PCOM Heroes on the Front Lines

Vignettes as told to Janice Fisher, Jennifer Schaffer Leone and David McKay Wilson

Theirs is a contract with humanity: to preserve health and life, at times heroically.

DIGEST MAGAZINE SALUTES ALL OUR ALUMNI FIGHTING VALIANTLY ON THE FRONT LINES OF THE COVID-19 BATTLE.

NICOLAS APPLYRS, JR., MS/BIOMED ’13, DO ’19, MPH (PCOM GEORGIA)

RESIDENT PHYSICIAN, LARKIN COMMUNITY HOSPITAL–PALM SPRINGS, HIALEAH, FLORIDA

"I never could have anticipated being on the front lines of a pandemic during my first year of residency. It has been a humbling experience. . . . In March, when COVIDI “ 19 began to spread here in South Florida, I was working in the Emergency Department. During this time, diagnosis of COVID-19 was challenging due to the lack of available tests nationwide. . . . As requirements for testing and medical management rapidly changed, we acted quickly and efficiently as a healthcare team. Protocols were put in place to ensure efficient triage of patients under suspicion of COVID-19 infection. Half of the Emergency Department was sealed off with a giant tarp for patients suspected of COVID-19. A makeshift tent was set up in the back of the hospital for patient screenings. It was extremely important to be mindful of contamination in efforts to prevent contracting and spreading the virus. These cautious efforts were in place for the protection of patients, co-workers and family at home. . . . The hospital where I work primarily serves the Hispanic/Latino/Latina population; establishing physician/patient rapport is very important. Although our patients appreciate a hands-on approach, COVID-19 made it imperative to identify new ways of showing care and compassion. During my training at PCOM Georgia, faculty placed an emphasis on obtaining a very thorough history on every patient, thus proving useful when inquiring about risk factors such as recent travel, sick contacts, occupation and modes of transportation. Assessing this information, we were able to backtrack a patient’s recent exposures, with the objective to stop the infectious cycle. We also applied many principles that were based on bioterrorism lectures during the triage of patients. These aforementioned methods have proven to be key with the prevention of an outbreak amongst patients in our hospital.” — As told to David McKay Wilson, 4/24/20

NICHOLAS C. AVITABILE, DO ’08

ASSISTANT PROFESSOR OF EMERGENCY MEDICINE, COLUMBIA UNIVERSITY VAGELOS COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK, NEW YORK

"Early to mid-March was when we started to see COVID19 patients in our Emergency Department. I started having symptoms on March 12, 13. My first symptom was a E “ dry cough. After that I had fevers, chills, body aches, some headaches. I knew I had to stay home and get better, but I wanted to be on the front line. . . . I was able to return to work two weeks ago, right before the peak. It was a completely different department. Most patients in the ED had COVID-19. . . . It was very hard to see people come in critically ill. I’ve never seen anything like this in the 12 years I’ve been in emergency medicine. I’ve never seen anything like this where it is so novel and so widespread. . . . Now that I’ve been back for the past two weeks, a lot of the patients have been older. EMS brings them in and usually has instructions from the family, if there’s family available. . . . Sometimes EMS will tell us a patient is full code: DNR/ DNI—do not resuscitate, do not intubate. Other times, even though they don’t necessarily have that form with them, people don’t want to be resuscitated should their heart stop. Sometimes they do. So we try to talk to the patient if they’re awake, alert, able to answer questions even though they’re very dyspneic. We ask them what they want, should the condition deteriorate. Sometimes they say, ‘Please talk to my family about this too because I can’t make this decision alone.’ . . . One patient really couldn’t make up her mind. She wanted to get to one of her granddaughter’s events in the spring, but she had been thinking recently that she didn’t want to be resuscitated. She felt guilty. We said, ‘You know, this is your decision. It sounds like your family loves you so much, but you need to make this decision for yourself.’ This happens on every shift, several times a shift. This is all very new for all of us. . . . I previously preferred 12-hour shifts. Now I can prefer 8 hours. It’s just too emotionally and physically demanding to deal with 12 hours of the COVID craziness.” — As told to Janice Fisher, 4/15/2020

JOSHUA BARON, DO ’03

EMERGENCY MEDICINE PHYSICIAN, BRYN MAWR HOSPITAL, MAIN LINE HEALTH, BRYN MAWR, PENNSYLVANIA

"The pandemic is a different reality for sure. The saddest thing is how sick the patients are. They come into the emergency room, one after another after another. They T “ can’t breathe. They are drowning in their own fluids. This virus is so virulent. It aggressively attacks the lungs and causes respiratory distress. It’s scary how some patients are overcome with a hunger for air. . . . The first woman I intubated was very sick. I helped her call her husband; I wasn’t sure she was going to survive. It could have been her last chance to say goodbye, I love you. . . . Overall, we are seeing fewer patients in the ER because people aren’t coming in with the ordinary scrapes and bruises that weekend warriors experience. There are fewer fender benders too. . . . As a healthcare practitioner, you have to be on your game. The mental stress is definitely trying. Every day—or even twice a day—a new protocol comes out about how we should treat patients with the coronavirus. The procedures keep changing. What’s the appropriate PPE? Are we intubating too early? Are we trying to avoid intubation? We are learning on the fly how to attack this virus. I’ve been reading research nonstop to stay one step ahead. . . . In March, my colleagues and I in the emergency room were doing the intubations. As ER docs, we take pride in our expertise in protecting airways on a regular basis. Then we realized how important it was to keep our frontline people safe, so we created a COVID-19 intubation team with anesthetists and nurse anesthetists who put on Power Air Purifying suits to do so. . . . Like many spouses of frontline providers, my wife is scared I’m going to get sick—or worse. I contemplated moving to my parents’ place in Ambler while they are wintering in Florida. I’m afraid that I might infect my wife and daughters, but I’ve been very careful. I take my shoes off in the garage, then strip down. I shower immediately. I social distance at dinner, around the house. It’s sad not to hug and kiss my kids. I hope I’ve developed some degree of immunity. If I were to get sick, I’d find alternate housing. For now, I’m trying to be as ‘normal’ as possible—during an abnormal time.” — As told to David McKay Wilson, 4/11/20

