Hospital Featured

Code Lavender – Help for the Healers

At the height of the pandemic’s first wave, Dr. Tazeen Beg was racing through Stony Brook University Hospital, administering anesthesia and placing patients with COVID-19 on ventilators.

A clinical anesthesiologist, Beg usually provided perioperative care for surgical patients. So when the coronavirus came close to home, she volunteered to join the hospital’s COVID airway team. The experiences she faced as a member of the response team that intubated patients with severe acute respiratory syndrome have stayed with her.

“It would just bring tears to our eyes watching those patients talk to their family at that time,” Beg said. “Telling them, ‘Okay, I love you, take care and I’ll come back’ – things like that. But I knew it was just not gonna happen.”

Dressed head to toe in personal protective equipment, Beg and the airway team visited patients who were struggling to breathe on their own. The team’s arrival would concern patients who heard on the news about the low survival rates among people who were intubated. This sparked questions Beg struggled to find answers for.

“A young guy, I still remember his eyes when I was talking to him, and he’s like, ‘Oh, am I gonna die?’” she recalled. “I just didn’t know what else to say. I’m like, ‘No, I’m gonna take care of you. It’s gonna help you breathe better.’”

He recovered, but that wasn’t always the case.

Dr. Tazeen Beg. Photo provided by Stony Brook University.

More than 400 COVID-19 patients were admitted to the hospital in April 2020 – and at times, Beg was intubating nearly 20 of them per shift. There was barely enough time to look after the patients, let alone herself.

“We were running in the hospital from emergency room to the ICU,” she explained.  “We didn’t even get enough time to actually get ready for the next patient. It was just so busy. It was just too overwhelming for everybody at that time.”

Dr. Adam Gonzalez, director of behavioral health for Stony Brook Medicine, anticipated these experiences as soon as the virus showed up in New York. He met with the hospital’s disaster mental health committee in early March 2020 to address the approaching threat.

“It’s a lot of go go go to make sure that they’re able to do what they have to do to get the job done,” he said of doctors like Beg as well as nurses and other front-line medical workers. “Over time, the stress and the emotions that come up as a result of being involved in these traumatic experiences can really take a toll and add up.”

The hospital already had a remedy for what Gonzalez knew would be the emotional fallout of working on the vanguard of a pandemic. It was a crisis intervention program called Code Lavender that was pioneered by the Cleveland Clinic in Ohio and brought to Stony Brook less than a year before the coronavirus swooped in – thanks to an obstetrician-gynecologist who had had an epiphany.

When a routine delivery took a turn for the worse, Dr. Megan Lochner, a clinical assistant professor in the hospital’s gynecology and obstetrics department, performed an emergency hysterectomy on her patient and stopped internal bleeding twice. But in the end, Lochner was left alone to handle her own emotions.

Dr. Megan Lochner. Photo provided by Stony Brook University.

“I never left and nobody, nobody in that room asked me if I was okay,” she said. “It was at that moment that I said, ‘I’m not letting this happen to anybody else.’ … I needed help and I couldn’t find it. I said to myself, ‘I have to help my colleagues not feel the way that I feel.’” Her answer was to start a mental health initiative as a pilot program in the highly stressful neonatal intensive care unit to provide support for health care workers who may feel overwhelmed.

Now, when a worker calls Code Lavender, a team composed of chaplains, physicians, social workers and psychologists as well as patient advocates and personnel from employee assistance jump into gear. They provide an immediate calming influence and decide if further assistance is needed – including one-on-one sessions with trained staff members called “wellness champions.”

From the start, Lochner said, the program showed employees that addressing the emotional side of their jobs shouldn’t be pushed aside until they were off the clock. “When you demonstrate that it’s okay to have feelings and to cry, be scared and angry, when you show people that that’s okay,” she said, “then they are going to also show their emotions.”

When the pandemic hit, the program went hospital-wide almost overnight, Lochner said, as more and more health care workers began to feel the pressure of taking care of more and more patients who were getting sicker and sicker. “It was just too much,” she remembered, “code blue after code blue every 10 minutes back in April and people got to the end of their rope.”

Once Code Lavender expanded, efforts aimed at general wellness and prevention were added. Employees could meet through daily virtual support groups and meditation sessions. Therapists taught de-stressing exercises and chaplains provided a hotline to discuss spiritual well-being.

The university’s Employee Assistance Program contributed to the effort by providing pet therapy and hardship funds to minimize the stress and burnout that is all too common among hospital workers – even when there isn’t a pandemic. These programs bring together a response team to provide holistic support following an adverse or traumatic event. Therapists are available around the clock to provide health care professionals with mental health advice.

Gonzalez, who is director of the Mind-Body Clinical Research Center in the university’s Renaissance School of Medicine, championed the creation of a respite room where employees can take breaks and decompress before returning to work. The hospital’s empty adolescent psychiatry unit was transformed into a space where stressed health care workers could relax, enjoy a snack or speak to the psychiatric staff available on hand.

With more than 19,000 visits in the first four months, the feedback helped create a new permanent respite room elsewhere in the hospital. The room features a calming environment with plants and soothing music, where workers relax with small Zen sand gardens or crossword puzzles or adult coloring books.

“We are continuing to build out our Code Lavender response work hospital-wide,” Gonzalez said. “We are identifying wellness champions on each unit that can serve as a point person for wellness and support.” And an inspiration exchange wall offers employees space to post messages to motivate, inspire and support each other.

Gonzalez said this approach helps remove the stigma associated with mental health care. “Engaging in mindfulness and meditation sessions focuses more on overall wellness,” he said, “promoting a skill that people can utilize to cope with the stress that they’re experiencing.”

Looking back on her own traumatic experience, Lochner said if it had happened today, “I would have called the Code Lavender. … We have created a culture of compassion here that did not exist, where we can look out for one another. It doesn’t even have to be an official code. If we see somebody is suffering, we’ll say, ‘Looks like you really need a lavender moment. Why don’t you go take a break? I’ll watch your patient for a little bit.’”

Danielle Curry, nurse manager in the hospital observation unit, was one of the many medical workers who took advantage of Code Lavender and its resources during the pandemic.

Last winter, during the so-called second wave, Curry treated a patient with COVID-19 who was in respiratory distress. She was giving the patient CPR while other health care workers put on protective equipment. Curry didn’t feel the need to completely protect herself since she’d already had a bout of COVID-19 and recovered. Besides, she was concentrating on saving the patient’s life.

But then, Curry said, “the patient’s color changed. It felt like an eternity before everyone came in there. I had never had a full blown code blue under COVID before.”

Curry described her own unexpected reaction. “I became very emotional,” she said. “Everything hit me at once. I was beside myself.”

She called Code Lavender. “It was very helpful because I was able to talk about how I felt at the moment,” she said, adding that the wellness champion who responded “cared and she helped.”

Psychiatric nurses, like those who helped Curry, offer in-person support, including meditations, empathic listening, encouragement and resource flyers. The nurses also organize donations for wellness baskets and snack packages for all units. The Department of Psychiatry and Behavioral Health developed a helpline for employees and their families that provide on-the-spot counseling and other resources, including COVID-19-related mental health counseling.

Lochner also explained what makes the hospital’s response to the mental health crisis of health care workers unique. “We anticipated the need, as opposed to responding to the need,” she said. “We got over 400 emails from kids and from community members with pictures and video clips that they made for us and we were able to print them out and display them throughout the whole hospital. We also had pet therapy with an iPad, which sounds kind of silly, but people loved it.”

Colleen Stanley, the lead coordinator of the Employee Assistance Program, and her colleagues also saw what was happening. Stress, she pointed out, can show in many forms – anxiety, depression, domestic violence, substance misuse, insomnia, nightmares, intrusive thoughts, fear of bringing the virus home, fear of joblessness, a sense of being out of control, and the list goes on.

Medical workers stop to read thank-you cards on display at Starbucks in the hospital lobby. Photo provided by Stony Brook University.

These concerns prompted the Employee Assistance Program, in partnership with the hospital, to create a training program for supervisors to learn how to recognize when workers may be having difficulties that could impact their job performances. Special mental health response teams were formed to identify workers’ reactions to – and symptoms of – trauma and to provide tips for managers to deal with them.

A hardship fund was started to relieve the financial burdens of hospital workers, who can apply for grants up to $599 to help with non-recurring, unexpected, critical expenses such as family crises, acute illness, natural disasters or fires.

Dr. Cynthia Cervoni, a psychologist in the university’s consortium program and a contributor to the Code Lavender response effort, emphasized why her job is so important, especially in such turbulent times.

“On a very basic human level, protecting the mental health of hospital employees is important because they are people and they are suffering in their own way and we want to be able to provide that service,” she said.

