1 Late March 2020 Dr. Roy G. Basch was dead tired. It was past midnight and he had been driving north for over an hour on the New York State Thruway, from Montefiore Hospital in the deep Bronx to his new house in Columbia, New York, the town where he had been born and raised, 128 miles north of Manhattan. The house was a grand 1854 classic sitting high up on Mount Merino overlooking the Hudson and the Catskills. Columbia, to its inhabitants, was known as a town of breakage. If something could break-especially something to do with town government or weather forecasts-it would. But Roy had been assured that the house was now breakage-free. He and his wife, Berry, had been living in Costa Rica on a mountain above Carmona, Nandayure. A paradise, yes. But with the coronavirus rampant in America, they decided to move closer to their daughter, Spring, who was working and living with a long-term boyfriend in New York City. When Roy was asked to help out at the hospital in Columbia, they had taken a trip back home and, falling in love with the town, they found and bought their dream house. Going home. For good. In all ways. Two more hours to go. He was drinking coffee but, strangely, the caffeine didn't seem to be working. The initial jolt had been fine, then vanished. His eyelids were getting heavy and scratchy, and he couldn't stop yawning. Weird. He cranked down the windows and let in the cold air to help him stay awake. It had been a long day. He'd gotten up early at their daughter's condo on the now-chic Upper Upper West Side-not far from the George Washington Bridge, where his immigrant grandfather Samuel Fuchs, a metalworker, had toiled. A rare photo showed Sam hundreds of feet above the Hudson, with an acetylene torch and no safety harness. In his spare time he'd made, out of copper, elegant Sumerian wine vases, all curves and shine, copied from the Museum of Natural History. Tough, that generation. That afternoon at Montefiore Hospital, Roy had given a Surgical Grand Rounds, a talk to a packed house of 300 doctors, nurses, and others, on "Staying Human in Medicine: The Danger of Isolation and the Healing Power of Good Connection." At dinner that night at the NYC Sailing Club, he'd drunk too much wine with eight of the top Montefiore surgeons. Awareness had recently heightened of this novel coronavirus out of China that was spreading rapidly. The main precaution recommended by the CDC was not to shake hands but to bump elbows. A few days before the Montefiore gig, he'd also done one at Downstate Medical School in Brooklyn. He was in demand as a speaker because he had become a celebrity, the real live doctor who was the model for the hero of the classic "internship" novel called The House of God, and its sequels, Mount Misery and Man's 4th Best Hospital. Now he was exhausted. Hence his torpor behind the wheel. Finally, with relief, he turned off the thruway at the Catskill exit. He passed the Catskill Country Club. In his boyhood, the private golf course near his home in Columbia did not admit Jews. But Catskill Country Club, a public course a half hour across the river, did. Finally there it was-the Rip Van Winkle Bridge across the Hudson River. God I loved my summer job as toll taker on the bridge during high school and Harvard, with my snappy uniform and gun in the drawer that had never been fired since it was put there in 1939. Looking up at Olana, the grand palace on top of the hill built by the painter Frederic Church. He turned left along Mount Merino and then right into the long driveway of the new house. He got out of the car, dragged himself into the house. The sharp, tart scent of fresh paint was a joy, snapping him awake for a moment. The renovation was finally complete. He called Berry, still at Spring's apartment. "I'm home, hon," he said. "Thank God." "Long day. Love you, g'night." "Love you too, sleep tight." It was almost two a.m., but he was now so tired he felt jazzed. He dragged himself up the 1875 grand staircase, the creaking a comfort. He poured himself a shot of George Dickle sipping whisky and lay back almost horizontal on the new leather-scented couch and watched the news, all bad. After a few minutes he clicked it off and sat up. He was so tired he slouched back in the couch. And then tried again to get on his feet. On your feet yay and a sudden blow a sense draining to steady falling forward fell facedownonfloor . . . Berry called his cell phone at six in the morning, no answer. She left a message. At seven, nothing. Another message. She steeled herself and called Dr. Amy Rose, the intensivist in charge of the Kush Kare Hospital emergency room and ICU, and left a message to call. Nothing. Panicking, she called Amy's uncle Orville Rose, their dear friend and forever doctor for the town, who knew everything. Almost 75, Orville was old enough to be up early. He picked up on the second ring. "I'm frantic," she said to Orville, telling him the details. "Somebody's got to go over there. There's a spare key under the back door mat." "I'm on my way," said Orvy. At Roy's house, Orville put on a mask and gloves and went in, shouting for Roy. No answer. Worrisome. He walked through the rooms and finally found Roy sprawled facedown on the oak floor, in a significant puddle of blood. Orville tried to turn him over-whoa!