On her 45-minute commute home from work, Navdeep Kaur will start feeling sick. It’s mid-March 2020, and Kaur, 32, is a critical care nurse in the ICU at NYC + Health Hospitals/Elmhurst, so she will know what it means when her lower back throbs and her face feels warm but she can’t stop shivering. She will know without taking her temperature or checking her pulse. She will know without even taking a test.
In a week Kaur—bone-tired, feverish, gasping for a deep breath—will compose letters to her two young sons, telling them how much she loves them. She will write about what kind of people she wants them to be when they grow up. She’ll remind them that she’s always with them, even if they can’t see her. Tears will stream down her face while she writes; sobbing will make it harder to breathe.
A coworker who lives nearby will check in, and she’ll explain: the exhaustion, the pain, the letters.
“You’re not going to die. You’ll be fine, okay? You’re fine,” he’ll tell her. But he has seen what she has seen. So when she snaps, “How would you act? If you were me, how would you act?” he will admit that he’d be just as scared.
During the few weeks that she treats COVID-19 patients before she becomes one, Kaur watches how people succumb to the virus. She observes their deterioration: cratering blood pressure at first, then slow heart rate—flatline. It’s so sudden and swift that she will not want to wait for it to happen to her. So she will write now, before she is too sick to hold a pen.
She will, after an eventual test, spend almost two weeks at home, in bed. She will never be admitted to an E.R. She will never be on a ventilator. She will be considered one of the fortunate ones. A “mild case” who needlessly found the words to tell her boys what their mother dreamed for them in case she wasn’t around in a month or a week to tell them herself. When she returns to the hospital—flattened but alive—it will all be so much worse.
There is some debate about when the coronavirus landed in the United States, but news outlets reported the first confirmed case just three weeks after New Year’s Eve. The patient had returned to Washington State from China, the virus on board with him. Clusters soon spread across the state and then, weeks later, the outbreak arrived in the east. New York announced its first case on March 1. On March 11 the World Health Organization called it: COVID-19 was a pandemic; 29 Americans had died.
We had read stories about “warlike” devastation first in Wuhan and then in Milan, even as we set off to work in open-plan offices that morning. Some of us had drinks with our friends in crowded bars that night. But a sense of foreboding was in the air, even then. And at Elmhurst Hospital, a teaching hospital in Queens that serves one of the most diverse zip codes in the nation, the crisis had arrived.
Jasmin Moshirpur, M.D.—the chief medical officer for NYC Health + Hospitals/Elmhurst/Queens and the dean for Elmhurst/Queens Programs at the Icahn School of Medicine at Mount Sinai—had been informed via email that Elmhurst would be designated as one of a few receiving hospitals for coronavirus patients. The notice meant that those who tested positive in the New York area or even those who were suspected of having contracted the virus would be diverted to Elmhurst and cared for in its facilities, limiting the toll on other institutions. Perhaps another person would have balked, thinking about potential exposure or the crush of desperate patients. But Moshirpur is a veteran of Elmhurst. At 82, she has been practicing there for over five decades, and her view on medicine is uncompromising: People who need health care should get it.
She was at a medical conference when the notice pinged into her inbox. Remembering it now, she shrugs: “I read that email and I said, ‘We did deal with Ebola, with SARS, with 9/11, with AIDS, so this is another problem that we have to face.’”
But the virus was soon stampeding through the hospital. As of 9:15 a.m. on March 25, New York had confirmed almost 17,000 cases across its five boroughs (with 30% concentrated in Queens). Elmhurst was overrun. One case had become two and then 10. That morning the hospital confirmed that 13 people had died in its care in just 24 hours. The number made news in New York, of course. But outlets around the world picked it up too. A headline in the Guardian compared Elmhurst to the besieged hospitals in Italy or Spain, two countries that had been ravaged for weeks. Veronica Henry, 75, who serves as the hospital’s regional senior associate director in the pathology department, heard from friends in her native Barbados who’d seen Elmhurst’s jammed E.R. on TV. They were afraid for her. A progressive care nurse got calls from relatives in Ecuador—was she all right?
