On Saturday, March 28th, Dawn Kelly got the phone call summoning her to the hospital to say goodbye to her husband, Larry. A palliative care social worker was pressing her to think about what her husband would want.
In other words, Larry wasn’t going to make it. They needed her permission to take him off life support. Dawn’s knees gave way; she grabbed the kitchen counter so she wouldn’t fall.
Dawn last saw Larry 11 days earlier, in their apartment on the Upper West Side in New York on March 17th at 5am. Barely able to walk, he asked her to help him get into clean underwear before the ambulance arrived. He texted her one last time from the hospital before he was put on a ventilator, which required being put into a drug-induced coma: "I promise I'll never stop fighting."
Larry didn’t have a living will; he’d kept putting it off. “What would he want?” Dawn replied to the social worker. “He’d want to live.”
‘You probably have it’
Lawrence Kelly's was an early case of coronavirus in New York. The week he got sick, the first virus-related death was reported in the city. Mayor Bill de Blasio was in the process of shutting down the schools. Governor Andrew Cuomo cancelled the St Patrick's Day Parade. The World Health Organisation declared the coronavirus a global pandemic. New York hospitals were bracing for the onslaught.
Larry hadn’t been feeling well for about a week, and Dawn had been getting annoyed. “Go get tested,” she urged him. “You probably have it.”
She was a special-education teacher in Brooklyn. Larry (64) had retired a few years earlier from his career in the New York City public school system. His 28-year-old daughter Jackie, the younger of his two daughters, had moved home temporarily, and she was also feeling sick. The two of them went for coronavirus tests at an urgent care clinic on March 12th while Dawn was at her school in Brooklyn, training to teach remotely.
Both Jackie and Larry felt rotten, but Larry’s symptoms – cough, chills, fever, laboured breathing – were far worse, bad enough that the urgent care doctor sent him directly to the emergency room.
Larry had become so sick and weak that he was terrified
The doctors kept him overnight, then sent him home with a prescription for antibiotics. Larry’s brother Danny, who lives nearby, filled the prescription and delivered Gatorade to the apartment, where Larry had moved to the foldout couch in the livingroom to try to keep from infecting Dawn. By the morning of the 17th, Larry and Jackie still hadn’t been notified of their test results. Jackie seemed to be coping, but Larry had become so sick and weak that he was terrified, and he called 911.
As they waited for the ambulance, Larry had a lot of advice for Dawn, as usual. He was obsessing about alternate-side-of-the-street parking; he had found a perfect spot he didn’t want Dawn to lose. (The next day, the parking rule was suspended and stayed so for months.) He told her to check the mail. He had always paid the bills; he tried to give her a crash course on the family finances. He showed her where the life insurance policies were. “You’ll need 12 death certificates,” he instructed her.
The paramedics arrived, and somehow they knew the results of Larry’s coronavirus test. “He has it,” they told Dawn. As they took Larry, masked with oxygen, to the ambulance, he raised his hand to wave goodbye.
The sickest patient
Jessica Montanaro was the nurse on duty at Mount Sinai Morningside when Larry arrived. She had been a nurse for 18 years, five of those as a nursing co-ordinator in the ICU at Mount Sinai. Since February, the staff in the 24-bed unit had been getting ready for coronavirus patients, practising donning and doffing their protective gear and preparing negative pressure rooms, typically used for airborne viruses.
Larry was the first patient she admitted who was alert. “He kept asking me over and over if I was going to help him breathe,” she remembered. “But he could still smile. When Jackie called and told him she had tested positive, his whole focus shifted.”
In that instant Jessica herself felt fear. “I was suddenly acutely aware that, despite the PPE, this was a deadly airborne virus we didn’t know very much about, and I was sitting in a room with a very sick patient. I couldn’t let on that I was nervous, but I was. Now, the disease is scary,” she said. “Then, it was terrifying.”
Larry was put on BiPap, a noninvasive breathing machine that helps a patient breathe through a mask. Jessica had the following day off. The next time she saw Larry, two days later, his condition had deteriorated so precipitously that he had been intubated – a tube inserted down his throat – and put into a medically induced coma. A ventilator was breathing for him.
How can patients get better if they don't have loved ones by their hospital beds giving them the energy they need to fight?