MICHAEL BENNINGHOFF, DO ’01

SECTION CHIEF, CRITICAL CARE, AND MEDICAL DIRECTOR, MEDICAL ICU, CHRISTIANACARE’S CHRISTIANA HOSPITAL, NEWARK, DELAWARE

"I serve on ChristianaCare’s COVID-19 Steering Committee, which meets daily to determine clinical guidelines for the health system’s intensive care, respiratory I “ care and dialysis units. We embrace all the evidence out there, including the experience of our patients and publications from other national and international cohorts. We are consistently looking for new ways to tweak our guidelines. We learned from the Italian cohort. We learned from the Seattle cohort. We learned from the New York cohort. And then we pivoted our care. . . . The mantra early in the coronavirus outbreak was to intubate right away. We followed that protocol in mid-March. Then we looked at our situation. It just seemed like we were using up our resources, which were finite. We had to make sure we had room if we experienced a surge. . . . We learned from the Italians that the disease isn’t your run-of-the-mill respiratory distress syndrome. It’s a different beast. We stopped early intubation. Instead, we used high-flow oxygen, with patients on their stomachs, awake prone position. We had success with steroid anti-inflammatory treatments as well as monoclonal antibodies. There’s lots of doom and gloom about coronavirus; you have to celebrate your wins. It feels good to have positive outcomes. And that is good for everybody’s morale. . . . We found that if you are younger and just your lungs are involved, we have been able to get patients through it. Unfortunately, many patients who are older have kidney failure and require dialysis. Combine that with acute respiratory distress, and that’s usually fatal. . . . We have layers of care for our caregivers. Our work schedule for physicians in the ICU helps too. They work five to seven days in a row, then have five to seven days off to recover and recharge and get back in the mix. That translates into 16 shifts a month, which they get to select. It helps prevent burnout. At the beginning, we were unsure of what we were dealing with—from the infectious nature of the virus to whether we’d have a shortage of PPE. . . . I feel blessed to work for a health system that supports its frontline staff. Donations of PPE came in from businesses around us. We’ve had tremendous support from our community. Every day, lunch is gifted by a local restaurant. Acts of kindness go a long way in times like this.” — As told to David McKay Wilson, 4/14/20

GINA M. BLOCKER, DO ’10, FAAEM

STAFF EMERGENCY PHYSICIAN, ST. LUKE’S/ BAYLOR HOSPITAL, HOUSTON, TEXAS

"I was in the Army for 10 years prior to moving into the civilian world in 2017. I did my training at Carl R. Darnall Army Medical Center in Fort Hood, Texas. And then I was I “ stationed at William Beaumont Army Medical Center in El Paso. El Paso had more veterans, and Fort Hood had more healthy young servicemen—lots of kids, and the ER was always bustling with young families. . . . Now I’m drawing on the things that I learned—my skill set, my mentality— compartmentalizing my work life versus my home life. I am used to the critical care aspect, but it’s the preparation for going to and being at work that are different. As a breastfeeding mom, now I’m taking precautions for myself and my three-month-old. . . . I work my shifts fully donned in my own PPE, and I have to doff everything when I pump breast milk in my office. It’s a decontamination ritual that takes me about 15 minutes, and then I pump for about 22 minutes. I do that three times during each nine-hour shift while managing critical patients, taking calls from nurses, doing verbal orders, admitting patients to the hospital, checking lab results. . . . There’s the mental worry that I didn’t doff appropriately, and I’m trying to keep the breast milk as sterile as possible. . . . At home, my eight- and seven-year-olds are always asking, ‘Mom, you’re going to fight the coronavirus today, right?’ And my three-year-old says, ‘And you’re going to win!’ . . . The hardest part is when I come home. Usually I’ve been gone for at least 10 hours, and my kids haven’t seen me all day; they want to hug Mom, jump on Mom. I sneak in the front of my house, and I get completely stripped down, and then hop in the shower for 30 minutes, scrub, scrub, scrub. . . . The community support for us has been amazing. But I’ll say generally, for the physicians: we’re exhausted. . . . I’m meeting with people’s families and they can only see a tiny bit of me. I can’t even hold people’s hands. . . . Our cases are inching back up over the last four days since we opened up our state of Texas. I am concerned about the uptick. We’re not ready to reintegrate everyone back into the society at this point. . . . I wish I had a camera on me so that I could blast from the rooftops what this is actually doing to people. One of my close friends, 31 years old, no medical problems—she wound up in the ICU, intubated on ECMO [extracorporeal membrane oxygenation]. She was sedated for six weeks. She’s in recovery now. . . . Somebody said to me, ‘You know, you’re like a real-life hero.’ I never considered myself a hero. I always just said, ‘I answered the call.’ ” — As told to Janice Fisher, 5/23/20

ANDREW CANAKIS, DO ’18

RESIDENT, INTERNAL MEDICINE, BOSTON UNIVERSITY MEDICAL CENTER, BOSTON, MASSACHUSETTS

“When I graduated from PCOM two years ago, I never thought I would be able to add ‘global pandemic’ to my repertoire of skills and experiences, yet h ere I am, a second-year resident in the midst of COVID-19. And since residents are often the first physicians patients see when they come to the hospital, we are truly on the front lines. . . . I’ve worked in the ICU throughout the outbreak. I’m fully garbed most of the time, with face shield, mask, gown, booties and bouffant to cover my hair. We all need to minimize our exposure. At first, I was anxious. But then I was there, gowning up with nurses, pharmacists and respiratory therapists. Our multi-disciplinary team is all in it together. . . . Daily, it is my job to cover the COVID consult pager, which means if a patient on a floor has increased oxygen demand, I evaluate to see if that patient needs to go to the ICU. If he or she can’t speak for himself/herself, I work to reach family members. We have very serious life decisions happening over the phone. . . . In terms of medicine, we are all learning new therapies together and vigilantly checking new trials around the world. . . . The ICU is eerily quiet these days. Patients stay in single rooms, behind glass doors, many on ventilators. There are no longer visitors crowded in the rooms or waiting in the hallways. Normal hustle and bustle has been replaced with silence and emptiness. . . . What drew me to internal medicine was the patient contact, interacting with families and helping them make complicated decisions. It is so hard on families who can’t see their loved ones in the ICU. I often end up on videoconference calls with healthcare proxies and families, updating them on the patient prognosis, asking what are their wishes about breathing machines, CPR. Last week, I was able to obtain permission for two family members to come into the ICU to see a very sick patient. It had taken over a week of advocacy to allow them to come in, dressed in full PPE. I was able to open that door for them (literally and figuratively); the experience brought us all to tears. . . . I miss sitting across from a family to discuss next steps in treatment. I miss hugging them as I share good news or comforting them as I relate bad news. I miss the power of touch. That’s what makes us human. At the moment, the power of words has become much more important. There is hope in our words, our compassionate communication—our commitment to our patients.” — As told to David McKay Wilson, 4/19/20

