Frontline Fighters Against the Pandemic
These medical professionals in the metro Atlanta area, like their global colleagues, have been at the forefront of the fight against the Covid-19. We talked to them to get their unique perspectives: What’s it like to be a soldier in this bizarre war against a virus? How has this crisis affected doctors professionally and personally? How well-prepared are Georgia’s hospitals to take on a Covid-19 surge?
“It’s almost like walking into a war without armor and ammunition,” says Dr. Nithi Anand, neurologist and headache specialist with WellStar Medical Group in Marietta, Georgia.
All the doctors we spoke to, from physicians specifically engaged with Covid-19 patients to specialists from other disciplines, agree that the advent of the coronavirus has dramatically altered their regular medical practice and hospital routines.
Dr. Usha Anand, physician at Kennestone Hospital and Team Lead for the hospital’s Emergency Covid-19 Surge Plan says, “We are no longer just able to walk in and check on a patient. We have to be prepared ourselves first, with proper personal protective equipment. I think that makes a lot of difference, because there is fear to go in and see a patient without it. Also, the [rapidity] with which patients go down, makes us more concerned than usual.”
Dr. Mini Gupta, pathologist at Atlanta Kidney and Hypertension, paints a stark picture of the pandemic: “The number of patients that are critically ill whom I visit at the hospital has literally doubled. Patients appear stable, and then in the next 48 hours we find them in the ICU. It’s very heartbreaking for us to see our patients suddenly deteriorate and we feel helpless and frustrated.”
As a pulmonary critical care specialist, Dr. Neelima Kothari is right in the midst of the action. “Covid-19 Pandemic just raised awareness of how important breathing is in our lives. Most symptoms patients are experiencing are [difficulties] with upper airways and lungs, fever, coughs, shortness of breath, etc. When they come to the hospital with these symptoms, the first thing to watch is their oxygenation. A patient can deteriorate very fast if the oxygen demand [is not met]. We have also seen patients that come in with little or no oxygen and within hours, their oxygen levels have surged. That is why the practice has become so demanding and critically overwhelming, currently. Albeit it is the time of the pandemic, but we as professionals have to ensure to exclude all other possibilities such as asthma, COPD (Chronic Obstructive Pulmonary Disease), atypical pneumonia, issues with deficiency of breathing, etc… It is challenging to accommodate all these patients coming to the hospital. Basically, that is the big difference right now.”
|“We have spent most of our adult life building ourselves, honing our skills to practice our profession. I don’t know what to do other than dentistry, but I don’t want that to become my death sentence,”|
The focus on treating Covid-19 positive patients and the intense efforts to prevent its spread has meant that specialists from varied disciplines are enormously challenged in delivering the critical care needed for their patients. Marietta-based gastroenterologist, Dr. Sachin Goel, says, “Patients with inflammatory bowel disease, colon cancer, etc., still need care; they need interventions, procedures. Because of the shutdown and the social distancing, the ability to deliver that high level of care has been compromised. We have tried to work around that with selective scheduling of our procedures, but the challenge remains for the outpatient side. On the inpatients side whom we take care of in the hospital, we could be asked to consult patients who are either sick with Covid-19 or who are suspected; they are called ‘persons of interest’ or POIs, and so we have to take appropriate precautions.”
Dr. Paulomi Shroff, a specialist in breast surgery with the Philip Israel Breast Center, rues the loss of human touch at her practice: “We [used to] spend a lot of time with patients under diagnosis, touching them during review, just trying to offer them comfort. Unfortunately, we will be doing less of that as the interactions are happening at a significant distance.”
Telemedicine, now an imperative in the medical world to prevent the community spread of Covid-19, has dramatically changed how doctors interact with their patients. Says Dr. Paulomi Shroff, “Medicine in general is slow to change, slow to do things differently. This, we had to adapt to, literally overnight.” How do patients react? Dr. Nithi Anand says, “Patients are much more willing to do a video visit rather than postpone their problems, especially knowing that they don’t have to come out of their safe zone. Looking at the future, telemedicine is going to be part of our practice going forward. Covid-19 simply made us quicken the whole telemedicine process.”
