The survivor
Doctors had little idea of how to treat New Jersey’s first Covid-19 patient, said Susan Dominus in Only as his condition worsened did they realize how desperate his fight was.
ON THE EVENING of March 4, James Cai, a 32-year-old physician assistant, was languishing on a cot, isolated in a small, windowless room on the emergencyroom floor of Hackensack University Medical Center, when the television news caught his attention. Before that moment, Cai had been in a strange medical limbo, starting midday on March 2, when he left a medical conference in Times Square because he had a bad cough. Instead of heading to his home in Lower Manhattan, he texted his wife that he was going to spend the night at his mom’s place in New Jersey. His mother was out of town, and if he had the flu, he could spare his wife and their daughter, a cheerful 21-month-old who clung to him when he was home, the risk of catching whatever it was. That was Cai: cautious, a worrier, overprotective, the kind of medical professional who liked to rule out the worst-case scenarios first.
At his mother’s home that evening, he waited until about 8 o’clock, when he thought the urgent-care facility nearby would be relatively empty, then headed over for a flu test. There he learned that his heart rate was elevated. He got a flu and a strep test and asked for a Covid-19 test as well, only because they might as well be exhaustive. The doctor told him he did not have the test; neither of them thought much about it after that.
On March 2, many doctors on the East Coast still saw Covid-19 as a distant threat. At the urgent-care center, the doctor reported that his chest X-ray looked normal; the flu and strep tests came back negative. But the doctor was worried that Cai’s symptoms were consistent with a possible pulmonary embolism. He advised him to go to the nearest emergency room, HUMC, where they could give him a CT scan. Cai drove to the hospital and waited for his scan. Not long after, he was moved to the small, windowless room, where he started to feel even worse: short of breath, feverish. In the morning a nurse came to give him a Covid-19 test. The nurse was wearing full personal protective equipment. The following day, an infectious-disease doctor, Bindu Balani, came to see him, also wearing PPE. She explained to Cai that he did not have a pulmonary embolism, but pneumonia. Also, it became clear to Cai that something about the CT—a shading in one lung—had given them cause to test him for coronavirus.
Cai’s symptoms matched up almost perfectly with those of Covid-19: cough, heart palpitations, fever, diarrhea, shortness of breath. But what were the odds that he, James Cai, 32-year-old mediocre basketball player, doting father, conscientious physician assistant, intrepid foodie, would be the first person in all of New Jersey to come down with it?
The next day, the hours passed slowly as
Cai awaited the results of his test—until that evening, when he looked up at the television in his room. The evening news was showing a post that had just appeared in the Twitter feed of the governor of New Jersey, Phil Murphy. “Tonight, Acting Governor @LtGovOliver and I are announcing the first presumptive positive case of novel coronavirus, or #COVID19, in New Jersey,” the tweet read. “The individual, a male in his 30s, is hospitalized in Bergen County.” Cai’s heart rate, already too fast, sped up. Please, God, don’t let that be me, he thought. Soon after, an emergency-room doctor came in and told him what he’d already known.
Cai worked for a medical practice that had four offices around the metropolitan area, most of them in heavily Chinese and Chinese-American neighborhoods like Flushing and Chinatown. Many of his closest colleagues and friends were immigrants. As soon as he saw the television news, Cai had texted the photo he’d taken to one of them, his close friend
Yili Huang, a cardiologist. “It can’t be,” his friend wrote back. Now Cai let him know that it was true.
Just a few weeks earlier, Huang and Cai were catching up on the phone when the subject of the coronavirus came up. Though Huang reassured Cai that he didn’t think Covid-19 would ever be a crisis in this country, in late February Cai made two trips to Costco to buy provisions: frozen vegetables. Frozen fruit. Twenty pounds of rice. If the virus became prevalent in New York, Cai knew what his family would do: They would lock down for two full months.
Now he felt he had let down his guard, and the worst had happened. He felt real terror, as did the rest of his family. His father, who lives in Shanghai, reached out to doctors who had managed the illness there. His wife’s family was doing the same. Huang was getting in touch with everyone he knew who he thought might be able to help. He spoke to Chinese doctors from Shanghai who had been deployed to Wuhan, all of whom painted a dire picture of the damage the virus could do.
O CAI, IT seemed that the doctors were trying to keep him calm. He remembers many telling him this would feel like a bad flu, though the care he was getting was not always comforting. A nurse came in at some point to take his blood pressure and temperature, but his voice was fearful. “Turn your face away,” he told Cai. He placed a thermometer on the tray and told him to use it himself.
TBy Saturday, March 7, Cai was afraid to go to sleep. He was barely able to talk without collapsing into coughing fits. Earlier that day, he had started receiving oxygen from a tank through a nasal cannula. But as he monitored his oxygen levels from his bed, he could see they were dropping.
Cai’s family and friends continued to communicate with doctors in China. It was common practice during the Covid-19 outbreak there to give patients a second CT scan to provide a clearer view of the progression of lung damage. Earlier that morning, Cai had told the infectious-disease doctor on call that he wanted a second CT scan. When
of his friends and family, the beeping machinery above his head. And yet he was still afraid. He prayed to God; he prayed to Buddha. He bargained: He would save so many lives if only his own could be spared. He would stop working so hard so he could be a better father to his daughter. ROUND NOON THAT day, Hall sat down in the study of his Long Island home to translate the Chinese medical guidelines. He opened a Microsoft Word document and started typing. Just before midnight, having worked for close to 12 straight hours, he sent it off to Arad. Around the same time that Hall sat down
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