On March 20th, Danny tried to visit his brother in the hospital. The virus was still so new in the city he didn’t yet realise that no visitors were allowed. “How can patients get better if they don’t have loved ones by their hospital beds giving them the energy they need to fight?” he wondered. A guard in the lobby called the ICU, and a doctor came down to talk to Danny. Larry was the sickest patient they had, she said. Danny didn’t tell that to Dawn and Jackie.
That day there were more than 4,000 new confirmed cases in New York City; 665 people were hospitalised, and 47 people died. Cuomo ordered half of the workforce to stay home. The only exceptions were those employed by essential businesses like pharmacies and groceries.
A life in the city
Larry Kelly grew up in Sayville, New York, on Long Island, the second of six children in a close Irish-Italian family, member of the Class of '73 at Sayville High, game for any sport, outstanding as a wrestler. He wanted to be an actor and had won a scholarship to attend the American Academy of Dramatic Arts on East 30th Street. Dawn Hewins, from Brookline, Massachusetts, was a student there too.
They went out for a while, broke up, got back together, got married at City Hall, had some successes in the New York theatre world – Larry wrote a play, Out!, about the 1919 Black Sox scandal, that was produced off-Broadway in 1986 – started a family, decided they needed more reliable income, got education degrees and became teachers.
They moved into a modest brick co-op on West 92nd Street in 1997. I lived there too. Larry, an apologetic but helplessly addicted smoker, was often out in front of the building, always happy to chat. He was an ebullient presence, all 5ft 6in of him, with a winning smile.
He taught English and drama at a high school in Harlem where the students were mostly black and Latino. He started boys and girls soccer teams and a drama club. He advised the debate team. He persuaded the English department to add the plays of August Wilson to the curriculum. His point: "These kids don't want to read, The Canterbury Tales!" He started his semesters with Fences. From there, he could take them to Shakespeare.
He was the teachers’ union representative, and then, encouraged by his principal, earned another master’s degree and returned to Randolph as an assistant principal.
Two years later, he was asked to start a programme for students who had been suspended from their schools. He and five teachers would work with them for the duration of their suspensions: 60 days, 90 days. The programme, begun in the basement of Martin Luther King Jr High School, became the Manhattan Alternate Learning Center for at-risk students. Larry won a battle to get the students credits toward graduation for their schoolwork. He retired in 2017.
Since then, Larry had been enjoying himself. He'd finally quit smoking. He played poker on Friday nights, and he and Dawn went to baseball games and out to hear music. They delighted in their grand-daughters whenever they could see them; their older daughter, Jessica Christopher (33) had moved with her husband to Maryland. They visited Larry's brother Michael in Florida.
He'd been doing some dinner theatre – You Can't Take It With You, in South Orange, New Jersey – and had just opened in Fair Lawn in the Radburn Players' production of, The Underpants, Steve Martin's adaptation of a German door-slamming sex farce. "I'm big in Jersey," Larry would brag.
The whole cast of The Underpants got sick.
Larry was the oldest, and the sickest.
Saying their goodbyes
In the days after Larry was admitted to the hospital, the crisis hit the city. The ICU in mid-March was swamped. “We got the sickest of the sick,” Larry’s nurse, Jessica Montanaro, said. “You know what you sign up for in a trauma hospital; your nurse brain doesn’t change, you know what you have to do. But it was shocking.”
When she went home to Westchester after a shift, she'd sit in the car, sometimes for half an hour, pulling herself together before she could go in the house to her husband and 10-year-old daughter. "Even when I wasn't at the hospital there was never really an on-and-off button." Because there was no school, her daughter spent days with her father at the pizzeria he ran in the Bronx.
She found herself particularly disturbed about Larry. “I liked him,” she said. “I was shocked at how fast he deteriorated. He looked so healthy, and fit, other than not being able to breathe.” Once, while flipping him onto his stomach to ease his breathing, she noticed the tattoo on his back: the king of hearts and the queen of diamonds playing poker, wearing Comedy and Tragedy masks.
“The saddest thing to me is that these patients have to die alone,” she said. “I talk to patients all the time, even if they’re in a coma. I just sit with them and tell them they’re not alone.”
Before the pandemic, a ventilator was intended primarily for short-term use. Total sedation is necessary; the patient’s reflex is to fight the intruding tube. People usually come off ventilators quickly, one way or another: able to breathe again for themselves, or gone.
Larry was on a ventilator for 51 days.
