It was a scene he saw play out over and over inside Elmhurst Hospital in Queens, New York, and when he talks about it now, Dr. Chris Ertl struggles to speak without getting choked up.
He recalls how he, along with other doctors and nurses from the 4th Medical Battalion, 4th Marine Logistics Group Marine Forces Reserve, worked tirelessly to help physicians and nurses at a strained City Hospital treat hundreds of patients stricken with COVID-19. Their work was overwhelming, exhausting and, on many days, there were patients who succumbed to a virus that has led to an unprecedented worldwide pandemic.
“What stuck with me in a sad way were those times knowing that someone was going to die and you would see the staff hover and you’d look over and you would see them continue hovering over a bed and you knew the patient was in extremis,” said Dr. Ertl, who serves as a Commander in the U.S. Navy Reserve Medical Corps and is an associate professor in the Department of Surgery at WMed. “The staff wouldn’t leave because they felt so bad that a patient was dying without their friends or families, so they would just hover so that the person wasn’t alone.”
Bearing witness to those types of moments was something Dr. Ertl said no physician can prepare for. In late March and early April, as the coronavirus pandemic took hold in the U.S. and elsewhere, he was well aware that a call might come with deployment orders from the U.S. Department of Defense to help in cities and hospitals hit hardest by COVID-19.
By the first week of April, Dr. Ertl had learned he would be leaving Kalamazoo and be deployed with his Battalion to New York. Dr. Ertl said the deployment to New York City, as well as cities across the U.S., the U.S. Virgin Islands and Guam, marked the first time in our country’s history that the Federal Government responded to a National crisis with Military and Public Health assets, with medical personnel serving as “the tip of the spear.”
For Dr. Ertl, his orders to go to New York to combat COVID-19 was his second deployment since joining the U.S. Navy Reserve Medical Corps in 2012. From 2013 into 2014, he spent eight and a half months in Afghanistan, where he helped treat war casualties and worked with the Afghan army and police to get the country’s healthcare system up and running.
But nothing could have prepared Dr. Ertl and the other members of his unit for what they encountered when they arrived in New York in early April.
“You don’t know what it is like until you are there and that’s true for any kind of worldwide event,” Dr. Ertl said. “You can hear all of the stories and get all of the briefings you want but you walk in and there are no pictures that would convey what it was like to live it.”
After arriving in the Big Apple, Dr. Ertl’s unit was initially sent to the Javits Center on Manhattan’s west side but it quickly became clear to military commanders that members of the Medical Corps were needed most in New York’s four largest city hospitals that had been inundated with patients because of the coronavirus pandemic.
At Elmhurst Hospital in Queens, Dr. Ertl said members of his unit walked into a facility that was overwhelmed. His first few weeks there, he recalled how the buzzing of alarms was a constant sound as many patients were hooked up to four to seven different IV fluids and the hospital’s oxygen system was struggling to keep up with demand.
Every patient in the hospital, he said, was being treated for COVID-19. Prior to the pandemic, the hospital saw a daily average of 20 to 44 intubated patients but when he arrived there in early April, there were 177, all of whom had tested positive for the coronavirus.
Dr. Ertl said inside the hospital, recovery rooms and preoperative areas were converted into makeshift intensive care units. Every usable hospital bed was filled, and the hospital’s hallways were lined with carts and patients on stretchers. Every ICU, he said, was hot because spaces were cramped and ventilators and computers constantly in use.
Dr. Ertl said he and other physicians in his unit committed to working 24-hour shifts to provide ample relief as doctors were each caring for 40 to 50 patients per day.
Dr. Ertl said he and other physicians were equipped with plenty of personal protection equipment such as N-95 masks, face shields and gowns. But ventilators were in short supply, prompting doctors and nurses to convert anesthesia machines, as well as CPAP and BiPAP machines, into ventilators.
Even when a ventilator was available and ready for a patient, Dr. Ertl said he and other members of the care teams found themselves having to change the volume and pressure control settings for patients as much as two to three times per day because of how COVID-19 affected and altered patients’ lung physiology.
“You were always making your best physiologic estimate on what to do with patients,” Dr. Ertl said. “And it made it exceedingly difficult to care for the patients because imaging and laboratory were overburdened as well.”
As they worked each day, Dr. Ertl said the toll of COVID-19 on the hospital and the city was evident. Patients who died were placed in unused portions of the hospital, he said, and then eventually taken away in refrigerator trucks. Regularly, he said he and other doctors would see patients improve only to watch them suddenly take a turn for the worse.
“That grated on the staff and the nurses,” Dr. Ertl said. “They would come in every day and see the same patients and then the next day they would see that the patient wasn’t there, and it was because they had died.”
Dr. Ertl said members of the care teams at the hospital found that COVID-19 was unpredictable, an enemy that would not allow them to let their guard down.
“The only thing that let you know that a patient was going to be extubated was when you actually saw them being extubated,” he said. “We did have some patients who survived but the hard part was you would see someone who you thought would make it and they didn’t.”
Outside of the hospital, Dr. Ertl said New York City was devoid of its normal hustle and bustle as residents quarantined inside their homes. During previous trips to the city with his family, he recalled how it was packed with people and traffic. During his deployment, though, he said the city was a literal ghost town as Times Square was empty and a drive from midtown Manhattan to Queens took a mere 15 minutes.
“I stood in Times Square on the street with no one else around,” Dr. Ertl said. “It was a cool but eerie experience. Hopefully, I will never see that again and no one else will either.”
In all, Dr. Ertl was deployed to New York for seven weeks before being sent to Portsmouth, Virginia, in early June for a 14-day quarantine before returning to Kalamazoo.
As he returns to Kalamazoo, Dr. Ertl said he is proud of the service he and members of his unit were able to provide in New York. The entire experience, he said, served as a reminder to him that physicians and care teams must push through, work hard and not give up, even under the direst circumstances.
“There are a lot of people who didn’t believe this was real and it was,” Dr. Ertl said. “We did our part and we helped. I think the biggest message I heard repeatedly is when they saw the uniforms walk in, they knew there was hope.
It makes you feel proud because, whether it’s on a big scale or a little scale, bringing hope makes a big difference.”