-dead or unconscious bodies are heavy! He tried again, but no way. Roy groaned, awoke. He needed help to roll over, dazed and bloody. Orville did a quick assessment. The blood was from a gash in his forehead and temple, clotted-hours old. A fall on his face-there had been no time to prevent a direct facedown hit-could be heart arrhythmia-transient, now in normal sinus; breathing okay. No signs of stroke. Feels feverish. Been drinking-George Dickle. Kind of obese. Disoriented, mumbling. Probably drunk. Please don't let it be a stroke! Orville called Lebowsky Ambulance and Taxidermy to take Roy to the hospital, then called Berry. "Clearly he fell, fell on his face." "But why? He never has fallen that way, never. Why?" "Dunno, but we'll find out." Roy was now fully awake, in normal sinus rhythm. Angry that he was being taken to the hospital. Orville knew Roy well; the Jewish community in Columbia was small and tight, and he'd helped Roy into medicine-as he did a generation later with his niece Amy. At the start of Covid, when the emergency doctors at Kush Kare realized how dangerous it was to stay and take care of patients at Kush Kare, many of them quit. Those who remained were now really stressed. Orville knew Roy was back in New York and had asked if he would help, and if he knew any doctor friends who might come to help as well. Roy said he would be glad to, and he brought in two other former interns of the House of God: Eat My Dust Eddie and Hyper Hooper. Both were recently retired in California, and bored. They jumped at the chance to work with Roy again and had already arrived at Kush Kare. Roy was supposed to join them after the event at Montefiore. "So I passed out, from exhaustion," Roy said, lying on a stretcher in Emergency. "Big deal. As I told you in detail, it was a long day, and I was dead tired. For some reason I blacked out and fell." "What was the last thing you recall?" Amy said. She was in full anti-Covid garb, covering every part of her body. "Finishing my drink-just one-maybe two-of bourbon. So I fell down. So what?" "So clearly you didn't try to break your fall," said Amy. "That's not normal. Your heart might've stopped, couldn't pump the blood up to your head-" She looked at the cardiac monitor. "EKG just now is showing runs of atrial fibrillation." She pointed the temperature gun at his forehead. "A hundred and one-fever. Blood pressure low." "So? If you do an EKG, everybody my age has something-often runs of atrial fib." "I am your doctor now, Roy. Me and Orvy," said Amy. "As you know, 'if a doctor tries to treat himself, he has a fool for a patient.' Okay?" He nodded. "I have to work you up completely. Starting with chest films." "For what?" "Covid." Roy looked startled. "There's no sign of it. No breathing problems." "It's becoming clear that all kinds of symptoms could be Covid." She saw his face go white. "Roy, honey, we're just finding out how easy it is to catch this. And spending all that time without a face mask in big crowds, right?" He nodded. "The only restriction the hospitals made is 'No shaking hands.'" "So you were exposed for hours?" He sighed. "Why do you think I fainted?" "Either the atrial fib, or, most likely, orthostatic hypotension, fainting. You fell without putting your hands down to break the fall. It's one of the first protection reflexes a baby has-if they sense they're about to be dropped, out go the arms to protect themselves. What's it called? The Moro reflex? If you didn't extend your arms, that means you were out before you hit the floor. Our Covid expert here, Dr. Dandona, has had two other patients with your symptoms. He thinks that Covid can damage peripheral small blood vessels, and so the blood pools in the legs. And with your heart straining, the blood didn't get to the brain." A cold, damp shiver went through Roy. "Oh God." "There's no test for the virus yet," she said. "But clinically I think you've got it. You're in good shape