ST. GEORGE — It was Cedar City Hospital Dr. Jarid Gray’s first day of his exchange to Long Island Jewish Medical Center in New York to assist with coronavirus cases.
Gray struck up a conversation with an alert patient who had shown nothing more than mild symptoms of the virus. It was a lively talk, but Gray had to break away to take care of another patient.
The doctor returned 10 minutes later and there was no way for the two to resume their conversation.
The patient was dead.
“She was not respiratorily sick. Chances are she probably had a heart attack from the disease,” Gray said. “I had a conversation with her and 10 minutes later, code blue. She died.”
Gray was one of more than 100 doctors, nurses and other caregivers – including staff from sister hospital Dixie Regional Medical Center – who traveled in the second half of April to the New York City/Long Island area to give a helping hand to the overburdened staff of several hospitals.
Doctors in New York have faced the pandemic on a scale that far dwarfs the experience seen in Utah.
As of May 8, according to the Utah Department of Health, Utah had 61 deaths in three months because of the coronavirus. The New York State Department of Health said there were 216 deaths from COVID-19-related disease in that state – on May 8 alone. And the death rate has been on the downturn there.
As the debate continues on the balance between the needs of the economy and the needs of public health, Utah – and Southern Utah in particular – enjoy an abundance of available hospital beds. This has resulted in local and state leaders feeling comfortable enough to end stay-at-home recommendations and reopen businesses on May 16.
But Gray’s experience in the New Hyde Park neighborhood near Queens, New York offers either a harbinger of what may be to come if the virus gets out of control, or a bullet Southern Utah has managed to avoid.
“You really don’t have an idea of what you’re up against,” Gray said. “I mean, even a third of this would be devastating. It wouldn’t take much of a cluster of cases in St. George to reach a critical mass.”
Nonstop code blues
In most hospitals, a “code blue” is defined as a call for medical personnel and equipment to attempt to resuscitate a patient going into cardiac or respiratory arrest.
At Cedar City Hospital, Gray said he hears about one to two code blues a month. When he previously worked at Dixie Regional Medical Center, they were more frequent – maybe one or two a week.
At the hospital in New York full of coronavirus patients, there were 28 – on his first day there alone.
“I just started tallying it each day. The lowest out of the 11 days that I actually worked was 12 and the average was probably about 19 to 20,” Gray said. “In one day, we exceeded what I would hear in a year.”
At Long Island, Gray said there were between 660-770 patients being treated at a time, 90% of them being for COVID-19.
“I mean that right there is almost as many hospitalizations as the entire state of Utah,” Gray said.
But numbers can’t convey the reality of watching person after person in a losing fight against a new virus that has no known treatment or vaccine – where the only thing doctors can really do is make a person comfortable and hope the virus works its way through their system.
Gray said he saw many treatments tried, including hydroxychloroquine, and there was no effect.
Of the patients he directly took care of, Gray was only able to discharge two. But he wouldn’t describe the two he was able to release as “better.”
“They were well enough to get out of the hospital,” Gray said. “But I wouldn’t say they were better.”
Coldest heart in the room
Gray said dealing with death is a part of being a doctor.
“We accept death as part of this job. We accept diseases particularly,” Gray said. “I’ve been called a lot of things. I’ve been accused of having the coldest heart in the room, but I may be quite pragmatic and I’ve always been that way.”
Yet, Gray’s voice breaks when he talks about the deaths he had to watch over at the New York hospital.
“The death doesn’t impact me as much as the inability to really be able to kind of hold patients’ hands through it. You know, that’s kind of the thing that really helps me to feel like the family understands what’s going on. I’ve got to be able to hold their hands through the process and not being able to do that … It’s really been hard for me because I think that’s one of the major roles we have as a doctor. To help people understand that transition between, you know, death, living, dying and death.”
“Usually if I’m talking to a patient and a family about maybe we should not do any other aggressive measures, they’re sitting there with me with their loved ones and we’re having this discussion and so they’re seeing what’s happening in front of their own eyes, and you can read the room a little bit. No families are present. So making these calls over the phone when the last time they saw their family member they looked sick, but they weren’t that bad. They will say, ‘You know, you talked to me yesterday and said everything was the same and now you’re to tell me they’re going to die,’ and it’s because they can’t see it.”
As a new virus with no treatment and no vaccine, families can’t be there to say goodbye except perhaps through a video chat. Doctors also can’t truthfully say to the patient or their families that “everything is going to be better.” They just don’t know if it will be.
“This job, normally we expect that there are some things we can try that can make some impact and sometimes it just doesn’t work out and that you come to accept that,” Gray said. “But it’s really disheartening to talk to a patient and talk to their family on the phone and say, ‘We’re not sure any of this is going to help. We’re not sure how long they’re going to be sick. We’re not sure if they’re going to get better. We can’t even tell.’”
Because the main symptoms of COVID-19 are fever and respiratory distress, many see it as not much more than something like the flu or bronchitis. But Gray said it can attack the entire body.
It can cause blood clots that either become a heart attack, stroke or organ failure and has also been seen to cause children’s immune systems to overreact.
“It has impacts on multiple organ systems and that I think is one of the misperceptions that I think a lot of people have. I was a bit surprised to see how much more of a systemic disease it is than just a pulmonary disease,” Gray said. “I think the concern that everybody has with this from a medical standpoint is it’s unknown how this virus will behave. It’s the very first time we’ve dealt with it in the human population.”
