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As the COVID-19 crisis continues to unfold, the medical staff at Mount Sinai Brooklyn is providing regular dispatches about the daily experience fighting the virus. In order to respond to the vast influx of patients, many doctors have found themselves doing jobs that are very different from the ones they’re used to — like colorectal surgeon Julia Zakhaleva, who is currently working in the hospital’s second makeshift ICU. Dr. Zakhaleva said that things appear to have turned a corner at the hospital in the past two weeks, praising chief medical officer Dr. Peter Shearer for bringing in more personnel and resources for the hospital in its time of need. However, while the staff may be starting to see a glimmer of hope on the horizon, there are still many dark and difficult days to get through, which Dr. Zakhaleva details in her dispatch below.
Around two weeks ago, there was an old gentleman who got admitted and was intubated immediately upon arrival because his respiratory function was really bad. He got transferred to us and was doing very poorly. We had to tell the family the prognosis was extremely poor. But we managed to halt his deterioration somewhat. He was stable in critical condition for the next two days. And then on Saturday I came in at 7 a.m. and around 7:20 a.m. he coded. I had to call the family and confirm with them that they did want what we call full code, and they said they did, so we continued to do chest compressions and medical resuscitations, but we knew that we would not be able to save him. And we couldn’t and we didn’t. About 15 minutes later, we had to call his family to tell them that he had passed away. And although they knew it was coming, it was a tremendous shock for them.
By then, we had lost a lot of patients, but for some reason, he was really just a tremendous punch in the solar plexus for me. I had to run out just to pull myself together. And I literally had five minutes to myself when I got a call that another patient was coding. So then we had to do this all over again, and the same thing happened. Having so many sick patients on our hands, we kind of have to process it and move on and take care of the ones who still need us. The hospital was so overwhelmed that day, and while the body of the first gentleman had been prepared, we didn’t have enough manpower to move that body into the morgue, because we needed the bed. So I actually had to help out with one of the nurses and one of the transporters to move the dead body to the morgue myself. That was probably the worst day that I had.
Could I have waited? I could have. Was it a situation so dire that the physician and the nurse had to do it themselves? Probably not. But we did not know. We had waited for a few hours, we did not know how long it would take, and we knew there were patients in the ER desperately waiting for that bed.
I’m usually a colorectal surgeon. I’ve been at Mount Sinai Brooklyn for about two years now. Once all this started, I was initially asked to cover one of our med-surg floors, which is a mix of medical and surgical patients, because a lot of medical doctors were getting sick and they were getting too busy. The floor was still COVID-negative at that time, and my job was just to help expedite all the care and possible discharges. But I soon realized that a lot of nurses were out and getting sick, and the rest of the nurses were being overwhelmed because the patients were so sick and were getting worse. So I decided I would just stay there all day and help them any way I could.
I was doing things that I hadn’t done for a long time. When patients deteriorate and their vital signs become unstable, we have something called rapid response where a specialist, usually an intensivist, and sometimes a respiratory therapist and nurse practitioner and anesthesiologist, decides the patient needs intubation and take measures to stabilize the patient. So that’s something that theoretically we can do, but it happens usually once every few weeks or once a month. Suddenly, we had to do it five, six times a day, just on our floor.
It was surreal. It was a completely out-of-body experience. I was doing this and yet part of me was just looking at myself and my whole situation from the sidelines and wondering how we got there and when it would end and when the help was coming.
Fortunately, relatively quickly, that help did arrive. We got more nurses, more staff, more hospitalists. Dr. Shearer and our leadership did a very good job bringing in the resources and manpower. After about a week, there was enough manpower to cover that floor, so the whole department moved to our makeshift ICU that was created from the operative spaces on the surgical floor, and now we are assisting in running that ICU. Now that there’s help, it feels better. I don’t know how far that light at the end of the tunnel is, but it feels like we are at least detecting that it’s there.
I’ve been in the ICU now for about three weeks. I think, from a personal standpoint, the surgical team maybe has it easier than others because we’re used to being gowned up and masked for long periods of time. It’s part of our routine. But just staying in those rooms knowing you cannot take anything off yourself and that you have to be so mindful with what you touch and constantly sweating under the masks and gowns, and having the noise of the generators and ventilators … It just was like a constant noise in your head that you can’t separate yourself from.
And then the patients being so sick, and knowing that even with our best efforts, we probably wouldn’t be able to do much for them, just to support them and unfortunately watch them deteriorate and eventually die. And having to give updates to the family and initiating those discussions with a family where we try to find a way to let them know that despite our best efforts, the outcome would not be really good. I don’t even know how to say it. We started initiating discussions about the goal of care for intubated patients, and we tried to convey to the families and get our palliative-care physicians involved, but it was tremendously hard. I mean, what can you tell those families where they can’t even come visit their family members — the children who are worried about their parents, the parents who are worried about their siblings and husbands and wives? How do you tell them we’re doing everything we can, but we can’t do much, please consider letting them go, because we know they’re suffering and they’re not going to recover? But you can’t tell them that, because you understand where they’re coming from, not being able to assess and see and feel on their own. That took a tremendous toll on all of us, just communicating with families and trying to be compassionate but realistic.
I think I just got myself so physically exhausted from being there and being gowned up and masked and fully equipped and dehydrated, too, because we try to limit the number of PPEs we would waste so we wouldn’t go in and out every few minutes, and we’d try to limit what we’d drink so we wouldn’t have to go to the bathroom that often. I was so physically exhausted that I came home and just collapsed. I would maybe spend an hour or so watching YouTube videos, and then I would find myself falling asleep, and then I would wake up at 5 a.m. the next day to start it all over again.
I don’t think I’m burnt out. I don’t think any of us are. But I also think that most of us just did not have the time to stop and process. I think we just know what we need to do and we just keep doing it. I don’t think honestly that most of us have enough time to pause and really think deeply about the entire experience, and I don’t necessarily think right now would be a good time to do that. I think we just need to keep doing it and getting the patients treated and hopefully helping them, and maybe we’ll think about it when it’s over. Just show up, do your job, do what needs to be done, and there will be time to think about it later.
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