In late March, Dr. Franz Yanagawa ’00 was in Guatemala on a mission trip with a colleague from St. Joseph’s University Medical Center in the northern New Jersey city of Paterson. They had completed a day of 27 surgeries when the wife of the clinic’s founder rushed in and announced: “You guys have to get out of here.” The coronavirus threat, which had seemed insignificant at home when they left for Guatemala, had mushroomed into a crisis. The United States, the woman said, may close its borders and leave you stranded.

A few days later, Yanagawa, a critical care physician who’s also board-certified in general surgery, walked into one of St. Joseph’s first Covid-19 wards. He wore full personal protective equipment in what felt like a sauna. Though he had expected to find mostly older patients, many were middle aged, some not much older than he is. All of them were very sick. The next day, working on another Covid-19 ward, he was asked again and again to put chest tubes into patients whose lungs had punctured. “I had never done so many in a single day,” he says.

The odyssey of caring for Covid-19 patients is nearing its second month for Yanagawa, who’s spending long shifts wrestling with an unpredictable disease that’s leaving the medical world searching for answers and treatments.

Yanagawa almost didn’t go into medicine. At Episcopal, he helped lead the Mental Health Awareness student organization and set his plan to become a psychiatrist, only to be scared off by a college biology class that was a medical school prerequisite. Late in his college career, however, he yielded to a voice inside him that said he needed to put away his fears and pursue medicine. “God gives us each a purpose,” he says. “I heard that voice, and somehow I knew I was supposed to be a doctor.”

Like many in the medical field, Yanagawa says he initially thought the novel coronavirus was little to worry about. “I remember my wife had seen it in the news and said, ‘Hey, there's a coronavirus going around.’ And I said, ‘Honey, they're a billion coronaviruses all the time.” It would probably just be another flu, he thought.

His first few days in the Covid-19 ward proved him wrong. Though the disease seemed to attack chiefly the lungs, he began to suspect something else was afoot when patients crashed and died almost overnight even as their respiratory systems were improving.

The virus is so new that research is spotty and unreliable, leaving doctors no treatment blueprint. “You have to take into account the smallest details,” Yanagawa says. “There's a certain sense of terror to every decision. You say, ‘Boy, I hope I’m right because, if I'm wrong, somebody could die.’ ”

After his first 11-day stint at the hospital, Yanagawa pored over his notes and case files and theorized that the disease might be causing blood clots. He explained his theory in a conference call that Stanford physicians had set up to help them prepare for their first surge of patients. Physicians at the Massachusetts General Hospital said that they, too, suspected the disease causes blood clots — something research has now confirmed. “The solution to this is to come together in collaboration and bounce ideas off each other,” Yanagawa says. “There's no one institution that could do it by themselves.”

Yanagawa says he can’t predict the short-term trajectory of the virus, but he believes medicine will eventually solve this mysterious disease. “Necessity is the mother of invention,” he says. “Ultimately, we will get a better understanding of this disease. And sometime in the future it'll just be locked away in a textbook that a med-school student will read about as just another run-of-the-mill thing.”