but, frankly, your weight is a risk factor-I just read a paper showing that Covid thrives on fat. The fever might vanish in a few days, but it's all new territory in medicine, this virus. Nobody knows bubkes. We're flying blind. I'm going to have to admit you, to watch you carefully." Roy let this sink in, his face still blanched. "One more thing?" "Sure, hon." "I'm scared of being in the hospital for any length of time. They're dangerous, especially in spreading pathogens. And from what I've heard about the Kush management? Death! So can I arrange it to stay at home-at least until we see if it's going to get worse or not?" "Roy, Roy!" she said, shaking her head. "There are things we can only work up with you right here, under observation. With this virus, things can change in a split second. This hospital, especially with the new team-me and the great nurses and Hooper and Eddie-is really the safest place around." "Okay. But let's make it as quick as possible. I want to get to work with my guys here. I got them here, and I don't want to let them down." 2 It was a hard May 2020. Kush Kare Hospital in Columbia, New York, was the flagship of Kush Kare Private Equity Inc., a for-profit chain of hospitals across America. A for-profit that was listed on a lot of lucrative trading routes. Clearly its workings were murky-maybe not equity at all. A clever goulash of nonprofit and big-time profit. It was on the same site as the very first hospital in Columbia, called Whale City Infirmary, founded just after the Civil War. A grand charitable mission: to care for each and every wounded, even the rare Confederate soldier who wound up there. And it was totally free. With the rise of Covid, the hospital was a zoo: frazzled doctors, nurses, techs, labs, cleaners. And patients stacked up lying on stretchers in hallways, coughing, crying-and dying. Dr. Amy Rose was nine hours into her six-to-six shift, and it seemed like 20. She could not go on. She went on. She was chief of both Emergency and the ICU, the Intensive Care Unit. Her official title was "intensivist," one of the ones who run toward the danger. She had done just that for a month in the bone-dry Har Har Somali refugee camp, but she had never seen anything quite like this. No doctor, she thought, had ever seen anything quite like this. Even after two months, they were flying blind. Risking. One patient might look healthy, only to die suddenly. Another might look sick as hell, and make it. Being a virus, Covid had no curative treatment. They didn't even know what would help. But we docs like leaning out over the tips of our skis. It's exciting and terrifying at the same time. The hard thing for Amy was ensuring she had no exposed skin. For 12 hours a day she was sealed head to toe in plastic PPE, personal protective equipment. It was stifling. The pants and gown and mask and protective N95 face shield and gloves made each of her senses blur and rebel; her fingers felt fuzzy and far away, like she was a spacewoman out on a moonwalk. Real life seemed more virtual than Zoom. It was nearly impossible to feel connected to a patient, or to fellow health-care workers. Now there was no touch, no contact of any kind. Except eyes. They almost never went into a patient's room. She felt like a leper. When a physical intervention was strictly necessary, several space-suited docs and nurses went in. Otherwise, all patient information and care were addressed from outside, either on screens or with robots controlled by toggles on handheld joysticks. The rooms were sealed off, with negative pressure airflow. Bad air sucked out, good air pumped in. The only other time someone (let's face it, usually a nurse, not a doctor) entered the patient's room was, with a surgical-gloved hand, to hold the hand of someone dying alone; if possible, holding up an "I"-phone or laptop so that family members could be "with" their loved one. Amy knew scientific studies demonstrated that a crucial element of healing is experiencing a feeling of connection with the health-care provider. Eye contact, touch, voice, facial expressions of all kinds, are key. Without good connection, mortality and morbidity go up. Isolation is death. Connections heal. Of these the only one that remained was eye contact. Years ago, Amy had spent a few months working in Casablanca. The women's jellabas covered all but their eyes. And what eyes they were! Not just the dramatic makeup, but the dramatic way they used their eyes, taking in and sending back all kinds of strong emotions. Excerpted from Our Hospital by Samuel Shem All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