Last year, Cervoni, Lochner and Gonzalez collaborated on a research paper with the American Psychological Association titled, “Supporting Health Care Workers During the COVID-19 Pandemic: Mental Health Support Initiatives and Lessons Learned From an Academic Medical Center.” It elaborates on the hospital’s efforts to support the mental health of its employees.

“Health care workers are such valuable members of our community,” Cervoni said. “They’re taking care of all of us at a time when it’s needed so it just makes sense to take care of them as best as we can.”

Listen to more of Cameron Albert’s report:

A Nurse on the Front Lines

It’s the morning of April 1, 2020, and Lindsay Nolan has just arrived at Stony Brook University Hospital for her shift as a nurse on the medical surgical floor, located on level 12 South. Typically, this is where the patients of least concern stay, but there’s nothing typical about this day. At least not yet.

Lindsay, a 26-year-old registered nurse, greets the night nurse she’s taking over for, who is standing in the hallway next to a closed door. On the other side are two COVID-positive patients. Two bulky, white pulse oxometer machines in the hallway each display a squiggly line and two numbers that track the oxygen levels in the patients’ blood. The chords of the machines trail under the door, connected to the patients inside by skinny white stickers. Nurses have been instructed to limit their time in the room – personal protective equipment (PPE) is running low, and not much is known about how the new virus spreads.

“He’s really sick,” the night nurse says of the dark-haired man in the room. “He’s already on 50 percent oxygen.” She finishes her shift report and says goodbye to Lindsay.

It’s hospital protocol to check on the sickest patients first. Lindsay opens the door with her gloved hand and swiftly steps inside the beige room, closing the door behind her. The 41-year-old man in the bed by the door is barely breathing. The muscles in his chest and shoulders surge to expand his lungs. To no avail.

Lindsay instantly knows he needs more than the clear, plastic Venturi mask that covers his mouth and nose. She draws the curtain between the two beds and the room dims as the cloth blocks the natural light flooding in from the window.

A Venturi Mask on a Mannequin Head
A Venturi mask on a mannequin head.
Photo from Medline Industries

On average, the air we breathe contains about 21 percent oxygen. A Venturi mask administers air with oxygen levels starting at 25 percent. The patient’s mask is operating at 50 percent oxygen – its highest setting. The air pumping through his mask is saturated with more than twice as much oxygen as he’s used to, yet his lungs cannot take it in.

He has COVID-19.

Lindsay calls a “rapid” – hospital jargon for requesting backup. No one responds. On a regular day, three people from the rapid response team and a handful of other medical professionals would have arrived almost immediately.

Lindsay has worked at Stony Brook University Hospital for three years, so even though she doesn’t usually take care of severely ill patients, she knows not to panic. Her training and experience kick in – and suddenly, she’s on autopilot. At moments like this, Lindsay would explain what’s happening and try to keep her patient calm. But the man she’s treating understands little English. He strains to speak to her in Spanish but can’t get out many words. She gives him a second IV and draws his blood as gingerly as possible, trying to stabilize him while he gasps for air. The other patient in the room, an elderly man with dementia, is screaming for water.

About 10 minutes later, a man on the rapid response team finally arrives. He happens to speak Spanish. The patient agrees to an immediate intubation and calls his wife. Moments later, his English-speaking daughter asks from the other end of the line to talk to someone about what’s going on. Lindsay grabs the phone, explains the situation and reassures the teenager that they’re doing everything they can to help her dad. She puts the man back on the phone. The girl keeps an optimistic tone, but Lindsay hears her voice crack.

An anesthesiologist enters the room and begins the intubation process. A metal tool is carefully – but forcefully – pushed into the sedated man’s trachea to guide a plastic tube through his airway. A small inflated balloon is then placed inside his trachea to secure the tube as it’s attached to the ventilator, which forces oxygen-rich air through his lungs. He’s rushed to the Intensive Care Unit (ICU).

Lindsay never sees him again.

“I followed his life case,” she says months later. “Because he was just – I don’t know. Something about him.” The man was well below the high-risk age group with no pre-existing health conditions. His daughter was only 15.

“He ended up passing away,” she says. “And we had a lot of those, unfortunately. They got really bad on our floor, and then they would pass away. A lot of the stories are not great stories.”

Sidewalk chalk art outside Stony Brook Hospital.
Photo by Kathleen DiBenedetto

While Lindsay struggled to keep this man alive, she herself was sick with the virus. She’d just returned to work after self-isolating for 10 days. He was her very first patient on her first day back on the job.

Lindsay didn’t know she’d been exposed to the coronavirus until her boss called her on March 21 and told her a coworker had tested positive. Lindsay had contracted the disease on Friday the 13th from another nurse on her floor who unknowingly treated a COVID-positive patient. She started feeling cold symptoms a week later. Her only COVID-specific symptoms were the losses of taste and smell, which weren’t yet known indications of the virus. It took about six weeks for her senses to fully return. Lindsay describes her sickness as slightly worse than a bout of the common cold. Her nose was clogged and there was intense pressure on her sinuses.

“I stayed home only 10 days because they needed me back at work,” she says. “So, if I was fever-free for three days, then I didn’t have to quarantine anymore.”

Lindsay never had a fever, so she waited until three days after the worst of her symptoms subsided. Still weak, she went back to work. Some of her coworkers got much sicker than she did and she says she would have felt guilty staying out much longer. Before she left, there were only a couple of patients with COVID on the medical surgical floor. By the time she returned, all 29 were COVID patients.

The next few months were a blur.

The “new normal” for most Americans consisted of working from home, wearing a mask and staying six feet away from others. The new normal for Lindsay and many other health care workers meant patient after patient like the 41-year-old man. She says she became so desensitized to death that it almost disturbs her.

“We didn’t really have time to stop and think … because we’ve gotta keep going. It’s sad that just happened, but you have four other people to take care of upstairs. Time to go back to it.” Equally disturbing was the lack of basic hospital supplies that Lindsay once took for granted.

During one of her shifts at the height of the pandemic, the hospital ran out of body bags. “We had someone pass away, and we didn’t know what to do,” she says, “we just put them in [a shroud] without the body bag.”

Supplies were rationed at the hospital like water during a drought. A limited number of masks and disinfectant wipes were allotted to her floor each day. When supplies were exhausted, they were replaced with cheaper alternatives. The disinfectant wipes became a watery, orange-scented spray that doubled as hand sanitizer and the customary plastic blue gowns became thin, translucent paper ones. Before COVID-19, the hospital would be fined by The Joint Commission – an auditing agency that enforces health care safety standards across the country – if employees were caught reusing masks. But before long, it became impossible not to do so.

A Group of Four Nurses Standing in Front of Two Closed Doors
Lindsay (right center) and three of her colleagues.

“All of a sudden, the CDC, when we didn’t have supplies, was saying, ‘Oh, it’s okay to reuse masks for 10 days,’” Lindsay says of the Centers for Disease Control and Prevention guidelines at the time. “But literally last week, you were saying it’s not okay… They were only changing the rules because of the supplies – not because of actual studies. It was very obvious.”

The Strategic National Stockpile (SNS) was started by former President George W. Bush to store emergency PPE and other health care supplies to support hospitals in the event of a national public health crisis. According to Harvard Business Review, the national stockpile was inadequately funded and hadn’t replenished its supply of masks since the H1N1 pandemic – the so-called swine flu of 2009. With a global shortage looming, the stockpile was exhausted in February, 2020. Since then, the SNS has expanded its supply of PPE exponentially and restructured its operations completely.

Under the circumstances, Lindsay says the hospital did a good job working with the supplies it had. Her friends who work at other hospitals can’t all say the same. Because no rationing took place, they had to reuse more than just masks.

“They would have a gown that you wear when you go into a patient’s room,” Lindsay says, “and then when you get out of that patient room, you hang the gown up and then the next nurse uses that gown, too. Everyone’s using one gown for that room – like, everyone’s using the same gown. We were able to have our own gowns … We had to reuse masks, but within reason. It wasn’t anything that was egregiously disgusting.”

Lindsay commends Stony Brook Medicine’s allocation of supplies and expresses gratitude for the support she and her colleagues received from the community. Family members of nurses and patients would present health care workers with homemade masks, hand-written cards and gift baskets. Local businesses donated food every day – from pizza to salad to garlic knots. Appreciation from the community served as much-needed encouragement for exhausted hospital employees.

The chaos of COVID finally started dying down at the hospital last June. By August, things were more or less back to normal. Even so, the coronavirus left many vulnerable patients in its wake. Hydroxychloroquine, touted by then-President Donald Trump as a coronavirus cure-all toward the beginning of the pandemic, ended up causing further complications for many COVID patients.

