Here, where the critical patients with COVID-19 are kept, it is quiet. There are no families talking among themselves; visitors are not allowed. There are no televisions tuned to daytime talk shows; the patients are unconscious, eyes closed under a loose braid of tubes. The yellow ones feed the patients; the blue tubes keep them warm. The clear tubes are for breathing, what is keeping them alive.
The staff are here, too, at Temple University Hospital’s Esther K. Boyer Pavilion. They also are quiet, listening to the mechanical whoosh of the ventilators. They speak to ask for an alcohol swab or for a phone number for a patient’s next of kin. A nurse named Frank Evans props open the door to a patient’s room at the end of the hallway.
“I’m going to FaceTime your grandson,” Evans says. They are stopping treatment for this patient. He is not going to make it. Evans reaches behind his back for the straps of the yellow gown he must wear around the sickest patients. His forehead is covered with a Gritty-patterned bandanna, his nose and mouth with a mask. All you can see are his eyes. They blink behind a plastic shield.
Seven people have died of COVID-19 at Boyer since Temple converted the building into its coronavirus hospital last month, and on Tuesday, another is about to. But 85 people have recovered. Now 161 patients, all confirmed or presumed positive for the coronavirus, wait in the eerie quiet to find out whether they, too, will walk out.
More COVID-19 patients have come through Temple’s Boyer building than any other single hospital in Philadelphia, most walking in from the poor neighborhoods that surround it. Many of them are black or Latino, some unable to describe their symptoms in English. Forty patients on Tuesday were in critical care, with 25 on ventilators.
Less than two months ago, Boyer was an office building for departments like cardiology, neurology, and surgery, linked to the hospital building by a covered bridge. Patients came to Boyer to see their doctors for routine exams after hernia operations and heart procedures. In March, Temple redeployed the building as its coronavirus hospital. Now the chairs from those waiting rooms are piled upside down on top of each other in the hallways.
As the virus began to overwhelm hospitals in Seattle, then New York, Amy Goldberg, Temple’s surgery chief, and Claire Raab, associate chief medical officer, walked the seven floors of Boyer to figure out how to turn 85 doctor’s offices into beds for COVID patients. “You’d think you could just flip a switch and it’s a hospital," Goldberg says.
You can’t. Typical hospital beds won’t fit through the entries of these rooms, so patients sleep on stretchers. Nurses need to be able to see in, so the wooden doors have been thrown open and replaced with clear sheeting. There are no call buttons, so each patient gets a flip phone programmed with nurses’ cell numbers. The monitors in these rooms aren’t wired to alert staff if a patient’s vital signs crash, so the screens must be positioned in front of windows, some sitting on chairs, propped up on bed pillows.
On its top floors, Boyer already had some space outfitted for critical care. Here, patients sleep two to a room behind glass sliding doors. If not for the pandemic, Raab says, two infected people never would be so close together. But long ago, this building was a children’s hospital, and with two hook-ups for ventilators, one can’t be wasted. “We’re doing a lot of things that we wouldn’t normally do before,” she says. “You never think you’re going to be FaceTiming people’s families to say goodbye."
For these doubled-up rooms, each patient is labeled "A" and "B" but also “door” and “window." No mix-ups can be afforded. A paper sign says “NAME ALERT,” meaning there is a similarly named patient on the wing. Because they are hard to identify under their head-to-toe gear, the nurses have written their own names across their face shields.
Felicia Nemick, a nurse with bright blue eyes between a bandanna and a mask, waits outside a room where another nurse is taking a patient’s temperature. She calls out to Nemick for an alcohol swab, her voice muted through the wall. Nemick passes it through a toed-open door.
Here, as in every other hard-hit city, few things are in as scarce supply as personal protective equipment, or PPE. Clinicians enter the rooms of COVID-positive patients draped in gowns, masks, goggles, and gloves. To do otherwise would be to risk infection. To leave the room is to change clothes.
Nemick explains how nurses and doctors now “cluster care,” doing as much as possible — pills, injections, temperature checks — each time they enter a room. “We can’t deliver medications at all times of day," Nemick says. “It would waste too much PPE.”
The nurse and the rest of this critical-care team are adjusting to new tasks in a new space. Just as the building had been repurposed, so have the clinicians. Physicians who normally wouldn’t be involved in critical care are treating COVID patients in teams of threes. So a urologist or a trauma surgeon might work with a hospitalist — an internal medicine doctor — and a pulmonologist, who specializes in lungs and respiratory disease.
“If we just stuck to the typical job descriptions," Raab says, “we wouldn’t be able to do it.” There wouldn’t be enough staff. Each team works four days of eight-hour shifts. The shifts would be longer, the doctors say, if the work wasn’t so difficult.
Asked how his day has been, Gerard Criner says: “They’re all the same.”
“There’s a lot of work to be done,” says the director of the Temple Lung Center, and chairman and professor of thoracic medicine and surgery. “There’s a lot of sick people.” A man wheels a red bin of infectious medical waste past him.
The doctor thinks the number of new COVID infections in Philadelphia will peak this weekend, followed in quick order by the peak in hospitalizations. Twice a day, Criner gathers the 30 treatment teams in a room and pulls up the charts of Temple’s COVID patients. He reviews their symptoms, looking for signs they might do well in a clinical trial.
Criner says he has been speaking for months with colleagues in Wuhan, the Chinese city at the epicenter of the pandemic. He says these people “told us what we needed to do": Maintain separate elevators and hallways for COVID treatment. Use CAT scans of lungs to identify patients likely to have the virus. Try drugs that have helped rheumatoid arthritis patients. For each treatment area, avoid contamination with a separate entrance and exit.
“ENTRANCE ONLY,” reads a sign taped to a wall made out of high-grade white cardboard and held together with cherry-red duct tape. “Don’t blow on it,” Goldberg says. This is the partition for what used to be Boyer’s lobby, a sunny space with a restaurant. Now it is an open floor with 21 beds and recliners for the COVID patients in the best shape: those who can still breathe on their own.
These patients can eat, too, but most of them don’t, leaving remnants of red soup and chicken. In a bed in the corner, a woman coughs so hard and persistently into her mask that she cannot get a grip on a gray sweater hanging off the edge. A nurse helps her pile it into a pillow underneath her head, then hands the woman a yellow inhaler. She shakes it, and inhales deeply.
Coughing, labored breathing, the plastic clatter of food trays being carried away: These are the sounds of the bottom floor, where hope is the greatest. Many of these patients will go home without ever being heavily sedated and intubated with that clear tube down their throats.
Upstairs, patients still waiting on their test results have rooms to themselves, on the chance they are not infected. It was a normal thing before, to have your own room; in these new, strange times, it is a strain on space.
Now, another nurse pulls Nemick into a corner. “She’s positive,” he says. “She is?” “She just became positive.” They have been waiting on a patient’s test results. Now that she is confirmed to have coronavirus, another positive patient will share a room with her.
Nemick pulls the thin yellow gown over her head and ties it around her waist. They need to move the patient. She adjusts her N95 mask and puts on fresh gloves. This patient is on a ventilator, and if a tube comes loose in transport, invisible pieces of the virus will rain down through the air.
The nurse clears the hallway.