The strain on not just the doctors and nurses but the hospital’s basic infrastructure was becoming untenable. Because the neighborhood is home to tens of thousands of people of color, scores of whom are immigrants with low-wage jobs, the population around Elmhurst Hospital was at higher risk for getting the virus than people in other areas. But Queens has just 1.5 hospital beds per 1,000 people, compared with 5.3 in Manhattan, making Elmhurst Hospital crowded under normal circumstances. With the virus raging, it was accepting 125% of its standard maximum intake.
Late one night that month, Moshirpur called the E.R. to see how her staff was coping. When one of her directors picked up the phone, his first words were “I have to divert the patients.”
Moshirpur tried her usual mix of commiseration and frankness. “I said, ‘Look, we’re being designated as one of the few receiving hospitals, and almost no other hospital got that notice. What’s the problem?’” She imagined he was tired, feeling overwhelmed and stretched thin. But then he went on: “He tells me, ‘The hub of the E.R. is full of patients, the wheelchairs are full, and the stretchers are all taken; there are seven patients in ambulances that we don’t even have a wheelchair or a stretcher [we can use] to get them into the E.R.’”
Looking at me now, via Zoom, she drops her gaze for a moment, thinking. When she lifts it, her mouth fixes in a tight line: “And that is how we faced COVID for almost two months in the hospital.”
Given the nature of her work in the management of the hospital itself, Moshirpur spends much of her time in meetings, coordinating supplies for her departments, securing funding, or discussing hiring and bottom lines. But she’s happiest on the hospital floor, teaching. Her relationship with her students is paramount; maintaining it is one of the reasons she never went into private practice, although it would have been more lucrative. She couldn’t bear to leave hopeful new doctors in someone else’s care. She has too much she wants to tell them herself.
The core of doctors’ responsibilities is, as she puts it, to “listen to the patient’s needs.” She has come to believe that listening with intent—just that—is 70% of the diagnostic process. And the rest? It’s quick thinking, good training, and the simple, potent fact that patients put their lives in doctors’ hands and trust them to act, even if, as has been the case in treating COVID-19, the path forward is not clear.
In the months following the initial surge in New York, doctors and public health experts have made some progress in treating COVID-19. Some people are flipped onto their stomachs—a longstanding low-tech effort to reduce pressure on patients’ lungs. Fewer are put on ventilators. Certain drugs have shown modest success in speeding the time it takes a person to be released from the hospital. The risk factors, too, for contracting a serious case of the virus are better understood and incorporated into treatment plans. In some states people in their 20s or 30s are accounting for an increasing number of hospitalizations—worrisome, but a sign that older, more vulnerable people are adhering to public health recommendations.
Still, to an essential, alarming extent, the same is as true now as it was in the spring: Doctors do not know what causes some coronavirus patients to survive and others to die. And that makes teaching hard—what expertise could Moshirpur impart when the world is facing a virus no one quite understands?
Moshirpur has marshaled other hard-won wisdom instead: She showed up, because that’s what she expected of her team. She did not panic, understanding that the hospital was looking to her for guidance. Moshirpur has been a constant presence in the halls of Elmhurst since the beginning of the outbreak, infuriating her children. “We were so upset when she was still going into work with all of this, because we were worried for her,” says Gita Shaari, Moshirpur’s daughter, who, like her mother, is a doctor. “Although she is a strong person, her age is still her age. It took me a little while to realize that nothing was going to stop her.”
Moshirpur has been like this since childhood. The nice word is determined. Obstinate might be a better one. She was raised in Iran, the daughter of a formidable, progressive mother who encouraged her in school. Moshirpur wanted to go into law, but her mother’s support had its limits. “She talked me out of it,” says Moshirpur, who still speaks with the lilting accent of her homeland. “She did believe that I’m a softie. I would never judge against anybody regardless of how wrong they were.” In the end she studied medicine and specialized as an ob-gyn—one of the few women in her class. She moved to New York in 1962 to be a resident and later married and had three children. She is well-acquainted with the pain that those with loved ones treated in Elmhurst have experienced these past few months—the anguish of an unexpected loss. Her husband died of a sudden aortic aneurysm in 1996. He was a cardiologist; it was a condition he would have seen in his own practice.
Moshirpur carried on. “She just channeled that loss into working harder and being the role model that he would’ve been,” Shaari says. “He died, and she moved on through her work.”