“Not only is it very expensive, it’s actually really bad on the heart,” Lindsay says of the drug. “A lot of people are speculating that the hydroxychloroquine, you know, messed up these people’s hearts, and that’s why they were having arrhythmias that put them into cardiac arrest.”

By the time there was a second influx of COVID patients last November, the treatment protocol had changed. Rather than hydroxychloroquine, qualifying patients were given intravenous injections of steroids and Remdesivir, an antiviral medication.

“I feel like there was a lot better turnover the second round versus the first round,” Lindsay says, noting that men between the ages of 40 and 65 still tended to fare poorly.

“I’m not sure why,” she says. “I’m sure years from now we’ll hear more research.”

Lindsay’s parents are on the upper end of that age range, and during the first wave of COVID, she didn’t visit them in New Jersey for nearly four months. When Lindsay finally saw them in person late last June, it was a somber reunion. Their 15-year-old dog Cody – part of the family since Lindsay was 11 – had to be put down.

Lindsay Nolan Holding her Dog Cody Beside her Brother
Lindsay with her brother, Michael, and the family dog, Cody.

“Even though I’m 26, I’m like a child still,” she says, sweeping her long brown hair behind her ear. “And now I have to tell my parents we have to put down the dog.”

Since then, Lindsay has seen her parents as well as her older brother and his two young children multiple times, and under happier circumstances. She’s been fully vaccinated since January. Her crystal-blue eyes brighten when she lists the loved ones she’s visiting next – her grandparents, her aunt, her friends.

Lindsay Nolan Giving a Peace Sign Beside a Medical Student Administering her Vaccine
Lindsay receiving her second dose of the Pfizer vaccine.

For as long as she remembers, Lindsay’s always wanted to work in health care. Her selfless nature stood out throughout the pandemic – she readily guided new nurses coming into the hospital, she sprinted to respond to her colleagues’ calls for “rapids” whenever she could, she stepped in for nurses who were assigned to COVID patients and hadn’t yet contracted the virus, she picked up a friend’s Thanksgiving shift to give her the day off with her family.

Lindsay was asked to be one of two charge nurses for a new COVID floor that opened in January with staff selected from various units in the hospital. She oversaw the nurses on the floor directly beneath her own – level 11 South. Three years of clinical experience on the 12th floor plus months of facing the worst of the pandemic enabled her to take on a job that typically requires more schooling. She assumed the extra responsibilities of this leadership position without the increased pay.

A former pediatrics unit, the new COVID floor was already ICU-equipped, and every room was turned into a negative pressure room where the air pressure inside the room was lower than that outside the room to keep contaminated air from flowing back into the hospital.

This time, Stony Brook University Hospital was prepared. But that didn’t take the pressure off health care workers.

Though intubations were rarer in the second wave, COVID still took the lives of otherwise healthy patients. One man on the floor celebrated his 50th birthday in a hospital bed. Lindsay describes him as a relatively healthy man with a touch of extra weight. After weeks in the COVID unit, he needed to be intubated, then rushed to the ICU and eventually put on emergent dialysis, a form of life support that filters salt, waste and excess fluids from the blood. One of Lindsay’s coworkers who’d taken care of him every day followed his progress. He didn’t make it.

In March, a staff shortage on the medical surgical floor meant that Lindsay had to return to her old job, though she says she would have been willing to stay on the front lines for as long as necessary.

“Not to be dramatic,” she says, “but it’s like – it feels like you’re at war with people … you had an experience with them like none other. And it was just hard.”

It won’t be long before the coronavirus waves a white flag at Stony Brook University Hospital. It’s been more than a month since Lindsay last took care of a COVID patient – a testament to the effectiveness of vaccinations across Long Island and the state and country.

“People who came out of their other jobs have been sent back because we have numbers decreasing,” Lindsay says. “Which is great. Things are thankfully a lot better.”

Because of the trials and tribulations created by COVID-19, Lindsay says she’s become a better nurse, and she believes the entire health care system is now more equipped to handle future crises. Though she hopes no similar catastrophes happen anytime soon, she’s glad to know her hospital and community are better prepared for them.

“I gotta say, years from now, talking to nurses that I’ve worked with during this time – I feel like it’s gonna be such a surreal feeling,” Lindsay says. “It really is.”

Four Nurses Standing in Front of a Window
Lindsay (left center) and three other nurses.
Photos provided by Lindsay Nolan unless otherwise credited

Surviving COVID-19

More than 219 million people worldwide have been diagnosed with COVID-19 – some 41 million Americans among them. Almost 4.5 million have died – including nearly 670,000 Americans. But amid the grim statistics are the stories of those who recovered. Nobody knows how many people that may be. Data on recovery is sketchy at best and fundamentally unreliable. And recovery is hard to track and even harder to define when symptoms may linger long into the future. Still, millions of people across the globe and right next door have survived their brushes with the disease caused by the coronavirus. They all have stories.

Here are just a few of them. 

‘Mom, you’re a Viking! We don’t go down like this.’

When 75-year-old Gail Rooney woke up on March 29, 2020, she thought she had the flu. She felt lightheaded and was having trouble breathing. She waited awhile, but then she decided to go to the medical staff in her assisted living facility in Medford for a check up. 

Even though a novel coronavirus was already sweeping the globe, tests were not available in her facility, so she was sent by ambulance to Stony Brook University Hospital, where she was diagnosed with a new disease called COVID-19.

“I didn’t know what to think at the time,” Gail said. “Because we didn’t know much about it.”

She doesn’t remember most of her almost one-month stay in the hospital, but her oldest child, 51-year-old Colleen Dixon of Lindenhurst, recalls feeling on edge from the start – not knowing if her mother would survive or if she would even be able to say goodbye. It was hard for Colleen to concentrate at her job as a medical biller, unsure of her mother’s condition.

“It was heart wrenching, it was gut wrenching,” she said. “You literally sat on pins and needles every day wondering, ‘Are they still alive? Did they pass away and they just haven’t gotten around to calling me?’”

The only way she was able to see her mother was through FaceTime, thanks to nurses in the intensive care unit (ICU). What she saw was her once-strong, active mother unconscious in a hospital bed – intubated on a ventilator and being cared for by nurses dressed in large, white hazmat suits.

“We think she can hear you,” Colleen remembered the nurses telling her. 

She would give her mother words of encouragement, telling her to keep fighting. “My mother happens to be about 50 percent Norwegian,” Colleen said. “So I would be like, ‘Come on, mom, you’re a Viking! We don’t go down like this.’ I would try to be that cheerleader … I felt like it was important for her not to hear sadness or fear in my voice.”

Every day she waited for the nurses and doctors to give her updates. Sometimes, she called them several times a day. She was grateful for any bit of information, even if it was that her mother’s condition hadn’t changed.

“No change meant she’s still here,” Colleen remembered thinking.

In the meantime, the medical staff at Stony Brook University Hospital was scrambling to treat an increasing number of patients. It was the “first wave” as many people called the early weeks of the pandemic, and New York City was where the tsunami hit. Long Island wasn’t far behind.

Around the same time Gail was admitted to the hospital, Dr. Apostolos Tassipoulos, Stony Brook’s chief of vascular surgery, was researching new treatment protocols for COVID-19. One of his residents had noticed an unexpected trend in COVID-19 patients in the ICU – high rates of thrombosis, a type of blood clotting that occurs in veins or arteries. Tassiopoulos started making calls to doctors and researchers in Italy and China to see if they were finding the same issue. 

“The guys in Italy clearly confirmed that they were seeing a higher rate of vein thrombosis in these patients,” Tassiopoulos said. “We decided that probably we need to be more aggressive with preventing these thromboses, particularly in patients that were in the intensive care unit.”

He pitched the idea of adjusting blood thinners according to a patient’s D-dimer levels – the leftover protein particles floating in the blood after a clot breaks down. After some research and conversations with colleagues, Tassiopoulos and his team began treating patients with the new protocol of administering higher doses of blood thinners based on their D-dimers. Mortality rates dropped from 58 percent to 27 percent. 

The new protocol helped save Gail Rooney’s life. After nearly a month in the hospital, she was taken off the ventilator.

Colleen remembers getting the call that her mother was awake. She was going to survive. “When I heard, I ran to everybody like, ‘She made it, she made it, she made it.’ My coworkers were all crying with me.” 

Gail was released on April 28, 2020 – after 30 days in a hospital bed, 15 of them on a ventilator. From there, she was sent to a rehabilitation center in West Babylon for in-patient physical therapy. 

But Gail’s fight didn’t end there. She ran into more complications and was sent to Good Samaritan Hospital in West Islip, where she was diagnosed with colorectal cancer. Several weeks of chemotherapy and radiation treatments followed. She is now cancer-free.

