Austin Williams, M.D., ’07
As a general surgery resident, my role in the Covid-19 response has changed several times. Since elective surgeries have been canceled, the number of operations we are doing has drastically decreased. However, with the number of Covid-19-positive patients being admitted to the hospital in general and the intensive care unit more specifically, the number of bedside procedures that are required has increased. These procedures include: 1) inserting central venous lines (or central lines for short) which are large intravenous catheters inserted in either the patient's neck or groin to allow the administration of certain medications and more invasive monitoring of a patient's fluid and cardiovascular status; 2) inserting catheters through which to perform dialysis as kidney failure can be seen in patients who are very ill, 3) insertion of chest tubes to drain air or fluid from around the lungs. Our response has been to create a surgery procedures SWAT team, of which I am a part, which are senior surgical residents who respond when patients who are in the hospital are getting very sick and need transfer to the intensive care unit, or patients who are very sick are being admitted through the emergency department. These types of emergencies are becoming more frequent as the number of Covid-19-positive patients we are seeing increases.
The biggest challenge at this moment is the unknown. While Pennsylvania and the nation as a whole have been practicing social distancing in order to "flatten the curve" and not overwhelm the healthcare system, the details of a surge of patients—how large and when—are at this point unknown. These unknowns weigh heavily on administrators and clinicians alike as we stand prepared to face whatever comes our way, and look to the future at when and in what capacity we can start turning things back toward normalcy.
My liberal arts education at F&M taught me a great deal about critical thinking, a skill that is absolutely essential during a health care crisis. I use critical thinking when thinking through specific patient problems, and while thinking through the crisis on a larger scale to be able to respond continually and effectively.
Protect yourself. What we have learned from the response to Covid-19 abroad and, unfortunately now in our own country, is that the virus spares no one, including those on the front lines. Appropriate personal protective equipment (PPE) is an absolute must when caring for patients who have not yet even tested positive for the virus but who are displaying symptoms to avoid infecting oneself, and becoming a vector. If those on the front lines are infected an unable to respond to a surge of patients, we will not be successful in the fight against this virus.
Andrew Foley ’13
I am in my final year in medical school. When the outbreak started in Boston in March, I was working in the Mass General Hospital Emergency Department, completing my final "Capstone Course" in preparation for residency. Things were chaotic at the time. The protocols for triaging and treating patients with respiratory illnesses seemed to be changing by the hour. The chance of exposure was high. There was so much uncertainty at the time. As a student, I could not see any patients with suspected COVID-19. In fact, I could not see any patients with an undifferentiated respiratory illness. As a result, my role was to help see as many patients as possible who were not sick with COVID-19 or suspected cases.
A week into my work in the Emergency Department, all medical students were removed from clinical rotations. This was hard because I wanted to continue working alongside my teachers and colleagues, but I also recognized that, in my role as a student, I was not essential personnel. I had to come to terms with the fact that my risk of transmitting the virus to patients or other providers likely outweighed the benefit that I provided in patient care. This was an important and humbling realization.
When I was no longer able to work in the hospital, I joined the COVID response team at our medical school. We set about finding ways to support our colleagues on the front lines and our fellow medical students. We created something called the COVID-19 Student Response and had hundreds of students contributing to the effort. I helped to create a curriculum for medical students around the world so that they could learn about COVID-19 and what they can do to help. I am also currently taking a virtual class in obstetrics in preparation for my family medicine residency and am working with obstetricians to call high-risk prenatal patients who cannot come to the clinic or hospital because of the risk of infection. We complete telehealth visits over the phone and triage patients depending on their current health status. I have volunteered to start working in the Boston Hope Medical Center, a field hospital in the Boston Convention Center, where I will help care for patients who are recovering from COVID-19.
The biggest challenge that I am facing is maintaining hope for our society. COVID-19 has exposed and exploited the disgraceful inequities we have tolerated in our nation—the wealthiest country on the planet—for so long. It has exposed the pervasive distrust of experts and disregard for facts by our recent political leadership, which has led to countless, unnecessary and untimely deaths. The solution to this mess is a political one, not just a scientific one, but I am unsure that we are able, as a society, to make the right choices to heal our nation’s wounds.
Audun Lier ’08
“Do you have any symptoms?” “Did you get to eat?” “Did any of your patients die today?”
These are the conversations that my wife and I have on a daily basis as we navigate our new normal. At the moment we are currently separated by the Long Island Sound while completing our specialty and subspecialty medical training in two different states – she in Obstetrics and Gynecology in New York and myself in Infectious Diseases (ID) in Connecticut. We discuss when the quarantine measures will end, how new laws in New York and Connecticut may affect our weekend commute between the two states and when we will finally be able to see our friends again.
The COVID-19 pandemic has affected all of us in every area of the globe. What was once followed with academic interest as a new epidemic on the other side of the world has quickly reached our doorstep in the U.S. and changed our day-to-day lives. Due to the influx of new cases and resultant staff shortages at her hospital, my wife has been redeployed from the labor and delivery floor to the general medical floors to take care of COVID-19 positive patients. Prior to her first shift she remarked that the last time she took care of a male patient was during medical school, approximately four years ago. Routine internal medicine terms such as electrocardiogram, arterial blood gas and atrial fibrillation are not part of her daily business. She courageously dons (puts on) and doffs (takes off) her personal protective equipment (PPE) and meticulously washes her hands to avoid being infected. One night she sent two patients to the ICU who required higher oxygenation requirements. During transfer, one individual asked if they were going to make it. She didn’t have an answer. It was frightening. Most alarming is that these patients are both young and old.
My daily routine is completely different. The ID division at my hospital decided that the clinical fellows would ultimately not be redeployed, rather remain as consultants to assist the hospitalist teams with management of COVID-19 infected patients. Initially, we rounded in the hospital and offered treatment recommendations. However, we were eventually mandated to stay home in order to reduce our exposure to other healthcare workers as well as to help conserve our hospital’s supply of personal protective equipment. Working from home has been surreal, particularly in the detail oriented medical subspecialty of infectious diseases. In our line of work, the meticulous history taking and physical examination of patients at the bedside can often elicit a critical diagnosis that was previously missed. Additionally, I felt guilty working from home while my wife was on the front lines.
Every week my hospital’s infectious diseases division gathers for a virtual Zoom meeting in order to discuss new COVID-19 cases, as well as highlight important variations in clinical manifestations of the disease process. We debate the worthiness of medications such as hydroxychloroquine, tocilizumab, steroids and discuss enrollment criteria for ongoing clinical trials at the hospital. At times, anecdotal stories are also shared. I have enjoyed hearing from my older experienced ID colleagues who have previously served on the front lines during other pandemics, most notably HIV/AIDS. As physicians in the early stages of our careers, the COVID-19 pandemic may be the defining pandemic of our generation.
In summary, I am impressed and inspired by the large number of creative minds who are working tirelessly during this time in order to help beat this pandemic. The entire scientific community is collaborating together, sharing information pertaining to epidemiology, physiology, drug treatment and vaccine development. Clinical trials are underway. University research labs are donating reagents and equipment to their local hospitals. Neighbors are sewing face masks for themselves and others. I take comfort in the resilience of those around me and in knowing that the knowledge gained from this pandemic will inform our efforts for the next pandemic.