Larry had seizures. Infections. Fevers. Pneumonia. Cerebral haemorrhages. Doctors struggled to take Larry off sedatives long enough to assess his brain activity. Their somber conclusion by the end of March: “No mentation.”
Dawn, Jackie and Danny were allowed to visit March 28th, one by one, to see Larry, through a glass wall, and say their goodbyes.
But Larry held on.
Danny relayed updates to friends and family. The notes from the last days of March through the first weeks of April were grave.
“The status of Larry’s brain is the complete focus,” he wrote on March 31st. “He is still having intermittent seizures, and the doctors have told us that traditionally patients who have had this trauma to their brain for this period of time are in danger of irreversible damage.”
He concluded that note with what became a hopeful mantra: “Miracle Larry.”
Jackie and Dawn kept to themselves in the apartment, afraid to go out. The city had closed down. Sirens blared without respite. Jackie, who works in marketing for Estée Lauder, had recovered from the virus pretty quickly, but she and Dawn were both struggling with their jobs. Jackie was on all the phone calls, when they came, with her mother and the hospital, recording what the doctors – rarely the same one – reported. “There was lots of crying ourselves to sleep,” Jackie said.
‘Let’s Go Miracle Larry!’
The death count in the city reached its peak on April 7th – 598 – in an 11-day stretch when more than 500 people were dying every day. On Easter Sunday, April 12th, 573 people in New York City died of the virus.
That day, Larry opened his eyes.
He had what the doctors call a “purposeful response”. He turned in the direction of a doctor who was calling his name. Over the next few days he could squeeze a hand. He could follow a pencil with his eyes. He knew who he was. He knew he had a wife and two daughters.
The family clung to that tiny sliver of good news, aware of how tenuous it was. “All we really knew was that he wasn’t a vegetable,” Danny said.
At Dive Bar on West 96th Street, the Kellys’ favourite local joint, a big hand-coloured sign was taped to the window: “Let’s Go Miracle Larry!” The owner told Dawn it wouldn’t come down until Larry came home.
Plans started to be made for a tracheotomy, an incision in Larry’s neck, so that the tube down his throat could be removed and the ventilator, which he still needed, could be hooked up through a trach tube, but there were obstacles before the operation could be performed. Larry had been given the powerful opioid fentanyl for weeks. As the doctors reduced his dosage, he went into withdrawal. They had to wean him with methadone.
At the end of April, Dawn learned that Larry had been moved in the middle of the night to Mount Sinai Beth Israel Hospital, to a unit set up specifically to get patients off ventilators. Although she was startled and angry that he'd been moved without her knowledge, she was also encouraged.
Larry was the new unit's first patient; he'd been chosen because he had a chance of surviving. Erica Crouse, a physician assistant in North Carolina who had volunteered at the beginning of the pandemic to help out in New York, was the first person to take care of him there. "The question was his mental status," she remembered. At this point, with Covid-19, it was a rare occurrence that a person was on a ventilator for so long. "We didn't know how anyone was going to respond."
On May 1st, Erica set up a Zoom call for Larry and his family. It was the first time Larry had seen them since he was wheeled to the ambulance in March. “Hey, Dad,” said Jackie, softly.
They started Zooming every day, and Dawn could witness Larry’s halting improvement. He still couldn’t talk, and sometimes he fell asleep, but soon he was forming words; he couldn’t yet use his voice, but they did their best to read his lips.
On May 5th, Danny knew Larry was back: He saw his big brother smile at a nurse and blow kisses in her direction. And when the family was trying to discern what Larry was saying and got it wrong, Larry would roll his eyes.
The month inched by.
Slowly, Larry’s lungs began to work again, and by May 8th, the ventilator was all but sidelined. By May 15th he was breathing almost exclusively on his own.
A feeding tube had sustained him for more than two months, and Larry, who loves to eat, had lost 30 pounds. He had started eating puréed meals: puréed chicken, puréed applesauce, puréed mashed potatoes.
“Aren’t mashed potatoes already puréed?” he would grumble. “I don’t know why they can’t purée up some ravioli and tomato sauce.” He craved McDonald’s. He was thrilled when an aide brought him an Italian ice.
By Memorial Day, May 31st, some measure of relief had spread through the city. Daily deaths in New York had come down to double digits; 49 people died that day, with 466 new cases and 140 hospitalisations.
‘I’m not dead!’
