REVIEW: The Sky Was Falling: A Young Surgeon’s Notes on Bravery, Survival, and Hope by Dr. Cornelia Griggs

Reviewed by Carolyn Roy-Bornstein

We can all remember where we were during those early days of the coronavirus pandemic. When the news was chilling. When information was scarce. When the problem seemed to be someone else’s… until it was everyone’s. In early March 2020, I was on a ferry going to Martha’s Vineyard for a weekend with friends—a plan we’d debated sticking to as news reports grew grimmer. On the ship, we moved away from anyone who coughed. We opted for the outside upper deck even though it was freezing. We kept a wary eye on the news streaming across TVs hanging in the ship’s dining area. Two deaths had already occurred in Washington state. No one knew what to expect. Everyone was on edge.

As we all watched the pandemic unfold on TV in those early months—refrigerated trucks being used as pop-up morgues in New York City, shortages of ventilators, personal protective equipment and medical personnel, talk of rationing resources—Cornelia Griggs was living the nightmare in real time.

In her final months of a pediatric surgical fellowship at a New York hospital and sensing that she and her medical colleagues were about to collectively experience something global and historic, she began keeping a detailed journal. That journal eventually becomes The Sky Was Falling: A Young Surgeon’s Notes on Bravery, Survival, and Hope (Gallery Books; March 2024), written to save her sanity, to document a global crisis, and ultimately to be a guide for future healthcare workers dealing with the next pandemic or other medical catastrophe.

The entire book encompasses just six months, from February through July of 2020. Griggs shares personal stories and details of events most of us only read about. She and her husband, both surgical trainees and the parents of young children, craft their last will and testament as the horror of the pandemic becomes apparent. A colleague asks Griggs to play her daughter’s voice to her if she ends up intubated with a poor prognosis. “I think it would bring me back,” she tells her.

The hypothetical concept of rationing health care that was intimated in the news is terrifyingly real in Griggs’s world. Her hospital runs out of dialysis equipment and feeding tubes. The extracorporeal membrane oxygenation (ECMO) team decides that using extracorporeal cardiopulmonary resuscitation – a form of life support for patients whose lungs and heart aren’t functioning – will risk too many health care workers’ lives “on the off chance of saving a tenuous one.” Griggs worries about the scarcity of ventilators as they learn to split one ventilator to serve two patients. “What will happen if we run out of vents?” she wonders. “If I get sick, will the hospital have one for me?”

Griggs’s disillusionment with government and health care institutions comes quite early in the pandemic. While the public is being assured that COVID is a disease of the elderly, her pediatric colleagues who have been deployed to the adult COVID wards are watching 30-year-olds lose their battles with the virus. Griggs herself is cannulating the necks of infants to receive lifesaving ECMO to fight COVID-19. Her hospital’s shortage of PPE compels her to write an op-ed for the New York Times called “The Sky is Falling,” detailing the critical deficiency. The upside of telling her story so publicly is that masks pour into the hospital which she surreptitiously distributes to the wards she knows need them most. The downside is the criticism she gets from some colleagues who seem to think she is airing the healthcare system’s dirty laundry.

Even though her bravery is on display over and over again, from risking her career in order to open our eyes as a whistle-blower to risking her life battling a deadly virus, Griggs seems to feel decidedly untough, rendered insecure by the unrealistic patriarchal expectations of medicine in general and surgery in particular. She shares with readers the well-known sentiment in surgical residency programs that “If you miss a day of work, we want to know your hospital room number and the ventilator settings.”

She wonders if she is doing enough for her patients. She gets pressure sores on her face from wearing her mask for so long. She loses weight. She battles depression and anxiety, insomnia, and nightmares. She misses her kids. She thinks about quitting as she watches myriad colleagues opt to stay home with their children. She does not begrudge anyone their decisions. She acknowledges the great privilege she has in being able to send her children to live with her parents in Connecticut while her friends live in basements and RVs parked in driveways, waving at their families from the back porch to keep everyone safe.

Through Griggs’s eyes we see the pandemic unfold in waves. On call nights, she makes a habit of walking through the ER before going home, checking out “the board” where patients’ diagnoses are written in magic marker, just to make sure she isn’t going to be called right back for an emergency appendectomy. Before COVID, the pediatric board is a healthy mix of broken bones, asthma attacks and allergic reactions. As the pandemic takes over, the board fills with cough, fever, and shortness of breath. She worries that children’s diagnoses of diabetes and cancers are being missed or are coming too late as parents avoid hospitals at all costs. As health-care teams get a handle on treating the physical aspects of COVID, Griggs notices diagnoses on the board becoming increasingly mental-health related. Panic attacks. Suicidal ideation. Aggressive, out-of-control behavior at school. She worries about long-term effects like obesity from all the screen time and sedentary isolation.

Griggs recalls Camus’ character from The Plague who notes, “There’s no question of heroism in all this. It’s a matter of common decency…the only means of fighting a plague is—common decency.” It is a lesson Cornelia Griggs and her colleagues learned well. Despite doctors’ and nurses’ systems failing them, they do not fail each other. They do not fail their patients. They cover each other’s shifts. They bring each other coffee and donuts. Nurses clean rooms and deliver meal trays to patients so that their aides are not putting their lives at risk for minimum wage pay. They make pacts with each other that no patient will die alone. They occasionally make small exceptions to COVID protocols, slipping family members in to see their loved ones before they die.

On one such occasion, a wife keens loudly when her husband takes his final breath. A young nurse-in-training tells a veteran nurse afterwards, “I can’t handle the wailing.” “No, honey,” the older nurse assures her with a small smile. “That is a beautiful sound. That is what it’s supposed to sound like when your world is falling apart.”