Stepping Out Of the Shadows, Again

We’ve had a Nor Easter with heavy rain and snow squalls three days this past week, and the wind is rattling the windows in my ninety year old house. Typical weather for March in New York City. Finally. The winter has been cold and damp, with no snow to brighten the long darkness that wraps around me like a wet blanket on my way to work at 5:30 am, and closes in as I negotiate the subways and commuter railways home at 7:00 pm. If an emergency doesn’t roll in.

After a brief four days on a medical relief mission to Puerto Rico in October, the cold has been been my constant companion en route to numerous the Humanitarian Emergency Response and Relief Centers (HERC) along with scores of other skilled and dedicated public health professionals, the National Guard, and numerous New York City agencies attending to more than 51,000 asylum seekers, many of them women and young children in emergency relief shelters in all five boroughs of New York City.

Meeting essential needs, medical, psychological and material, requires a lot of ingenuity, but it always seems that a brief huddle with our administrators and colleagues facilitates the process. It is a collectively experienced group of providers, some of them immigrants themselves. Despite the profound exhaustion, I sleep soundly.

The high level of alert and need for quick adjustment to ever changing, volatile and life threatening situations has not allowed time for rest and recovery, and we are all looking forward to a new normal that is an ever moving target. PTSD affects patients and health care providers alike. But the collective positive energy of New Yorkers (like folks dropping off clean clothing and baby supplies to the National Guard on their way to work) during every phase of serial emergency events, combined with the return to daylight savings time and some sun, is most welcome and appreciated. As will an upcoming vacation as long as something else doesn’t happen.

The End?

Mayor Adams has lifted the vaccine mandates and mask mandates in most settings. Javits and the other vaccine mega sites are all closed or closing. My temp agency has informed me that the NYC HSS Shelter Immunization and Testing Projects are winding down. The Medical Reserve Corps of New York City and Suffolk Counties re-upped for the Omicron surge, but are now back to restarting long delayed drills and trainings for future disasters. There are no lines in front of urgent care centers, and no pop up testing sites. The New York Recovery Network (NYRN) has an active schedule of nursing and medical missions in South and Central America, India and Nepal, Egypt, Thailand, and West Africa for 2022. We’re packing up supplies this weekend to send to Ukraine, and I would not be surprised if there will be a deployment there or one of the neighboring countries providing refugee assistance, and my name will go on that roster.

I “retired”in 2020 because I was afraid for my life, not because of crime but rather negligence, and was fortunate to find per diem employers, including New York City and New York State, that were able to provide staff with adequate PPE and emotional support. Now, I’ve slipped back into somewhat of a routine with all the other hospital based, battle hardened nurses, doctors, and awesome support staff working with immigrants and high risk families–though just about every family is high risk at this point after all the pandemic pressures.

The COVID 19 ramp up was so steep we were at risk of falling to our deaths and thus this escalator down seems way too fast. It makes sense that since 77% of New York City residents are fully vaccinated, it seems reasonable to not require proof of vaccination as of the date of this writing. The 23% of persons at most risk of infection (the unvaccinated), generally won’t wear masks without a fight and shouldn’t be allowed the platform to disrupt COVID recovery more than they already have. But please allow health care workers and those with high risk conditions the courtesy of masking without drama when asked because the burden of disease, both physical and psychological, is very heavy and we are very tired and post traumatic stress disordered.

What got us through? The 7 PM clapping was thoughtful though most didn’t hear it above the monitors beeping, repetitive hospital overhead code calls, crash carts careening down halls and bumping into walls. The food that showed up unordered three times a day for months was most welcome. Health care workers relied on each other like never before, and we did our best, but there were too many of our colleagues who died of COVID–or suicide. President Biden’s remarks after his inauguration not only gave us thanks–but provided assurance that the ship was now under the control of a sane and competent captain and crew even as the waves of unrest and needless deaths of persons of color threatened to swamp the lifeboats. Enough politics, though all of that needed to be said so the negative energy can be discharged.

I want to thank all the drivers and escorts, the administrators and tech support specialists, the physicians, my fellow nurses, nurse practitioners, physicians assistants and medical assistants with whom I have crossed paths, even if it was in the elevators. We were thrown together on a daily basis, and yet safely vaccinated and tested thousands of the most vulnerable men, women and children in New York. I rode the Long Island Railroad on the 4:45 am or 4:55 pm trains to Javits for both day and night 12 hour shifts. I drove to places in The Bronx I had never been, found parking (God was obviously on my side), and took my co workers home at 10 pm because the subways are in very bad shape right now.

I now know more about neighborhoods in Brooklyn than I thought possible. And places in Queens near the penultimate stop on the A Train that took as long as my trips to Brentwood and Riverhead in Eastern Suffolk. I braved the subway to East Harlem (even God could’t help with parking there) where the garbage bags teeming with rats were piled as high as the first story windows. And to get home, I copped a ride with the driver to Barclays in Brooklyn for a two hour odyssey on the Long Island Railroad and Number 7 train (creepy station to wait in, but there were transit cops and a booth clerk on duty) to get back to Queens, because even this bad-ass, who survived the South Bronx in the 1970s and 1980s, was afraid to go down the steps on the 1-2-3 past all the spaced out addicts shambling around.