CASEY NAUGHTON DOWLING, DO ’89, FASA

ANESTHESIOLOGIST, WINCHESTER, VIRGINIA

"We’re nestled in the Shenandoah Valley and apparently were somewhat protected from COVID at first. We have been learning ever since it hit New York. W “ The information has been a tsunami daily, and yet we still just don’t know what’s going to happen. And that is so unbelievably stressful. . . . I get emails from the American Society of Anesthesiologists, from the CDC, from the FDA. . . .There is no literature on this, so it’s been a collaboration of physicians: ‘How did you take care of these patients? How did you cover for lack of PPE?’. . . . Our hospital was very proactive in turning to us to say, ‘Look, if we get a big surge, you’re going to be our go-to people to help us cover that ICU.’ It makes perfect sense. Anesthesiologists are the experts on intubation and extubation. If you’re looking to have the least amount of aerosolization, you want the most practiced, the most experienced person doing that. We’re also the intensivists of the ORs; we take care of everybody’s diabetes, high blood pressure. We hang pressors, we do lines, we do transfusions, we do codes, we do all of that. Osteopathically speaking, we take care of the whole person—that’s what anesthesiologists do. . . . Fifteen to 20 of us have volunteered to cover intensive care. We went up, four at a time, for a two-hour orientation. And then we’ve been going two at a time every day to orient, do rounds and try to write a note. Again, stressful. It was like being an intern again. . . . I can’t say enough about the people that were already taking care of those respiratory patients in the unit, their grace under fire. And I can’t get over my people, the anesthesiologists who have come up with so many different ways to tent, to intubate and extubate and cover themselves. . . . Back when there was not as much testing, I took care of the very first person under investigation that needed to go to the operating room. Most operating rooms are the wrong pressure. They are what’s called positive pressure: You want the infection to stay away from the patient, so you’re blowing it all down and away. But with a patient who’s infected, you’d be blowing it all over the room and giving it to everybody else. It becomes very involved. . . . We literally created our policy of how to handle it that day, a Saturday. My chairman came in, the safety officer came in—it took a village.” — As told to Janice Fisher, 4/24/2020

JEREMY A. DUBIN, DO ’02, FASAM

MEDICAL DIRECTOR, FRONT RANGE CLINIC, FORT COLLINS, COLORADO, AND ASSISTANT CLINICAL PROFESSOR, UNIVERSITY OF COLORADO SCHOOL OF MEDICINE, AURORA, COLORADO

"I work very long hours these days as medical director at the Front Range Clinic, Colorado’s largest network of outpatient substance abuse treatment centers. I’m up early and work into the evening. I answer emails and texts and put out two or three fires before 8:00 a.m. Then I go downstairs and have an online meeting with staff to game-plan the next 48 hours. We see up to 1,200 patients a week, in 19 brick-and-mortar clinics, three mobile units and more than two dozen points of care embedded in homeless shelters, syringe access centers and counseling clinics. . . . It’s crisis command from my home, still seeking PPE, coordinating the delivery of essential medical services, figuring out staffing. That’s our next contingency: what to do when the staff gets sick. As of mid-April, we have two N95 masks for everyone. We had a stockpile, but every day is a scramble. I’m in touch with vendors in more than 10 counties, tattoo parlors, construction sites. . . . We still need testing for the virus. There is a lack of a comprehensive testing infrastructure for COVID-19. This is hopefully improving. We are looking now for antibody tests, and the scams have begun. It’s the Wild West out here. . . . The severity of our patients has gone up significantly—with the fear of sickness, isolation at home, getting laid off or furloughed, adapting to virtual healthcare visits with providers. We’ve seen more relapses, more overdoses. One patient who’d been stable for seven months just overdosed and passed away. . . . We do have patients with COVID-19. Patients may use their COVID-19 diagnosis as an excuse not to come in for treatment. We are keeping our antennae up. We make plans to meet in the middle. We might ask: ‘How about you drop off a urine sample in 10 days and increase your virtual visits?’ Stable patients get the benefit of the doubt. But it’s more challenging for new or unstable patients. You need to do urine tests and see many of them in person. We need to make sure they are taking the medicines we are prescribing to them and to provide continued treatment accountability. We still have a robust urine collection system, with heightened precautions. We have some patients who show up, pee, get their vitals taken and then talk to us from their phone in the parking lot. . . . I am humbled by the work my colleagues are doing in the ICUs and on the front lines. I’m now receiving videos that teach outpatient physicians how to run ventilators, if everything goes south. I’m board-certified in family practice and addiction. The last time I ran a ventilator was in my residency 20 years ago. I’m quasi-terrified. But I’m watching the videos. I’m learning again in case they call me in.” — As told to David McKay Wilson, 4/18/20

LISA FINKELSTEIN, DO ’87

MEDICAL DIRECTOR, TELEHEALTH, ST. JOHN’S HEALTH, JACKSON, WYOMING

“ My motto used to be: ‘Telemedicine is medicine.’ Today I say, ‘It takes a pandemic!’ Even in Teton County, Wyoming, with 10,000 full-time residents, we’ve had 95 COVID-19 cases since late April, with one death. Now we’re concerned about the arrival of tourists in May for the annual hunt in the mountains for antlers shed by elk each spring. Jackson Hole, the parks and restaurants are closed for social distancing, but the governor decided not to cancel the state’s signature event. We’re worried hundreds will come to find a rack, and bring the disease with them. . . . When I came out here to this very rural state 17 years ago to practice urology, I traveled long distances to see patients. One clinic was 75 miles away—through Hoback Canyon—via a road closed at times by avalanches. Another clinic was either a four-hour drive or a flight on a twin-engine King Air turboprop. . . . We launched our first telemedicine initiative in 2010, but the technology was not ready for prime time. It was frustration after frustration. . . . Two years ago, when the technology had improved, I became president of the Wyoming Medical Society. Telemedicine was my initiative. I led by example, with a HIPAA-compliant Zoom license, and virtual visits with patients hundreds of miles away. I spoke to the legislature. I spoke to the governor. I traveled the state to get physicians on board. It was like pushing a rock up the Grand Teton. . . . I had grueling conversations with doctors so resistant to change. But my hospital network backed it. A Wyoming state grant that sponsored 500 Zoom licenses for telemedicine technology meant a good network was in place when the pandemic struck. Then we tripled the number of licenses in six weeks. The house is burning down. What was just dribs and drabs is now a firehose. . . . From the start, Medicaid and Blue Cross gave us parity on telemedicine visits. Remote patient monitoring is the next step. It is reliable. Patients will be set up with a pulse ox, thermometer, blood pressure cuff, scale. There are telestethoscopes that read heartbeats over a smartphone and digital devices that look into eyes and ears. . . . Patients love the convenience. They don’t have to take the day off to be seen. They can even do televisits from work. It takes stress off being sick. I can do 80 percent of my exams with eyes on my patient over Zoom. . . . I really believe that the coronavirus crisis marks a before and after in telemedicine. Once the dust settles, physicians who incorporate telemedicine into their practices will have a leg up. . . . My next initiative focuses on telemedicine education for medical students and residents. It goes back to my motto: ‘Telemedicine is medicine.’ The paradigm has shifted.” — As told to David McKay Wilson, 4/28/20

