Brendan Barrett graduated from Lansing High School in 2008, studied religion at Princeton University and graduated in 2012. After college, he traveled some and then went on to medical school at Weill Cornell Medicine on a scholarship from the U.S. Navy.
Barrett finished medical school in 2017 and began four years of hands-on, practical residency training in emergency medicine at Jacobi Medical Center, Montefiore Medical Center and Einstein Hospital, all of which are in the Bronx.
“In the Emergency Department, we are the first in the hospital to see patients. We stabilize them and either send them home right from the ED or admit them upstairs,” Barrett said. “Sometimes, patients are very sick, shot, stabbed, etc., and we have to do critical procedures. It’s a fascinating mix of cerebral medical thinking and very on-the-clock action and decision-making. I love it.”
Emergency medicine in the Bronx is a challenge by itself.
“We have an underserved population,” he said. “There is a heavy disease burden and a lot of violence – it’s a great place to learn emergency medicine.”
Sometime in December of 2019, Barrett became aware of a new illness cropping up in China.
“At first, it seemed remote,” Barrett said. “Some of the hospitals I work at had prepared for ebola a few years ago, so when we started to wonder if certain patients could have the new coronavirus, we at least had some procedures in place to handle a small number of patients with dangerous, highly-contagious diseases.
“The first real hiccup was that it was hard to get approval for tests, and the tests were slow and not very reliable. If we could have tested more, and done proper contact tracing, we might have been able to contain the disease better. But we as a country didn’t act quickly and decisively enough, and then it was too late.”
Residency is a “hands-on” experience, and Brendan and his co-workers were learning and adapting to the new disease.
“In the early days during the surge, we would put in a breathing tube when patients couldn’t oxygenate their blood,” he said. “But we noticed that those patients who we intubated often did worse than anticipated. A lot of them died. Now we try to avoid intubating patients with coronavirus for as long as possible. If you need to intubate someone, in general that’s not a great sign, but it’s especially bad for patients with coronavirus.”
Problems with the supply of personal protective equipment (PPE) meant conserving and re-using the gear that was on-hand.
“Before coronavirus, when we had patients with tuberculosis or measles, diseases that are on the same spectrum of contagiousness, we used to walk into a room wearing an N95 mask and, as soon as we were done, dispose of it, because the mask had been contaminated,” he said. “With corona, supplies got tight, and we had to just keep the same mask on for the entire shift. Some hospitals didn’t have enough masks to give out even one a day to everyone, and people would use the same dirty mask for days on end. Not surprisingly, doctors, nurses, techs and other hospital staff started getting sick too. One of my co-residents ended up in the ICU. A nurse at Jacobi died.”
A crowded hospital required staff to balance proper hygienic procedures against personal patient care.
“We got really hyper-vigilant about cleaning everything we touched and washing hands obsessively, but when there are a bunch of patients all next to each other in a hallway, that can become tough to do,” Barrett said. “You can do it for short periods, but over 12 hours, in a cramped space, when you are interacting in a hands-on way with dozens of patients, it’s tough to do.
“And you have to see the next patient, no matter what just happened. We’ve gotten a little better at taking a few seconds after a code to pause in a respectful silence, but there’s not always time. We have stopped allowing visitors in the hospital, with only rare exceptions. It’s such a contagious virus and PPE is short, so it’s too dangerous to have extra people in the hospital. But this means that a lot of people can’t see their loved ones. It’s terrible.”
The end of March to the beginning of April was the peak in the Bronx.
More recently, “volume has been down,” he said. “A lot of people staying home means less trauma, a lot fewer car accidents. But some people are staying home too long, getting really, really sick and then coming to the emergency department too late. Fear of catching coronavirus at hospitals has meant that some people stay away from hospitals at just the time when they most need medical attention. I’ve seen people die because they were too stubborn to come in until it was too late.”
Barrett has learned more general lessons about responding to a crisis like the coronavirus.
“Another huge part of the pandemic is the thought that, as people are dying left and right, how much of this could have been avoided if we had responded better,” he said. “I had hoped that, on a national level, we could have had a robust response, accurate testing, coordination, cities not fighting each other to get masks. That didn’t happen. Sixty thousand deaths is definitely an undercount.”
He has had positive experiences as well.
“There have been a lot of things that are really depressing about everything going on,” he said. “But it has been inspiring to see people stepping up and helping any way they can. A lot of people have been reaching out. A neighbor drove hundreds of miles to deliver 3D-printed masks to a Brooklyn hospital that needed them. People have made cloth masks at home. It’s an awful situation that this outpouring of generosity can’t minimize, but it’s very touching to see nonetheless. Still, I wouldn’t want to do anything else.”
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