EP. 110: THE SKY WAS FALLING — STORIES FROM A COVID DIARY

May 1

WITH CORNELIA GRIGGS, MD

A pediatric surgeon and writer shares dramatic stories of struggle and courage that defined the early days of the American epicenter of the COVID-19 pandemic, New York City.

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Episode Summary

In spring of 2020, Cornelia Griggs, MD was finishing her nearly decade-long training to become a pediatric surgeon in New York City, when COVID-19 struck and life fell apart. The hospital was flooded with mysteriously sick patients for whom no known treatments existed, basic supplies disappeared from shelves, and each day at work took on an existential burden as she wondered if this would be the day she caught the deadly disease herself.

Dr. Griggs describes these dramatic stories from the early days of the pandemic in her 2024 memoir, The Sky Was Falling. Today, she is a triple board-certified pediatric surgeon, having completed medical school and pediatric surgery fellowship at Columbia University Medical Center, and her adult general surgery residency and surgical critical care fellowship at Massachusetts General Hospital, where she currently practices.

Over the course of our conversation, Dr. Griggs describes the course of her challenging training in medicine, why it takes “a little crazy” to succeed as a surgeon, harrowing moments that defined heroism amid the throes of the pandemic, how she continued working even when giving up was the easy option, and more.

Cornelia Griggs, MD is a triple board-certified pediatric surgeon. She completed medical school at the Columbia University College of Physicians and Surgeons, where she graduated with Alpha Omega Alpha honors. She completed her adult general surgery residency and surgical critical care fellowship at Massachusetts General Hospital, where she currently practices. She is a graduate of Harvard College and earned a certificate in health policy from Harvard’s John F. Kennedy School of Government. Her writing has been published in The New York Times and many top medical journals, including the New England Journal of Medicine.
In this episode, you will hear about:
• 2:26 - What initially drew Dr. Griggs into the field of medicine and to the speciality of pediatric surgery
• 14:35 - Why the operating room is a “safe space” for Dr. Griggs
• 19:36 - The sense of alarm that Dr. Griggs experienced in the early days of the pandemic that drove her to write her viral New York Times op-ed, The Sky is Falling
• 28:26 - How Dr. Griggs fell into an “investigative reporter” headspace as the pandemic raged around her in New York City
• 30:26 - The sense of fear that enveloped both patients and the medical community during the first months of the pandemic
• 40:27 - A moment during the early pandemic when Dr. Griggs seriously considered leaving the city and her post in the hospital
• 46:30 - How ICU nurses brought dignity and humanity when tending to seriously ill COVID-19 patients
• 51:16 - The hopefulness Dr. Griggs carries in seeing the large number of people who have entered medicine since the pandemic
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Tyler Johnson: [00:01:02] In spring of 2020, Doctor Cornelia Griggs was at the end of her nearly decade long training to become a pediatric surgeon working in New York City when Covid 19 struck and life fell apart. The hospital was flooded with mysteriously sick patients for whom no known treatments existed. Basic supplies disappeared from shelves, and each day at work took on an existential burden. As you wondered if this would be the day you caught the deadly disease yourself. Doctor Griggs describes these dramatic and unforgettable stories from the early days of the pandemic. In her 2024 memoir, the Sky Was Falling. Today, she is a triple board certified pediatric surgeon, having completed medical school at Columbia University and her adult general surgery residency and Surgical critical care fellowship at Massachusetts General Hospital, where she currently practices. Over the course of our conversation, Doctor Griggs describes the course of her challenging training in medicine. Why it takes a little crazy to succeed as a surgeon. Harrowing moments that defined heroism amid the throes of the pandemic. How she persevered, working despite facing times when giving up was the all too easy option, and more.
Tyler Johnson: [00:02:20] Doctor Cornelia Griggs, thank you for joining us and welcome to the show.
Dr. Cornelia Griggs: [00:02:24] Thanks so much for having me.
Tyler Johnson: [00:02:26] Well, we like to usually start by asking our guests, can you tell us what brought you initially into the field of medicine? How did you decide to become a doctor?
Dr. Cornelia Griggs: [00:02:35] Sure. I think all of my career decisions have been a little bit roundabout. There are some people that knew that they wanted to be a doctor since they were a toddler, and they were operating on stuffed animals, but I was very theatrical as a child. I wanted to do theater, music, be a director. Everyone in my family is involved in the arts or writing or communication in some way. There are no doctors in my family, and so it felt like a foreign world. But I was really, really good at school, and I loved science, and I first experienced medicine through service. I went to a Quaker high school, and we were required to do 150 hours of community service in our junior year of high school, and I decided to volunteer as a candy striper, which was an old fashioned term for student hospital volunteers. But I actually had like the red and white striped uniform. Um, this was at a pretty old school hospital in the Washington, D.C. area, and I was in the emergency room and in the same day surgery department. And I remember the first time I kind of saw surgery, my eyes lit up, but I don't think I thought I had the stuff to be a doctor because it seemed really intense. And like I said, I was a little more artsy. Um, when I was younger.
Tyler Johnson: [00:04:08] We're going to have you sing for us later in the program, okay? So just be getting ready.
Dr. Cornelia Griggs: [00:04:12] If you come to one of our family gatherings, you will hear me sing. So that volunteer experience had kind of planted the seed. And in college, like many college freshmen at Harvard, I decided to take some of the basic pre-med requirements. I think something like 50% of my class, like, entered pre-med, and it didn't cover your bases. You know, it dwindles. It dwindles very quickly.
