When a ferry crashed in lower Manhattan earlier this month, ambulances took dozens of people to hospitals around the island.
Bellevue Hospital took in 31 passengers, but they all had minor injuries. The most seriously hurt patients from the crash went elsewhere. Dr. Suzi Vassallo said that's because Bellevue still can't handle serious traumatic injuries.
Superstorm Sandy closed Bellevue in October.
The hospital got back in business in December, but only partially. "We don't have an operating room yet," Vassallo said. "And you always have to have that kind of backup for any critical trauma."
Recently, Dr. William Goldberg arrived at his ER shift and found that a stabbing victim had been transferred to another hospital.
"He was probably fine, but because we don't have the resources we normally have, they basically packed him up and shipped him over to Cornell," Goldberg said, referring to New York-Presbyterian's Weill Cornell Medical Center, the area's only other trauma center.
It's a point of pride among staffers that Bellevue usually takes all comers — whether they have a bad stomach ache or a gunshot wound. Goldberg says not being at full capacity, even temporarily, stings a little.
Ambulances don't bring the most serious cases here, and when people walk in the door who might be suffering a heart attack or a stroke, doctors and nurses stabilize them and send them to a full-service facility. For the moment, Bellevue doesn't have an "upstairs" where it can send patients for surgery or keep them overnight for observation.
To operate on patients, house them overnight, monitor them in the intensive care unit, or deliver their babies, hospitals need rock-solid electrical and fuel systems. They need heating and cooling. They need pumps to move water and fuel—and elevators to move people—up and down the 22-story complex.
All of these were lost for Bellevue in Superstorm Sandy.
Hundreds of people are working to restore the systems. Belllevue's chief engineer Patrick O'Brien, gave a tour of the basement, where the problems started.
Flooding wrecked the water pump motors, leaving the hospital no way to replenish four 55,000-gallon rooftop towers that supply water to the complex. Only one of the pumps has been restored, just enough to get things going, pending a longer-term solution. Eventually, a new system will place two pumps on the second floor, presumably out of harm's way from flooding.
The room with the fuel pump had a heavy steel and rubber "submarine door," so that even in the event of a flood, the fuel pumps could still send oil up to the backup generators on the 13th floor and keep the hospital running. But when Sandy came, these pump motors also got soaked and failed.
Reconstruction is costing hundreds of millions of dollars, and has proved to be a series of compromises between what can be done now and what will have to wait. While some large systems are being moved out of the basement to higher ground, others, such as the air handlers that cool and heat the buildings, will stay put — and could be damaged in the next storm.
"At some point, you have to just make priorities, you just can't move every single thing, it's just not feasible," O'Brien says.
Bellevue's reopening will be welcomed by nearby hospitals, which have seen their emergency rooms slammed by seasonal flu. New York-Presbyterian's CEO Dr. Steven Corwin says Cornell is seeing twice the usual number of trauma patients in its ER, putting a strain on the hospital during emergencies.
Take, for instance, a serious car accident. "You could be talking about 10 or 15 doctors, allied health personnel, in a trauma room, to stabilize somebody to have multiple operations," Corwin says. "So that's a big burden on an emergency system, especially if you're getting routine visits and influenza visits as well."
State health inspectors visit Bellevue next week to test newly repaired systems. They'll declare whether Bellevue is ready to take in patients and keep them overnight. If not, then O'Brien and others will need to keep working around the clock, and the ER staff will keep dispatching patients to other hospitals.
This story is part of a collaboration with NPR, WNYC and Kaiser Health News.