A commonplace of writing advice is to explore what you are most afraid of: Find your fear, and there is your story. Like most people, I dread going into hospitals. I fear infection and the sense of looming decay. Hospitals, we know too well, can be the portal to death but also a place of miracles and cures. Still, the fear of hospitals is very real. Who hasn’t heard a family member or friend plead, “Whatever you do, don’t put me in a hospital”? Who hasn’t experienced the worry that wafts from the waiting rooms or seen the looks of dread and glazed eyes in the coffee-cup-filled lounges?
In June 2020, when I heard of the possibility of reporting and writing this book, I didn’t hesitate for a second. I would be able to penetrate one of the world’s greatest hospital systems, in New York, and interview those who had lived and led the city through a once- in-a-lifetime pandemic. What these medical professionals did and what they learned, the mistakes they made, the breakthroughs they discovered and the triumphs they experienced, would come to set a template for the entire country. I needed to understand the fear that overcame everyone who stayed in New York throughout the surge of March and April as hospitals in the city were overwhelmed—and to understand those whose lives are lived as a calling to save every life they can. I would discover that many of my questions would not have an easy answer: What draws people to fight for the common good in a crisis? How can people expose themselves to so much risk?
In March 2020, as tents reminiscent of the Civil War overtook the grounds of hospitals throughout New York City, gallant descriptions of past wars were used again and again to rally the city of dreams. The governor of New York had his finest moment, using his rhetorical flourishes to swing for the big leagues of leadership, indicating we would fight as was done on the beaches of Normandy, meet the enemy as the Union had at Gettysburg, endure the hardships as the residents of Stalingrad had when under siege. All of it was meant to comfort as the unfathomable scenes cascaded: of refrigerated trucks, now temporary morgues, parked on Lexington Avenue and on the driveways of NewYork-Presbyterian’s premier teaching hospitals— Weill Cornell Medical Center on Manhattan’s Upper East Side and Columbia University Irving Medical Center in Washington Heights. That spring, night after night, New Yorkers gathered at their windows at 7:00 p.m. and cheered for the doctors and nurses and respiratory therapists and physician assistants and transporters inside every hospital in the city who showed up every day to try to save lives. New Yorkers banged pots, they yelled, they drove in the streets honking horns. They waved to their neighbors and sometimes sat outside on their stoops and called to each other across the street. They sang arias as people had in the hot spots of Italy earlier that spring. The evening applause became the soundtrack of a city in crisis, and it went on for months. But the banging of the pots, the pans, the calls for glory could not camouflage reality: New York and its hospitals were completely unprepared, even at NewYork- Presbyterian, the Mount Olympus of healthcare systems. They were so unprepared that academic chairs of the medical schools affiliated with the hospital were deployed as volunteers to help sort and fold six hundred thousand pairs of scrubs the hospital ordered in haste to protect thirty thousand employees. The scrubs arrived separately, tops and bottoms, and all had to be matched for size. And in the end, unlike after wars or massive terrorist events, the hospitals erected no enduring stone memorials to all those who died in service to save lives. Photos on the bulletin boards of nurses and respiratory therapists and doctors who had died vanished, as if a collective corporate decision had been made not to tarnish the brand. When I asked about this later, I was told there were “privacy concerns.” The shame of silence haunted many who desperately wanted to honor the dead.
The COVID pandemic started in Wuhan, China, a city that few in the United States had ever heard of, and ended up devastating nearly every corner of America. But if there was one city that had to be saved, it was New York, because if the virus truly went out of control there, it might have spread with such ferocity that the death toll in the United States could have been in the millions. New York was the fort that had to be held, and it was, at profound cost: Thirty-five employees of NewYork-Presbyterian—doctors, nurses, transporters, cleaners — and more than thirty thousand residents of the city died. In addition, there were untold thousands of survivors burdened with mysterious long-term side effects of the disease and uncountable men, women, and children who lost loved ones. And while the blight that spread across the country would kill more than one million Americans by April 2022, had NewYork-Presbyterian crumbled, the damage to the nation and the world would have been many times worse than what we did experience.
At the beginning of the pandemic, there were three things that many at NewYork-Presbyterian assumed—three things that turned out to be wrong. The first was that they had what they needed to handle it. The second was that people across America would come together and cooperate to win the war against COVID. The third was that the vaccine would be the end of the pandemic. December 14, 2020, the day the vaccine arrived, did turn out to be thrilling—and, as we know now, heartbreaking. But it’s easy—too easy—to assert that because COVID has persisted in an increasingly contagious (if also increasingly harmless-to-the-vaccinated) form, nothing done during that first year really mattered. When historians look back at the first year of the pandemic, they will recognize not only the immeasurable heartbreak but also that New York held on, and that made the difference.
The doctors in my own family were treated with reverence, as high priests from another culture. One cousin spoke often of her training at the Mayo Clinic during World War II, when the first doses of sulfa powder came to her unit and saved the lives of dying children. One of the few women at Mayo in that era, she projected the formality of a character in an Edith Wharton novel, occasionally calling her husband, a prominent surgeon, “Dr. Fischer” at the few family gatherings they found the time to attend. The fact that their patients came first was never questioned. Many of the doctors I met in my months of reporting shared the same belief.
