David Kaufman, M.D., Reflects on Experiences During Pandemic
Our story begins in earnest in early March.
At Strong, we were lucky. We worked with incredible people.
We were lucky. We had leadership who trusted we would make the right decisions and gave us direction when there were honest differences of opinion. We had leadership who, from the get-go, placed patients and personnel above fiscal concerns.
We were lucky. We had creative hospital engineers who worked with wise hospital epidemiologists to jury-rig existing intensive care units so every room had negative pressure, thus protecting personnel just outside these rooms. No other hospital engineers in the region were able to accomplish this feat. Additionally, our hospital epidemiologists made sure we were able to don and doff our PPE according to best practices with just-in-time training.
We were lucky. We had Environmental Services personnel making sure our spaces were clean and workable and trusting in their leadership that it was safe to come to work despite some of the rumors.
We were lucky. We had pharmacists, always intelligent and always up to date, who made sure we were using our medications smoothly and safely.
We were lucky. We had Clinical Resource Nurses in the COVID ICUs and, as always, in every nook and cranny in the hospital, doing all aspects of air traffic control.
We were lucky. We had experts in Infectious Disease who took on the arduous task of deciding which potentially antiviral medicines were safe to use and under which circumstances. As everyone knows this algorithm was not just a moving target but one that would zigzag as well as accelerate and decelerate with alarming frequency.
We were lucky. We had colleagues who created on-call teams to place arterial and central lines, to do percutaneous tracheotomies, and to turn the most critically-ill patients into the prone position. We had a cardiologist do all necessary echocardiograms and create a protocol for codes so we could safely resuscitate both COVID positive patients and those ruling out for COVID.
We were lucky. We had our colleagues in the CICU who came into the HIDU on a moment’s notice when we were reaching the limits of conventional ICU support and considering ECMO.
We were lucky. We had nursing colleagues from Pediatrics, Med-Surg, the OR, the Cancer Center, the ED, Ambulatory Care and Imaging Sciences who came into the HIDU to extend our reach or to pick up our non-COVID responsibilities, some once worked in the ICU and some never did. Regardless, they all came.
We were lucky. We had the next generation of physicians, URMC’s medical students, assisting our Respiratory Therapists by getting ventilators ready for patient use.
We were lucky. We had colleagues in Palliative Care who had virtual conversations with patients’ families, doing one of the many things they do best, having difficult conversations with the greatest care and compassion.
We were lucky. We had ethicists who put together a protocol that would allow us to save the most lives if we were ever unable to give everyone who needed a ventilator a chance.
We were lucky. We had selfless colleagues in the ED and our hospitalists on the floors who recognized when to bring us patients and then figured out how to get them home safely.
We were lucky. We had Supply Chain experts and Equipment Technicians who worked tirelessly to make sure we would never be wanting for something necessary. They kept us stocked from PPE to medications to equipment.
We were lucky. We had surgeons who made the difficult decision of who had to have an operation and who could wait. Sophisticated choices that required them to simultaneously think about the patients under their charge and the looming pandemic.
We were lucky. We had dedicated anesthesiologists and OR staff who kept the lights on and helped turn the PACU into a SICU.
We were lucky. We had Primary Care Physicians who helped us communicate with families who we were unable to meet face to face.
We were lucky. We had Patient Care Technicians, GeroPsych Specialists, and Unit Secretaries who do what they always do, make units function seamlessly from one moment to the next.
We were lucky. We had industrious Social Workers who worked their magic, as they always do, to help us navigate care for so many families under the usual stress of having a family member with a critical illness and the additional weight of pandemic restrictions on hospital visitation.
We were lucky. We had Neurointensivists who shared their expertise and technology to help us investigate both primary and secondary neurological complications in COVID patients.
We were lucky. We had specialists ready to assist us day and night with both our usual complex patients and complexities unique to COVID.
We were lucky. We had scientists who put aside their own beloved work and helped solve our problems with a creative spirit and a rigor that helped us decide what to do and what not to do.
We were lucky in the ICU. We had each other. Nurses, who have always given, give more than is conceivable, more than is imaginable, and more than is fair to ask of anyone. We had student nurses at the ready and at their side. We had APPs and residents who ran to danger intelligently but with gusto and a desire to treat those who needed them the most. We all had Respiratory Therapists at our side, some of the bravest souls imaginable who did their jobs fearlessly. We had Attendings who were unbridled in their ability to rise above and beyond what we could expect. As the number of units increased from first one HIDU to six, more and more Intensivists were lining up to manage new and perplexing twists on old foes like ARDS and sepsis.
At Strong, we were lucky. We were together. A family. Never alone. In the words of the 17th century English poet John Donne:
No [hu]man is an island entire of itself; every [hu]man
is a piece of the continent, a part of the main;
if a clod be washed away by the sea, Europe
is the less, as well as if a promontory were, as
well as any manner of thy friends or of thine
own were; any [hu]man's death diminishes me,
because I am involved in [hu]mankind.
And therefore never send to know for whom
the bell tolls; it tolls for thee.