Tyler Johnson: [00:04:34] Just in case you happen to accidentally fall into being a doctor sometime, right?
Dr. Cornelia Griggs: [00:04:38] Just as a backup plan. And then I love travel also. And the summer between my sophomore and junior year, I signed up to do a work volunteer experience that was called College Corpse, which is like a Peace Corps type experience for college students. And I was assigned to do a homestay with a family outside of Cape Town and Cape Flats, which was sort of the boundary between the townships and the suburbs of Cape Town. This is.
Tyler Johnson: [00:05:05] In South Africa.
Dr. Cornelia Griggs: [00:05:06] In South Africa, sorry. And I spent the summer there, and I was doing like ride alongs with EMS, volunteering in a free HIV tuberculosis clinic. I delivered a baby for the first time, and that was the experience where I thought, this is the most human thing you can do with your life. I want to do this. So that is when I decided. But interest in medicine wasn't necessarily born out of a specific fascination with cells or disease or something really sciencey. It was the human story and the human connection. And I think that's still what I love most about medicine.
Tyler Johnson: [00:05:48] So I always feel really torn because we ostensibly have you on the program today to talk about your book, which we're going to get to in a second, but we could also spend the entire time talking to you about. Your decision to go into a career not just as a surgeon, but as a pediatric surgeon? There's this paragraph in the book you're talking about the process of deciding to become a surgeon and then eventually a pediatric surgeon. And you say, how hard could the residency, the surgical residency, really be? I was aware that the very hubris of that thought wasn't the worst quality for a surgeon. You had to have a streak of it to brandish a knife for a living. I often think about the fact that outside of the context of the operating room and the medical field, what we do to other human bodies would be considered assault. Maybe it's more than hubris. Maybe every surgeon is somehow a little sick in the head. So first off, I just want to make clear that you wrote that that's not my opinion, okay? I'm just. I'm just saying you wrote that about your own tribe. So I guess with that sort of very candid self-awareness in mind, how did you make the decision to become not just a surgeon, but then a surgeon operating on kids of all things, which I have to imagine I'm not a surgeon, but in some ways is has to be even more technically demanding, if only because the the structures are so small. Yeah, but also is just so weighty, right? I mean, it's a little teeny kid whose body is on the line and yes, who you're trying to fix, but also who, you know, could be hurt or left injured or even dead if something in the surgery goes wrong. So can you talk a little bit about that process of deciding to become a surgeon and then a pediatric surgeon?
Dr. Cornelia Griggs: [00:07:40] Absolutely. Yeah. And I mean, every word of what I wrote, like doubly for the record, I think people talk about it more often. The decision to become a surgeon or being a surgeon as like the risk of forming a God complex because the decisions we're making in real time often are literally life and death. There is a scene in the movie malice starring Alec Baldwin that is a pretty epic speech, and the most extreme version of, like, someone playing an actor acting out a God complex. And he says very dramatically, are you asking me if I have a God complex? I'm telling you, I am God. And I think that's a very stereotypical view or dramatized stereotype, stereotypical view of a surgeon. And to be fair, most surgeons are not like that. We're very real. We're very human. But I do think you have to have something a little crazy to decide to operate on humans and definitely to operate on children, and I mean crazy in a good way here. Right? Because I love other surgeons. I especially love other pediatric surgeons. But I'm also married to a surgeon. My father in law is a surgeon. My brother in law's a surgeon. Now, as opposed to my childhood, there are tons of surgeons in my life, right? But it's just a crazy thing to do with your life. And it's also so awesome, right? With great power comes great responsibility.
Dr. Cornelia Griggs: [00:09:16] Once I got to medical school, I thought there was no way I would do surgery because I just wasn't into the bravado and the competitiveness and the show offishness of the culture around surgery at the time. And so I actually chose to do my surgical elective in medical school. I was at Columbia in Cooperstown, New York, and Cooperstown was really fun and funky because when you did a rotation there, you lived in a house with other medical students, and it was a community hospital, and it was supposedly like a more low key surgery experience. And I signed up to do surgery there because all the super gunner kids going into surgery wanted to do their surgery rotation on campus at Columbia because they wanted the visibility with the program director and the division chief, so that they would have a better chance of matching and get their letters. So you didn't do your surgery rotation in Cooperstown if you intended to go into surgery, but then I frickin loved it. I felt electric and alive in a way that I hadn't experienced on any other rotation in medical school, and even now as a surgery attending. I love when people want to go into surgery, but I stand by the advice that if there's something else that you love more, do that, obviously.
Dr. Cornelia Griggs: [00:10:35] But if there's something else you love as much in medicine, like probably do that other thing because there's a ton of personal sacrifice involved in surgery. And so you have to love it so much that that overcompensates for the level of personal sacrifice. And if you have a family, you're making a sacrifice on their behalf when you choose surgery, or if you don't have a family but intend to have a family like you're kind of. Making that sacrifice for these non-existent family members or future family members. So I stand by that advice too. And then the same thing. Okay, I decided to become a surgeon. I love it more than anything else. I do a Subinternship my fourth year at Columbia. I get the visibility, I show them this is where I want to be. I rank Columbia number one for surgery residency. I match there, I'm a surgeon, and my very first day as an intern was at the children's hospital. It was brand new. Day one baby intern and I didn't even know how to dose Tylenol for children. And it come 5:00 they handed me like the pager and the trauma pager and said good luck. And then all of a sudden, 6:00, everyone was out of the building and I was totally overwhelmed. And at that time in my surgery residency, the idea of taking care of children and being primarily responsible for them as a doctor was terrifying.
