Signs of Hope

Host: 00:00
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about overcoming adversity. I'm Jon Earle.

Dr. David Reich: 00:07
It was leap day, it was February 29th, and I was having dinner with my husband, with a former trainee of mine, and I get a call that a couple was coming into the emergency department with recent travel to one of the countries where COVID-19 was prevalent and that they had symptoms. They were tested, and 24 hours later I got a call from the health commissioner saying that there were patients at The Mount Sinai Hospital with confirmed COVID-19.

Host: 00:39
That's Dr. David Reich, President and Chief Operating Officer of The Mount Sinai Hospital. He's talking about the very first confirmed case of COVID-19 in New York City. When we first spoke to Dr. Reich for the podcast in mid-March, he was working like crazy to prepare his hospital for the coming onslaught. At the time, nobody knew exactly how many beds or ventilators we would need, and some of the projections were pretty frightening. At the time I asked Dr. Reich what was on his mind. What was he worried about? And how was he staying resilient? What I want to do now is play a clip from that interview. It's both a time capsule from an earlier phase in the pandemic and a window into the mind of a guy facing the challenge of his career. A challenge with so many lives on the line.

Dr. David Reich: 01:22
Well, you know, I have to be quite honest that no one, I think, would be able to sleep at night if you just consider the worst-case scenarios. And looking at the pictures of Wuhan and the pictures in Italy are very, very frightening. So I have to admit that I compartmentalize. I try to think about what I can do and not what I can't do. And I focus on the next task ahead of me.

Host: 01:46
I know we're in the thick of it right now, but I'm wondering if you have a sense of how you're learning and changing as a result of this. And when you picture yourself or your life afterwards, how do you think things are going to be different?

Dr. David Reich: 01:58
Well, it's actually funny in some ways I feel blessed being a bit older in that I found myself in the past two weeks sort of reverting to the way I interacted with people in the 80s—more phone calls, more direct conversation. And it's reassuring to me to hear another person's voice and to connect with them in that way when I don't have that same social interaction. And interestingly, at least in my life, I enjoy that ability to be alone in the house and to have a chance to think differently about life. And also, as always, the things that we take for granted. And I didn't mean to say crises are wonderful, don't misinterpret that part, but there can always be a silver lining in that adversity can make you think about what's important in your life.

Host: 02:51
A month later, on April 15th, we caught up with Dr. Reich again to get a sense of where we are right now in the fight against COVID-19 and to hear about what he's learned in the past month. So if you remember last time we spoke it was March 19th, which is almost a month ago.

Dr. David Reich: 03:07
Wow.

Host: 03:07
It feels like ages. And to use the battlefield analogy, at the time people were saying that the enemy was approaching and that we were preparing our defenses. Where would you say we are right now in the battle?

Dr. David Reich: 03:21
Well, it looks to us like we've reached a point where we understand exactly how much stretching of our staff and use of resources that we're going to have to throw at this. But it's still a very, very difficult pathway because this is a disease with a very high death rate. It's taking a huge toll on people. And even though they're being absolutely amazing, their fatigue will set in relatively soon because it looks like the decline in the number of cases will be much slower than the rise up to this peak or plateau was in the proceeding weeks.

Host: 04:02
So would you say that there were still in hand-to-hand combat but the pressure is not increasing?

Dr. David Reich: 04:08
Well, I think that you're going with all of these war metaphors. I think I'd have to say that what we're dealing with right now is just a crisis which is moving into a chronic phase. Initially, you know, it did have a war-like footing in that we had no idea what was going to happen. And we were constantly changing regular patient units into isolation units for COVID patients. And we were worrying if our equipment would be sufficient to get us through the next day or two and whether we'd have enough ventilators. And those worries are perhaps behind us—unless the people of New York somehow stop the social distancing, and the case number starts to go up again. But now we're focused on dealing with a new set of challenges. We have patients who are on ventilators and they may stay on those ventilators for weeks or months. Many of them may pass away over time, but some will survive and be in a state where they need ventilator support. It's unknown just how long this will be. And I don't think the European experience is that far ahead of us that they can give us much information.

Host: 05:13
What's been the most surprising thing for you about how all of this has played out?

Dr. David Reich: 05:18
I guess the fact that I just cannot figure out the playbook. That there is no way that I know what the challenges are going to be the week after next or an even, you know, maybe three days from now. It just always is different.

Host: 05:34
What's the challenge right now as we're sort of at this plateau moment?

Dr. David Reich: 05:39
Keeping everyone going really. The morale piece is huge. And, figuring out what we're going to do with 160 patients on ventilators and knowing that perhaps in the next week, maybe only 25 percent of them will not be on ventilators. And unfortunately some will not be in ventilators because they'll pass away. Some will not be on ventilators because they've done well, are getting better, and that's great. But just dealing with this massive number of people who require critical care.

Host: 06:11
As you think back over the past month, is there something that you've seen that you think will stick with you for the rest of your life?

Dr. David Reich: 06:18
Well, I think the thing that I'll always remember is seeing how people adapted and just took care of every patient they possibly could with a certain assurance and grace and courage. Everyone stepped up. I mean there are people, sure, there are people that ran away, but the vast majority showed up and they showed up every day. They worked through holidays, they work through weekends and they gave up themselves, and we saw a really wonderful human spirit. And the resilience is not me. The resilience is of all the people around me, and that's what provides that energy back and forth that makes it all possible.

Host: 07:02
Do you have a current estimate of when things in New York City will be, you know, quote-unquote back to normal?

Dr. David Reich: 07:08
Oh, I just couldn't say at this point. I think COVID-19 is a pivotal point for society because it changes the way people think about their relationship with one another, with work, and just how vulnerable we are to something we can't even see. And the challenges, the changes, they're tough. I mean I'm old enough to have been already at a mature point in my career for 9/11, and I just remember the trauma that 9/11 left with us and how it took us a long time to get back to that. And even when we see a new building went up over 10 years later, I guess we kind of felt the wounds start to heal at that point. And so I think it's going to be years again for the wounds from COVID to heal and long after there's a vaccine and there's better control and perhaps prophylactic immunoglobulins, other medical therapies that make it a less deadly disease and a more controllable disease, that the trauma of the COVID era will have repercussions for some time to come.

Host: 08:14
Lastly, Dr. Reich, a final closing message for listeners.

Dr. David Reich: 08:19
The final message right now is—hang in there. We see what we've been able to accomplish and we see that there is going to be an end to this. But we have to have patience. And I'm probably the least patient person there is so maybe I'm the wrong person to give this advice, but if we hang in there together and we just keep on this course, we will see this through to its—not end, but to where it evolves. And we will become stronger because we developed this resilience based upon our own ability to respond to challenges we never even thought possible.

Host: 08:58
Great. Thank you so much, Dr. Reich.

Dr. David Reich: 09:00
Thank you.

Host: 09:04
Dr. David Reich is President and Chief Operating Officer of The Mount Sinai Hospital. Road to Resilience is a production of the Mount Sinai Health System in New York City. It's produced by Katie Ullman, Nicci Hudson, and me, Jon Earle. Lucia Lee is our Executive Producer. If you'd like to support Mount Sinai's COVID-19 efforts, please follow the link in the show notes. Your donations help us save lives. Thank you. We'll be back with more episodes soon. To stay in the loop, sign up for our newsletter. I'll put a link to that, too, in the show notes. Until next time, stay safe and be well.