MELANIE GARTHWAITE, MS/FM ’17

SUPERVISOR, STATE OF NEW JERSEY TEMPORARY MORGUE FACILITY, MONMOUTH COUNTY, NEW JERSEY

"As of early May, New Jersey’s COVID-19 death toll exceeded 7,800. The number of deaths at hospitals, nursing homes and funeral homes far exceeded their A “ storage capacity, so the state opened a second temporary morgue facility in Monmouth County (Central New Jersey). The facility has a capacity for 1,400 bodies. So far, we’ve accepted 190 people, with 100 still here. We are working in conjunction with the New Jersey National Guard and the New Jersey State Police. . . . At the Southern Regional Medical Examiner’s Office where I work under normal circumstances, our case volume hasn’t gone up that much, since South Jersey has not yet been as severely impacted as densely populated North Jersey. Many COVID-19 cases do not fall under the jurisdiction of the medical examiner. But if someone is found dead in his/her home, and we don’t know why he/she passed away, the case is accepted by the Medical Examiner’s Office. . . .We don’t do the transport to the temporary morgue sites. One of the sobering realities is how the remains arrive—in U-Haul trucks from hospitals, refrigerated trailers, minivans, Suburban SUVs. . . . In my line of work, we don’t get to save people. But I believe we are on the front lines, aiding the overwhelmed mortuary services sector. There’s such a backlog with cremations and burials. In some places, cremations are being scheduled for June or July. . . . We don’t give people deadlines. Some funeral homes store bodies here for a couple of days. Others can take a couple of weeks or a month before they can be cremated. There are quite a few cases from nursing homes who have no next of kin. We are working with the State Police to identify next of kin so the people can be finally put to rest. I’ve spoken to families from all over the world, people who are trying to figure out where their loved one is. . . . We’re trying to keep our spirits up. We listen to music. We are working in a beautiful setting, surrounded by blooming gardens. What a drastic difference: a warm greenhouse and a cold refrigerator. . . . One of the hardest aspects for the families is the lack of human interaction when their loved one passes away. When somebody dies under normal circumstances, most families have a funeral, a memorial, some kind of celebration of life. Friends and loved ones surround those who are mourning. They comfort through hugs and embraces. . . . We’re scheduled to close on July 1, but that will depend on how things evolve. We need to be cognizant of the possibility of a second wave of the virus after lockdowns lift.” — As told to David McKay Wilson, 4/29/20

WILLIAM GREENHUT, DO ’08, FACEP

ATTENDING PHYSICIAN, EMERGENCY MEDICINE, AND ASSOCIATE DIRECTOR, EMERGENCY DEPARTMENT, MONTEFIORE NYACK HOSPITAL, NYACK, NEW YORK

"In New York City’s northern suburbs, we knew a hurricane was coming in late February. Instead of running away, we chose to run toward it. We chose to stand in it for 12 hours a day, every day, not knowing when the storm would pass. We educated people early about the outbreak. But once it became widespread, it adversely affected communities with lower economic status and large populations of people who couldn’t easily adhere to social distancing. . . . Overall, the volume in our Emergency Department is down 20 to 40 percent. But 80 to 90 percent of our new patients are suspected of having coronavirus, so it takes a disproportionate amount of resources. We converted part of our ED into two new ICUs. COVID-19 is a huge stress on the hospital. . . . At first, we were told that COVID-19 primarily affected older people and those with respiratory problems. That gave us a sense of calm; we were a little relaxed. I have pictures of myself back then, just wearing a surgical mask. Then the numbers grew. Today, I wear a filtered mask, a cap, gown and utility goggles. I get dehydrated because I need to take off my mask to drink. I fear that the virus is on the gown, on my cap, on everything I’m wearing. . . . Putting young patients on ventilators is one of the toughest things I do. I’m 40 years old. I watch patients in their 20s and 30s in total terror, gasping for air, looking to me for help. I share with them that the majority of people survive the illness, but 15 to 20 percent require hospitalization for several days. I try to give them a realistic hope. But it is an alarming experience for them—and for me. . . . Our nation has a poor success rate getting patients off the ventilator. We treat anyone over the age of 70 in respiratory distress with oxygen. We place them on their stomachs, in prone positioning, and pray for them. If they go on a ventilator, there’s a good chance they will never come off, never see their family again. . . . I’ve found that our hospital staff has a shared, overwhelming sense of obligation to be with our community during its time of need. We know what we are supposed to do. No one else can do it. We take the risk. It’s our job, our calling.” — As told to David McKay Wilson, 4/12/20

JAMES NICK HERNANDEZ, PharmD ’19 (PCOM GEORGIA)

INDEPENDENT PHARMACIST, BIRMINGHAM, MICHIGAN

"I work as an independent comopounding pharmacy a little bit west of downtown Detroit. It’s nice to be able to say about a medication, ‘If that’s not working, let’s try to tailor I “ it to you.’ . . . In the beginning of the COVID-19 pandemic, the first week after the quarantine was put into effect, work was chaotic; we were just slammed. People were worried about whether there would be drug shortages, whether they’d be able to access their medications. My boss, the owner, told us, ‘We have to change some things, because everything around us is changing.’ . . . We started offering curbside service and a lot more delivery, same-day delivery service—the owner has five kids. . . . We’re also pretty busy providing masks, regular surgical masks. We started making our own hand sanitizer at one point just to try to get it to our patients, to doctors’ offices. Because we’re a compounding pharmacy, we were able to do that. . . . Earlier today we spent about an hour and a half moving 14,000 pounds of hand sanitizer. It came on a semi truck, and we had to borrow two forklift pallet jacks to put it in one of our storage container sheds. . . . So COVID has meant that we’ve had to adapt on a daily basis. But mostly it’s about being here for the patients, providing whatever we can. We get a lot of questions: What should I be doing? What should I be taking? Are there certain vitamins or supplements? . . . A lot of our patients have been coming here for years. We know most of them on a first-name basis. In times like this, we just try to provide the best care we can. We never want to have to tell them they cannot get medication due to shortages of any sort.” — As told to Janice Fisher, 4/21/2020

JACK KELLY, DO ’85

PROFESSOR OF EMERGENCY MEDICINE, PCOM; PROFESSOR OF EMERGENCY MEDICINE, SIDNEY KIMMEL MEDICAL COLLEGE, THOMAS JEFFERSON UNIVERSITY; AND ATTENDING FACULTY AND EMERGENCY PHYSICIAN, EINSTEIN HEALTHCARE NETWORK, PHILADELPHIA, PENNSYLVANIA