Dr. Cornelia Griggs: [00:12:02] And I felt that I don't even know how to change a diaper. How am I going to tell a parent how to take care of their baby? I don't this isn't me. And I think a lot of people feel that at least surgery residents when they rotate through pediatric surgery. And then, you know, life happened. I met my husband, we got engaged. I actually transferred residencies to MGH so we could be together. And I had my daughter. A lot of things happened in those years, and it's all detailed in the book. But then I became a parent, and at that point in my residency, I was going to do trauma, acute care, surgery, critical care. I had already done an ICU fellowship. I loved just taking care of sick people. I wanted to be with the sickest of the sick. I wanted to do all the hard things. I wanted the scary traumas. I wanted to be in the heat of the moment, those high adrenaline, decision making places. And we were making our schedule to come back for fourth year as a class, and no one wanted to do PD surge over the summer because it's notoriously the busiest time, and it was going to be a two month block. It was an unfavorable rotation and time to be doing the rotation at that time, and no one else in my class wanted to do it. And I was like, I'll suck it up, I'll do it. I like the pediatric surgeons.
Dr. Cornelia Griggs: [00:13:24] And over the course of those ten weeks, I fell in love with pediatric surgery. And I think the experience of coming back to it as a parent gave me a totally different perspective. And I'd had a really complicated pregnancy. And so I understood the parental distress around the idea of bringing a sick child into the world in a totally different and very personal way. And I went from being terrified of sick children to feeling that I was uniquely suited to take care of them and their families. So that's kind of the ultimate driver. And I also just loved the technicalities of the procedures. I mean, who else in surgery gets to operate in the chest and on the liver in the same day? Do like minimally invasive corrections of congenital anomalies. But I also have days that are totally elective routine. Go home at 5:00. It's I love the variety. Every day is a little bit different. And when you're on call, you never know quite what to expect. Sometimes there's a messy trauma, sometimes there's a tiny preemie, complicated, born in the NICU, and you have to be able to flex in either direction.
Tyler Johnson: [00:14:35] So mostly we want to talk today about your experience during the pandemic. But I have to ask, building on your answer to that question, I have to ask this one more thing. So this is one other place in the book. You say you're talking about how you get up very early in the morning and going into the hospital, and then you say. I quickly update the attending physicians, the supervising doctors who are ultimately in charge of hospital patients care. And then I'm off to my happy place, the operating room. Room five is like my second home now. The ritual and intensity of the operating room have always made me feel safe. Somehow, when I'm operating, I go into an altered state of consciousness, laser focused on the task in front of me. It's been this way since medical school, when I watched my first operation on a patient's carotid artery. Each human being contains a predictable set of organs, but subtle differences make our anatomies as unique as our faces. As a surgeon, you come armed with knowledge and experience, with human anatomy and a reverence for the surprises that lie under the skin, the unexpected course of an artery that feeds the liver, an abundance of fat in the overweight, or a paucity of it in a cachectic cancer patient who is wasting away. Every appendectomy is the same, but also slightly, sometimes wildly different. And there are always new ways that even the most standard procedures can go wrong.
Tyler Johnson: [00:15:59] Okay, so here's my thing. I have talked to enough surgeons now to know that what you describe is the thing for surgeons, right? There is this like frisson that like, happens to surgeons the first time they walk in the operating room. It's like some center in their brain they didn't even know was there. Lights up and they're just, you know, hooked. But the thing that I do not understand is that if you have a little teeny person whose entire life is in front of them and they are sedated, anesthetized on the table, unconscious, and you have cut into their chest or their abdomen or whatever, and now they start to have a bleed that you didn't anticipate. Or it is some, you know, variation of their anatomy that is different from anything that you have ever seen before. But you have to fix the thing because their life is on the line. How in the world is that the place that makes you feel the word you use in the book is safe? That doesn't just seem counterintuitive. That seems nonsensical to me.
Dr. Cornelia Griggs: [00:16:59] Yeah, because that moment is exactly what I trained for. That's exactly why I put in all of those hours. I did nine years of surgical training after medical school. That's gross. That's too much. But that's the exact right amount of training that you want someone to have had if they're going to operate on your child. Right. So that moment in the operating room that you're describing is exactly when I feel totally prepared. The mundane stuff in the operating room is fun, too, but I don't know, sometimes I'm doing a case and there will be interesting anatomy and I'll audibly, you know, squeal or make an excited noise. And I want the whole room to look, look at this, look at this. And I can just tell that other people don't feel the electricity the way I do, but I just think the human body is so fascinating.
Tyler Johnson: [00:18:01] You're like, med student who's going into psychiatry is not quite nerding out about.
Dr. Cornelia Griggs: [00:18:05] They're like shuffling. they feel a calf cramp. They're hungry. Right, people? The same question people ask me. And I don't have a perfect answer for you. Part of my answer is, I don't know. I don't know why I feel safe or good or in my happy place in that moment or in the operating room in general. People will say, you mean you've done a 14 hour procedure and you didn't go to the bathroom, you don't eat, you don't drink water, and you don't feel the need to do those things because adrenaline takes over and the focus takes over. Athletes describe it as being in the zone, and you don't feel that way every operation, right? But an operation that requires a lot of intensity and focus, I definitely do something else takes over, and I think I'm now addicted to that feeling, and I can't imagine doing anything else. Although if I had to, if I was disabled for some reason and could no longer use my hands or safely operate, I would find something else in medicine or maybe writing that would make me happy. But I would be devastated if someone told me I could never operate again. That would be. That would be hard.
