In normal times, hospitals enclose many stories. The stakes are as high as possible — literally life and death — and emotions are correspondingly unleashed. Decisions, descriptions, explanations, relationships, values — all of those tangled things matter.
Now, though, during the global pandemic that has ensnared the world — and whose domestic story began in the metropolitan area’s Jewish community — hospitals, the people who work there, and the patients and families they serve have even more stories to tell us.
Stories, moreover, with real morals. Stories that can teach us lessons about how to behave, and how to make sense of our ever-changing new world.
It’s hard to tell these stories as they still are going on, but Dr. Adam Jarrett has figured out how to do it.
He’s the chief medical officer and executive vice president of Holy Name Medical Center in Teaneck. His experience with the pandemic is personal, intense, and ongoing. He’s told his story with his friend Paul Rosengren; their book, “In the Time of Covid: One Hospital’s Struggles and Triumphs,” details what Dr. Jarrett has seen, and also what he suggests we do as we move forward.
Dr. Jarrett’s book begins with a quick history of Holy Name; it’s relevant because the hospital was founded just a few years after the pandemic of 1918, and in response to it. It’s almost as if pandemic and response is part of the medical center’s DNA.
He starts his personal story with an anecdote set a few days before our world shut down in mid-March. The first cases already had been admitted to Holy Name. He and the hospital’s president, Mike Maron, got up very early in the morning to take an Uber through Manhattan’s still-not-emptied streets to CNN headquarters, where they waited until they were able to tape a segment with co-anchor Alisyn Camerota. Then they were driven back to Teaneck.
Everything they did that day — spent time together, unmasked, in small spaces, talked to lots of other people, shook hands, touched lots of things, ate and drank in public — were once natural but are so no longer.
The next day, Mr. Maron, along with his wife and son, were diagnosed with covid-19. They’ve all recovered, but Mr. Maron’s case was serious and worrying. No one else he came in contact with that day, including Dr. Jarrett, caught it. And that’s how the disease works. It’s unpredictable, it’s dangerous, it takes advantage of any opportunity it has to sneak into an unguarded person’s body, and it strikes in different ways, with varying degrees of severity. (And of course it’s also wrong to ascribe intent to it. It doesn’t really take advantage of anything. It’s a virus. It’s mindless. It’s probably not helpful to forget that.)
Since then, Dr. Jarrett has learned a great deal.
He’s proud of the way Holy Name has reacted. “Early on, we were very outspoken about the need for significant shutdowns,” he said. “I saw where we were headed. I was very concerned that we were going to be swamped here.”
But Holy Name is an unusual place, he said. “Mike Maron surrounded himself with a team of really good people. I know that he understands, far more than any other nonmedical CEO I have dealt with, that health care isn’t done all that well. Just look around.
“So the mantra here at Holy Name is we don’t necessarily look outside our walls and say ‘Look at how it’s being done over there,’ and then try to do it. If that were true, then our health care system would be all fine and dandy. But it is not.”
Armed with that knowledge, “Mike creates an environment where it is okay to think outside the box,” Dr. Jarret said. “So when the chips were down, and the governor of New Jersey very appropriately called a state of emergency — what that does is, it lets you bend the rules.
“I try to make the argument in the book that rules aren’t necessarily always good. So it’s good to surround yourself with people who really know the rules, and who challenge them.”
It’s like what English teachers used to say about learning grammar — once you know the rules, then sometimes you can break them, but not without deep background and real reason.He, Mr. Maron, and other leaders — whom he names, with great care and obvious admiration, in his book — took action.
At the beginning of the pandemic, Holy Name changed its physical structure; they remodeled parts of the building to allow for more covid beds, and they set them up so the rooms had negative pressure. That meant that all the aerosolized virus would be sucked back into a filter and disposed off. Equipment was moved to just outside the rooms, so adjustments could be made from that other, safer space.
The staff also put mirrors over patients’ heads; they had to lie with their heads toward the door, thus depriving nurses and doctors of any view of their faces. The mirrors took care of that problem.
This, along with other innovations, meant that health care workers would have to spend less soul-deadening time putting on layers of protective gear for unnecessary forays into the rooms, and then taking them off again. It meant that the hospital could waste less of the protective gear that was so hard to get.
It also meant that the staff could spend more of the time inside the rooms with patients when it really mattered.
Dr. Jarrett has many difficult-to-read but important-to-know passages about what it’s like to face death so frequently; even for health care workers, there was far more death than they were used to or knew how to handle. The staff understood how terrifying it had to be for patients to face death alone — to die alone — and how often they were there at the bedside, when family couldn’t be.