"I’d seen hundreds of viral influenza-like illness patients since late February. On March 16, as I finished my shift and came home, I felt utterly exhausted. My body ached. My nose was I “ stuffy. My temperature was 99.1 I felt better after taking Motrin. But my lethargy and aches continued for five days; I had no cough, no diarrhea. My temperature remained at 99. … On March 21, I called my primary care doc and had a viral panel drawn and a COVID-19 test. My test was sent three states away. I didn’t get my results until seven days later. The test was positive. … A day later, on March 22, I became dramatically ill with severe shakes and rigors. My wife [Fran Sirico-Kelly, DO ’87] listened to my lungs. ‘You have crackles in your left lung base,’ she declared. ‘Your heart rate is 105 and pulse oximeter is 91 percent. You are going to the hospital.’ That night, two of my emergency medicine colleagues examined me in the ER. They found bilateral ground-glass infiltrates and a left lower lobe pneumonia. But my oxygen saturation was 96 percent and I really did not meet criteria for admission. They gave me IV antibiotics and a Z-Pak. ‘I think I can tough it out at home,’ I said. … I self-quarantined in our guest bedroom. My wife delivered food and medicine to the upstairs landing. It was one of the darkest, most awful periods in my life. The viral symptoms were brutal: severe body aches, no energy at all. Every breath, associated with dull central chest achiness, was hard work. When I developed shakes and rigors, I’d burrow under five blankets to cope. … Every day got worse. I would check my vitals and send pictures to my wife so we could map out the clinical course. Her anxiety was high. She worried if she would find me alive in the morning. … I was alone. It was my personal struggle. Each day, my wife would make me a double cappuccino and freshly baked muffin (her way of cheering me up). I’d shave and shower off 24 hours of viral sweat. I still felt weak and dizzy. … It took eight days before my temperature stayed normal. By April 1, I’d lost 10 pounds along with strength and resilience. Each day, I began to feel better. I began to take two-mile walks with my wife, and I resumed strength training. … I went back to work Easter morning. It was my personal resurrection victory. … Now I’m three weeks’ post-quarantine and have regained all my strength. I’ve gained back six pounds. My heart rate, which was sustained for some time between 100-105 beats per minute, finally returned to the 65-70 beats per minute that I’m used to. There are so many COVID-19 patients coming into the ER. And I’m back in the game, working with my ER team.” — As told to David McKay Wilson, 4/11/20

RICHARD PESCATORE, II, DO ’14, FAAEM

CHIEF PHYSICIAN, DELAWARE DIVISION OF PUBLIC HEALTH, DOVER, DELAWARE

"In emergency physician by training, I find that emergency medicine is at the nexus of public health and patient care. My job with the state Division of Public A “ Health, which I started in late February, is an evolution of my work. . . . We had our first COVID-19 case in midMarch. Never in my life did I think I’d be on midnight phone calls about testing with the US Department of Health and Human Services and the White House Coronavirus Task Force. . . . I also do per diem ER work in North Jersey and the Philadelphia area. We took lessons from the harder-hit areas, and it gave us a head start about what to expect. We looked at the clinical course of patients, and saw that in New York and New Jersey, there was ruthlessly efficient transmission of the coronavirus at the long-term care facilities. We made sure we had infrastructure in place to get patients the care they needed, when they needed it, where they needed it. . . . My days are varied. Today I was at a new testing site in south Delaware; we were working out the kinks at a drive-thru facility that got 600 tested in less than four hours. Other days I’ll be out at industrial sites, at pop-up care sites in at-risk communities, running viral tests with my notebook in hand. . . . At the State Health Operations Center, my clinical background helps mobilize science into the community through developing guidance for transmission precautions, testing and biosafety guidelines and protocols. . . . During the early phase of the pandemic we did everything we could to protect as many people as possible. Now that we have the lasso on the bull, we look to suppress the virus through more widespread testing and contact tracing—mitigation strategies. We have selected a vendor to assist in the hiring of more than 200 contact tracers to identify and reach out to those people the patient had close contact with—within 48 hours of their diagnosis. . . . As we move into summer, we purchased 200,000 oral patient-administered tests—they rub the swab into their mouths, and you get results in 48 hours. We’re targeting 80,000 tests a month. . . . In mid-May, we’re staring down the barrel of Memorial Day weekend. Our beaches will open in the next few days for limited activity, where social distancing can be maintained. Out-of-state visitors have to quarantine for two weeks to control crosspollination. You can come to your cottage, but you have to stay inside.” — As told to David McKay Wilson, 5/13/2020

SURAJ KUMAR SAGGAR, DO ’02

CHIEF, DEPARTMENT OF INFECTIOUS DISEASE, HOLY NAME MEDICAL CENTER, TEANECK, NEW JERSEY

"New Jersey has faced an extraordinary COVID-19 outbreak, suffering the second-highest death and infection totals in the country after New York. . . . As the contagion escalated N “ in mid-March, our Bergen County hospital came under siege; it seemed that overnight we were in the midst of a war zone. Patients were high acuity, and a large number had severe outcomes. Those on ventilators saw a 10 to 15 percent survival rate. . . . The surge of patients required that our medical units be modified. Our materials management personnel got creative. Within a week, the “shell ICU” was created—a modular MASH unit built to accommodate 40 infected patients. Areas were converted into negative pressure spaces, drawing out air to prevent contamination inside. Monitoring equipment was placed outside pressurized rooms, which reduced the amount of PPE used. We used inpatient isopods and transport isopods. All of these measures helped us conserve critical resources during a supply shortage. . . . By the end of March, we were solely treating COVID-19 patients. Daily, we were building out to accommodate increasing need. Our administration appealed to the public for donations and supplies. . . . The epicenter of the pandemic in New Jersey, we have become a national model. We are heartened by our unprecedented frontline care. We are also burned out. Many are suffering from acute stress, PTSD. Our hospital has had an up-close view of daily tragedies. We have mourned the death of four employees, and over a dozen doctors have been sickened. Our hospital CEO also contracted the virus. Personally, I can tell you that the fear I saw in patients’ eyes still sticks with me. The sounds of the pandemic have become embedded in my consciousness. They keep me up some nights. . . . As an infectious disease physician, it has been intellectually stimulating to witness a pandemic in real time, the first in the social media era. The pace at which risk-assessment, research and guidance has emerged, the way clinicians across disciplines, across the globe, have come together, is truly remarkable. . . . Here in Teaneck we have reached our peak. We are seeing fewer COVID-19 patients. . . . I have become involved in clinical trials: Kevzara (primary investigator) and expanded access of the drug remdesivir (sub-investigator). I’m also looking at potential therapeutics and serum antibodies. There is anecdotal evidence that the drugs may help patients infected with COVID-19, but peer-reviewed studies are needed. . . . We’re not out of the woods yet. There will likely be more waves of the virus. We need to stay ahead of the curve. We need to be vigilant. We need a vaccine. Herd immunity will take longer.” — As told to Jennifer Schaffer Leone, 5/11/2020 PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE

