As you can imagine, these are unprecedented times.  The Covid 19 pandemic and its surge in New York City over the last 4 weeks has crippled our health care delivery systems.  Montefiore Medical Center, the major provider of healthcare in the Bronx and ordinarily dedicated to serving a socio-demographically vulnerable patient population with a high burden of chronic disease has rapidly transformed itself from a quaternary healthcare system into a makeshift triage and critical care facility.  All of Montefiore’s ambulatory clinical activities were halted within a period of one week, leaving our chronic patients abandoned.

We have adopted telehealth technologic capacity, which though innovative presents a number of unique challenges for our patients.  All elective procedures and ambulatory surgeries are on hold and those staff members who ordinarily operate those entities have been deployed to medicine and ICU wards. Everyday we have had a new ICU floor open in areas of the hospital such as the conference centers, operating rooms, the cafeteria, surgical floors and ambulatory buildings to try and accommodate this explosion of critically ill patients.  A tent has been erected as an extension of the emergency room to increase triaging capacity.

Everyday brings new challenges the most salient of which are staff shortages, because of illness and deployment to makeshift wards, supply shortages, such as personal protective equipment and ventilators, infection control challenges related to the daily onslaught of critically ill patients.  Worse of all is the high death rate and watching patients die alone, without family and loved ones.

Our division has felt the brunt of some of these challenges.  Kidney disease is a prominent feature of Covid 19 and because of severe staff and machine shortages and a disproportionate need for dialysis (both temporary and continual) we have had to resort to an older dialysis technology named “peritoneal dialysis” which is well suited for this type of war-time medicine. It involves placement of a plastic tube in the abdominal cavity and the exchange of dextrose containing solutions every 4-6 hours to clean the blood and remove fluid.  We have deployed a team of doctors who is traveling through the hospital twice a day to help teach the nurses how to do peritoneal dialysis, and in some instances, to do the dialysis exchanges for them.

One observation that has helped to maintain our morale and ability to keep going is the comradery we, as a hospital community, feel towards each other.  We have come together and have taken turns crying on each others shoulders, all very briefly as we watch the next patient being rolled in.