After spending last summer in the rehab center, where she could only communicate with her family through a window, Gail is back home in her assisted living complex. She is fully vaccinated and happy to be alive to hug her two granddaughters – Colleen’s daughters – 18-year-old Erin and 21-year-old Kayla. After so much time apart, the first thing Gail did when she finally saw her daughter and granddaughters was embrace them.

“I suddenly became a little kid again,” Colleen recalled. “No matter how old you get, part of you still longs for the comfort of your parent. You don’t realize how much you need it until it’s not there anymore.”

Gail said she doesn’t take life for granted after surviving a disease that has killed more than 660,000 Americans. She hopes other people won’t either.

“If you get the chance, go get vaccinated,” Gail said. “Don’t take other people’s lives for granted.”

‘This whole pandemic has just taught me that life is very short.’

Kristin Silvestri got the call that her father had tested positive for COVID-19 as she left her neurobiology class in November 2020, a month before she was set to graduate with a degree in biology from Stony Brook University. She left the campus, contacted the school to report her exposure and went for a rapid test. Later that evening, she got her results. She, too, was positive.

Since the beginning of the pandemic, at least one in seven residents of Suffolk County – more than 214,000 people – have been infected with COVID-19. The Silvestris – including Kristin’s parents, her sister and her sister’s fiancée – joined the group. The family thinks Kristin’s father was exposed after taking her mother to a hospital a week earlier for other medical issues, but they are still unsure.

For any family, being infected with COVID-19 can be frightening. But for the Silvestris, it was especially so. Her father’s cousin, whom Kristin grew up calling uncle, died of the virus in April 2020. 

“It was a shock because I had parents that were the same age as my uncle,” Kristin said. “And I didn’t know what was gonna happen.”

Kristin’s parents lost their senses of smell and taste and suffered with migraines and fevers. Kristin also got migraines and a fever, but maintained her senses of smell and taste. No one had major issues besides the common body aches and headaches. After 10 days, Kristin and her family recovered – and she and her mother have since tested negative.

While recuperating, Kristin kept up with her classes and assignments since she said her final semester was more manageable than previous ones. And she stuck with healthy routines. “I knew I had to maintain my health at the time, so I was eating very healthy, drinking a lot of fluids,” she said. “I was able to bring myself back to recovery faster.”

Kristin and her family played it safe throughout the pandemic, so she said it was disheartening when they became infected by chance while other people her age who were acting less responsibly went unscathed.

“It bothers me because I’ve experienced loss,” she said. “I wasn’t partying, I wasn’t doing those things. I got COVID on coincidence. … I was doing the right thing, and I still got it. And there’s people that are out there, doing whatever they want, whenever they want.”

The pandemic affected the Silvestris in a very personal way, but Kristin – who did indeed graduate last December – was affected professionally as well. Kristin decided not to start a career in health care. Instead, she wants to pursue her dream of owning her own business. For now, she runs an online cookie business called Downtown Dough with her older sister.

“I was doing the right thing, and I still got it. And there’s people that are out there, doing whatever they want, whenever they want.”

– Kristin Silvestri about her COVID-19 diagnosis

“This whole pandemic has just taught me that life is very short,” she said. “It just changed my whole outlook on life and what I want to pursue in the future. … I just want to do whatever I love.”

Kristin’s entire family is vaccinated. But she isn’t and she’s still not sure if she will get the vaccine. Even so, she wants to travel to Europe one day, something she had planned to do last year before the pandemic sent everyone home.  

“That was the biggest thing I wanted to do through college,” she said. A trip to Europe beckons when the global pandemic ends and the world returns to normal. 

‘What I Learned From Almost Dying.’

Doug Jansson settled onto a wooden stool on the stage at Living Word Church in Hauppauge, pink and blue lights glowing behind him. His wife, Kelly, and their three children listened to him from the front row. 

“It is the day we have been praying for,” a church director said as he introduced the lead pastor who needed no introduction.

Jansson looked like any other 43-year-old dad — he wore a blue-checkered button-up shirt and loose-fitting jeans. The neatly trimmed full beard on his face made up for the lack of hair on his head. Even with a mask on, it was easy to tell he was smiling. 

If Jansson hadn’t titled his sermon, “What I Learned From Almost Dying,” it would have been hard to tell that just a couple months earlier, he was on his deathbed in Stony Brook University Hospital, about to become another victim of COVID-19. 

It began in early December 2020 when his entire family tested positive for the virus. For the first week, he experienced flu-like symptoms, nothing out of the ordinary for those who get COVID-19.

A week later, his family began to recover while his symptoms got worse. A friend in the medical field recommended he go to the hospital. Jansson was placed in an ambulance thinking he would be back home in no time.

“I honestly just thought that, like, it was going to be a quick thing,” he said. “I was hoping that I’d be home that night or the next day.”

No one could have predicted the mountain of complications that Jansson would experience. He was given medication, and when that didn’t work, he was placed on a ventilator. His condition was getting worse.

On Christmas Eve 2020, the pastor was close to taking his last breath after testing positive for the coronavirus just a couple weeks earlier. His oxygen levels were low and sinking fast. Eventually he was put on extracorporeal membrane oxygenation (ECMO), which is a heart-lung machine that supports either of these vital organs when they are too compromised to function on their own. In Jansson’s case, his lungs weren’t pumping enough oxygen to keep him alive, even with the ventilator.

Without it, the likelihood of Jansson’s survival was approaching zero, said Dr. Allison J. McLarty, director of the ECMO program at Stony Brook University Heart Institute. “My wife was called to the hospital the day before I was put on the vent and basically told to say goodbye,” Jansson said. 

“I honestly just thought that, like, it was going to be a quick thing. I was hoping that I’d be home that night or the next day.”

– Doug Jansson

“There were really, really scary times,” he said. “But we’re people also with strong faith in God.”  And his family was “praying like crazy for me. They were rallying the church and the community and even the online community to be praying for me.”

Jansson remembered wrestling with the bleak reality that he might not return home to his family. This was before he was sedated and put on the ventilator, when the doctors told him the medications were not working.

“I just went to God with them and said, ‘God … I’m gonna fight with everything I have to be here, but I also trust you and trust not only my life in your hands, but my wife and kids’ lives, that if this was the time that I’m going to be taken that you’re going to carry them and sustain them and give them all that they need,” Jansson said. 

Luckily, it never came to that.

The ECMO treatment worked and Jansson’s condition improved, and eventually he was taken off the machine. But he wasn’t out of the woods yet. About a week later, his right lung collapsed and he was rushed into surgery. In three different surgeries, three tubes – Jansson describes them as each the size of iPod charging cords – were inserted into his chest, back and side.

“I got a nurse there holding my hand,” Jansson told his rapt congregation. “I’m breaking this poor lady’s hand and they’re putting another tube in me. And I’ll tell you, when that second tube went in my back, my lung began to fill with oxygen again. It was probably the most painful thing I’ve ever felt in my life.”

He shared with his congregation details of the procedures he endured, explaining he had to be awake during each of them. And he thanked the doctors who worked to save him and relieve what he described as immense pain. 

“I went through it. And it’s not because I’m strong – biggest wimp in the world, got a little cut on my finger doing yard work and I was like, ‘Oh, Jesus, help me.’”

After 20 years as lead pastor, his congregation is used to his personal tales. Even his most intense hospital stories are punctuated with funny anecdotes. Yet he always ends with a deeper, spiritual message:

“But there was grace, and there was strength.”

Instead of becoming a statistic in a global pandemic, Jansson – after 63 days in the hospital – became the only COVID-19 patient at Stony Brook University Hospital to come off ECMO and go home to his family during the course of the pandemic, explained McLarty of the Heart Institute.

Recovery was still a battle. After spending more than two months in a hospital bed unable to move, Jansson could barely swing his legs to the side of his bed without getting dizzy. 

It would be a few months until he would be strong enough to get back on the stage at Living Word Church and give a full, hour-long sermon again. He started slowly – getting on stage for a few minutes to give the announcements and a short prayer. 

“It was actually really difficult that first week.” he said. “When I was doing the announcements I had to keep stopping. Everybody was gracious.”

He is still recovering. His doctors aren’t quite sure if he will ever be back to his old self. Plenty of COVID-19 survivors are still battling so-called “long haul” symptoms from their infections. But Jansson says he feels about 80 percent better, and hopes to keep improving.

“I’m doing my best to just try to be taking walks and exercising and just really trying to get those lungs using full capacity again, because they’re not there yet,” he said. “But it’s getting better and better every week.”

Even after all the pain and uncertainty, Jansson keeps a positive perspective on his near-death experience.

“Our faith, I would say, has been strengthened,” the preacher said. “Just seeing God do what several of the doctors really truly called a miracle.”

‘We don’t have all the answers.’