AMANDA L. SCOTT, DO ’19

GENERAL SURGERY PRELIMINARY INTERN, NEWARK BETH ISRAEL, NEWARK, NEW JERSEY

"Our entire hospital is now a COVID-19 unit. It happened so fast. Overnight. . . . I’m in a 14-bed ICU managed by the surgery team. We have PACU and O “ same-day surgery nurses, none of whom are trained in ICU levels of care, all of whom are unbelievable. The team consists of an anesthesiologist running the ICU, me, one resident, an intern who is going into radiology, ortho PAs, neurosurgery PAs and nurse anesthetists. . . . Tensions could be so high, and people could snap. But I have not experienced a second of negative energy. It’s nothing but positive, optimistic teamwork, and it makes it all worth it. . . . I’m so grateful that I had a month of ICU. The ICU team at my hospital has done a great job in training us and getting us ready for this. . . . I’m getting the sickest patients in the hospital, and I try to FaceTime with their families every day. . . . I lost seven patients in the last five days. These patients will go directly from us down to the morgue. We have to talk to their families to see where they want their remains to go. . . . I stand with my patients as they are dying, and I hold their hand and say, ‘You are not alone. I’m with you. We are here with you. Your daughter loves you so much, your son loves you so much.’ And I just repeat it over and over until they pass, so that when I call their family members, I can tell them I did that much. . . . I feel like I’m at war. When I’m home, I can’t get that vision out of my head—of standing in the middle of the unit. I’m having a hard time sleeping. But I have such a wonderful support system: my program director, the chair of my department, the head of nursing. The president and CEO of our hospital has organized the Newark Police and Fire Departments to assemble outside our hospital with all the cop cars and fire trucks and salute us and tell us how much they appreciate us as healthcare workers on the front line. . . . I do believe PCOM prepared me for this moment. Sometimes I took courses that made me think, ‘We’ll never need this. Why are we doing this?’ I am ready and able to handle this time of pandemic emotionally. I feel very, very blessed. . . . I’m going to be a very well rounded radiologist (my ultimate goal), that’s for sure. Lord willing.” — As told to Janice Fisher, 4/16/2020

JASON A. SMITH, DO ’08, CIC, FAOASM

MEDICAL DIRECTOR, SPORTS MEDICINE, MERCY HEALTH; AND MEDICAL DIRECTOR, TOLEDO – LUCAS COUNTY HEALTH DEPARTMENT, TOLEDO, OHIO

am a primary care sports medicine doctor with 40 high schools, colleges and organizations under my direction. I work for the United States Soccer Federation, too, when I “ the national teams play in Ohio. And I see patients who have varying degrees of musculoskeletal problems. I have no background in public health. So, it came as a surprise to me on March 11 when I was asked if I wanted to serve as the county health department’s medical director. The role would take 10 hours a month—or so they said. . . . By March 13, I officially had the job. The next day, our county had its first COVID-19 case. . . . One of my first tasks was to cancel the Mercy Health Glass City Marathon, a premier event, after the CDC prohibited gatherings of more than 50 people. I’m medical director of the race, which usually has 10,000 runners and 25,000 spectators. Spring high school and college sports had to be cancelled as well. . . . I’m now working at least 70 hours a month on the county job. It’s the most challenging thing I’ve ever done. . . . There are three things you look for in a county health department medical director: previous work in public health (I had no experience); a master’s degree in public health (nope); a desire to practice medicine related to public health services (I never showed it). But I’ve now come to realize that my skill set as a sports medicine physician was grossly undervalued. I’m precise in my execution. I know how to set up protocols to protect people—how to prevent and treat injuries. . . . Within the first week, we had protocols to test first responders at their homes. We made recommendations for them about PPE use—what to wear and when to wear it to avoid exposure. We established infection control procedures at the county jail. Since early May, our jail has been COVID-free for two weeks. We haven’t had a first responder test positive in 12 days. We are protecting those who are protecting us. . . . To date, our county has had 1,806 cases and 165 deaths. We’ve plateaued, with about 30 new cases a day. The scary thing is that we don’t know if we have peaked yet. . . . We’ve started to open up in Ohio. I meet frequewntly with the Chamber of Commerce about how to do it safely. We are all under pressure. If you do too much, you’ll be faulted. You do too little, you’ll be faulted. I think it’s better to do too much than too little. . . . If we were in a baseball game, it feels like we’d be in the second inning. This isn’t over. It’s not going away. We’ve got to be smart and safe for our families and others. We have to stay on task; an uptick in cases could come about if we relax social distancing measures too quickly and too much. While we undoubtedly need to concentrate on issues such as soaring joblessness, we have to prepare for a second wave. We know it’s coming.” — As told to David McKay Wilson, 5/7/20

LAUREN TAVANI SOTTILE, MS/PA-C ’08

MEDICAL ICU PHYSICIAN ASSISTANT, CHRISTIANACARE, NEWARK, DELAWARE “ I ’ve worked in the medical ICU for almost 12 years.

A lot of changes came with the COVID-19 pandemic. . . . You’re constantly reading new articles and shifting your treatment paradigm. In critical care, you’re always having conversations about goals of care. When every conversation with a family member is over the phone and they can’t see their loved one—that’s been really hard, harder than I thought it would be, especially since some of the patients we have cared for have tragically passed. You hear the desperation in the family members’ voices. All they have is you, telling them what’s happening. . . . Our entire unit is COVID-19. We haven’t seen a normal ICU patient in six weeks. . . . Three or four advance practice providers are scheduled every day, part of a multidisciplinary team: the APP or the resident, the intensivist, the bedside nurse, respiratory therapy, pharmacy. We have a whole fleet. . . . When we’re having a rough day, we talk to each other about it. The hospital has a number of different resources available for us. And in weekly team meetings, we talk out anything that’s going on. We also try to focus on the positive moments—like when we have a good outcome. We share the news, we celebrate it; the positive moments can really carry you through darker ones. . . . Never in my life have I been thanked so much for being a healthcare worker. Our walls in the ICU are covered with pictures and signs that children have sent to us. I have not had to bring a meal to work in a month; every meal is donated by someone. My coworkers have had strangers buy them gas, buy them coffee. So many things have happened over the past six weeks that have made me see the good in people. . . . When you go into health care, it’s a life of service, but you get so much more in return than you ever put back. You don’t expect anything like this. But I think it’s a testament to what humans can do when we’re faced with adversity and how strong we can be when we come together. I know we’re going to get through it.” — As told to Janice Fisher, 5/1/2020

