Sharon Pollard, director for respiratory care at Long Island Jewish Medical Center in New Hyde Park, N.Y., had eight ventilators left and needed more. Overnight, at least 17 new patients required them.
Teams at the hospital unloaded ventilators delivered by the Federal Emergency Management Agency. The machines were bound for a central depot to distribute to many other hospitals. Ms. Pollard asked if they would leave some at her hospital, which had more than 400 coronavirus patients, many of them growing worse and others still arriving.
She asked for 25 and got 15. “We’ll take anything,” she said.
New York City hospitals faced the full force of the pandemic in recent days, as the coronavirus disease surged through the city and on Monday claimed 731 lives, the highest number of deaths in a single day.
Hospital loudspeakers sound constant alarms for doctors to aid patients in a crisis that has stretched the capacity of New York’s medical community and sparked the ingenuity and resourcefulness of its members
Within hours, Ms. Pollard had used all of the new ventilators, leaving eight in reserve. Twenty more arrived March 29, and Ms. Pollard worked frantically to assemble the parts, as a biomedical engineer tested them. Once finished, other workers ran them to hospital floors where they were needed.
While they worked, Ms. Pollard’s cellphone rang from one of the intensive-care units. “I need one more,” the caller said. No one ferrying the finished ventilators had returned. “I got you,” Ms. Pollard said. She grabbed one of the new ventilators and ran for the elevator.
As the elevator doors opened on the fifth floor, a waiting respiratory therapist took the machine from Ms. Pollard’s hands. “Thank you,” the therapist called out as she ran off.
When Ms. Pollard returned to assemble the remaining ventilators, she repeated a phrase, as she had many times over the past days: “God is good all the time. And all the time God is good.”
At Northwell Health hospitals in and around Queens, N.Y., last week, the surge was felt by doctors, nurses and others disoriented by the speed and scale at which the pandemic became their sole, urgent focus.
They tried to stay a step ahead, tearful over deaths they couldn’t prevent and fearing for their own health. By Monday afternoon, the intensive-care units at three Northwell hospitals had met or surpassed full occupancy.
Some signs point to New York reaching a plateau in the pandemic. While a leveling off could still mean hundreds of deaths a day, the number of coronavirus patients needing intensive care and use of ventilators statewide dropped Monday. “This is a projection,” Gov. Andrew Cuomo said Tuesday of a possible plateau.
This account from three hospitals in the Northwell Health system in Queens and neighboring Nassau County, N.Y., is based on interviews with doctors, nurses and family members over the past seven days.
Dr. Hugh Cassiere said he jolted awake on March 25 with the idea of modifying breathing machines using 3-D printed parts to convert them to ventilators.
He and his colleague Stanley John refined the idea for the machines they pulled from storage the next day, confirming that the devices came with software to use them as ventilators. Dr. Cassiere thought the emergency use would help relieve the ventilator shortage, but he didn’t know if doctors would use the devices.
The U.S. Food and Drug Administration approved such use of the devices, manufactured by Philips NV, but only for less-critical patients, not those with the worst symptoms of coronavirus disease. The breathing machines—typically used as bi-level positive airway pressure devices, known as BiPAPs—are for patients who can still breathe on their own. They work as a face mask to deliver oxygen.
While acutely ill coronavirus patients couldn’t use them, Dr. Cassiere and Mr. John believed some patients could be switched to the Philips device.
The two men worked with a biomedical engineer to produce 3-D printed parts that connected throat tubes to the machines. Soon, at least 50 less-severely ill patients were using them.
Northwell wanted to see if the modified breathing machines could be used for patients who couldn’t breathe on their own. The wife of a ventilated patient who wasn’t expected to survive agreed to try the device on her husband, before his life support was removed. It worked.
Mark Jarrett, a doctor and Northwell Health system’s quality chief, announced on April 1 the decision to expand use of the Philips devices, which also were modified to prevent spread of the virus into the air. He acknowledged it could be used in an emergency for coronavirus patients.
Within three days, doctors at the Northwell hospitals had used the machines for 70 coronavirus patients and another 18 patients without the disease. That helped to limit ventilator use at its 23 hospitals.
The FDA hasn’t issued an emergency-use authorization for the devices, a spokeswoman said Tuesday. The agency said it would allow emergency use if companies applied for it. A Philips spokesman declined to say if the company had done so.
“This is an emergency,” Dr. Jarrett said Monday. “We need to do what we consider safe to keep patients alive.”
Rosemarie Robinson, a nurse, arrived last Monday at Long Island Jewish Forest Hills and wondered how much worse it would be. She manages the nursing staff in intensive care and worried about having enough help.
That day, close to 50 intensive-care beds on two floors were nearly full with patients on ventilators and tethered to six or more intravenous lines. Ms. Robinson needed enough nurses to check IVs, oxygen levels and blood pressure. Patients also needed to be turned to help them breathe, a job that requires as many as eight people.
Some Forest Hills nurses couldn’t work that day because their exposure to the virus forced them into quarantine. Others were already working 16-hour shifts. Nurses from Northwell hospitals arrived to help, including a team from pediatric intensive care, but they needed training. There were a few new nurses from a temp agency.
Every wave of arrivals left Ms. Robinson at risk of being understaffed. The hospital was transferring patients to help make space. Ms. Robinson identified patients able to be moved, knowing empty beds would quickly fill.