So when the pandemic hit, Moshirpur knew she would keep going in, waking up before dawn for her 6:30 a.m. shift, despite her children’s and 10 grandchildren’s pleas. While New York haggled for personal protective equipment—PPE, in the medical parlance we all now know—like masks, Moshirpur realized that doctors and nurses and technicians were also in need of emotional support that FEMA couldn’t provide. Her staff was drowning.
“I had people—they’re tough, and they’re strong and resilient, and they’ve faced a lot of problems in the past,” Moshirpur says. “They would come to my office, close the door, and without even talking, start crying. That was the degree of the stress that some of our people had, and the only thing that I could do was talk to them.”
Moshirpur remembers the mothers in particular. She works with an E.R. attending physician who has three small kids. She works with nurses and cleaners, people with babies at home or grown children like hers who are terrified for them. And she knows as we all now do that health care workers are not spared. The virus finds them too.
Veronica Henry, director of the pathology department, watched several coworkers fall ill. Some died. Then the virus crept closer. Her sister got sick, then recovered. A friend lost her son. He died in Elmhurst. It was so fast she hadn’t even realized he’d been admitted.
Even pre-pandemic, work in hospital labs—which includes making sure each patient’s test results are accurate and fast—is quiet and meticulous and unsung. To handle viral specimens, techs need to wear full PPE, including special hoods meant to ward off infection. The effect is not just isolating but almost claustrophobic. It is not the stuff of soaring documentaries or prime-time TV shows. It is not even the stuff that caring, well-intentioned people were thinking about when the clock struck 7 p.m. and New Yorkers threw open their windows to clap for essential workers for months on end.
A devout Episcopalian, Henry felt tested. She started texting her priest. She attended church via Zoom. “I needed more spiritual guidance than I ever have in my life,” she says. “Because I have never, ever experienced anything like this. There’s so many of God’s people going at one time. It’s very hard. It’s very difficult to speak about, to tell you the truth.”
Almost 4,000 people work in Elmhurst Hospital, and around 3,000 of them are women. That ratio is the norm in the health care and caregiving industries, not the exception. The New York Times reported in April that 77% of U.S. health care workers are women, as are 52% of people considered to be essential workers. Women now make up just over 50% of all medical students and are overrepresented in specialities like pediatrics and geriatrics. In nursing, women are even more dominant; nearly 9 out of 10 nurses and nursing assistants are women, according to the Times, as are most respiratory therapists, a majority of pharmacists, and a clear majority of pharmacy aides, technicians, and other hospital staffers, like housekeepers.
Meida Sanchez, 52, has been cleaning rooms at the hospital on and off for over a decade. She moved to New York from the Dominican Republic with her first husband in 1989. Queens—save for a short stint in the Bronx—has been home ever since.
In the shadow of the pandemic, Sanchez now spends more time disinfecting than she used to, but her routine has remained for the most part the same: Her shift begins at 7 a.m. with—barring emergencies—a lap around her rooms. She knocks on each door and, if the patient is awake, introduces herself. Then she sweeps, wipes down the spots people touch most, like the door handles and bed rails, scrubs the bathroom, and mops. She loves the work—the actual cleaning. (“If we live together, and you say, ‘Meida, come to cook,’ I say, ‘No, you cook and I clean.’”) But it’s the patient interaction that she prizes most. In the morning hours, sometimes someone will ask her a question or tell her about their pain, and she’ll comfort them: “I say, ‘Okay. Be patient. That’s not going to be for [much] longer. It’s going to be better. God is going to help you.’”
Listing her responsibilities, talking about her two sons, Sanchez comes across as unflappable. One gets the sense that after surviving what she has—abandonment, domestic violence, depression—she has stared down her most potent fears. But the virus did shake her. She dreaded getting dispatched to that first coronavirus unit, and when she was sent to clean its rooms, she moved as fast as she could, sweating through her goggles and face shield.
She hated the feeling, how frantic it was. Sanchez is not the kind of person who rushes to be finished with her work. After those first anxious shifts, she made up her mind: She’d stop running.