Like Doug Jansson, many COVID-19 survivors are still recovering. Even some survivors infected during the pandemic’s first wave in March 2020 continue to experience symptoms.

For many, the challenges are physical. Doctors have found COVID-19 can impact several parts of the body, including the lungs, heart, brain, kidneys and other organs. But what doctors aren’t sure of yet, is if – and why – these symptoms will persist and for how long or how to treat them.

That’s why Stony Brook Medicine opened a post-COVID-19 clinic in Commack for survivors known as “long haulers” – people who experience long-term symptoms. The clinic allows doctors to monitor and research post COVID-19 issues, while also treating patients. It was the first of its kind on Long Island. Other hospitals and health care networks have since opened similar clinics. 

Dr. Sritha Rajupet, the lead primary care physician at the clinic, has been working there since it opened in November 2020.

“We recognize that people are still struggling,” Rajupet said. “We wanted to be able to provide a resource to our community. … So largely, it was one to meet that need, but also to think about where is the future of our research.”

Doctors at the clinic are using this opportunity to research how the disease affects individuals and how to care for survivor populations in the future. About 200 patients visited the clinic in the first five months.

Mental health services complement physical treatment. One resource is an intimate survivor support group that meets virtually once a week.

“We recognize that people are still struggling.”

– Dr. Sritha Rajupet, lead primary care physician at the post-COVID-19 clinic run by Stony Brook Medicine

Dr. Jenna Palladino, a health psychologist at Stony Brook Medicine, runs the support group, which is open to anyone impacted emotionally by COVID-19. The virtual group is made up of seven survivors from different parts of New York. Their ages range from late 20s to mid 60s, so many of them experienced the infection differently, but still share similar struggles.

“One thing everyone really connects with is just this kind of like, ‘Am I healthy? Am I going to get it again?’” Palladino said. “This kind of fear and this loss of time … and just feeling like fatigue and frustration with other people for not taking it seriously.”

Most of the group’s members were infected during the early weeks of the pandemic, and some are still experiencing physical symptoms, like loss of taste and smell, which has contributed to the decline of their mental health. The members share the day-to-day stress that comes with losing olfactory functions, like not being able to enjoy a meal with their families the way they used to, Palladino said.

“They learned from each other ways to cope with that or manage those symptoms a little bit more,” she explained. “They didn’t necessarily need my psycho-education in the same way they needed to hear from each other and support each other.”

Health care professionals like Palladino, who are helping survivors on the long journey to recovery, have learned much from their patients as well. “I think this has all been an incredible year of reconnection for all of us,” she said.

“I think it humbles all of us as providers. … We don’t have all the answers, and we need to work with our patients to learn from them… how to manage and give support in a way I’ve never had to before. What I mean by that is, I’ve never lived through a pandemic, while also counseling people in a pandemic. It is definitely a different experience as a clinician.”

If you are a COVID-19 survivor looking for help, you can visit the website of Stony Brook Medicine’s post-COVID-19 clinic for resources or to set up an appointment.

Medical Students Chart a New Course

Fourth-year medical student Alyssa Mangino sat casually in front of her laptop, the faint radiance of the Zoom video feed illuminating her face. Behind her, brown blinds obscured the nocturnal world outside. Her eyes gleamed as she spoke, and occasionally she gestured with her hands. Mangino’s dark blonde hair curled along the side of her head, barely touching her shoulders.

“As medical students, we were pulled out of our clinical duties when the pandemic hit,” she said. “So it was like the only thing we were allowed to do that would allow us to be part of the pandemic and help people.” 

Her desire to continue helping people led her to Stony Brook University’s COVID-19 Service Learning course. “I wanted to get involved,” she said.

Video by Kraig Klein

Crafted by Stony Brook’s Renaissance School of Medicine, the course aims to prepare medical students for tackling the coronavirus on the front lines. It consists of 15 to 20 projects, depending on how many students enroll. The projects offer glimpses into different aspects of hospital routines. It was partially meant to help students graduate on time since other medical courses had been suspended. But its primary mission is to educate as many students as possible about working in a medical environment as COVID-19 rages around them.

Dr. Lisa Strano-Paul, the school’s assistant dean for clinical education, explained how the course works.

“Students chose a project and completed the associated readings or attended educational sessions to learn the background information,” she said. Students then “explored the diseases or problems the activity was designed to help, completed the service learning activity and submitted a reflection about what they learned from their experience.”   

Dr. Andrew Wackett, vice dean of undergraduate medical education, offered more details.  “Students received credit depending upon the number of hours they dedicated to service learning.  Twenty hours of work was equivalent to one week of credit. The course counted towards fourth-year credit, so first- through third-year students could only apply up to four credit hours towards their fourth-year elective time.”

Wackett also explained the basic methodology of the course. Students were required to review written and recorded training materials at the start of the course.  “These materials taught the epidemiology, pathophysiology, treatment and prevention of the disease and trained students on the proper use of PPE,” he said, referring to personal protective equipment.  Students then applied their newly learned knowledge in a series of hands-on projects.

Strano-Paul and Wackett said at least 100 students took the course when it was first offered in the fall 2020 semester. They were subdivided based on the project they signed up for, with each project overseen by medical staff.  Wackett added that the course was designed so students in any year of medical education could take it.

“Even first-year students had been trained to obtain a history physical exam from a patient at this point, so they were able to assist with setting up telephone calls and following up with patients,” he explained.  “Only third- and fourth-year students were allowed to participate in giving vaccinations, as New York State requires CPR training and extensive clinical experience.”

Students could sign up for multiple projects. Mangino, for example, worked for a month on a project that collected data on COVID-19 patients who were treated in the hospital’s emergency room. Then she signed up for a different project that involved personal protective equipment. 

“I helped make gowns and some of the PPE the hospital was short on,” she said.  The PPE included items in high demand such as face shields.

The desire to help out at the hospital following the university’s shutdown in March 2020 was a major motivation for medical students signing up for the course.

“We had been kicked off rotations at the time since there wasn’t enough PPE for us to actually help out at the hospital,” fourth-year medical student Kyle Albagli of upstate Clifton Park, explained.  The 26-year-old said he “wanted to try to find a way to help out, and this was a great way to do it.” 

His classmates echoed the sentiment. “I felt I had to do something to help patients and the medical community during such tumultuous times early in the pandemic,” explained oncology student Naveen Mallangada of Mineola.

“Students were not allowed to work from March to June, but we wanted to contribute, and the best way was to do it virtually or in non-clinical settings,” Victoria Yuan, a fourth-year medical student from Brooklyn, said.

Many students worked on the PPE management and production initiatives, keeping track of the supply or assembling new gear for use in the hospital.

“At that point we weren’t sure how long the supply would last, and if we would have to start, for example, recycling N95 masks,” Albagli explained.  “We had a whole system in place where we would monitor people taking masks, and when they came back and they needed new ones, they would drop off the old ones so that they could be re-sterilized and saved to be used if we ever ran out.”

Mallangada coordinated medical student volunteers in assembling 3D-printed face shields from SBU iCREATE – a department within the university’s Division of Information Technology that provides tools and resources for faculty, staff and students to work collaboratively on projects that can benefit from advanced technologies. The 25-year-old also helped gather non-sterile gowns for the hospital to keep up with the demand.

“I felt I had to do something to help patients and the medical community during such tumultuous times early in the pandemic.”

– Naveen Mallangada, oncology student from Mineola

Most students who collected PPE also worked on other projects.  “I delivered food to in-patient teams, brought groceries to elderly neighbors, and mentored underclassmen,” said Ariel Yang, a fourth-year medical student.

One of the more complicated initiatives focused on the hospital’s telehealth programs, which connect health care workers and patients remotely, usually by phone. 

Brecken Esper, an anesthesiology student from upstate New York, explained his role:  “I was mainly involved in helping educate and set up patients so that they would be able to have successful telehealth appointments with their various Stony Brook Medicine physicians and other practitioners across the Stony Brook network, in order to reduce the exposure for having patients going to the office or hospital setting. This included giving patients’ tips and tricks on how to make their telehealth appointments successful. Lastly, it involved assisting with the actual telehealth process, helping patients set up their devices and their various software applications.” 

The telehealth initiative was further divided into concentrations based on patient demographics.  One such sub-group focused on aiding elderly patients.  Yang and fourth-year internal medicine student Alexandra Coritsidis from the central New York village of Newport were part of the team that called older patients who might be isolated. 

“I worked with geriatric patients to mitigate any loneliness caused by social distancing,” Yang said. 

“I called to see if they needed help getting groceries or medications,” Coritsidis said. “And if they did, there was another separate service where medical students ran errands and brought that stuff to them.”  She also called patients who had been hospitalized with COVID and had been discharged.