Tyler Johnson: [00:19:18] We could spend the entire hour talking about surgery and the psychiatry of surgeons. But rather than doing that, I do want to turn to the the main.
Dr. Cornelia Griggs: [00:19:28] Get me banished from the field.
Speaker4: [00:19:32] To just remember it is you saying it, not me.
Tyler Johnson: [00:19:36] But I want to turn. So the thing that brought you to our attention and the book that you've just published is called the Sky Was Falling. And it's a sort of I mean, it's a memoir that interlaces some of your own personal experiences, including things that we've been talking about already. But the impetus for the book is your experience, to some degree, as a sort of firsthand witness and to some degree as a sort of very slightly removed second hand witness in a sense of the sort of tsunami of the pandemic hitting in Manhattan 4 or 5 years ago. So I'd like you first to walk us back. You know, I have this very visceral sense in my bones of those. And this is living in Northern California, where the tsunami never hit as badly. And to the degree that it did hit, really didn't hit until the second or third wave a year after the initial wave in early 2020. But I still, even so, have this very visceral memory of what it was like, like as a doctor who was kind of following the stories coming across the Wire, I think before most people in the general press, like you could kind of tell that something was building, right? Like you sort of started to wonder when you heard about the stuff in China. And then there was the stuff in Italy that made you more suspicious. And then you started to hear that maybe there was an index case yet, and you just felt this sort of like it was like your muscles were sort of tightening and tightening, and you were kind of like looking everywhere, like looking to the sky to like, see if something to your point, the point of your title was going to be falling out of it. But can you tell us from your perspective? Because of course, you were living in Manhattan. Not when it hit, but in the weeks before it hit. Walk us through what that was like for you.
Dr. Cornelia Griggs: [00:21:22] Sure. So it's interesting and I'm so glad I wrote it all down because there's a lot that I blocked out or don't remember as well from that time, but I remember a few distinct scenes. There was a week in mid-February where so many people were sick, and so many kids were out sick in my daughter's nursery school class that they they only had three kids or something tiny in class, and they sent a notice, like over the parent like messaging platform, like there are so few kids today we're going to go out to pizza in the West Village, just like we're just going to do a spontaneous field trip. Is this okay with you? And I remember like, being at the hospital and being like, wow, that's crazy. There are so many kids out sick. And then it was like being a detective and putting together like, pieces of data that woke me up. And so that was a moment, right? And then we had two kids in the PICU who were so, so, so sick on ECMO and not getting better.
Tyler Johnson: [00:22:29] Just for our, our folks who are maybe early in their training or not even medical folks. What what is ECMO?
Dr. Cornelia Griggs: [00:22:34] So ECMO is like bypass but prolonged bypass. It is extracorporeal membrane oxygenation. It's a machine that oxygenates your blood for you. And it does that through large cannulas that go in your vessels, and it sucks your blood out, oxygenates it and puts it back in.
Tyler Johnson: [00:22:56] It's effectively like an artificial heart and an artificial lung at the same time.
Dr. Cornelia Griggs: [00:22:59] Yes, it can do both depending on what kind of ECMO. And so pediatric surgeons really pioneered ECMO. And ECMO is for people who are failing even on the ventilator, like they're on maxed out settings on the ventilator. They're not getting better. We need to go a step more invasive beyond that, because there's obviously big risks involved with ECMO, bleeding, stroke, infections, other complications. But the great thing about Echoing Kids is we save most kids with ECMO. Kids do well. And these kids were not getting better and we were calling it flu, but they didn't have flu. And I was just like, what is this? Why aren't they getting better? They're not responding to the normal things. And their lungs were liquefying. They had so many chest tubes in them. Popping pneumothoraces, you know, when the lung drops. And there were two of them.
Dr. Cornelia Griggs: [00:23:54] And I just remember saying to myself over and over, because I kept flogging them, you know, that was my job as the pediatric surgery fellow, to try and do anything to get them better, to save their life. And I just kept saying that to myself in my head, what is this? This is different. And at the same time, I was really online. Like if I was waiting for a Cat scan to come back, I'd be scrolling Twitter. That was at that point how I got a lot of my news, and I followed a lot of doctors, intensivists and surgeons on Twitter nationally and internationally. And February was when we started to hear more percolating out of China and Europe. And I remember when things started to get really bad in Italy. There was a ICU doctor who I knew of from having done a critical care fellowship, and it was like a good, well known international ICU doctor. And I don't remember the exact wording of the tweet, but it was, this is coming to you and your problem is not going to be running out of ventilators. It's going to be running out of staff because your staff is going to get sick. And when I read that in February, that is when I started to panic internally. And I remember reading that tweet, and then the next morning, getting on the subway and looking around with all of those pieces of data jostling around in my head, and I thought, we're going to get crushed. New York is going to get crushed. There's just no way.
Dr. Cornelia Griggs: [00:25:29] And everyone at the hospital was still really business as usual. I mean, my pub date was March 12th of this year, 2024, and we weren't masking. We weren't even close to masking on March 12th, 2020. Like we we knew so little and we forget how little we knew because we have talked about Covid ad nauseam now, but we knew so little we didn't know if we were carrying it on our bodies. We didn't. We were washing our groceries, you know, we were just we knew so little. And I am not a panicker. I feel calm when people are dying because I'm a little bit crazy. Right? Um, as we covered before and not not because the dying makes me happy, but because that is where I know that I can apply my expertise and really effective way, which is a good feeling. And I often and successful at bringing people back from the brink, which is another amazing feeling that I'm also addicted to. And me, I know myself. I am not somebody who freaks out over little things. I'm usually the exact person you want to call in the most horrific scenario you can imagine, and I'll talk you through it. And I was freaking out. And that was a really unusual experience for me as a human, as a doctor, as a surgeon, I was looking around at all my colleagues at the hospital thinking, am I crazy or is everyone crazy? Am I crazy or is everyone else crazy? I wasn't sure if I was just losing it and being paranoid, but I really didn't think I was.
