From the front lines: 3 physicians share vital COVID lessons
Key Takeaways
COVID-19 left its mark on American physicians, but sharing their experiences may offer an opportunity for healing.
These three physicians’ stories offer vital clinical lessons from battling COVID-19, along with effective coping strategies.
With so many unanswered questions lingering 2 years after the height of the pandemic, these doctors also offered a glimpse of what may lie ahead.
No physician has come away from the past 2 years unscathed. The mental anguish and fear of serving during a pandemic, the fraught political climate, and the virus itself have all taken their toll on doctors. But from COVID’s chaos emerged some valuable clinical and life lessons. Perhaps both can be medicinal.
MDLinx interviewed three physicians, two of whom were in the thick of the pandemic’s dark, early days in New York City. While the situation has improved, these doctors’ experiences reflect a healthcare system and a nation forever changed by a global pandemic.
An emotional experience
For Jayram Pai, MD, an EM physician who spent 2020 as a Mount Sinai resident, the fear and anxiety of working amid a global pandemic was twice as intense. His wife (then his girlfriend) was a pediatrics resident at the time. He said the dire nature of the situation hit as he was helping her review adult critical care to prepare for extra ICU shifts.
"We both had a sense of duty, of what needed to be done—living up to your moral and ethical obligations as a physician. "
— Jayram Pai, MD
“But you don't want to see your girlfriend do that," he continued. "Every day, just wondering, ‘Is she going to develop any symptoms? Is she going to get sick? Is she going to die?’ For me, that was far worse than any personal concern of getting sick.”
Fear was a constant companion for Jillian Gansert, MD, as well. At the height of the pandemic, Gansert, an FM physician, had 200–400 patients testing in her hectic West Philadelphia outpatient office. Like so many other doctors, Gansert’s fear extended beyond concerns for personal safety.
"I felt fear and exhaustion often, but I felt most afraid for my peers who were seeing patients who were acutely infected in the hospitals," she said.
Trevour Pour, MD, also an EM physician working in New York City during COVID’s peak, took some solace in his low-risk profile for COVID, but this did little to assuage his concern for others.
"I will say that the uncertainty was challenging."
— Trevour Pour, MD
Pour said. “The main fear I had was infecting other people, because I realized that there was a decent window of time that you could become infected, not know it, and be a carrier.”
Regardless of these concerns, each of these doctors (like so many other HCPs) did their duty in the face of existential risk. How they got through the pandemic reveals the grit and resilience of their profession, as well as some strong coping tactics.
How they coped
When faced with radical uncertainty, many people take solace in what they do know. That was the case with Dr. Pour. His clinical instincts, it seems, kicked into overdrive.
“I definitely coped with the uncertainty by just devouring whatever available literature there was on the topic,” Pour said. “I was reading dozens of journal articles a week, just trying to wrap my head around the available data because I didn’t feel like I was getting a great synthesis of information from any source.”
As a resident, Pai pulled through by leaning on his senior attendings and ED leadership—people like Pour.
“It’s odd, because you don’t feel like the people that are in charge of you have a vast amount of knowledge about this particular disease more than you do,” Pai said. “But still, they took all of the experience and knowledge they had in everything that was as relevant as it could be, and they were still really good about taking us through the best way to manage the limited information we had at the time.”
Gansert also drew inspiration from her colleagues and the examples they set.
"I feel honored to have worked with so many brave healthcare and other essential workers who continued on in the face of danger and uncertainty. "
— Jillian Gansert, MD
“I faced less risk than a lot of my peers, but it is humbling to have been a part of the worst of it and to have made it to the other side stronger.”
Part of that strength stems from the myriad clinical lessons that were drawn from fighting COVID-19.
What they learned
When asked what he knows now that he wish he knew in 2020, Pai said:
“I mean, all of it, right?”
His answer speaks volumes to the colossal amount of uncertainty faced by physicians. Examples of this, Pai said, are intubation protocols. He explained that at the time, SOP was to intubate anyone with low oxygen saturation. He said that a pressing concern was that the nasal cannula would aerosolize the virus, jeopardizing everyone in the room.
The other major lesson for Pai was the clotting propensity of COVID patients.
“I’ve seen some people that have really no clotting risk factors other than having COVID, and they’ll throw a lot of clot,” he said. “And I’ve seen other patients who have clotting risk factors who’ve not thrown clots. It’s odd.”
Pour also said the main lessons he learned were in how to treat COVID.
"The iterations of treatment that we’ve gone through since the beginning have been well-intentioned, but we frequently missed the mark."
— Trevour Pour, MD
“I wish I could go back and just say, ‘Treat these people the way you would treat someone with RDS’—maintaining oxygen saturation, intubating only when necessary, getting steroids—doing the things that are just good critical-care techniques,” he added.
Of course, all of these clinical lessons were hard-earned. The American milieu is not what it was in 2020.
Public perception
Regardless of one's politics, it’s undeniable that the pandemic has become politicized and has been for some time. Perhaps as an unintended consequence of that politicization, many of the pandemic’s lessons remain unlearned.
One of those lessons is that COVID-19 is an evolving entity. The situation today might not be the same in 3 months.
"A lot of people feel like COVID is ‘over,’ but there is still some risk. "
— Jillian Gansert, MD
“It's important to weigh that risk against other risks—lack of social interactions, mood disorders, etc. Using a rational risk-benefit system could be useful in avoiding the most ‘risky’ activities while still maintaining a more normal life,” Gansert added.
That level of nuance presents a communication challenge—one that public health officials have yet to master. We’ve learned a great deal about COVID, but there are still many unanswered questions.
“Will it just become a seasonal coronavirus, or [occur] throughout the year [creating] a virus syndrome?” Pour said. “Or is it going to turn more lethal again? I’m not sure that we’ve done a great job at being clear with the public about all of these different variables, because it’s complicated."
“For someone who doesn’t really understand virology, it might seem like we just don’t know what we’re talking about.”
Pai said that amid the political battles, something simple has been lost.
"Some kindness—I can’t tell you how far that goes."
— Jayram Pai, MD
Pai recalled patients who accused him of faking their COVID diagnosis, one who tried to spit in his face, and others who refused tests because they were convinced he’s “getting paid to falsify the swab results.”
Pai, and so many other healthcare workers, aren’t asking for much.
“It doesn’t need to be a thankful patient,” he said. “It doesn’t need to be a patient who’s overly grateful. Just a patient who’s kind.”
What this means for you
The interim since the height of the pandemic offers all clinicians the opportunity to reflect on their experiences, and hopefully heal from any trauma they might have experienced. The time that’s passed also affords you the chance to reflect on the clinical as well as the social and personal lessons of COVID-19.