In the initial weeks of the novel coronavirus pandemic, healthcare professionals were scrambling to take care of their patients as best they could.
The evolving COVID-19 virus with no known initial treatment left them “physically and emotionally” exhausted.
Newspaper Media Group’s The Criterion Sentinel interviewed a group of female physicians, who Amie Thornton, president of Hackensack Meridian Health (HMH) JFK University Medical Center and chief hospital executive, called amongst “the point head of the spear” when talking about those on the front lines of the battle against the coronavirus.
They not only touched upon the impact of COVID, but their experiences of being female physicians today.
The coronavirus touched each of their specialties.
Dr. Ghazia Pervaiz specializes in hospital medicine attending for team health. She admitted countless patients and coordinated care.
Dr. Lisa Casale, chair of JFK’s Critical Care Committee and vice president of the JFK medical staff, specializes in pulmonary/critical care. She coordinated care via HMH Network initiatives and treatment guidelines.
Dr. Vijaya Tirunahari, vice-chair of pulmonary medicine, specializes in pulmonary/critical care medicine. She provided pulmonary consults and treatment recommendations.
Dr. Pooja Shah specializes in infectious disease. She obtained Remdesivir, the first drug approved for use against the novel coronavirus by the U.S. Food and Drug Administration (FDA), in October 2020. As such, JFK became a well-known facility for advanced care for COVID patients.
Dr. Vidya Ramachandraiah, associate medical director of the intensive care unit (ICU), specializes in critical care medicine. She coordinated care for critically ill patients
Dr. Namrata Baxi specializes in nephrology. She provided specialty care for patients with kidney failure.
First wave
During the first wave of the pandemic in March 2020, JFK University Medical Center in Edison consistently had the third highest COVID census in the state.
“Hackensack [University Medical Center in Bergen County] had the most and St. Joseph’s [University Medical Center] in Paterson had the next,” Thornton said. “We are not nearly the third largest hospital in the state so the concentration of COVID patients here was dramatic for our size hospital. Our typical critical care census would be anywhere between 30 to 40 patients. During the peak of COVID we literally had three to four times that number of patients. We turned our cardiac rehab gym into a 20-bed ICU in addition to having a 28-unit.”
At one point, all 320 patients housed at JFK were related to COVID.
“Within 10 days, my team had a census of 20 to 200,” Pervaiz said.
Casale recalls at one time her team had 100 pulmonary consults.
“I came in at 7 a.m. in the morning and left at 10 p.m. at night completely exhausted,” she said. “I don’t know how we saw all those patients, but we did.”
Baxi remembers those days leading up to the COVID storm as “peace.”
“Everyone was just preparing for what was to come,” she said.
But as the first number of patients started trickling into the hospital, it’s a storm no one could have imagined.
“Never in our wildest dreams had we thought this would be a storm that would come all at once,” Baxi said. “Usually, patient numbers go down because patients would have been discharged. This time, we would come in the next day and I wouldn’t see patients on my list because patients would have coded in the middle of the night and would have died. It’s something you didn’t expect … we didn’t learn this in textbooks coming out of fellowship two, three years ago. It’s just shocking to see this many people die.”
The trauma of the height of the coronavirus remains raw for those on the front line.
“All we saw was a lot of suffering … a lot of people dying,” Ramachandraiah said. “At that point the hospital had a policy not allowing visitors in the building to prevent the spread of COVID. Patients were either dropped off at the emergency room or EMS [emergency medical services] would pick them up. Thereafter they never got to see their family members again. The majority of patients who ended up in critical care died alone away from family.”
Ramachandraiah choked back tears recalling those moments.
“The worst part for me was just before they were place on life support (ventilator) when I had to tell them to call their loved ones, to make that last phone call knowing that they are never going to survive this,” she said. “It was really, really exhausting. The only people around these patients were the nurses and us holding their hands and there were patients that would ask me, ‘I’m going to die, right?’ looking right in my eyes and there was nothing we could do. It was hard and even now, the trauma never leaves you, but we still have to put on a strong face and move forward and continue doing what we do.”
Tirunahari said speaking to the families was “physically and mentally” exhausting.
“They are fathers, mothers, who have little children and they ask you, ‘It’s going to be OK, right?’ He [or she] has to take care of his [or her] kids … that was the toughest part,” she said. “I have two teenagers at home and just thinking about that, it’s so hard. I have no words. [All we] could do was comfort as much as we could with our words and support.”
Casale said since COVID-19 is such an evolving disease, it made treating the disease that much more challenging.
“We had no idea how to treat these patients,” she said. “These people would come to the emergency room and look fine and two minutes later they would be on a ventilator. We didn’t have the medications, we weren’t sure what we should be using. Recommendations changed pretty much every 24 hours.”