Dr. Cornelia Griggs: [00:27:02] And I wrote this op ed called the Sky is falling and people were kind of like nervously joking and laughing like, oh, COVID's coming, we're going to be inside for two weeks. Like we're going to make some sourdough and stay at home and do some craft projects and be cute with our kids. And I was like, you don't get it. You don't get it at all. No, no, this isn't cute. This isn't fun. This isn't a little vacation. This isn't a way to, like, imagine being cozy at home. Like a lot of people are going to die. And I wrote it much more eloquently, I think, than that. But that was the reason I wrote that op ed and that op ed in the New York Times, for lack of a better word, went super viral. And I wrote at the end of it, like, if I'm wrong, if I'm the Chicken Little of the Covid pandemic, and this is a massive overhaul, and you all call me hysterical, like, I can live with that, I will be so relieved if I am wrong, if this is not what I think it's going to be. And I'm not an infectious disease expert, I'm not an epidemiologist. I am getting my master's in public health right now. But the experience of living in New York and knowing myself as somebody who was not a panicker, I think gave me the wherewithal to say out loud, this is going to be horrible, and everybody needs to apply whatever expertise they have to try and mitigate the amount of harm that is about to descend upon us.
Tyler Johnson: [00:28:26] Yeah. So I, uh, did not write a super ultra viral New York Times op ed. But as someone who has never been very much into social media, I did start to do some social media posting during that time. Yeah. And it was a similar kind of like I remember sending putting a thing up probably end of February of 2020. That just kind of said, hey, from what I'm reading in Italy and just sort of what I think I know about this, like I would recommend maybe going out and stocking up on some extra groceries. And I would recommend, like checking in on elderly family members and like, you know, like sort of a list of things that you could look to do and like. And at the same time, I remember we have a very small house here in Palo Alto. We have like no storage space. And so we just had this random corner of the bedroom where we just stacked like dry goods and cereal and like, and, you know, whatever toilet paper and stuff. But it it took on this, like, I don't know that I have ever been part of something where it felt like there was such a sense of like collective premonition. Right? Like it was like there was this just this sort of like shared. Even people who I think that people who were not in medicine, it was maybe difficult, more difficult to articulate it, or maybe they just felt it later than those of us who are in medicine did. But it was like you had heard about an earthquake that had happened somewhere far away, but that you knew that the that like it was still going to reach you. It was just a matter of time before, like your own house started shaking. So I think at this point it's become pretty clear that nobody really I don't think we will ever really know where quote unquote, the first case in the United States was because there was so little diagnostic testing at the time, and Covid can look like so many things and whatever.
Dr. Cornelia Griggs: [00:30:14] Much ado about that, and dissecting that down to the single first pathogen is less interesting to me than all of the human stories that unfolded after.
Tyler Johnson: [00:30:26] Right. But whatever the answer to that question is, what is clear is that Manhattan just was overwhelmed, right? I mean, it was like the wave of the tsunami just crested and broke over Manhattan. Yeah. So talk us through. Then, after that sort of period of premonition, what was it like to be there on the ground as all hell broke loose in a way that had not happened almost literally within living memory?
Dr. Cornelia Griggs: [00:30:57] No, there was definitely as this tsunami was crashing upon us and it felt that fast and that sudden. And before I describe more of it, I want to acknowledge, like I am a pediatric surgeon, right? Like in the wake of Covid or any big battle, there's always going to be someone who is like more frontlines, more sure, Covid badass in the trenches than somebody else. And and I told this story not because I am an infectious disease expert and not because I was the most frontlines of the frontlines. Right. But because immediately as the reality of how bad it was going to get became apparent to everyone who was living in New York City at the time, I went into investigative reporter mode a little bit in my head, which was a little bit dissociative, but I was just observing and taking in all the data around me, a to keep myself and my family safe and to be making real time decisions about what to do and how to flex and change plans to mitigate risk. And also because of the story. Right? I mean, as somebody who writes the plot could not be more dramatic. And I was living in the middle of it, and my mother's a career investigative reporter, and she always taught me like, everything's material, the best way to get back at life when something really terrible happens is to write a great book,
Tyler Johnson: [00:32:31] Let Alone when you're actually living through the apocalypse.
Dr. Cornelia Griggs: [00:32:34] But yes, when you're actually living through it. And so that was the mode that I was in. And that's why you hear the voice of a pediatric surgeon describing a Covid story, not because I am the single most informed doctor to tell this story, but just because I think very few people have that duality, the ability to go back and forth between I am a medical doctor taking care of patients, and then also I am a reporter sort of observing what is going on. And I was in that reporter mode as everything was unfolding and I was taking meticulous notes on everything, because for me, that was therapeutic, that was meaningful. It made me feel better. It was how I processed everything that I was seeing. It was therapy, but the entrance to my office to get to the floor where the pediatric surgery fellows. Sat in the children's hospital, you'd get off the subway. And then there was a one of the main entrances of the hospital. It was a shared entrance to the main adult emergency room. And so my first snapshot every morning was the number of people waiting to get into the E.R., and it was like watching an avalanche happen in slow motion. It was just so overwhelming. And there were I was in upper Manhattan, but there were places in Queens, in the Bronx that were hit even harder, if that's possible to imagine. But there were so many desperate, sick people in despair, and the look of terror on their eyes is unforgettable. And that was what set the tone of every morning, of every day. As I kept showing up to work during March and the first few weeks of April.