And back to those construction workers, who transformed Holy Name’s roof into a maze of huge foil-covered pipes, as if some extraterrestrial children had been playing with giant toys there. “They essentially moved in for five weeks,” Dr. Jarrett said. And then, when they were done, he had to talk their families into letting them back home; they hadn’t been exposed to covid and weren’t contagious, but their loved ones needed reassurance. “There are some stories in the book of me trying to convince spouses that it’s okay to let them back,” he said.
Dr. Jarrett includes a chapter about vaccinations. “People have to know that we have to vaccinate as many people as we can, as fast as we can,” he said. “That is critical.
“Historically, I am not a big believer in jumping into treatment early — the way a treatment should be rolled out demands patience — but there are exceptions.
“And we are in one now.
“It is important to understand the limitations of science, but in the midst of a pandemic, because we are in such a dire position, the vaccine must be an exception to the rule.
“In the meantime, wear appropriate PPE!,” he said. “Use social distancing. Wear masks. On the one hand, do not be afraid of taking the vaccine. On the other hand, do not be lulled into the thinking that the vaccine will end the need for masks and social distancing.”
Dr. Jarrett, who is Jewish but not Orthodox, is impressed by how the local Jewish community responded. “A couple of members of the staff participated in a Zoom call with Orthodox rabbis,” he said. Those were representatives of the Rabbinical Council of Bergen County. One of the meetings, in early March, included representatives of Teaneck’s health department. “It was a very controversial meeting,” he said. “There were people on both sides, saying we should or shouldn’t shut down. I came out very strongly on the side of the shutdown.
“I was very impressed that the Orthodox rabbis did what they did after the debate.” What they did was mandate a shutdown of all services, saying that health and science were paramount, as halacha — Jewish law — made clear. Since then, the RCBC has been careful, proactive, and widely seen around the country as a leader in the fight against covid in the Jewish world.
“It was a brave decision,” Dr. Jarrett said.
“What the Bergen County Jewish community did was incredibly impactful. It helped stop that first wave. They made that decision at least days if not a week before the rest of northern New Jersey did, and it absolutely made an impact not only on the Orthodox community but throughout the rest of the county.
“Since then, I’ve been in touch with the rabbis on a weekly basis, giving them updates and advice,” he continued. He’s done the same thing with the North Jersey Board of Rabbis, the RCBC’s progressive counterpart, but because its members’understanding of the demands of halacha is different, it’s less necessary.
“The RCBC’s decision not to resume life as usual back in July, when things were quiet, really was great,” he said. “I know they felt all sorts of pressure to resume normalcy, and they didn’t. And that gave them a great deal of power over the pandemic.”
Dr. Jarrett thinks that it’s important to be realistic. As our understanding of the novel coronavirus that causes covid-19 has grown, and our use of therapeutics has improved, so too should our expectations.
“In March and April I was very strong in terms of saying that we needed to shut down as a society,” he said. “That was very controversial. But I felt that schools had to be closed. I knew that at the pace that people were getting it, it was necessary. I was very supportive of it.
“But I am not supportive of it throughout the pandemic. We can’t just shut down. The economic toll, the psychological toll, will be too great.
“The difference is that we are not at risk of being overwhelmed — at least not today. We might be after the holidays. We might have to shut down again. But now, the hospitals are better prepared, and the patients are not coming into the hospital with the same rapidity.
“My position has been that schools should be open, but in a different way. It should be a combination of remote and in-person learning. There should be social distancing.”
He would put shuls and churches in the same category, he said. “They should be open in some way. There should be a significant number of restrictions.”
We’re still in for a long haul, he added. “We have to make smart decisions. Maybe it’s okay to have small weddings and funerals. It’s not normal, and we can’t do them the way we normally would do them, but we could have small, modified versions of life-cycle events.”
That, he repeated, is because “it’s not the way it was in March and April, because we are not on the verge of being overwhelmed.”
It’s all about balance, Dr. Jarrett said. “It’s a matter of walking a fine line. We have to make sure that we are shut down enough not to overwhelming the system, but not so shut down that the other implications become too great.”
But, he said, to stay on that high wire, it is important to keep wearing masks, to keep social distancing, to be very careful.
“What we do in our day-to-day lives will impact not only friends and family. It also will impact the safety of health care workers. Wearing a mask is a mitzvah. Socially distancing is a mitzvah.”