Teams across MedStar Heart & Vascular Institute have responded to the crisis by helping healthcare colleagues outside of their cardiovascular specialties.
In more than one instance, electrophysiologists and general cardiologists assisted in seeing patients in the emergency department overflow unit at MedStar Washington Hospital Center. Covering this unit decompressed the main emergency department, allowed those dedicated providers to focus on high acuity coronavirus patients, and protected other patients from unnecessary exposures.
Cardiology hospitalists and Advanced Practice Providers also helped staff a general medicine unit to relieve hospitalists working overtime to treat COVID-19 patients. Sarfraz Durrani, MD, an electrophysiologist, recounts his personal experience of redeployment.
I began my medical career in Kashmir in the early 1990s, during the civil unrest in that state. At the time, there were daily pitched battles in the streets of the capital city of Srinagar, and we received casualties in the ED, sometimes even in the middle of the night. It was a harrowing time, and we lost a lot of our patients. We ran out of medications and operated with search lights. Just going to the hospital and returning home was fraught with danger. From that experience, I learned to control my fears and focus entirely on taking care of my patients.
Since that time, I have lived through the AIDS crises in New York during my residency, worked in refugee camps during the war in Albania, trained doctors in remote places like Tanzania and back home in Kashmir. I have climbed tall mountains and hiked treacherous trails. I was certain nothing I do now in my work would ever faze me.
The day I volunteered to take care of the COVID-19 patients, I thought I was emotionally prepared for anything I might encounter. I had first taken care of my home responsibilities. My 87-year-old father is living with us: He was visiting from India and has been stuck here for the last few months. To protect him and the rest of my family, I moved into our basement, to minimize everyone’s exposure, in case I contracted the disease. I felt ready to spend a week on the hospital’s COVID-19 floor.
But this work was like nothing I have ever experienced—more emotionally challenging, more frightening. As physicians we learn to deal with our insecurities—and mask fear. Appearing fearless is simply part of our profession. But in this pandemic, we providers are part of the story, and I found I was monitoring myself for symptoms as closely as I was monitoring my patients.
During the last three decades as a physician, I have seen some patients who are relaxed, some resigned, and others scared. Usually, I walk into their rooms, confident that I can reassure them. But this is the first time I saw fear in my patients’ eyes, and I hoped they did not see the same in mine.
I wanted to give these patients the sense of calm that they deserved, and it didn’t take long for me to become relaxed and my own fears to slip away. But I also let down my guard, and soon realized that this could also lead to carelessness in protocol to gown/glove and to deglove.
When one of the patients required a rapid response, I could see how my carefully thought-out ritual of self-preservation could quickly spiral out of control, and into chaos. Then I saw this amazing team fly into action. They had always been there, dealing with these situations all along. Everyone was calm and focused, and the situation was managed, and chaos reigned in.
I learned a lot in just a few days about medicine and about humanity as I covered the COVID-19 floor. I am sure we are all reflecting on this and more, and learning something new about both. I can’t stress enough how impressed I was by the nurses, technicians, hospitalists, NPs, cleaning crews, and techs who continue to work with the COVID-19 patients. They will be doing this day after day, long after we, the temps, are gone. They are the real fearless heroes, and deserve a medal for putting their lives on the line every day. Meanwhile, the fight goes on.
—Sarfraz Durrani, MD
Lessons in medicine and compassion.
Physicians in our Graduate Medical Education program play an essential, ongoing role to provide the highest quality, safest care for our patients. Throughout the course of our response to the pandemic, cardiology fellows and residents continued to learn and to work. They each spent time in the ICU, caring for patients who were both COVID-19 positive and negative.
In one particular case, a COVID-19 patient at MedStar Washington Hospital Center began to decompensate overnight, with several ventricular tachycardia incidents and a rapidly dropping oxygenation level. Cardiology fellow Zyad Qamer, MD, was called to provide care for the patient. He made sure the patient was comfortable, and talked to the patient about his impending death.
The patient said his only wish was to see his wife one more time. Dr. Qamer diligently called the patient’s wife every 30 minutes, until she finally answered around 1 a.m. He spent the next 45 minutes helping her set up FaceTime® on her tablet, so she could interact with her husband. He also followed up with hospital leadership to get the wife approved to come to the hospital. Dr. Qamer then organized transportation for the wife and talked to her while she was on her way.
When she arrived at the MedStar Washington, Dr. Qamer met her at the entrance. He explained to her what she should expect when she saw her husband, which eased her pain at seeing him in his condition. The patient was transitioned to comfort care and died within a few hours. But thanks to Dr. Qamer, both the husband and wife had some peace during the last few hours of the dying process