Casale is a JFK representative for a network critical care group, which met through phone calls and Zoom meetings every few days to come up with the latest updates on recommended treatment and protocols.
“Because it changed so quickly it was very scary for us to care for our patients because we weren’t even sure what the recommended treatment was,” she said.
Remdesivir
Then came news about Remdesivir, the first drug approved for use against the novel coronavirus by the FDA in October 2020. The drug is developed by Gilead Sciences, an American biopharmaceutical company headquartered in Foster City, California.
At the height of the pandemic, Shah was tasked with researching what the hospital could use to combat COVID-19. She said Remdesivir had been studied initially to treat Ebola, a deadly viral infection.
At the time, Gilead Sciences was only releasing its drug when asked personally by healthcare professionals for use in intubated patients.
“It was this whole process and we had to wait for a positive swab,” Shah said, noting at that time results were taking days to come back. “Then Gilead changed their minds; rather than the company decide, they would have dedicated hospitals with a protocol set up and one physician in charge at a hospital to decide if the patient met the criteria required for the drug.”
Shah said with a little bit of luck she was able to get in touch with someone at Gilead to pitch JFK University Medical Center as a dedicated hospital.
JFK was initially one of only three hospitals in the state dedicated to administering Remdesivir.
“When people heard we were giving [Remdesivir], we were getting people from other states,” she said. “It was something we could offer our patients. All of us can attest, we talked to a lot of family members and had difficult conversations. It was never an easy conversation. I felt us having something, we could say to the families, ‘We have this drug, we are doing everything for your loved one, this is the best thing I can offer.’ It gave the family something at least, a feel that we are all working together, and we are doing everything to save their loved ones even though we don’t know if they are going to survive or not. I wanted the families to feel like we did everything we could within our power. I didn’t want them to come here and think they were just going to die,” Shah said.
The unknown
Long days at the hospital and concerns of bringing COVID home weighed heavily on the minds of the physicians.
“I quarantined myself at home for half of April [2020],” Baxi said, saying she told her loved ones, “Don’t come near me.”
“I have two little kids, but I also have in-laws, who are obese and diabetic. They stay with me. Initially it was all the older people with COVID … we didn’t really know how much to be careful,” she said.
Casale said she took her clothes off in the garage at home.
“It was pretty scary,” she said. “I had a trunk full of PPE (personal protection equipment) that I had just in case if I needed to get something from the car quickly.”
Pervaiz said she didn’t take her shoes into the house for months.
“I wipe them down when I leave work now and put them by the front door and everyone knows not to touch them … even my baby, who is three now, he knows not to touch them,” she said.
Pervaiz added during that time she was reminded by her oldest child to smile.
“I went home late as the norm and I was putting my kids to bed,” she said. “My 6-year-old daughter said, ‘Mommy, can you at least smile for me?’ I realized at that moment I hadn’t even smiled for so long.”
Teamwork
The pandemic brought the teams at the hospital closer together.
“All of us talked to each other multiple times a day,” Shah said. “I think my phone would go off and it would be a message from each one of us in this room and other groups obviously. Mainly we all worked together so well during the pandemic, and it just made our bond even closer.”
Casale said the pandemic has made everyone stronger and emphasized teamwork.
“We still continue to work close together to provide the best care for the patients and provide the latest treatments and we all speak to each other multiple times a day,” she said. “There is a lot of communication and a good support system at JFK. The administration tries to support us, too, and help us with the care of patients.”
Casale said it’s important to have someone who cares about the physicians at the hospital. She said administration, led by Thornton, is very easy to communicate with. They have an open door policy and they are ready to listen to requests, problems and accommodate patients.
“It’s one of the great parts of JFK,” she said, adding everyone can call each other at any time.
Thornton provides updates on a daily basis on the happenings of the day. Pervaiz said she still looks forward to those updates.
“I would read them, it’s the last thing I did when I went to bed, and still do,” she said. “Just having one person there keeping track of everything, pinpointing things, highlighting them and adding something positive at the end – I think some of those darkest days, it provided everything is not all bad. It will get better at some point. I love those updates.”
With all the support, Pervaiz said it allowed everyone to do what they needed to do and get through the hard times.
“My medical director, anytime he could look at the schedule and give me a day off, he’d give me the day off rather than take the day off himself,” she said, letting her spend time with her children. “It’s the little things like that that got me through the worst part of it.”
Today
It may not currently be the height of the pandemic, but the physicians said they still make those difficult phone calls.
“We still have a lot of unvaccinated patients coming in,” Casale said, noting more younger patients are also admitted to the hospital.
Thornton said every COVID case is intense. The hospital tracks the COVID numbers on a daily basis.
“At the very peak, the entire hospital [was COVID patients], anything that could possibly hold a bed,” she said. “By summer of 2020, we actually had a period where we thought we might get down to zero COVID patients. We got down to 10 to 12 [patients]. Then as variants started to be introduced and winter came last year, what we call wave two, Thanksgiving, Christmas into January, I think we had 120 [patients]. Not nearly what we had in the first wave.