There was a considerable amount of bonding at JAVAX on those very long shifts surrounded by the US Army Reservists guarding the vaccine supplies. Annette, we hit it off right away despite you being from Brooklyn and me from the Bronx. Not only could you get clients registered in a flash, you held hands and distracted the terrified, calmed the agitated, and help soothe the grieving. Michael, you’re from the Bronx too, so I speak your language. You reminded me of my son (about the same age) with your stand up comic humor that would morph immediately to kind and dignified questioning to obtain needed information from clients who had been waiting in line for hours for their shots. Aaron, I hope that I will get to see you in one of the off-Broadway shows or find you waiting tables in one of the Greenwich Village restaurants that survived the pandemic. Percy, you are both kind and courageous. You and Devonne saved that man’s life with quick, heroic action. And Diana, when you “click” with someone you’ve met only twice, it’s always a good day. Dimitri, I think you’re from Ukraine and if I’m correct, I hope that you and yours are okay.

I’ve only hit the highlights here. All the people I volunteered and/or worked with, no matter what their role, were typical New Yorkers who rose to the occasion, doing whatever needed to be done–and then some. And to the thousands or so I jabbed, and who murmured your appreciation, blew kisses, offered blessings, and squeezed my left elbow so your arm would be relaxed when I injected the vaccine, thanks for trusting us, and science.

Farewell to Dr. Bert Bell, A Mentor and A Friend

I met Dr. Bertrand Bell in 1986 when I began my public health internship at Bronx Municipal Hospital Center–better known as Jacobi. His warmth, enthusiasm for his job as the director of ambulatory care services was inspiring. And his genuine interest in my career interests was equally so, given the numbers of students in all disciplines that clamored for his attention.

From Day 1, he insisted that Nancy DeVore, CNM, my direct supervisor, should get me “into all the top level meetings with the State” and “keep her in the loop on everything going on around here.” Bert, as he was known, had great affection and respect for the nurse-midwives who made up the majority of the professional staff in the Women’s Health Center that Nancy directed. He was also dedicated to the care of patients, not just patient care, and that focus guided everything he did.

On rounds, I once heard him say to someone who questioned why a patient had been admitted, “From what you’re telling me he is sick, and even though we’re not sure what he’s got, he’s sick enough to be admitted until we figure it out.”

I learned a lot by watching him keep the patient as the center of all his initiatives, his decisions, and all the battles–and there were a lot of them. He fought long and hard, but always with a smile, a big dose of compassion, and a tenacity that I will always remember and to this day strive to emulate.

Along with Dr. David Axelrod, who was the State Health Commissioner, Bert spearheaded the investigation into the death of Libby Zion. The Bell Commission was responsible for reducing the number of hours that resident physicians could work, trying to prevent mistakes born of fatigue from endangering patients and ruining medical careers. It was not popular, because hospitals needed more residents to cover their services–and that cost money that was hard to come by in a time when draconian cuts were being made to head off the astronomical rise in health care expenditures.

I was hired after my residency ended, but focused on clinical practice as a midwife instead of administration. I left Jacobi in 1991, pregnant with my first child, to take a job with better hours. Stepping off the fast track was a hard decision, but one I will never regret. Bert left Jacobi in 1991 as well, forced out because of what he had fought for–and for what he stood for: Patients above Profits.

The last time I saw Bert in his element was outside of his office, right across from the outpatient pharmacy and near the front entrance to the Jacobi Ambulatory Care Center. Right in the middle of it all. I remember that I was wearing a red maternity dress, looked like a tomato, and that he came running over to me.

“How are you doing? I heard you’re leaving us.” His smile was the same.

“Yes, but it’s still an affiliation position and I’ll be doing labor and delivery shifts here.” I recall glancing at the nondescript door to his office that had been adorned with a huge “Let’s Go Mets” sign the year they won the World Series-1986. The year I had started my residency. The year I graduated. The year I began my dream career. The one I was backing off on but would never give up.

“Good for you. Take care of yourself and your family. Regards to your husband.” Bert reached out and touched my belly, the look on his face intent, like the astute doctor he was, evaluating the patient I would soon be. “You look great. I’ve got to go.”

We hugged, the genuine kind that friends exchange when one is going off on an adventure. I don’t think he knew at that time his life was about to change as much as mine.

He disappeared into the crowd and headed off to a meeting. I had no idea it would be the last time we’d have an impromptu meeting in the halls at Jacobi.

He sent me a Sesame Street Play Gym with Bert and Ernie, as a baby gift. I know that was intentional. We danced at Nancy’s wedding a few years later, but I never again saw him in a crisp, buttoned up white coat trolling the halls to see what was going on. I sent him a copy of my memoir, Someday I’m Going to Write a Book: Diary of an Urban Missionary, to be sure he approved of the mention he got–as well as to let him know that I did return from not one, but three maternity leaves. That I indeed made good on my promise and intention to “do good things.”

The Mets lost the Wild Card game and were eliminated from World Series contention this week. This week, the world lost a great man, a great doctor, and a champion for patients’ rights and patient safety.

Bert took a big fall for his beliefs–and I know he never regretted it. Nancy’s career was just as star crossed. I’ve taken quite a few hard knocks myself. Bert never responded to my letters. I hope he at least read Someday I’m Going to Write a Book and saw that I put into practice everything the two of them taught me, and that I was still fighting for the patients. And that I’d learned, as Dr. Mark Legnini once said in the American Journal of Public Health, “Doing things right is not always the right thing to do.”

The picture in his  New York Times obituary was taken in 1991, and it is exactly how I want to remember Bert Bell–and myself sitting in the chair, next to Nancy, across from him.