Tyler Johnson: [00:34:19] If I can interrupt you there. I think the other thing that struck me so hard and and this is just like you are acknowledging your remove from the eye of the storm. I was even further removed because, as I said, in Northern California, we really were not hit that hard until until much later on. And even then, never as hard as Manhattan was. And we don't have the same population density and everything else. But nonetheless, the thing that I was so struck by, I mean, you were mentioning that look of fear in the eyes of the patients, but was also the sense of fear and impotence on behalf of the medical professionals. Right. Like I remember being part of this sort of loosely based network of people who I knew from residency who now were scattered across the country, including in Manhattan and Boston and other places on the East Coast. But we were a private group, though, for medical professionals that we were super active in conversation for probably the first six months of the pandemic. But the thing that is so remarkable, looking back on it is that, I mean, these were some of the most highly trained, most, you know, precisely honed medical professionals in their respective fields, young professionals in the world. And they were the people, in many cases, who were on the front lines taking care of patients. And all of that notwithstanding, nobody had any freaking idea what was going on, how to make a diagnosis, what to do.
Dr. Cornelia Griggs: [00:35:47] And then as the as the antiparasitics. Right. Antidepressants, SSRIs for a while,nyou know, horseradish.
Tyler Johnson: [00:35:59] And then for a while...
Dr. Cornelia Griggs: [00:36:00] Tincture of Sunflower oil.
Tyler Johnson: [00:36:02] There was this terrifying thing which I'm sure you you saw in more vivid color than I did, but where patients would come into the hospital, they would be sick. You would take care of them, they would appear to get better. And then on, like the fourth or fifth day, just as they were approaching discharge, they would just it was like a building collapsing, like a sinkhole opening up. Right? Like just complete cardiac pulmonary collapse.
Dr. Cornelia Griggs: [00:36:26] I don't know if we'll know this in retrospect or if some brilliant virologist has already figured this out, but collectively, for everybody who was working in a hospital in New York in the spring of 2020, there was something different about those early strains. And they killed people fast and they killed people ugly. And there was lore of people dropping dead in the streets. There was lore of security guards coming into work, finding the person who had worked the shift before them dead in their chair. I mean, that was the kind of apocalyptic stuff people were talking about. And I think some of it was real, some of it was exaggerated, but it really felt like The Hunger Games and you felt going into the hospital to work, like, is today the day I'm going to get Covid? And if I get sick, will my own hospital have a ventilator for me? I don't know. And. Whew. I don't think anybody who signed up to work in health care was prepared for that way of thinking and showing up to work, and if you worked in a hospital in New York City and you didn't have that thought, cross your mind. I would like to talk to you. I would like to know what amazing trick of the mind coping skills you have to get through crises, because I have a few up my sleeve. But universally when you talk to people who were there, there was a sense that there was something different about that early time. And I think what we will probably learn is that there were, you know, inborn genetic susceptibilities that made people uniquely vulnerable to those strains. And there have been existing theories about that, about like, why some people respond so briskly and devastatingly to a septic pathogen, and some people get a mild UTI.
Dr. Cornelia Griggs: [00:38:30] So that's for the immunologists and the infectious disease specialists and the geneticists to parcel out at some point down the road, or maybe never. But it was different in New York. And we absolutely, I think, got crushed and hit the hardest. And there were so many reasons why New York was the perfect setup for that. I mean, just the international hubs of transit, the size of the population, the density of the population, the paucity of hospital beds to support that population, the social injustice, the pay inequity, the number of essential workers that had no choice but to keep showing up to jobs, whether or not they were equipped with proper protective equipment to keep themselves and their loved ones safe. So many things. The fear and distrust of the medical establishment that was preexisting in a lot of those vulnerable communities in Queens and the Bronx, that made people really scared to even seek care or come to the hospital. I mean, in the early days, that was something that the hospital was really not happy with. Those of us who were online saying, this is real bad because we were fear mongering. We were stoking fear in the public and making them afraid to seek care. Or at least there was. There was a sense of scrutiny in that way, and it made me very self-conscious, especially as a trainee, that I had to walk a really careful line between wearing that investigative reporter hat and wanting people to know and see the reality of the situation without making people feel so panicked and scared that if they needed our help, they wouldn't come to the hospital. And the consequences of that now are kind of unknowable. But it was a little, you know, judgmental voice in the back of my head.
Tyler Johnson: [00:40:27] You know, I feel like the pandemic now, I feel like we have started to enter that phase as a sort of a collective consciousness where it's just far enough away that, like the intensity of the first couple of years there is coming to be a real danger of it just kind of fading into an average, you know, this sort of like, oh, you know, that was a sort of a hard thing that we sort of went through that was just kind of amortized out over three years or something. But but of course, that is never what it was. Right? It was it was this endless set of individual sort of snapshots. Right. And so there are two snapshots that I'd like you to draw out for us that I'm hoping you can. One is clearly, as you pointed out earlier, you are a person who, I think it would be fair to say, has a lot of grit. Right. You went through nine years of post medical school training. You operate on, you know, very small human bodies. You calm down when other people get amped up. You see bleeding from an unknown source and sort of methodically work your way through the problem, etc. but tell us about a time when you were just a hair's breadth away from just wanting to give up, like it was just too bleak, the weight was too heavy, it was too much, and you just wanted to throw in the towel and go lay on the couch and put your head in a pillow.