“Then this summer, we thought we might have a day we never thought it would go away from the environment, but I think we got down to three patients on July 3. Recently we’ve seen the delta variants and have seen a spike up,” she said.
For the past several weeks, the hospital has seen 20 to 30 COVID patients daily.
Thornton said the HMH network has mandated the vaccination for employees except for those with compelling medical exemptions.
“We are at 99% staff members and physicians all vaccinated,” she said. “It’s not 99% [vaccinated] in the community so people are still getting COVID and getting sick enough to be hospitalized.”
Shah said treating unvaccinated patients has been a challenge.
“We’ve all seen what COVID does firsthand,” she said. “There’s so much you can do to help them. We’ll give them all the care we can, but we just know that we need more people to get vaccinated.”
Pervaiz said on a positive note, vaccinations for children are in front of the FDA. Federal public health officials on Nov. 2 issued an emergency authorization for a low-dose version of the Pfizer-BioNTech vaccine for children ages 5-11.
She added for those who are pregnant or thinking about getting pregnant, the vaccine is important. She said they have seen firsthand how sick a pregnant patient with COVID can get.
The role of female physicians
“All these women came to work every day and did the toughest work, just as hard as their male counterparts, but then they had to go home and take care of their families as well,” Thornton said. “It’s not just the [actress] Ginger Rogers doing everything men do backwards, forward and in heels. It’s also having a whole other set of expectations … worrying about what’s going to happen to the teenagers, the 1-year-old, the 3- and 4-year-old, and 2- and 5-year-olds. It’s a different pathway to be a women physician, it’s the expectations.”
Thornton said the hospital’s chief of emergency physician, a male, literally lived in his basement for three months.
“His family had a tray of food for him downstairs and laundry to change into the next day,” she said. “It’s not to say he didn’t have an enormously hard job, he did, and we think he walks on water, but everybody here had to make sure the laundry was done for their families and there was food ready. And more than that, be that emotional support to their kids and their families.”
Baxi said at the height of the pandemic she could only quarantine for 10-to-14 days before the responsibility of being a mother kicked in.
“You have to take care of your kids,” she said.
Ramachandraiah said she didn’t have a chance to quarantine.
“There was no way,” she said, noting her kids were ages 1 and 3 at the time. “There was no way to tell them ‘You can’t come near Mommy.’ You can’t even wear a mask around them.”
Baxi said her children would pull off the mask.
Tirunahari said it was even hard around her children, who are in their teens.
Shah said even though she does not have kids, she worried about her parents. Her father is Dr. Pradip Shah, president of the medical staff at JFK University Medical Center.
“I didn’t want him to get COVID,” she said. “I was always afraid because he’s older and you just start to worry a lot. I took a lot of the responsibilities away from him. I would see more COVID patients … I did the best I could do.”
Shah also said even though her parents live near the hospital, and she lives 40 minutes away, she would do the commute back and forth because she didn’t want to go anywhere near her family.
“The fear of [COVID] is always there,” she said. “All of us had the fear of giving [loved ones] the disease at home, whether it was young kids, teenagers, significant others … I remember everyone would come and ask me questions ‘Pooja, I have kids what do I do?’ The kids are not going to understand … at the end of the day they just want a mom’s hug.”
Pervaiz said her 6-year-old daughter knows about COVID and that it makes people die. She said she has a lot of family support, but she worried.
“I live with my in-laws and they are my kids’ primary caregivers when I’m at work,” she said. “That was another challenge. Am I giving it to them? Am I exposing them? I worried about it. I also worried about my 6-year-old with home school and no social outlets.”
Pervaiz said she sought help from her daughter’s school counselors.
“The school counselor said the more you act normal around [your children] and they see you take care of yourself the better it is for them,” she said.
Casale said a good support system is very important, whether it’s physicians supporting physicians or support from relatives and spouses.
“It makes it easier to work together,” she said.
In one of her daily updates to the hospital staff, Thornton shared her take on the interview and listening to the physicians recalling the first COVID wave.
“I could never do justice to sharing their stories … but I can share the impact they have made on me,” she said. “At its heart, their experience was similar to their colleagues and partners, male and female, who lived through the first wave, courage in the face of risk and uncertainty, compassion when patients were facing dire circumstances without family at the bedside, dedication and grit when the demands far exceeded capacity, qualities evident to all who were here on the front lines.”
What doesn’t meet the eye is their ability to gain strength from one another, their willingness to lean on one another and their openness to name the struggles and fear, Thornton continued.
“These qualities are a different face of courage and strength and are uniquely meaningful in an everchanging world,” she said.
Contact Kathy Chang at [email protected].