“I said, ‘God, you are my God,’” Sanchez recalls. “‘I trust you. I believe in you. I know you’re there. And I’m going to do my job.’”
She resolved to take her time, scouring the units and watching the patients—intubated and on ventilators—for flickers of consciousness. She could see their skin swell and turn sallow. She wondered about their families who couldn’t see them or hold their hands or stroke their hair. And while she worked, she murmured her usual affirmations. “You are not alone,” she told them. “You are safe. We are here. Don’t be afraid.” Nurses sometimes reached patients’ relatives by phone, and Sanchez told them to ask: Is it okay if I pray? She allotted one minute per room, and she prayed and cried and begged. “Heal them.”
Sanchez lost count of who died and who lived, but later one patient saw her in the halls and wanted to know if she was the woman who had prayed for him. “I said, ‘Yes.’ And I told him, ‘You want me to still pray?’ He said, ‘Yes, pray.’”
When Kaur, the critical care nurse, returned to work, she didn’t recognize her own hospital. FEMA nurses had been dispatched to Elmhurst to help staff the units. New protocols and policies had been implemented. On her first morning back, she saw three shrouded bodies waiting to be picked up. Hospitals across the city were reporting their mortuaries were full.
Kaur had treated a coworker before coming down with the virus herself; his condition seemed to be improving just as she was getting sick. One of the last things she did before that fateful drive home was transfer him from critical care to another floor. But when she walked into her unit, she saw him intubated. “I was like, Wait a minute, is that him?” She couldn’t believe it. The last time she’d seen him, he’d been smiling. “I just stood still for a moment. I was like, That can’t be him; he was fine.” A few weeks later he was dead.
At first Kaur was shocked. Then she was furious. The loss haunted her; she didn’t know how to process it. She started having dreams about patients, seeing her coworker’s face. With other staffers, Kaur decided to plan a vigil. It was held at night, on the evening of April 16. A crowd of about 50 people assembled outside the hospital, and Kaur read a speech she wrote. Someone handed out tea lights. Others held photos of people who’d died, including Kaur’s coworker. He had been in his 50s, with no major medical conditions.
Talking about it now, Kaur tears up, but at the vigil her voice didn’t waver. New York was in the throes of the pandemic then—averaging about 400 deaths a day. “We want to pay our respects to those we have lost during these trying times,” she told the group. “We fought very hard with every strength in our body to keep you alive. And we want your families to know that you weren’t alone.”
Jocelyn Rodriguez, who also spoke at the vigil with Kaur, remembers it as a turning point. She, like Kaur, was born at Elmhurst Hospital and has worked as a nurse there for close to a decade. Before the vigil she’d felt underwater. Talking about the ordeal, grieving it too—it was like breathing again.
In New York now, the worst seems to be over, with just a few hundred new cases per day as opposed to several thousand. There are still fatalities, but deaths are mostly in the low single digits. For the bulk of September, the state’s rate of positive tests—a metric that Governor Andrew Cuomo tweets daily—hovered below 1%.
Data scientists and public health experts, however, have predicted that a second wave will soon bear down, not just on New York but nationwide. At Elmhurst, people feel it too. “There’s an eerie silence,” Rodriguez says. “Yes, the numbers have gone down, but you’re kind of like…” she trails off, searching for the words to explain it to someone who never had to listen to a drumbeat of dire codes or drape a stream of dead bodies headed for the donated refrigerated trucks parked outside.
“You know when you’re at the tip of the roller coaster and you’re watching it go, and you’re waiting for the fall?” Rodriguez says. “That’s kind of what it feels like. We’re just preparing ourselves for the fall.”
Somehow, in 12 months or 18 months or later, the crisis will end; Kaur knows that. Moshirpur does too. And when it does, some of the darkest memories will fade. But others are indelible, like a scar or a battle wound.
“What will stay with me for the rest of my life—and I don’t know how many more years that will be—is the teamwork,” Moshirpur says. The attendings who risked it all. The nurses who braved the crowded wards. The administrative and cleaning staff. Moshirpur had worried that some might shirk from the pressure, but they ran toward it.
“We tried to be good people. To be more close to each other,” Sanchez says. “To try to work together. So many, many of us changed. We are different.”
Mattie Kahn is the culture director of Glamour.
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