CITY THAT NEVER SLEEPS

New York City, The Big Apple, one of the most affluent cities in the world, was recently in the headlines riddled with demise, disease and COVID-19.

To twin brothers, Garrett and Kyle Hicks, it was a city they had never stepped foot in. As a critical care nurse practitioner from the Central Valley, Garrett says he was contacted by a recruiter saying there was a need for his assistance. Twenty-four hours later he was on a plane heading to New York with only a phone number and hospital address in hand. His brother Kyle, studying for his nurse practitioner exam, would follow him two weeks later to help in the fight against the coronavirus. "I kept seeing on the news," said Garrett. "They really needed help. It was a true crisis and I thought, with my background in critical care, I could really go there and help. I'm young and healthy. I knew what needed to be done."

Garrett and Kyle grew up in Clovis, California, and attended Buchannan High School where they were first involved in an EMT program that launched their careers in emergency medicine and critical care. The twins' mom, also a nurse practitioner, had her reservations about them leaving, but understood their reasoning. "My parents were apprehensive, they didn't feel it was worth the risk, but ultimately they were supportive," said Garrett.

They gave their current jobs notice that they were taking an extended leave and booked a one-way ticket to New York. On the plane, Garrett was one of six passengers. When landing, Garret says, "the airport was dismal. There was absolutely nobody there. I was afraid I wasn't going to be able to find an Uber to take me to the hospital."

Upon arriving at the hospital, Garrett

was granted emergency credentials. He worked in a makeshift ICU alongside a podiatry resident, who had no experience in critical care. He was provided one N95 mask and was told to use it for five days. At one time, he recalls there were more than 54 ventilated patients in a hospital that normally housed 14 ICU beds. They used a Post Anesthesia Care Unit (PACU), an open room, and filled it with COVID-19 patients. "The supplies were scarce. We were using a ventilator that was meant for short-term use, maybe a few hours. It was repurposed and used for 4 weeks," Garrett said. "There was not a way to prepare for this. The virus showed that we have a systemwide lack of resources and training to address issues like this." Garrett and Kyle say this experience has taught them more about medical management, ICU ventilated patients, managing Extracorporeal Membrane Oxygenation (ECMO) patients and more about Acute Respiratory Distress Syndrome (ARDS). They currently are still in New York and report that the situation is improving weekly and the access to resources is increasingly better. They plan to stay as long as they are needed, but eventually will come home to the Central Valley.

AJIT RAI, MD, ANESTHESIOLOGIST, DIDN'T TELL HIS PARENTS HE WAS LEAVING FOR NEW YORK. RAI HAD TRAINED IN THE CITY AND WHEN HE HEARD HIS COLLEAGUES WERE OVERBURDENED AND OVERWORKED DUE TO COVID-19, HE WAS EAGER TO HELP.

"My colleagues told me about the horrors they were experiencing in New York City hospitals," Rai said. "With elective surgeries ceasing, I felt an obligation to help."

Rai took a leave of absence from his anesthesia practice in Fresno for a total of eight weeks, but it wasn't Rai's first time on the front lines. He previously worked for Doctors Without Borders in the Middle East, providing care for war wounded refugees fleeing Iraq, Syria, Palestine, and Yemen. "When my parents found out, they were emotional at first," said Rai. "But they know me. They've grown accustomed to

"THE SITUATION WAS FAR WORSE THAN I EXPECTED. I'VE DONE HUMANITARIAN WORK ACROSS THE GLOBE AND I'M USED TO SEEING RESOURCE DEPLETION, BUT NEVER DID I THINK I'D BE EXPERIENCING THIS IN ONE OF THE MOST AFFLUENT CITIES IN THE WORLD." - AJIT RAI, MD

my adventures."

Like the Hicks twins, Rai found himself in a resource depleted environment. Upon his arrival, he was given one N95 mask and was told to make it last. "The situation was far worse than I expected. I've done humanitarian work across the globe and I'm used to seeing resource depletion, but never did I think I'd be experiencing this in one of the most affluent cities in the world," Rai said.

With his experience, Rai staffed the ICU and was on the emergency response team. Rai recalls over a 24hour period, putting 18 patients on life support. "Although the situation was dreary, what was most impressive was how resourceful everyone became," Rai said. "People repurposed their primary skill set. For instance, there were dermatologists, who didn't have critical care experience, asking how they could help. So, they stepped in and participated in end of life conversations with family members. This alleviated us to move on to other patients in need."

Rai states he has an obligation as a young, healthy physician to provide aid wherever it is needed most. "Just like you want your most experienced orthopedic surgeon replacing your knee, you want the most experienced COVID doctor taking caring of your loved one," said Rai. "There is value in continuity and expertise."

Rai is currently back home in Fresno, but plans to continue to provide care in any outbreak areas throughout the country and the world.