This has caused the false assumption that every cause of death is being labeled as COVID-19, though Centers for Disease Control and Prevention guidelines say doctors are not permitted to do that. But it isn’t untrue to say COVID-19 could lead to a heart attack or a stroke.
And that is one of the biggest reasons why COVID-19 is causing so much alarm in the medical community. When someone gets it and it goes beyond mild symptoms, doctors have no way right now to give a prognosis.
“Usually we could kind of give a timeline that they’re going to take if they’re going to get better, and that’s just really foreign to the practice of medicine in general that we can’t with this,” Gray said. “Even if somebody has stage 4 cancer, we can talk about palliative treatments and things that will improve their symptoms to make the rest of their life meaningful and we can’t really offer anything to these patients or families as far as what to expect. We really don’t know.”
Libbey Steed, a nurse at Dixie Regional Medical Center, also helped at Long Island Jewish Medical Center. She was profiled in a previous article before she departed for her two-week duty to help aid the medical personnel in New York.
In a statement provided by Intermountain Healthcare, Steed remarked on her own experience how even if there was little she could do medically, she could provide some kind of comfort.
“Every day here has been a hard day but filled with many little wins. Maybe we helped someone breathe that could not, maybe we held their hand and provided comfort, maybe we offered a smiling face,” Steed said. “Every day we do something for patients that has helped make life during this difficult time a little better, hopefully a little easier.”
Like an invisible bubble, Southern Utah has been protected from the devastation the virus has wrought in the rest of the country.
The drawback to that is it is causing some to let down their guard, with the feeling it can’t happen here. This is even after Washington County was the place with the highest rate of increase for the virus in the state over the last week.
While in other cities nationwide, the idea of someone not wearing a mask in a market or store is unheard of right now, there is less likelihood of seeing someone wearing a mask in the store in Southern Utah.
That fact is distressing to Gray. He said the two months of preventative measures being successful in keeping the virus to a low amount in the area has given people here a false sense of security.
“It’s like a flu shot. I get a flu shot and I don’t get flu. Was it because I got the flu shot or was it because I wasn’t going to get the flu out here?” Gray said. “I don’t want to see the disease in our state anywhere to the degree we saw there. I mean, even a third of this would be devastating.”
‘It’s not the flu’
A big pet peeve of Gray since taking on COVID-19 on the front lines are those who compare it to influenza.
According to the CDC, a range of 12,000-61,000 die in a 12-month span of the flu nationwide. As of Tuesday, 82,376 people have died of COVID-19 in a span of a little less than four months. That is around 10 times the amount of people that could be seated at Southern Utah University’s Eccles Coliseum.
“Influenza doesn’t come in and decimate a community like this,” Gray said. “So the ones who want to minimize it, that’s their comparison, but if they were walking around these hospital floors, they would not be comparing this to influenza at all.”
Besides the way the virus attacks multiple systems in the body, the other thing that was astonishing to Gray was just how when the virus is out of control, the entire hospital is overtaken by it. There is no longer a respiratory ward or a cardiovascular wing.
There is just COVID-19.
“The thing that you can’t be prepared for is a hospital that’s overflowing with the exact same diagnosis for every single patient. You just don’t see that in any, you know, any other circumstance,” Gray said. “I mean, I’ve been doing this for 20 years and nothing compares to the severity of the illness that all these patients have.”
Coming home with lessons
When Gray, Steed and the others returned home, they underwent an immediate round of testing that included a nasal swab and a blood screen.
Dr. Patrick Carroll, medical director of Dixie Regional Medical Center, has been meeting with those who returned from their tour of duty in New York.
What struck him was how despite a situation that at times seemed hopeless, they didn’t lose hope.
“One nurse said something impactful. They said, ‘Even with the devastation to see patients not surviving, even during a pandemic, we continue to believe the next patient would be the one who would survive.”
Along with nurses and doctors in New York pledging to return the favor if things get worse in Southern Utah, caregivers here have returned with the gift of knowledge.
There are plenty of lessons to learn and preparations to be made if the rate of cases continues to increase in Washington County and hospitalizations go up.
“Consistently one of the messages we got is preparation. You can’t prepare too early,” Carroll said. “We’ve taken that to heart and already put these things in place.”
Gray knows he will be much better at taking on the virus now than he would have been without the trip.
“Even if I only take care of six of these patients in the rest of my life, which probably isn’t the case, I will take care of them much better than I would have three weeks ago,” Gray said.
According to information provided to the city of St. George by Dixie Regional Medical Center, the hospital has the ability to staff 89 intensive care unit beds and has 79 ventilators on hand. There are 332 total beds with the ability to add 80-100 beds if necessary. Cedar City Hospital is a much smaller facility, at 48 total beds, and it is likely the most severe coronavirus patients would be transferred to Dixie Regional.
Gray agreed the local hospitals are as prepared as they can be, but if the problem gets anywhere near what he has seen in New York, the plan won’t matter.
“Mike Tyson said everyone has a plan until they get punched in the mouth. They got punched in the mouth pretty hard (in New York) and they completely revamped what their expectations were and what they could do instead of what they thought they were going to do. The reality of it is if it hits hard, we’re going to go from we’re starting to see some patients to full to the gills in 72 hours. It’s that type of rapid change.”
If that does take place, Gray will be ready.
After getting back on a Thursday and getting a clean bill of health, he was right back on the night shift at Cedar City Hospital on Monday.
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