An excerpt from Our Hospital.

Kush Kare Hospital in Columbia, New York, was the flagship of Kush Kare Private Equity Inc., a for-profit chain of hospitals across America. A for-profit that was listed on a lot of lucrative trading routes. Clearly its workings were murky—maybe not equity at all. A clever goulash of nonprofit and big-time profit.

With the rise of COVID, the hospital was a zoo: frazzled doctors, nurses, techs, labs, cleaners. And patients stacked up lying on stretchers in hallways, coughing, crying—and dying. Dr. Amy Rose was nine hours into her six-to-six shift, and it seemed like 20. She could not go on.

She went on.

She was chief of both emergency and the ICU, the intensive care unit. Her official title was “intensivist,” one of the ones who run toward the danger. She had done just that for a month in the Har Har Somali refugee camp, but she had never seen anything quite like this.

No doctor, she thought, had ever seen anything quite like this. Even after two months, they were flying blind. One patient might look healthy, only to die suddenly. Another might look sick as hell, and make it. Being a virus, COVID had no cure. They didn’t even know what would help. But we docs like leaning out over the tips of our skis. It’s exciting and terrifying at the same time.

The hard thing for Amy was ensuring she had no exposed skin. For 12 hours a day she was sealed head to toe in plastic PPE, personal protective equipment. It was stifling. The pants and gown and mask and protective N95 face shield and gloves made each of her senses blur and rebel; her fingers felt fuzzy and far away, like she was a spacewoman out on a moonwalk. Real life seemed more virtual than Zoom. It was nearly impossible to feel connected to a patient, or to fellow health-care workers.

Now there was no touch, no contact of any kind. They almost never went into a patient’s room. She felt like a leper. When a physical intervention was strictly necessary, several space-suited docs and nurses went in. Otherwise, all patient information and care were addressed from outside, either on screens or with robots controlled by toggles on handheld joysticks. The rooms were sealed off, with negative pressure airflow. Bad air sucked out, good air pumped in.

The only other time someone (let’s face it, usually a nurse, not a doctor) entered the patient’s room was, with a surgical-gloved hand, to hold the hand of someone dying alone; if possible, holding up an iPhone or laptop so that family members could be “with” their loved one.

Mary Platt, 43, had the classic signs and symptoms of COVID—including, on her chest X-ray, those glassy dots in the lobes of both lungs. For the past few hours the team had tried everything, but on 100 percent nasal oxygen, her blood oxygen saturation rate kept falling—it was now below 70 percent. The lungs couldn’t aerate the blood anymore. The sparkly shreds of COVID got in the way.

Now she was wide-eyed with fear, laboring to breathe. Without oxygen, her exhausted chest muscles were getting tired—on the verge of giving out. She was starting to die—and COVID, for some reason not yet known, could kill fast, shockingly fast. A person melts to blood.

“Mary, as we talked about before,” Amy said, “we need to put a breathing tube in, put you on a respirator to breathe for you. We spoke to your husband just now. Ventilation is necessary. OK?”

Tears ran down Mary’s cheeks. She nodded her agreement.

What Amy didn’t say was that of patients put on a ventilator, 80 percent never get off.

Amy put a hand on her arm and squeezed reassurance. She said—making sure to use the “we”—”We’ll be with you the whole time, taking the best care of you we can, together. Got it?”

Mary gave a weak smile and nodded.

The ventilator would do nothing to cure Mary, of course. All it did was buy time to figure out what the hell to do next. This new killer coronavirus—Jesus, had it only been here six weeks?—was crazy unpredictable. The only real treatment? Keep the body going and let it heal itself. And pray like hell for a treatment protocol.

A second doctor was always there to help if needed at an intubation. In this case his name was Dr. Binni Prabhat, Indian-born and raised in prosperous Kerala, Oxford-educated, so he had a sexy accent. He was a couple of years younger than Amy, slender, with a regal nose, alert brown eyes, and almost comic ears. He laughed a lot, and she had never seen him angry, even in the most enraging emergency moments.

She admired his unending calm. In the roughest times, the saddest times, calm.

“I don’t do calm much,” she had confessed. “I don’t get it. I need to learn how you do it. Tell me quick!”

“By using ahimsa.”

“Nonviolence?”

“That is not the proper translation. Better is ‘creative love.'” He smiled. “Never fight back into the face. In those predicaments, I tell myself, ‘Go for ahimsa. And never go in alone.”

“I wish I could learn that!”

“I shall welcome being deft in teaching you the creative love.”

She smiled, and he smiled back.

“And I’ll be deft in learning,” she said. “Creative love. Deal?”

“Even in this hellish pandemic, from our hearts.”

The intubation of Mary went smoothly. She was admitted to the ICU. A life saved? Odds not.

***

When the danger of dealing with COVID became apparent in late March, almost all the older, mostly white doctors gave their legally required four-week notice to quit Kush: they would officially flee in late April. Last week all four emergency doctors left. All over the USA, the only reasons good doctors would take a job in a Kush Kare hospital was either to stay in their community or for money. But most senior doctors didn’t want to die for, or in, Kush Kare.

And so, for the past month Amy had tried to recruit doctors to start right away. But nobody wanted to work there. Finally she asked her uncle Dr. Orville Rose, now semiretired, if he knew any doctors who might join in.

“I’ll try,” he’d said.

The very next day he called back. “I’ve got three great docs. You know one of ’em, and he knows you. Born and bred right here in Columbia. Guess who.”

She tried to focus, riffling through who it might be. A blank. And then: “Not Roy Basch?”

“Bingo. And not only him, but two of his best doctor friends, Eat My Dust Eddie and Hyper Hooper. They can start in about three weeks.”

“How the hell did you do this so fast?”

“One thing I’ve learned about our small town, dear, is y’gotta look ahead. I figured this crash would happen at KK, so I’ve been working on it for a while.”

“You knew this would happen?”

“Soon as I saw the COVID comin’, the rest was easy. Roy called his closest pals. They’d gotten bored in retirement—their children grown, gone—and they like action. If Roy calls, they come.”

Samuel Shem is a novelist, playwright, activist, Rhodes Scholar, professor in medical humanities at NYU School of Medicine, and a visiting artist at the American Academy in Rome. Shem’s new novel, Our Hospital, is the fourth and probable last novel of The Healing Quartet, spanning fifty years of American medicine. It started with The House of God, then Mount Misery, next Man’s 4th Best Hospital, and now Our Hospital.