As I discovered in the course of reporting this book, the span of NewYork-Presbyterian is massive, and so was the pandemic’s impact on it. It has 4,066 beds, and campuses that extend through every borough except Staten Island and up into Westchester County and the Hudson Valley. In 2021, there were 1.2 million separate interpreter sessions in 216 languages, most frequently in Spanish, Mandarin, Cantonese, Russian, Korean, Arabic, Bengali, Fuzhou, Haitian Creole, and Polish. Across the campuses, there are sixty-two pastoral-care employees. The hospital system uses 120,000 surgical masks a day. At the height of the New York surge, NewYork-Presbyterian employees were given 40,000 rides a week, 3,000 hotel rooms a night, and 34,000 meals a day. The hospital ran out of disposable thermometers and stethoscopes and cleaning supplies and hand sanitizer; it had to rely on sanitizer manufactured in the New York State prison system.Two football field–size warehouses were opened to accommodate the massive lend lease–style operations that transferred equipment to and from the hospital sites dozens of times per day. The number of isolation gowns used for PPE jumped from 15,000 a day to 115,000 a day; N95s from 2,500 a day to 16,000 a day. The hospital more than doubled its ICU capacity—and its ventilator supply—as 1,000 clinicians and nurses arrived to assist from the hospital systems of the Mayo Clinic, Rochester, Pittsburgh, Cayuga, and UCSF, among many others. In an ordinary year, there are 700,000 emergency department visits and 5 million ambulatory visits. But nothing about March 2020 and the months that followed was in any way ordinary—or planned for.
Through more than eighteen months of reporting on ten campuses of NewYork-Presbyterian, I interviewed nearly two hundred doctors, nurses, transporters, porters, and aides who worked at every level of the hospital system, from the morgue to the research labs. Many of them had never spoken about their experiences to anyone on the outside, including their families. They had one common feature: a belief that walking away from what they did was not an option. I heard over and over again variations of: I didn’t think about it. I had to be at the hospital the next day. The doctors and nurses worked themselves to tears and exhaustion, and some of them did not make it. But there was also a flowering of ingenuity and creativity, of improvisation and invention. They tightrope walked and they juggled a thousand and one objects and they leaped into space, hoping a trapeze was on its way. This was their moment, and they seized it, at great cost but with no choice in the matter. “The rapture of action,” the renowned heart surgeon Craig Smith called it. They were not divine, but they did divine things.
In an early all-hospital briefing, Steven Corwin, CEO and president of New York Presbyterian, had addressed thousands of NewYork-Presbyterian employees. His tone was somber: “We are in this together—the cavalry isn’t coming.” The next day, the city would announce that in the month of March, a thousand New Yorkers had died of COVID-19. Quarantined in his apartment near the hospital because of hospital policy, Corwin, had been a cardiologist most at home in the ICU. Before taking over the hospital, Corwin had run the ICUs at Columbia-Presbyterian.
But Steve Corwin was wrong. The cavalry rushed in from every department in the hospital. Accountants worked as transporters, wheeling the dying and the dead. At the height of the surge, Corwin got authorization to pay for three thousand hotel rooms around the city, food for the extended families of all employees who needed help, day care, and transportation—a billion-dollar outlay. In one call, he snapped, “I don’t give a damn what it costs.” He insisted on an unlimited line of credit to fund the hiring of doctors and nurses and former air force pararescue medics and to make sure that the hospital had a field hospital and oxygen farms. He all but scoured sofas for lost coins and hunted for equipment stashed in forgotten places. I found 200 N95s in a storage cabinet, a Goldman Sachs partner texted
Corwin. We will take them, the CEO replied. Two hundred masks could mean two hundred lives saved, and at that moment the hospital had only enough masks for the next forty-eight hours. Cosmetics companies and gourmet markets delivered crates of skin creams and delicacies for everyone working on the front lines. Surgeons, urologists, medical students, cardiologists, retired NewYork-Presbyterian internists fanned out through the corridors of the system’s ten hospitals, emptying trash cans and relearning how to titrate medicines in the ICU—a skill many of the older doctors had not used since medical school.
COVID would reveal everything—the pressure that made some crumble but also the valor that meant confronting the fragility of the big-business hospital system, with its marble halls and gleaming towers paid for by New York titans. All of these complexities had to be navigated by Corwin, an amateur historian and voracious reader who used literature as a personal tuning fork. In the first weeks of the pandemic, he would decide that it was crucial that everything they were going through be documented.
On the last day of August 2020, I was told to come to the Weill Cornell security office on the Upper East Side to get my hospital badge. It was the day I officially began the reporting of this book. After my picture was taken and the necessary forms filled out, I was given a red-bordered badge that allowed me to enter NewYork- Presbyterian buildings to conduct any and all interviews that had been scheduled.
The badge is now framed and on my desk. After decades of reporting around the world, I consider meeting more than two hundred of NewYork-Presbyterian’s staff, many of whom generously entrusted me with their life stories and their struggles, the most extraordinary experience of my career. The story of those who struggled to save the lives of the city is, most of all, a story of New York and its astonishing inhabitants.