MICHELE TARTAGLIA, DO ’02, FACOOG, CS

OBSTETRICIAN AND GYNECOLOGIST, CHRISTIANACARE, NEWARK, DELAWARE

“We are five months into this global pandemic, and we still know relatively very little about COVID-19 infection in the general population, let alone the obstetric one. There is insufficient data on vertical transmission of SARS CoV-2; an early study out of China is somewhat reassuring, while a new one from Italy hints at transmission. We don’t know if maternal infection has any immunologic benefit to the neonate. We are gathering more information every day here in the United States, but this does little to assuage the fears of pregnant moms. . . . The patients I see are overwhelmingly concerned about the impact coronavirus will have on their family’s health, if there is an increased risk of miscarriage or other complications. They are very anxious about delivery if they are positive at that point in time. They fear having to immediately isolate from their new baby and family. They are concerned about the impact it will have on breastfeeding. Worry is a constant companion during pregnancy; it is heartbreaking to witness this kind of anguish. . . . Perhaps more disconcerting are the health inequities that have been magnified by the pandemic. While I take labor and delivery call and do OB triage [ER shifts], my role for my department with respect to the COVID-19 epidemic has primarily been in the outpatient world. I manage our hospital’s COVID-19 Pregnancy Center, treating positive patients or those suspected of having the virus. We are able to provide lab services, maternal fetal medicine ultrasound services, prenatal care and basic urgent women’s healthcare needs to women who would otherwise not be able to be seen safely in their usual office setting. I see patient referrals from private practices as well as state-funded clinics. . . . Many of the patients I see live in crowded conditions, multiple adults and children under one roof—a greater potential for viral spread. Many rely on public transportation to get to their prenatal care appointments. Some work service jobs that put them in dangerous proximity to others. They lack access to health care and health insurance outside of pregnancy. Many struggle to afford even their prenatal vitamins. There are so many barriers. Too many barriers. . . . One afternoon, I admittedly hit my breaking point. I threw a box of PPE in my trunk, climbed into my Subaru and off I drove. I made my first impromptu house call to a COVID-19 positive patient whose situation rendered her unable to come to the center for her weekly progesterone injection that helped prevent a recurrent preterm birth. Without it, there could be a COVID-19 positive mom going into preterm labor because of a very simple injection. I thought showing up on her doorstep in all my PPE was going to be intimidating, but instead I saw a bit of relief on my patient’s face in the midst of all this craziness.” — As told to Jennifer Schaffer Leone, 5/15/2020

JUK TING, DO ’95

FIRST OFFICER, BOEING 747-400 PILOT, KALITTA AIR, YPSILANTI, MICHIGAN; AND STAFF PHYSICIAN AND ASSISTANT CLINICAL PROFESSOR, DEPARTMENT OF MEDICINE, CITY OF HOPE COMPREHENSIVE CANCER CENTER, DUARTE, CALIFORNIA

“I was one of four pilots on the first evacuation flight of Americans out of Wuhan, China [January 29, 2020]. During the flight, I recall thinking back to my emergency medicine residency at the Cleveland Clinic – South Pointe Hospital when I took flying lessons to reduce the stress of grueling residency training. I’ve been fascinated with airplanes since I was a child. My school bus used to pass by Orange County Airport in Virginia. I dreamed then—at best—I’d be a weekend warrior pilot, buzzing the neighborhoods in a small plane. But now I fly the Queen of the Skies: the Boeing 747. Since 2016, I’ve been an airline pilot, first for United Airlines Express, then Southern Air. I presently fly for Kalitta Air—all around the world—and I do still practice as a physician. I am able to combine my two passions: aviation and medicine. . . . I was in Hong Kong on reserve flight duty when volunteers were sought to pilot an evacuation flight into Wuhan during the height of the coronavirus outbreak. United States government officials and their families, as well as other American citizens, were trapped in the epicenter of a pandemic—without medical care, without food or water. . . . The 747 has two decks: the crew on the upper deck, and passengers below. The upper deck was sealed off. Seats and medical equipment were installed on the lower deck for 201 passengers who’d been screened and quarantined prior to boarding. None were showing symptoms of COVID-19. . . . My flight crew of 10 flew from Incheon, South Korea, into Wuhan. When we landed, Wuhan Airport was empty except for another evacuation flight next to us that arrived the same night to fly Japanese citizens back to Japan. Since we were the first evacuation flight, there was so much caution to protect the flight crew, airport staff and the passengers from this unknown virus. Boarding was very time-consuming—over six hours. I grew up in Taiwan, so I was able to coordinate between our flight crew and the Wuhan ground staff, who spoke little English. . . . Our outbound flight to Anchorage, Alaska, took 11.5 hours. For passenger safety, we could only fly slow and low at 27,000 feet, much longer than usual. In Anchorage, new crews took over and continued the flight to March Air Force Reserve Base in Riverside County, California. . . . I had to be symptom-free for 14 days before I could return to my hospital work. I was honored to be part of the evacuation. Returning the evacuees safely to American soil was a profoundly moving and uplifting experience for me.” — As told to David McKay Wilson, 4/21/20

*In honor and remembrance of Frank Gabrin, DO ’85, who inspired me and trained me in emergency medicine from 1993 to 1999. DIGEST 2020 33

DOMINIC VALENTINO III, DO ’01, FCCP, FACOI

CLINICAL ASSOCIATE PROFESSOR OF MEDICINE, PCOM; AND PHYSICIAN, CRITICAL CARE MEDICINE, INTERNAL MEDICINE, SLEEP MEDICINE, AND PULMONARY MEDICINE, CHRISTIANACARE’S CHRISTIANA HOSPITAL, NEWARK, DELAWARE

"I’m managing chronic lung disease patients with telephone and video virtual visits while also managing patients in the ICU. We want to keep our chronic patients out of the hospital to cut down on risks. We’ve had telemedicine capability for some time, but nationally there was slow adaptation due to lack of support from insurers. That’s changed on a dime. We can now talk to them and help them with the isolation they feel. Vital signs can be an issue, but many have pulse oximeters while others can take their own blood pressures. We can’t do OMM over the phone, but you can guide patients how to do it themselves. . . . In the ICU, I see patients with COVID-19 pneumonia that have multiple areas of their lungs that are inflamed and filling in with infectious fluid that doesn’t allow for gases to be exchanged. You can’t take it out with a diuretic. What’s making these patients so sick is their immune system ramping up into what we call an acute cytokine storm, causing damage to the lungs and other organs. We use steroids to curb the storm. While we’ve told people to avoid steroids before becoming infected because it could lower your resistance, once you have COVID, and your system is overly ramped up, steroids can play an important role. . . . We’ve made inroads with COVID patients by doing awake proning, which improves areas of the lungs that can perform oxygen exchange. We also use high-flow nasal cannulas, which have prevented some patients from intubation. Wall oxygen can go up to 15 liters a minute. We have devices that amplify the oxygen flow up to 50 liters a minute. Patients with the large nasal cannula can talk and eat, plus they are not aerosolizing the virus, which protects healthcare workers. . . . Personally, I use social media to reach more people with evidence-based messages about the coronavirus. I post weekly on my Facebook page—Dom Val—without hype and politics, in a straightforward manner. I discuss what we might expect in the coming weeks, pointing to CDC or other predictive models. I talk about the importance—and rationale—for social distancing and wearing masks in public. One post had 1,300 shares—all the way to Australia and Poland. I finish each post with a positive message about America’s response and my belief that our resilience will bring us through to the end. I want to help as many people as I can. What better time to do it?” — As told to David McKay Wilson, 4/22/20