Dr. Cornelia Griggs: [00:42:00] Oh my God, I think I felt that way so many days. It's important to be honest about that because especially in those early days, everyone was like health care heroes. There was a lot of language of war that was used, like you're on the front lines, like people were cheering for us and calling us heroic. And I did not feel heroic at all. I felt so many days that I wanted to just pull the blankets over my head and not go to work and do it again, the moment I came closest to just. Peacing out and not showing up and giving up. It was early April and I got a text from a friend and a mentor. He is an amazing orthopedic surgeon and before I started medical school, there was a brief period of time where I thought maybe I wanted to do orthopedic surgery. And so I did research with him and his group before medical school, and he wrote me a letter of recommendation for medical school. He operated on my mother, just like good guy, solid mentor, really good advice in my life. Was instrumental in getting me to medical school. He sent me a text and he said, I was here in 911, and my wife and my kids were terrified that they were going to lose me. He was working in the hospital. He was part of taking care of sort of the influx of patients. He sent me a text that was like, get out of there. Go to Connecticut. Go be with your kids. You are senior enough in your training that you can do that.
Dr. Cornelia Griggs: [00:43:46] And the advice was meant in like the kindest, most supportive way. Just like, go be with your kids. And I read the text and I just agonized over it because I was like, this is somebody who's given me really good advice for my whole medical career so far and who I really trust. And he's telling me, go be with your kids. I didn't know what I was going to do the next morning, but I eventually just got like so exhausted that I fell. I fell asleep and my alarm went off in the morning, and I didn't even make a conscious decision to do this, but I just sort of like. Followed muscle memory. I woke up to the alarm. I took a shower. I put on scrubs. I like, put in my earbuds, and I went to work. I just sort of acted as a robot. And I went to work that day and it was not a good day, but it was fine. And I don't think I ever made a conscious decision in my head, like, I'm not going to listen to him or I am going to listen to him. I just followed my body's instinct and I kept showing up, and I kept going to work. And looking back on that, and this is a big message in the book, is that sometimes when you're doing the thing that other people perceive as really brave, you're just doing what you know how to do best. And what I knew how to do best in that moment was to do my job.
Dr. Cornelia Griggs: [00:45:14] And yes, there was absolutely a part of me. And I think for many trainees that was terrified that if I did stop showing up that I wouldn't be graduated, and that I was flushing nine years of surgical training down the toilet, and that my job contract would not be honored, and the Acgme would say, she's not, you know, fit to take the boards. She needs to repeat time. Nobody really knew at that time, and I didn't know what the consequences would be if I stopped showing up, but it did not feel like a viable choice. It felt like a really consequential choice if you just as a trainee in New York City, if you said, I'm not coming unless you had a very solid medical reason not to be there. So that helped, I think, sway me in the direction of I kept showing up. I had to, or at least I perceived that I had to. But sometimes the brave thing doesn't look like brandishing a sword and running into battle with the intention of doing something brave. Sometimes bravery feels really pathetic in the moment. I did not feel brave and I would be giving myself too much credit if I even said I was making the conscious choice to to show up with a sense of purpose every day. I was just doing what I knew how to do best and what I knew how to do best. In the spring of 2020 was be a good doctor.
Tyler Johnson: [00:46:30] So let me now ask you, I want you to flip the lens. It has angered me ever since I lost it in the wake of 9/11. There was a poem published in some, I don't know, weekly news magazine, something I want to say it was by Toni Morrison, but that's probably wrong. But in any case, it was a poem about how the darkness of nine over 11 had provided the backdrop that allowed us to see the like, beauty and nobility and, yes, heroism of the first responders who rushed into the buildings as they were coming down. Yeah, except it was written in really powerful, beautiful language that I wish I had, but I've never been able to find it again. But all of that is just to say that in the same way that I think nine over 11 really did do that. I think the pandemic also did that right. And I totally hear what you're saying, that, you know, the the heroes burdened is to always be hyper aware of their own non heroism that everybody else seems to perceive. Right. And I totally get that. But I would like to hear from you even recognizing the sort of, I don't know, paradox of me asking you this at this point. What was a time when you were, you know, maybe sitting there fully masked and with all of your protective clothing on and whatever, when you you beheld a scene that just brought tears to your eyes because you looked over and thought, oh my gosh, like this thing I am seeing in front of me, this is the best that we humans have to offer.
Dr. Cornelia Griggs: [00:48:15] It was. Watching the ICU nurses do their job and do it beautifully. There's a scene in the book, and I was not a first hand witness to this, but I think it's probably the best story that exemplifies the moment of what you're trying to say. She. Describes a culture among the ICU nurses where. They never left each other alone, and they never left each other with a dying patient alone. And it was a rule people don't die alone. And this was a time when family members could not come to the hospital. This was a time when we had closets stuffed with people's belongings that were never claimed. This was a time when people were dying, and the only person who could be with them was a nurse who was assigned to take care of them that day, to hold their hand, to brush their hair for the last time, to FaceTime their family so they could look at their face and have some sense of peace and connection in those final moments. And I'm going to cry. Um, there is a moment in the book that I wrote about that. Adrian told me she was training young nurses who had not done the ICU. She was a seasoned ICU nurse. She was training them how to do that because we needed everybody in the ICU at that point and there was a patient who was the family member of somebody who worked in the hospital, and they made an exception for that person who was like already working in the hospital to come into the ICU to be with their family member who was dying. And it was that person and her mother, and I'm pretty sure it was their father that they were losing. But as they were saying goodbye, they started wailing and crying and sobbing loudly. And the ICU nurses who were training with Adrian. It started to get really rattled by it and shaken. And Adrian said, no, no, that is normal. That is what it's supposed to sound like when people are dying.
