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How could researchers dictate care to a doctor right there at the bedside, especially when a patientвЂ™s condition was so dire? Hahn pushed back: She had to rely on her clinical judgment and believed that it was unethical to wait for more information. They exchanged heated words, as the colleague implored her to stay the course. Word made it back to a doctor working with Spyropoulos, and that doctor called Hahn to urge her to reconsider, or at least to get more tests before acting. The research was trying to determine whether a standard dose of an anticoagulant or a higher dose yielded better outcomes for Covid-19 patients who were already on oxygen or a ventilator and were at high risk of organ failure and clotting. The meetingвЂ™s agenda included time for remarks from Alex Spyropoulos, a lead researcher at the Feinstein Institutes for Medical Research - the research arm of Northwell - who was running a clinical trial. Adey Tsegaye, a pulmonary-critical-care doctor who was calling in remotely, shared some of NarasimhanвЂ™s concerns. Narasimhan, who was in charge of more than 20 I.C.U.s across the Northwell Health system, knew heading into the meeting that it might be tense. Long Island Jewish, in Queens, had, at the time, treated more Covid-19 patients than any other hospital in the country the doctors there were still weary, still battered, their energy and time in need of careful rationing. Narasimhan and her team now had fewer hands to oversee new patients coming in and the long-suffering ones on ventilators who were still in need of meticulous care. The throngs of out-of-town health care workers who had come to New York City to help were also diminishing, heading home to regions whose own times would come. By then, the surge of Covid-19 cases, the waves of suffering that had crashed down on her hospital for months, was beginning, miraculously, to recede. She wanted to get back to the unit, but instead she was sitting in a conference room with about a dozen colleagues. Mangala Narasimhan, an intensive-care-unit doctor, started feeling impatient soon after the start of a meeting she attended at Long Island Jewish Medical Center on May 13.

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