As hospitalised coronavirus patients go, Larry was one of the lucky ones. He had no underlying conditions. He was cared for in a private hospital. Jack Cush, a lifelong friend from Sayville, now a rheumatologist in Dallas, often checked in with the hospital and helped the family decipher what they learned. Larry's daughter Jessica is a physical therapist; her training helped her know what questions to ask the doctors as Larry's case worsened and then seemed to improve. He has good health insurance. Tens of thousands in the city, particularly in poorer areas, do not have those advantages.
At the end of May, Larry was moved again, this time to the New Jewish Home on West 106th Street, to begin the long process of reclaiming his virus-ravaged body.
When I first spoke with him in mid-June, three therapists – speech, physical and occupational – were working with him six days a week. With the speech therapist he was practising his swallow, an instinct he had to relearn after having a tube in his throat for so long. Larry is right-handed; his right side, which wasn’t working yet – possibly a result of brain trauma, possibly severe atrophy – was worrisome to him. And the physical therapist was helping him begin to walk again, little by little. He was still hooked up to a feeding tube.
Talking is how he passes the hours. Also, with no baseball on TV yet, he’s gotten into watching golf. He doesn’t have his phone (to his dismay, his phone, his watch and his clothes were all lost when he was put into a coma), but his hands don’t work well enough to use one anyway. He video chats with his family and friends via Alexa, which he can control with his voice.
I had been following Larry's progress on his family's Facebook posts. The week of our first conversation he'd had a major triumph. "I took seven steps," he said. "I'm allowed to sit up on the side of the bed."
The last thing he remembered before being put under sedation was sending Dawn that text as he was gasping for breath. The next thing he remembers, he said, was weeks later: someone asking him to follow a pencil with his eyes.
I kept trying to yell, 'I'm not dead!'
Like a number of gravely ill Covid-19 patients, he also has memories of extreme terror from the time he was in the coma. “I kept having a sense that someone was trying to kill me,” he said. “I was in a very dark place. I kept trying to yell, ‘I’m not dead!’”
He was dumbfounded when his family told him about the terror he had missed, in the city and the world. "It's like something out of George Orwell, " he had said. "I woke up in a dystopia."
Dawn was at home; schools were closed. Everyone was wearing masks.
Danny lost his job as director of human resources at Yankee Stadium, along with 1,800 seasonal workers he supervised. One in five New Yorkers were unemployed. “I was astonished that I’d lost two months of my life,” he told me. “In a flip of a dime everyone’s life changed.”
From his hospital bed, Larry witnessed the news of George Floyd’s killing at the hands of police, angered and saddened by its horror. He was encouraged, at least, by the young people protesting. “We’re living in a nightmare,” he said, shaking his head.
‘Like Jackie Robinson’
On Day 98, June 22nd, Larry had an egg-salad sandwich. He was sitting in a wheelchair for our video chat, looking and sounding markedly stronger, and he’d had a haircut and a shave. When he had awoken, his daughters said, he had a full beard, and his face was puffy from the sedatives. The grooming had cheered him, but he was a little down.
“I get blue,” he said. “I’m here with my thoughts. It’s easy to be here all day and get despondent.” He hasn’t had any psychological counselling, which surprises him.
I always wondered what people would say about me when I died
His family had received a bill from Mount Sinai Morningside for $1.3 million (€1.14 million). “They bring you back to life and then kill you with the bill!” he said. His insurance covered nearly all of it. Danny reads Larry notes and posts on Facebook from his many well-wishers. “I always wondered what people would say about me when I died,” Larry said. “Now I know.”
June 29th was Dawn and Larry's 42nd anniversary. Dawn walked the few blocks uptown to drop off a card for him. Because nursing homes have prohibited visitors, she still has not been able to see Larry since March 17th. He waited until she got home and called her via Alexa so she could watch his aide help him open the card. "42," he said. "Like Jackie Robinson (the base ball player who wore a jersey with the number 42)."
By July 9th, the coronavirus-related death count in New York City was in single digits for the first time in four months. That hard-won moment, though, was all but eclipsed by the news from elsewhere in the country. Despite quarantine requirements for anyone arriving in New York from the many states with high infection rates, officials expect the virus to seep back to the city.
Larry received some news of his own last week. He will be coming home on Wednesday – 128 days after his ordeal began. “I wouldn’t wish this sickness on anyone,” he said. – The New York Times