Reopening New Jersey:
5 Lessons for Frontline Workers to Remember in the Second Wave of COVID-19
At the start of the pandemic, outside of one of the New Jersey hospitals where I was on call, there were two trailers packed with bodies. You could not do a lot as an interventional cardiologist except watch patients die from afar, which made me feel powerless. Every day, the body count grew larger and I knew I needed to do something.
Volunteering and risking your life during a global pandemic is a dangerous thing to do. I was scared — but then I overcame my fear. I heard my local hospital was short-staffed and needed hospitalists for COVID-19 patient care. I was tired of sitting on the sidelines and volunteered.
On my first night, I responded to a “COVID code blue.”
We had no clarity about how or if PPE worked and the federal Centers for Disease Control and Prevention had just changed the guidelines about not needing N-95 masks, which none of us believed. I saw one of my favorite nurses crying outside, and upon inquiring, it turned out the patient was the nurse’s brother-in-law.
I entered the room and to my surprise, CPR had not been because nobody knew what the protocol was for COVID-19-driven cardiac arrests. Someone said they’d read an emailed memo saying we should not be running codes or performing CPR on COVID-19 patients, so for as long as four minutes — it seemed like an eternity and is probably an eternity in terms of reviving brain function — nobody performed CPR.
I was not sure if I should instruct the team to start doing CPR to make the patient feel like we were doing something. Doing so, I thought, could have made the team vulnerable to COVID-19. I wanted to check that memo but it didn’t seem like the right time to open an email.
I made the decision to start CPR and asked the team to join only if they felt comfortable doing so. I led the code process while doing CPR and instructed the team to give epinephrine and other drugs. To my surprise, two other physicians decided to come and help out and an anesthesiologist also came later.
Unfortunately, the outcome was inevitable. The brother-in-law of that nurse, just like 132,000 people in the United States (and counting) did not survive despite all our best efforts. To this day, when I see that nurse, I sense a feeling of gratitude for the final effort we made and for not giving up.
Many health care workers acquired fatal COVID-19 during a code situation — many health care workers died trying to save patients. These were otherwise healthy doctors and nurses who were infected while trying to save patients. As doctors, we must never forget the doctors who died fighting to save another life. The pandemic is the 9/11 of our generation and we must do all we can do remember every life lost during this war.
So, what else did I learn as a volunteer in New Jersey COVID-19 units?
Here are five lessons I learned volunteering as a doctor during the pandemic.
1. Teamwork is critical. This experience has humbled me and has had a profound impact on how I view the importance of teamwork in the hospital. As a vascular specialist, I consider myself old school. However, during this time, I learned that no job is too big or too small and that all hands-on deck are required.
2. Be humble. I wanted to be there and make a difference and I learned that the best way to make a difference is to check your ego at the door and do any job that is required, regardless of your title, seniority or medical training.
3. The health care system must change. The need for change in the health care system is necessary and inevitable. The bureaucracy at the top of the hospital system impacts every other branch of the hospital and its ability to run efficiently. This must change.
4. Your zip code impacts medical treatment. As Americans protest throughout the United States, it is important to understand the role of inequality in medical treatment, too. Many Americans do not realize that people in larger cities and more desirable places to live will end up having access to better health care facilities and a better talent pool of doctors. Unfortunately, underserved rural and urban areas with poorly-insured patients are less likely to get talented doctors and state-of-the-art medical facilities.
5. Do not silence doctors. Every hospital has a media policy when it comes to making press statements or giving interviews. However, during a time of crisis, it is important to sometimes put these policies to the side to make sure doctors are free to speak independently about conditions like PPE shortages. Because of the brave voices who spoke up about this, thousands of people rallied around the country to donate PPE. If those doctors were silenced, many doctors might have never received the PPE they desperately needed. Media policies should never come at the expense of public safety and health for all: this includes the health of the physicians, too.
Dr. Anuj Shah, MD is an interventional cardiologist and vascular specialist.
