coronavirus patients - sent to a rehab facility, perhaps, or home. Or told not to come in. Few people with complaints other than covid-19 are even bothering to show up at the hospital.
On Wednesday, every bed in the medical ICU, whose capacity was increased from 20 to 26, held a covid-19 patient. The surgical ICU, now at 25 beds, held 21 covid-19 patients. Soon its capacity will rise to 39. It is barely enough now, and even with the expansion it probably won't be.
Maimonides has not yet experienced shortages of ventilators and protective garb that plague other hospitals. But there is a backlog of patients waiting for critical care beds. They are intubated in the emergency department, where a never-ending procession of ambulances brings patient after patient to a hastily erected triage tent outside.
"Our biggest issue is that the people we are caring for who are acutely and critically ill, it takes a very long time for them to show any signs of recovery," said Stephan L. Kamholz, chief of pulmonary critical care. "And some of the very first people who ended up on mechanical ventilation three, three-and-a half weeks ago, are still on it - if they're still alive."
One patient who was successfully taken off a ventilator recently was put back on after breathing problems recurred, Kamholz said.
"He died last night," said Omar Taha, a pulmonary and critical care specialist.
Doctors and nurses hurry through the surgical ICU hallway, bathed in yellow light. There is no time for wasted motion. They wear white lab coats or blue gowns, with hair coverings, gloves, face masks and goggles, their shoes protected by disposable booties. Signs with colorful illustrations remind them of the importance of each measure. Without looking, they poke at ubiquitous hand-sanitizer dispensers and rub their hands as they speed by.
Staff members have been repurposed. On Wednesday, a urologist, a trauma surgeon and a surgical oncologist were among the physicians working on Tower 8. With elective surgeries canceled, orthopedists are pitching in elsewhere. They are all covid-19 doctors now.
"A lot of the disease process, we're learning on the go," said Mehr Qureshi, the trauma surgeon, whose patients normally follow a steadier trajectory of improvement once they reach the ICU. "The things that we thought were working before are not really working anymore. . . . These patients can start to turn the corner, and then they get very sick very fast."
Monitors and IV poles have been moved into the hallway. This minimizes the number of times nurses must enter the rooms of infectious patients, limiting their exposure to the virus and preserving the precious masks and gowns in short supply at other hospitals. Long plastic tubes run beneath the doors to the patients, bringing medication and sedatives.
The monitors beep. Their lights blink. Overhead, speakers blare orders with varying degrees of urgency.
In patient rooms, it is calmer, almost placid. On this sparkling spring day, large windows allow sunlight to wash across the motionless figures in the beds. Outside, the squat brick buildings of south Brooklyn stretch for miles.
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In a hospital full of a deadly, highly contagious virus, front-line medical workers protect themselves with face masks, stoicism and prayer. Only a handful of Maimonides staff have tested positive for covid-19 disease, though more have served 14-day quarantines after exposures. The hospital declined to release exact numbers.
The workers discuss the risk matter-of-factly. They measure it, take precautions and try to do their jobs.
"At the end of the day, it has to be done. Somebody has to take care of these people," said Taha, the pulmonary specialist. "There's no time to be too concerned for ourselves. We take the proper precautions, and we do what we have to do for the patients."
Perez, the nurse, has moved from her home to a nearby apartment. She was afraid she would bring the virus home to her parents, her sister and her brother-in-law, who live with her.
Earnest, plain-spoken, she harbors no doubts about her role in the pandemic. She knows it will end sometime. Until then, her fate is in God's hands, she said.
"This is a battlefield, and we've turned ourselves from nurses into soldiers, in a sense," she said. "We all took an oath, and we all have a responsibility to our patients. This is what every single nurse was meant to do. This is what we were born to do."
Parita Soni, another pulmonary and critical care specialist who gave birth Jan. 27 at Maimonides, has also moved out. She pumps breast milk during the day and drops it off with her husband, who bottle-feeds their daughter. But she lives in a small apartment five blocks from the hospital, separated from her firstborn by the virus.
Soni returned to work in recent days. "I was very scared. But at the same time, all my colleagues are in this war, and I just can't stay home," she said.
The circumstances are taking a toll. "We're seeing stress, seeing despair, seeing concern," Kamholz said. "People who are appropriately capped, gowned and masked still have a concern about their own illness, and then, when they go home, they have concern about the safety of their loved ones and family. That's a little bit different than other diseases."
Before each shift, Perez said, the staff on Tower 8 gets together to pray. Sometimes the group is led by a Jew, other times by a Christian, still others by a Muslim. The day's prayer comes from the leader's faith, but it is, of course, for all.
“Every single morning, we pray together as a team, whether they’re religious or not religious,” she said. “We pray in Islam. We pray in the Christian faith. We pray in the Jewish faith. We include everybody, and we pray every single morning. As a team.”