She got a text from the hospital’s chief nurse executive: “Where are you?” Her boss said the hospital needed to open a third ICU. Ms. Robinson wondered how that was going to be possible.
Three days later, the hospital opened a 12-bed intensive-care unit. Nurses from California, Minnesota and Florida arrived to work there.
“I have never seen quite this many of the worst of the worst,” said Helen Bloch, an emergency room doctor of 35 years. Last Tuesday, she scoured medical records and vital signs to evaluate 40 patients stable enough to safely transfer from Long Island Jewish Forest Hills to other hospitals. Over the previous three days, the hospital had to relocate more than 90.
It was Dr. Bloch’s first day at the Northwell Health Center for Emergency Medical Services in Syosset, N.Y. Her immediate task was to comb through Forest Hills’ digital medical records, evaluating dozens of critically ill patients for anyone who could be safely moved.
Ambulances had over three days moved an entire hospital’s worth of patients from Forest Hills and a second hospital to make room for more.
Across the room from Dr. Bloch, monitors flashed 911 calls and a digital map tracked the locations of about 70 ambulances.
Emergency medical dispatcher Kelly Walters fielded a call for a man who had been to a hospital earlier in the week and tested positive for coronavirus. “We are sending the paramedics to help you now,” she said.
Dr. Bloch had worked most of March in the emergency room of Long Island Jewish Medical Center in New Hyde Park, and she was drained. So many patients had died. She, too, was afraid of dying.
While poring over digital medical records, Dr. Bloch approved moving one patient. Two hours later, the patient’s oxygen levels and vital signs dropped. Even a 15-minute drive was too risky. She canceled the transfer.
Then word came: Please find another patient to transfer.
Adey Tsegaye got to work Thursday morning at Long Island Jewish New Hyde Park. Before she reached the elevator, the loudspeaker blared a code for a patient in distress, summoning doctors at the Nassau County, N.Y., hospital.
Before the pandemic, hospital loudspeakers blared such codes around 100 times a month. Now, there are more than 100 a week.
Dr. Tsegaye met with the doctor who had worked overnight to review details about each patient. The unit had one empty bed left. The other 21 were occupied by patients on ventilators.
One patient stood out. Doctors had put a woman back on a ventilator after taking her off the device two days earlier. So many patients had made little progress, or had gotten worse. O ur one win, and we slid all the way back, she thought.
Dr. Tsegaye went to see each patient with a team of doctors and nurses, advance care practitioners and a pharmacist. As she sat later that day, recording information about her patients, her phone buzzed with a text from another doctor: He believed a patient was well enough to get off a ventilator.
Dr. Tsegaye ran through the unit. Two doctors and a nurse waited for her at the patient’s bed. The doctors found in a test given daily to every ventilated patient that the man could breathe on his own. Dr. Tsegaye had seen only one other patient in three weeks pass the test.
She peppered the doctors and nurse with questions. “I’m telling you, he’s going to be OK,” the nurse said. “We’ve got to try.”
“Let’s do it,” Dr. Tsegaye said. Another doctor removed the breathing tube from the patient’s throat. Dr. Tsegaye told the patient where he was and what had happened. Did he understand? She asked.
He responded “OK,” and gave a weak cough.
The doctors watched his breath and oxygen levels. Minutes passed. Both remained stable. Dr. Tsegaye walked back to her unit, hopeful of a win.
Physician Darryl Adler ended a 12-hour shift Saturday at Long Island Jewish Valley Stream at the bedside of yet another patient whose lungs had given out and needed a ventilator. She was 89 years old.
In a short span, he had seen many patients die on a ventilator, sedated and separated from family. Five had died on Friday, five the day before; four on Wednesday; two on Tuesday; five Monday; three on Sunday.
Dr. Adler asked the medical team at the patient’s bedside to give him a minute to call the woman’s family. He told Nicole Mitchell that her mother, Victoria Gourdine, very likely wouldn’t survive, even with a ventilator,
Ms. Gourdine lived near her daughter, but was independent. She drove to the store and sang in the church choir. In August, Ms. Gourdine had lost her husband of 50 years.
Ms. Mitchell tried to keep her distance during the pandemic, and they mostly talked by phone. She went to see her mother Thursday. Her mother’s breathing was heavy, but Ms. Gourdine refused to go to the hospital.
Ms. Mitchell returned Friday and called the ambulance. Her mother, who always dressed well, left for the hospital wearing her jewelry.
On Saturday, Ms. Mitchell learned her mother’s health had worsened. A nurse used her cellphone so Ms. Gourdine, her daughter and granddaughter could video chat.
“I am going to see you soon,” Ms. Gourdine said.
“I love you,” Ms. Mitchell and her daughter said.
The hospital later called to say Ms. Gourdine might need a ventilator and that Ms. Mitchell should prepare to make a decision to use it or to just keep her mother comfortable.
Then Dr. Adler called. Your mother needs breathing support, he told Ms. Mitchell, and she isn’t likely to survive. We can keep her comfortable, he said. Please just keep her comfortable, Ms. Mitchell said.
Dr. Adler relayed Ms. Mitchell’s wishes to the nurses and headed off to the emergency room.
Ms. Mitchell stepped outside to call a friend. “It’s too soon,” she said. “It’s too soon.” Her mother would be in a better place, she said, but that didn’t make the decision easier. Ms. Gourdine died hours later.
Write to Melanie Evans at Melanie.Evans@wsj.com