“I had some difficult conversations where I had to tell a patient she had to deliver a baby alone. I had to tell some people who were really concerned about the risks of their baby—about their newborn baby—getting sick.…”

– Cristina Young of Albuquerque, NM, fourth-year obstetrics and gynecology student

Cristina Young of Albuquerque, NM, another fourth-year obstetrics and gynecology student, worked the pregnancy hotline.   

“It was very emotional and difficult for a lot of the patients,” the 25-year-old recalled. “I had some difficult conversations where I had to tell a patient she had to deliver a baby alone. I had to tell some people who were really concerned about the risks of their baby – about their newborn baby – getting sick, so those two parts were really hard.  But overall, they were very rewarding.”

The course offered a variety of challenges. With the pandemic raging around them, students needed to observe social distancing protocols at all times. Organizing such a large-scale effort in a restricted environment proved to be trying.

Coritsidis listed just a few of the challenges the emergency department faced – “getting the volunteers together, creating the Google sign-up sheet, just figuring out an efficient way to make sure someone was there consistently.” 

Esper explained the demands of ramping up the telehealth program. “Most of our patients had never used the application we used, Microsoft Teams, before, so even things such as who calls the patient to set up the appointment, who’s going to troubleshoot when they’re having issues, what sort of device are they going to be using – these were all questions we had to figure out with the patients. Keep in mind, a lot of our patients may not have had the same access to technology or the same experience with technology that many of us in school can take for granted.”  

Young took on a unique role – educating doctors, nurses and other medical personnel in the appropriate use of PPE.  “That was difficult, going from a situation where you’re used to these people evaluating you, to having to evaluate them, and having to educate them and tell them what the new policies were.”

Safety restrictions prevented students from working where they wished they could be – in the hospital.  In pre-pandemic days, students could freely go wherever they wanted in the hospital as they fulfilled tasks as part of their rotations. But once the pandemic hit, large segments of the hospital were off limits.  Students had a choice of working in specific areas in the hospital, where they would have to observe social distancing and refrain from leaving their assigned area, or working remotely.  Either way, they were prohibited from direct contact with patients – a fact that pained several students.

“That was challenging, knowing people were in the hospital helping and I couldn’t help,” Mangino said.

“It’s not every day you get to feel you’re making a difference, and the course was nice in that I felt I was making a difference,” Pando said. “But I would sit there and wish I could help out more, wish I had a few more years of knowledge, to be able to help out in a different way.” 

Albagli fought off paranoia about the possibility of getting infected.

“At that point, no one was sure what was happening with this virus. Was it airborne? Was it just droplets? There were so many unanswered questions, and I think people wanted to keep themselves and their patients and everyone around them as safe as possible,” he said.  “Even though we weren’t having direct patient contact, it was a little nerve-wracking going into the hospital. We would pretty much wipe down every single surface we touched. We’d always make sure we had masks on at all times and keep a good distance from other people. That was probably the biggest challenge.” 

“At the same time that I was volunteering at the hospital, anti-Asian sentiment was at an all-time high. I was reading in the news and on social media news accounts of hate crimes against Asian people every day.”

– Ariel Yang, fourth-year medical student

Yang faced a different kind of emotional obstacle. Family pressures weighed on her mind. “My parents and my sister, a labor and delivery nurse, strongly opposed any volunteer work that would bring me into the hospital,” she explained.  “Amidst sensationalist news stories of young people hospitalized and suffering strokes, they were unwilling for me to take any risk that wasn’t absolutely necessary. We also sparred over the idea of donating our spare masks to the hospital. My father said, ‘If the hospital runs out of masks, it will find funding and get masks.  Our donation of masks would supply the emergency room for less than a day. But what will we do if we have no masks and this pandemic lasts for a year? Who will donate to us?’” 

The looming threat of racism didn’t help. 

“At the same time that I was volunteering at the hospital, anti-Asian sentiment was at an all-time high,” Yang said.  “I was reading in the news and on social media new accounts of hate crimes against Asian people every day. My family discussed, for the first time, the possibility of buying a gun to protect ourselves. I remember feeling hyper-alert while running around the neighborhood. Any time a car slowed down near me, I got anxious. Even in the hospital itself, I heard staff joking outside the office about how they don’t want to eat Chinese food because of the pandemic. On a Stony Brook forum, where I hoped to volunteer, I read countless posts calling Chinese people dirty and blaming them for the pandemic, even while posting articles about China donating ventilators to New York City.”

Despite the physical and emotional challenges they faced, the medical students gave the COVID-19 Service Learning course high marks.  

“It was really helpful to see people working together as a team, seeing how you can get something done very quickly,” Coritsidis said.  

“The course itself was a good way to incentivize volunteerism and give medical students a better view of all the services required to keep a hospital running in the face of crisis,” Ariel Yang said.  

“I think it’s a really good chance for people to get involved in a way that they’re passionate about, learn in a way they’re passionate about, and get more comfortable with self-learning and self-teaching,” Mangino added.

“One of the key aspects I took away from the course was adaptability and ingenuity in terms of coming up with different ways and solutions in order to solve some of the problems that we’ve faced,” Esper said. For example, students learned to use Microsoft Teams to organize telehealth appointments and in the process learned lessons about the value of communication. “It required imagining yourself in the patient’s shoes and looking at it from their perspective,” she said, “trying to walk someone through steps of a complicated procedure, sometimes without actually being there.”

Cristina Young agreed. “I learned a lot about patient communication, and communication in general. … The pregnancy hotline was my introduction to using telehealth and discussing things with patients over the phone, and that also included evaluating any patients that had been exposed. It was my first time conducting a physical exam when I couldn’t see the person that I was talking to,” she said.

“It was a great way to make us feel we were able to continue our education at a time we were so unsure what the next year was going to look like,” Pando said.  

Strano-Paul said the School of Medicine is planning to expand the course to “address other community health needs” and other illnesses. Wackett added that the course will be a “longstanding elective,” with the hope that it can be customized in the future to focus less on COVID-19 and more on other developing medical issues. Most of the students hope that future generations of medical students will be able to experience the course and reap the same benefits and lessons they did.

“In a microcosm, we learned what the whole country learned in 2020,” Yang said. “That all services are essential, and that in a war, every person has a part to play.”

Dark Days and Long Nights – On the Job with Stony Brook Nurses


It was 1979 and Carolyn Santora had just started her career as a nurse in New York City when she came across an advertisement in a nursing journal: “Once in a lifetime,” the ad read. “A university hospital opens!” 

She loved her big-city lifestyle, but the ad called to her. The opportunity to help open Stony Brook Hospital was one she couldn’t pass up. When the $150 million, 504-bed hospital admitted its first two patients on Feb. 18, 1980, Carolyn Santora was there – one of 800 employees who joined up during that year-long hiring blitz.

Now, more than four decades later, Santora is the chief nursing officer (CNO) at the hospital. “I’ve been here from the beginning, I’ve watched the growth,” she said. 

Indeed. Stony Brook University Hospital now employs more than 7,000 people and was recently named one of America’s 100 Best Hospitals by Healthgrades – a Denver-based company that rates physicians and hospitals – for the third consecutive year. Santora oversees a staff of 1,600 nurses and is responsible for all day-to-day nursing care. 

“But never in all of my years of nursing,” she continued, “did I ever imagine what this last year was going to be like.”

It was the year of the coronavirus. 

As COVID-19 held much of the world in its grip, nurses stood on the front lines, shouldering the responsibility of treating hospitalized patients while risking their own health and safety and that of their families. According to the Centers for Disease Control and Prevention’s (CDC) frequently updated COVID data tracker, there have been more than 554,000 confirmed cases of the coronavirus among health care personnel nationwide and at least 1,759 deaths.

Carolyn Santora (right) with two colleagues outside the hospital where she has worked for more than 40 years.

“In the beginning, everyone was scared. We were scared for ourselves, we were scared for our families,” Santora said. She explained that some nurses chose to move into their basements at home. Others moved into guest houses or guest rooms, all for the sake of protecting their families from the virus they were exposed to at work every day. “It was their mission. It was their passion to take care of these patients.”

Some nurses who lived on their own faced the mental stress of distancing themselves from their families during the holidays. Samantha Gross was a nurse who originally worked at Stony Brook Medicine’s Cancer Center, but was redeployed during the pandemic to the COVID unit. Since the start of the outbreak last year until this spring, she wasn’t able to visit her parents in New Jersey. 

“If you’re going in and out of COVID rooms, you’re not going to go hug your mom and then kill her. That wasn’t going to happen,” she said, shaking her head as she fixed her bright pink eyeglasses over the bridge of her nose. 

But having seen so many people die alone at the hospital without their loved ones by their sides, she was grateful that her parents were safe and alive. “My parents got vaccinated, so I just went home last weekend and gave my mom our first hug in thirteen months,” she said in April. “It was just insane. There’s something so normal, it feels so normal, but you also understand its been so long.”

