From there, changes came fast and hard. Certain sections of Einstein Medical hospital were cordoned off, with an entire wing reserved for COVID-19 patients. The cardiac intensive care unit was turned into a medical ICU to make more beds available. Surgeons and cardiologists were reassigned to work in the medical ICU so there would be enough physicians. A post-surgery area was turned into a new ICU just for COVID patients. At one point, all of the beds with ventilators were taken. “The hospital policies changed daily. We weren’t sure how bad it would get. We didn’t have the testing and there were concerns about personal protective equipment (PPE); we weren’t sure if we would have enough masks and gowns. Everyone was scared, but I never felt unsafe. In our ED, we implemented a policy of only having certain members of the team go into the rooms with COVID-19 patients — for example, for intubations, only seniors or attendings would go into the room,” Jonathan said in a phone conversation from Philadelphia. Jonathan’s rotation from March 9-April 5, as COVID-19 was spreading in Philadelphia, included quite a few of what he calls “the worse days.” On those days, if patients were intubated [breathing through a ventilator] and their respiration wasn’t improving, families had to make the difficult decision to withdraw care. While that was the best thing for them when there wasn’t any chance for meaningful recovery, “It was hard,” he says. “Most of the patients I saw in the MICU didn’t go home.” In April, he was supposed to begin an anesthesia rotation but was instead placed in the Emergency Department for April and May. The idea was to expose as few medical residents as possible to the virus, he said.
Illustration: Lydia Tarleton
Jonathan looks back to call those “the OK days,” when he was seeing patients who were not so desperately ill. Still, each time he Early on, before COVID-19 had spread walked into the room of a patient who had a fever, shortness of enough to be declared a pandemic, experts breath or a cough, his radar was were mixed on whether people should wear turned on, wondering if the pamasks. Initially, the thought was that they tient had the virus. weren’t of much help. In retrospect, Jeffery Hess thinks the U.S. This pandemic has been especially hard for the families, says missed its chance to slow the spread. Jonathan, because of the isolation “China and South Korea showed us the at the end. “The patient is upstairs way with masks,” he says. “South Korea nevand dying and we’re saying, ‘You er had to shut down. China enacted strict can have only so many people there mask wear and other requirements stopping with them.’ There was nothing else disease spread.” we could do, but it was horrible.” Jeff worked for the Centers for Disease Control and Prevention for two years and A more restrictive visitor policy also affects non-COVID-19 professes that he was always impressed with patients, like one Jonathan had how they did things –but he thinks the agenseen just the night before. In a sitcy missed the boat by not recommending uation made harder by a language masks earlier. “We know they work, but we gap, the father of a patient strug[the government] can’t say ‘you have to wear gled to make his case for visiting a mask,’” he says, sounding a bit frustrated. his daughter: “She won’t be strong “People say it doesn’t filter the air but it without me,” he told Jonathan. doesn’t have to. Use of a surgical mask can For that matter, how does a be just as protective as an N-95 mask in the young resident physician stay workplace, because it protects you from the strong? Living in an apartment on droplets spreading the virus.” his own, Jonathan has coped with the pandemic by lots of calls with family and friends, and running outside in downtown Philadelphia. He that many experiences with those discushas felt isolated and frustrated over various sions before leaving medical school, but I losses: a planned vacation, visits with fam- have surprised myself with how calmly I’ve ily and friends — everyday activities that been able to walk the families through things, to keep my emotions out of it and can’t be taken for granted anymore. Still, Jonathan credits his reflective help them make the hard decisions.” Thinking of the students coming up practice classes with Joseph Zarconi, M.D. (’81), and Delese Wear, Ph.D., behind him, Jonathan urges calm. with preparing him well for the emotion“Rising PGY4s, don’t panic. Your roal toll of treating patients at the center tations or your entire plan may be upended, and I’m sure you’re feeling stressed or of the pandemic. “One thing I draw on from those class- anxious, but NEOMED is going to be es is to focus on having empathy for the taking care of you, and other institutions patients and the families. I know how to will as well. You’ll get your residency one have those hard conversations. I hadn’t had way or another, and it will work out.”
NORTHEAST OHIO MEDIC AL UNIVERSITY