DANIELLE WARD, DO ’18 (PCOM GEORGIA)

URGENT CARE PHYSICIAN, ATLANTA, GEORGIA

“When the COVID-19 crisis first began, our volume was astronomically high. Normally in a shift I see about 20 to 30 patients; in one shift I had 60—I had to call in help. . . . We are still open during our normal hours—8:00 a.m. to 10:30 p.m.—but one of our two facilities sees the morning crew, and the other facility sees the night crew. . . . If anyone’s having coronavirus symptoms, we politely ask them to go to their car and give us a call. They can do a telemedicine visit. It’s our way of protecting the patients as well as ourselves. . . . When I come into work, I have my temperature taken. I used to be able to walk into a patient’s room and shake their hand, introduce myself. Now I’m going in wearing a mask, greeting them only verbally, so I don’t feel like the patients know me. . . . We’re not doing COVID-19 testing until we get the proper PPE, the N95s and the shields so we can protect our staff—not just the physicians, but also front desk workers, medical assistants. . . . I’m incredibly lucky and blessed to work. I usually have a patient waiting. A lot these days are hand lacerations and such—people are at home, they want to learn how to cook. They’re afraid to go to the emergency room at night, so they’ll wait and then they come see me. . . . In between seeing physical patients, I see my telemedicine patients— and most of them are concerned about COVID-19. So I talk them through it, find out their symptoms, refer them to the appropriate facilities to get tested if needed. A few of them call back in a few weeks and let me know they’re feeling much better. So that’s the highlight of my day. . . . The biggest thing we see is chest pain. But after a thorough workup and deeper discussion, we find it’s usually anxiety. So I let them know, ‘Hey, everyone’s anxious. I hear you, I understand your concerns.’ Then I tell them what to look for. ‘Around days seven and eight, that’s when shortness of breath develops. But anxiety can also cause that issue. Can you walk to this door without feeling like you’re going to pass out?’ It’s explaining things on their terms. And now I give them my personal email, so they feel a little bit better knowing they can reach out to me with questions. It calms them down. People are really scared. . . . I have a small role—I think about my colleagues in the ICU. But I try to help as much as I can.” — As told to Janice Fisher, 4/22/2020

SAI-KIT WONG, DO ’03

NEW YORK CITY ANESTHESIOLOGIST

“When the pandemic hit, I was not on the front line. I never imagined that I would be thrust into this position. In the 14 years I have been an anesthesiologist, I can count on one hand how many deaths I have had on the operating table. I’ve never dealt well with death. . . . Since March, all elective surgeries have been cancelled. I spend fewer hours in the hospital during the week, but each hour is more intense. I have taken on the ‘airway role.’ I respond to emergency intubations in the medical center. Many of the COVID-19 patients I see are in their 30s, 40s and 50s with no comorbidities. Some are elderly, fewer are children. When these patients require ICU level care, they often need extended respiratory support. They present with severe hypoxia or acute respiratory distress; their oxygen saturation levels are in the 50s or 60s. There is no time to waste delivering care. In my experience, 70 to 80 percent of those placed on ventilators pass away. It is difficult to predict who will live and who will die. . . . Here in New York, the unimaginable has become a ‘new normal.’ I recall a night on call when I was so emotionally drained. After a case, I pulled my cell phone out to call my pastor. As I moved toward a large window, I was paralyzed. Parked on the street below were four refrigerator trucks. Mobile morgues. No one prepares you for this. . . . . One of the most anxiety-producing parts of my job has been the shortage of PPE. For weeks my team and I were intubating COVID-19 positive patients with nothing more than N95 masks, eye shields, gloves and gowns. Through a miracle, I was able to—with my own funds—secure essential protective gear for myself and my department. We are now better prepared for battle, at least physically. . . . It is so hard to be isolated from my family. My four young children cannot comprehend why I cannot hug or kiss them or why when I am home, I am in quarantine in our home office. If I do have coronavirus, I don’t want to infect my family. There are people with mild symptoms or who are in the asymptomatic phase. We have no idea what the transmission potential of those asymptomatic patients is or how long that phase is. There is so much about this virus that we do not know. . . . My oldest son just turned nine. His birthday brought with it a frightening realization. I want to see my kids grow old, to spend time with my wife. I want to hang out with my boys and do stupid manly things and I want to see my girls on their wedding days. . . . I am far from a hero. I am a physician. I held and still hold a moral commitment to provide care to those who need it, despite risk to myself. That was the oath I took when I became a physician.” — As told to Jennifer Schaffer Leone, 4/2/20

ANNA ZACHARCENKO, PSYD ’06

FAMILY MEDICINE PSYCHOLOGIST AND CLINICAL ASSISTANT PROFESSOR, SCHOOL OF PROFESSIONAL AND APPLIED PSYCHOLOGY, PCOM, PHILADELPHIA, PENNSYLVANIA

"I serve two roles: as a psychologist and as a clinical supervisor of psychology trainees. As psychologists, we have rapidly shifted our mode of practice to a telehealth I “ platform. . . . In our remote sessions with patients, we’re seeing more frontline workers employed in healthcare settings requesting psychological support. These patients report fearing going to work. They’re wrestling with being dedicated to their profession and at the same time feeling protective of themselves and their family members. . . . Patients may fear they’re COVID-19 positive, or be struggling with the adjustment to sheltering in place. I’m focused on communicating as much emotional presence and kindness as I can on the video call or telephone call, because we are not face to face. . . . My patient may have learned that someone in their family, or a close friend, has died of COVID19. Given social distancing requirements, that patient may be robbed of the opportunity to engage in their cherished cultural rituals to say goodbye to their loved one or their friend. So their grief in some ways is disenfranchised. . . . As a supervisor, I am guiding our students as they continue to learn in a time of uncertainty. For some of our psychology students that I supervise, this may be the first time they’ve provided service telephonically. Coaching students in how to address bereavement issues can be challenging and also deeply rewarding. It provides me with a unique opportunity to bond with our students and to help them walk through this process. . . . Even if it isn’t a crisis call and no one is in imminent danger, if the patient is emotionally distressed, we want to make sure that we’re listening to the tone of voice and exploring what the silences and the pauses mean. . . . As a training program with a cognitive-behavioral orientation, we guide patients in examining their deeply held beliefs about themselves, about the world, and others. Needless to say, our beliefs regarding the safety of the world are being tested. . . . Similarly, in the supervision process, I’m asking students to examine their own thoughts and their own anxieties about how well they have helped the patient at this point in time. And that openness to self-reflection is fertile ground for maturing as a professional. . . . Given the profound losses due to COVID-19, there will be a need for behavioral health services as the future unfolds. This pandemic will provide us the opportunity to grow into more compassionate healers. At the end of the day, I want my patients to know that they were cared for during this frightening time.” — As told to Janice Fisher, 5/5/2020