There have been more than 1,400 positive cases among Stony Brook Medicine employees since the start of the pandemic, according to the university’s COVID-19 dashboard. This number includes hospital employees, clinical providers, and related health care support staff.

Kristie Golden, the hospital’s associate director of operations, explained some of the efforts taken to ensure the safety of both health care personnel and patients. “Various means of communicating with patients and staff were put in place using technology, telephone consultations, video conferencing and telehealth. In addition, we had recently opened up the new Pavilion, which gave us some much needed space within the hospital towers to spread out patients into single rooms.”

The first months of the pandemic were filled with more unknowns than knowns. The CDC and the World Health Organization (WHO) were constantly updating their websites with incoming information about the coronavirus – what it is, how it spreads, symptoms to watch for, underlying health conditions that can make the virus more deadly, and more. Then New York Gov. Andrew Cuomo held daily press briefings to inform and reassure viewers. 

The university hospital had to adapt to new information every day as phone lines were bombarded with callers from across Suffolk County asking questions about COVID-19 – questions about symptoms, about testing, about wearing masks, about traveling out of state, about quarantine protocols, about what to do if they test positive.

It was Susan Robbins’ job to find the answers. She’s the assistant director of nursing and she was assigned to start and manage a COVID hotline at the hospital.

On March 19, Robbins opened a call center in an empty room in the basement that conveniently housed computers and telephones. She staffed it with 24 nurses who were redeployed from departments in which functions were temporarily paused, nurses who were at risk because of underlying health conditions that prevented them from working in the COVID unit, and nurses who were pregnant. In its first week, the hotline received almost 1,200 calls. 

“As the CDC added new symptoms – this was an evolving disease – we added them to our triage of questions to be able to address those problems with the patients,” Robbins said, referring to a Powerpoint that served as a timeline of data gathered from the hotline. During the first wave of the pandemic, those symptoms included the loss of taste and smell, headaches, sore throats and muscle pain.

With the flood of information coming in, it was also important to keep nurses updated. Danielle Curry, the nursing manager at Stony Brook University, is responsible for hiring as well as performance programs and patient satisfaction, among other duties. She also became the liaison between the hospital administration and nurses, and her first priority, she said, was to reassure nurses that they were not alone. 

A nurse monitors a COVID patient on a ventilator in the hospital’s high-tech ICU. Photo provided by Stony Brook University

She implemented daily “staff huddles,” meetings in which nurses were given the rundown on COVID patients – how many there were, what level of care they needed, how many staff members were on the floor, and what they needed to do to keep their patients and themselves safe.

“I put on scrubs, and I was in the rooms with the patients, working alongside frontline nurses,” Curry said. She washed and toileted patients, performed physical therapy to clear their lungs, and with a specialized team, conducted a series of slow, synchronized turns called proning that moved patients from their backs to their sides to their stomachs to relieve respiratory distress.

“I didn’t just talk about teamwork,” she said. “I lived the teamwork model. It helped them realize that it was not just me dictating from the top down, and that I was really working alongside them to support them. We were all in this together.”

Many hospitals around the country faced shortages of ventilators and Intensive Care Unit (ICU) beds as COVID-19 created a surge in demand. This posed ethical challenges for hospital management when making decisions about withdrawing ventilators from certain patients and reallocating them to others.

“Thank God we never had to look at that,” Santora said. “We came close.” She closed her eyes, as if recalling the days she spent routinely counting and recounting the number of unoccupied ICU beds and unused ventilators. “At one point, we were at 90 percent utilization. That was scary.” 

Later that same day, she received a call that ten more ventilators had been secured for the hospital. She reenacted the relief that washed over her in that moment, clutching her chest and sighing as her shoulders relaxed. “We never had to make those kind of tough decisions,” she said.

The first-wave surge in COVID-19 cases also resulted in a critical need for nurses. Already, Suffolk County – where to date more than 218,000 positive cases have been recorded – was a hotspot. Santora knew she was going to need more nurses than she had. So she called Nancy Page, her counterpart at the State University of New York Upstate Medical University – a public medical school in Syracuse more commonly known as SUNY Upstate – that was not as hard hit as Stony Brook Hospital. At first, Santora asked for personal protective equipment (PPE) and other supplies. 

Suzanne Bucko, an upstate nurse who volunteered to work at Stony Brook, pictured in scrubs next to welcome sign.

When Page asked if she needed anything else, she knew asking for nurses would sound absurd – but she asked anyway. “I think I chuckled,” she recalled, “because it was such a ridiculous thing that anyone would send me nurses in the middle of a pandemic.” 

But sure enough, the next day, Santora received a call back– 20 skilled ICU nurses would be on their way to Stony Brook within days. “These nurses left their families, they left their homes to come work side-by-side with our nurses in these COVID units,” Santora said. “It was an incredible show of collegiality and of dedication.”

The upstate nurses who volunteered to work at Stony Brook University Hospital came in waves from Syracuse and would stay for two weeks at a time, residing at a nearby hotel during their deployment. 

One of those nurses was Suzanne Bucko, 35-year veteran who didn’t think twice. “It was our choice to go. We were there to do one thing, and that was to help these patients and nurses, and to help them get through this time,” she said. 

Another upstate nurse, Julianne Crisafulli, was shadowing a respiratory therapist at her hospital for a review of how ventilators worked. She overheard a conversation about a group of nurses from the emergency department and ICU going to help out on Long Island. 

“There was no question in my mind that it felt like exactly what I was supposed to do,” Crisafulli said. “It was almost a comparison that others have used – a September 11th situation with regard to health care. It felt like it was my duty to help, be a part of and serve those in the direst need.”

Every front-line nurse lives with that one unforgettable experience with a COVID patient. Maybe it was a pastor with young children or a patient who loves to swim in the summer or someone who rides horses. For Bucko, it was a kind, elderly woman who ended up passing away. She worked with another nurse, who stayed at the woman’s bedside in her final moments. 

“I’ll never forget the sight of Jennifer in there holding onto her hand until she passed,” Bucko said of her colleague. “That’s what we were there for – we were there to be with these people who didn’t have anyone, or couldn’t have anyone.”

For Gross, it was a 29-year-old woman with a long, black braid that fell neatly against the white sheet of her hospital bed. The rest of her was swollen and unrecognizable; she had four holes in her chest with tubes to help her breathe. 

Julianne Crisafulli, an upstate nurse who volunteered to work at Stony Brook, dons a mask and plastic face shield to stay safe on the job.

One nurse at the hospital came up with the idea of putting “About Me” posters in the rooms of COVID patients. Families would send in pictures of their loved ones in better days, in their happiest and healthiest moments. Gross explained that usually nurses would get that kind of information and insight from the families – the details about who this person was before becoming a patient, unconscious and medicated and on a ventilator. While it helped some nurses, it hit Gross the opposite way.

“There was a picture on the wall of her a few months before, unbothered, with her three-year-old. I just stopped, looked up and started crying in the room because, what am I doing for her and for this kid who now doesn’t have a mom? What can do this to this otherwise healthy young woman?” Gross said. 

What was most heartbreaking for her was not just the knowledge that this woman was not going to survive, it was seeing that beautiful, long braid – a testament to the life she had before the pandemic. 

“All of it sort of hits you at once.”

And when patients did end up recovering from COVID, the ICU nurses didn’t always get the chance to experience it firsthand.

“The patients come to us, they’re intubated – unfortunately, a lot of them ended up not surviving,” Hailey Kuzow, a nurse specialist, said. “And the ones that do survive, once they get better and they don’t need intensive care, they were moved off of our units. So, we never got to really see success stories.”

In the thick of things, Carolyn Santora came up with another idea – this time to mark the successes. “When a patient gets extubated successfully,” she said, referring to the process of removing a breathing tube, “we played chimes overhead for everybody in the hospital to hear. And everybody cheers. It’s rewarding to walk around the hospital and hear a chime, ‘cause that means we made someone better.” And whenever a COVID patient was discharged, a snippet of the Beatles song, “Here Comes the Sun,” sounded through the halls.

Inside and outside the hospital, community support boosted morale. Donations of PPE and food poured in and people who lived nearby stopped to leave uplifting messages and chalk drawings on the sidewalk outside.

An inspirational message written in chalk on a sidewalk outside the hospital.
Photo courtesy of Amy Lee Pacholk.

The past year was an unforgettable one at Stony Brook University Hospital. As Carolyn Santora looked back, she also looked ahead to embrace the hard-won lessons she and her nurses learned during a global pandemic. “One, always understand that there is an end in sight. Two, you are not in this alone.”