Dr. Cornelia Griggs: [00:50:24] And what the ICU nurses did all around the country. Like, if we want to talk, who was most badass? Who was most frontlines? Like, who was most there? They spent the most hands on time at the bedside. I relate that story to express the beauty of humanity, because those are the people who are often in like one of the most thankless positions also, and taking on the most risk. They're the same people who are helping their kids do school online and keeping food on the table and making meals and keeping everything together at home. And they were so firsthand. So front lines with a lot of the trauma and the beauty of being able to then like, also teach like the humanity of their profession to other people. I just, I think that's what immediately came to mind when you asked me that.
Dr. Cornelia Griggs: [00:51:16] And I also think it's inspirational going forward, because I was pretty sure that Covid was going to be the nail in the coffin of the medical profession, that no one was going to want to go to medical school anymore. Nobody was going to want to go to nursing school. And that just seemed like a bad cost benefit analysis. But I think we've seen the opposite. I don't know what the numbers are, but I am overwhelmed and inspired by the number of young people who lived through the Covid pandemic very recently and then were inspired to go into medicine, like these new health care workers. They're made of different stuff because because they saw it. And then they decided, I'd like to think I would make the same calculation, but I don't know, I don't know. And so that's what gives me hope in our collective humanity going forward, is that there are still smart, wonderful, dedicated humans that want to go into a field that is centered around primarily taking care of sick people.
Tyler Johnson: [00:52:21] Yeah. You know, as you describe the ICU nurses working like that, the thing that your description sort of reawakens in me so viscerally is the haunting, quiet silence.
Speaker4: [00:52:35] Yeah. I forgot to mention that.
Tyler Johnson: [00:52:36] That invaded the hospital. Yeah. Like you have no idea how busy and bustling and loud a place a hospital is until all of it goes away. Yes. And it's everything, right? It's. It's the chatter of a medical team in the team room. And it's sharing a meal together. And it's the back and forth between the, you know, the social workers and the case managers and the and the physical therapists and the doctors and the whatever, making a plan for a patient. And it's the joking between the the team members and the patient themselves and the patient themselves and their family member. Right. There's like all of this, this, sort of this. It's like when popcorn is popping in the microwave, right? There's just this sort of like all of these sounds happening and conversations happening.
Dr. Cornelia Griggs: [00:53:21] And Noise, you know, breaks in the silence. And that's what Adrian meant. That is that is normal. That is what it's supposed to sound like when people are dying, not ghostly quiet in the ICU. The only thing that broke the silence was constant. Sirens and codes being called overhead just are so bleak.
Tyler Johnson: [00:53:41] We had a guest on a couple of weeks ago who talked about how they instituted a policy in their hospital because it had become so wearing to and wearying to hear the constant code calls that they started to call out over the intercom any time someone was discharged from the hospital, just as a way of saying and good things happen too.
Dr. Cornelia Griggs: [00:54:06] Yes, they started playing a song. I think they started playing Here Comes the Sun every time someone got extubated for that reason, because otherwise it was just death and dying and silence.
Speaker4: [00:54:20] Yeah, it was just like this barren prairie with no vegetation, no life, just this sort of windswept, empty, silent prairie that seemed like it stretched out forever in every direction. Right? Yeah.
Dr. Cornelia Griggs: [00:54:32] I think they should bring that back. Play the happy songs.
Speaker4: [00:54:36] Totally. But part of the reason that I bring that up is because I think it's hard for people who are not in health care. You know, being an ICU nurse is hard enough on a normal Tuesday in 2015, right? You're taking care of people who are dying. You have to be incredibly precise, attend to all, you know, 27 different things at once. There's a bunch of stuff, you know, calling for your attention, whatever. So that's hard enough in the good times. But doing that in the midst of that sort of barren prairie of silence and with what felt like no support from anyone because you weren't allowed effectively to almost to talk to anyone or touch anyone, or, I mean, you just it was like operating in this sort of this sort of cone of silence and isolation and to be doing all of that. And do your job well in the first place, let alone, as you mentioned, people who would then stay after their hours assigned to work because they were already within the quarantine zone, to sit by the bedsides of people who were dying, or to hold the hand of the person while they said goodbye to their spouse over. I mean, the heroism is almost too poignant and too real and too raw. It feels like treading on sacred ground, like you almost don't want to articulate it because it's so beautiful that it feels like it will spoil it, to try to recount what it was like. And so we we thank you for wearing both of your hats, your journalist hat and your surgeon hat. And we thank you for the Chronicle that you've made of this very, you know, of this harrowing time, but one that I think will help it to live on in memory so that it doesn't just sort of fade into the forgotten past and become something that we, that we put away. I think maintaining it in our collective memory is important. And we we thank you for the work that you've done to do that.
Dr. Cornelia Griggs: [00:56:32] I agree, and thank you so much. That means the world to me and it was a blast talking to you. I really appreciate it.
Tyler Johnson: [00:56:39] Doctor Cornelia Griggs, thank you so much for being with us.
Henry Bair: [00:56:46] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at The Doctors Art.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
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Henry Bair: [00:57:19] I'm Henry Bair
Tyler Johnson: [00:57:20] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.