A Warrior Against Infectious Diseases

In her 31 years at Stony Brook University Hospital, Dr. Sharon Nachman, has been the principal investigator of more than 30 clinical trials – at least a third of them international research studies – seeking out new vaccines as well as treatments for Lyme disease and AIDS. So it’s not surprising that she’s the hospital’s director of the Office of Clinical Trials.

But even with all her experience, she said she’s never been as busy as during the COVID-19 pandemic, especially since Stony Brook has a part in the future of a vaccine that might help to control it. 

Nachman is a member of the Maternal Child HIV Network – she’s a pediatrician with an international reputation in infectious diseases in children – and her voice was firm as she explained how research networks once focused on HIV and AIDS trials have joined forces to look at COVID-19. The result was a new consortium of researchers called the COVID-19 Prevention Network, which formed under the auspices of the infectious diseases arm of the National Institutes of Health in mid-2020 to address the need for vaccines and monoclonal antibodies. Monoclonal antibodies are laboratory-made proteins capable of fighting off harmful pathogens like COVID-19 and offer a possible treatment for those infected with the virus.

“I was involved in listening and hearing all the discussions of the CoVPN,” she explained, using the acronym for the network. “And I submitted an application for our site to be one of the sites for vaccine trials. As those were rolling along, we were picked for the Novavax study.”

The Maryland-based biotechnology company, Novavax, is one of several firms working to develop vaccines to counter COVID-19 as the pandemic enters its second year. Unlike Moderna and Pfizer-BioNTech, Novavax has never brought a vaccine to market despite focusing on experimental vaccine development since its founding in 1987. 

But the Coalition for Epidemic Preparedness Innovations – a global foundation based in Norway that is dedicated to the development of new vaccines – saw something in the company and invested $388 million in its vaccine. With new vigor, Novavax pushed to get the attention of the United States, finding success in the form of $1.6 billion from Operation Warp Speed, a Trump-era partnership between the Departments of Defense and Health and Human Services to fast track vaccine development. 

Nachman wasn’t the only Stony Brook applicant to vie for a spot in the trial. Dr. Benjamin Luft, director and principal investigator for the Stony Brook World Trade Center Wellness program, also raised his hand. “He had a unique population that had co-morbidities and I was looking at the population of Suffolk County,” she explained. “So the CoVPN decided to merge our two applications into one application under Dr. Luft’s leadership so that we could do the Novavax clinical trial.” 

The trial enrolled about 500 patients in five weeks before closing last February and contributing to the pool of 31,000 participants from across the country. 

“No steps were jumped or skipped or stepped over or missed,” Nachman said. “But because of the pandemic, many people came forward to enroll in the study rather quickly. And that’s what allowed the study to complete enrollment and move on to the next step.” 

Since then, Nachman has been trying, in her own words, to “juggle” the non-Novavax and non-COVID studies that are pending. One, a Lyme disease vaccine for children, was slated to take place during the summer and fall while others have been put on hold. This isn’t because of a lack of funding but rather because the side effects of these vaccines resemble the symptoms of COVID-19. “The study looking at the RSV, the Respiratory Syncytial Virus, vaccine – the side effects of that vaccine are fever and runny nose. The last thing we need during COVID is to give you a vaccine that gives you fever and a runny nose.”

And of course, there are trials that for one reason or other, didn’t get off the ground. A trial earlier in the pandemic attempted to spearhead a treatment involving estrogen patches that might reduce the severity of COVID-19 symptoms. Nachman was to be the principal investigator but the project failed to enroll enough participants. 

“I think patients that came into the hospital were sick and did not want to hear about a study. There was a lot of concern in patients that we were giving them estrogen, particularly on the male side.” The reaction, she said, was, “‘I didn’t want to grow breasts’ – even when you explained to them that’s not going to happen.” 

As for the two-dose, protein-based Novavax vaccine, it has been shown to be 90.4 percent effective in preventing symptomatic COVD-19 based on results from its Phase 3 clinical trials. But the company has struggled to meet its production forecasts, forcing it to delay seeking the emergency use authorization from the Food and Drug Administration that would make it the fourth vaccine available in the United States.

From the beginning, there was concern that the Novavax vaccine may not be effective in an important segment of the population – children. To find out, clinical trials are looking at adolescents and teens aged 12 to 17 years old. 

Other vaccines are further along. The Pfizer vaccine has full FDA approval for anyone over 16 and emergency authorization for those between the ages of 12 and 15. Clinical trials are underway in children 5 to 11 years old. Moderna and Johnson & Johnson vaccines still only have emergency authorization for people who are at least 18 years old, but Moderna has expanded its trials in children under 12. Separate clinical trials must be conducted for children due to their disparate immune systems and responses.

Dr. Sharon Nachman. Photo provided by Stony Brook University

This is prime territory for Nachman, who is also chief of Stony Brook Medicine’s Division of Pediatric Infectious Diseases and a professor of pediatrics. She has been pushing since last year to include children in vaccine trials.

From her office on the fifth floor of the hospital, where medical textbooks and files are organized on shelves behind her, Sharon Nachman speaks her mind.  “Kids should have been studied up front when the adult vaccines were rolling out, then that would have resulted in no delay in getting kids vaccinated,” she said. “And we wouldn’t be in the position that we’re in now, where we’re not going to have an answer for kids for six to eight or maybe even longer months.”

Nachman said the practice of considering children and pregnant women as unique groups outside the mainstream has caused this situation. “As a pediatric infectious doctor, for me those are the ordinary people who need to get the vaccine,” she said. “There’s nothing special about [children] that would require you to put off studying them for months on end – and all it did was hurt the population.” 

It used to be even worse, she said, pointing out that as recently as the 1990s, licenses for vaccines and other drugs were routinely granted without certain groups, such as children, being studied at all. Nachman has been advocating for decades that children and pregnant women should be included in clinical trials such as the ongoing Novavax study. “Pediatric infectious disease requires you to be passionate about what you’re doing.” she said.

“Kids should have been studied up front when the adult vaccines were rolling out, then that would have resulted in no delay in getting kids vaccinated. And we wouldn’t be in the position that we’re in now, where we’re not going to have an answer for kids for six to eight or maybe even longer months.”

– Dr. Sharon Nachman

Studying these groups and getting vaccines to them are important because the coronavirus is mutating. Variants continue to show up around the world even as the highly transmissible Delta variant has become the dominant strain in the United States and other countries.  “By not getting vaccinated,” Nachman said, “you encourage more variants to go around the community.” 

These variants are uppermost in Dr. Kenneth Kaushansky’s thoughts. He stepped down as dean of the Renaissance School of Medicine in January but stayed on until the end of the academic year as senior vice president of Health Sciences, overseeing the hospital, the faculty practice and the health science schools. He had originally planned to step down last year after a decade on the job, but stayed on in light of the pandemic. “As ten years began to approach, here comes COVID,” he said of the convergence of his anniversary in the job and the pandemic. “It wouldn’t have looked good for me to say, ‘Hey here comes COVID, I’m out of here!’” 

He was recently elected to the board of directors of the New York Genome Center, which will allow him to explore some of the big questions about COVID-19 that revolve around the variants. 

“Number one – Are they more contagious? Number two – Are they more pathogenic, do they cause more severe disease all other things being equal? And number three, are they going to turn resistant to the vaccine, perhaps the most important question of all.”

He likened the process of developing vaccines against these variants as being akin to neighborhoods. “So if you look at a map of the spike protein, there are actually four different regions that almost everybody develops antibodies to … like four different zip codes.” The spike protein is what allows the virus to gain access to the cells of the respiratory tract. 

He explained that someone with antibodies to at least one of these neighborhoods would have a method of neutralizing the virus. “The virus needs to really come up with four different mutations to become immune to all these different antibodies. And that’s a tough nut to crack for a virus. … No one has seen a variant with these four mutations.” 

Nachman and Kaushansky agreed that the most important thing, besides the standard advice of wearing masks, is for people to get vaccinated. Now. 

To the people out there who are hesitant to get vaccinated, Kaushansky offers this: “We haven’t seen people’s arms falling off. … When there is one of these extremely rare side effects, it almost always, if not always, appears within six weeks of the vaccination. We’re now at a point where 30 million people are six weeks out from their vaccination and nobody’s getting these massive long-term complications.”

As a front-line warrior against infectious diseases, Nachman described the COVID-19 pandemic as being very different from previous outbreaks she’s experienced. In 2009, the swine flu pandemic saw more than 700 million cases of the H1N1 influenza virus worldwide with an estimated death toll of 284,000, according to the Centers for Disease Control and Prevention. “There were a lot of sick patients, both adult and pediatric,” she said. “But they weren’t the same degree of sick as COVID patients.” 

With more than 200 million people infected and a global death toll that has surpassed four million, COVID-19 already has a place in the history books.