Businesswise, one discipline that has been hit especially hard by the pandemic is dentistry. Dr. Nalini Kataria, a general dentist at Roswell, Georgia, had to close down her practice and lay off her handpicked staff. Besides the impossibility of practicing social distancing with patients, given the nature of her work, she also had to consider, the safety of her staff and elderly parents who live with her. It has been an emotionally draining experience, states Nalini. “We have spent most of our adult life building ourselves, honing our skills to practice our profession. I don’t know what to do other than dentistry, but I don’t want that to become my death sentence,” she says somberly.
Seeing how she and her practice were so vulnerable to the virus, Dr. Kataria decided to channel her free time towards creating a cost-effective mask that would “protect me, my staff, and my fellow dentists from contracting any disease like coronavirus. It started with stitching home-made cloth masks and very quickly I graduated to [using] 3D printers to make masks with filters and seals around them. And today, I contacted 3M to try and find out how I can test my mask, and apply to FDA to get it approved.” Keeping in mind the continued rise in the cost of healthcare, she wanted an affordable solution that could be reused while protecting the practitioners as well as the patients.
Is Georgia ready if a surge happens?
On an encouraging note, most of these doctors are confident that should there be a surge in Covid-19 cases, local hospitals are well equipped in terms of personal protective equipment and manpower planning. Mini Gupta says: “We, in Georgia, had some time that places like New York probably did not have. So, I feel that the hospitals here are definitely better prepared, than they have been in other places, where working has just changed uncontrollably, and overwhelmed the system. We do not have a dearth of masks and gowns because they are only given to people who need it.”
Paulomi Shroff emphasizes the effort to judiciously conserve resources: “We used to use one mask for every operation; now we use one mask for the whole day. We use the same mask when we go around the floors to check on patients because we don’t want to waste resources.”
Usha Anand, who is with the emergency surge plan at Kennestone Hospital, says: “I had reached out to primary care physicians, specialist, and family physicians, and many of them volunteered. We now have almost 70 physicians on the backup plan, in case our hospital is overwhelmed and our doctors exhausted. As compared to New York, I think we had some time looking up and building strong protocols to prevent things from going very bad. We do have enough ventilators and stuff like that in our hospitals. So, I’m hoping that the surge will not happen and will get controlled like this.”
Dr. Sahir Shroff, a cancer surgeon, emphasizes that there’s no room for complacency or cynicism about the pandemic: “There is an impression that people are overreacting or blowing things out of proportion. This is not true. People are dying, this is not a normal flu. This is a significant health crisis. When you visit one of those ICUs when you see patients critically ill and frothing, you begin to understand how significant this problem is. We should follow CDC guidelines and when it’s time to come back to whatever normal looks like, we all have to be socially responsible. Getting back to normal can’t mean that suddenly one day the light switch is on and we can all hang out together, from less than 10 people in a room, to hundreds going to a ball game together.”
How not to bring the virus home
Inevitably, the pandemic has greatly impacted the personal lives of these medical professionals. Every one of them has a special routine for re-entering their homes after work. Lab coats, masks, and stethoscopes remain out of the home in cars or garages. Returning from hospital duty, there’s zero interaction with family members until they have completely sanitized themselves. Says Mini Gupta, “I have friends with elderly parents who stay with them, so when they have a hospital rotation, they literally, for a week, don’t meet with their parents. They isolate themselves in the basement or a room in the house, just so that the week goes by.”
Keeping away from kids to ensure their safety can be extremely hard. Neelima Kothari’s daughter is a special needs child and is highly vulnerable to disease and infections. She says, “Albeit I have showered and changed and washed my hands multiple times, I’m still worried that if I touch her, my daughter can get contaminated, get sick, and deteriorate quickly. She cannot express herself, so I have not touched her in the last one month, so I’m sure internally she must be emotionally disturbed. That has been very challenging.”
“Especially nurses and the EMS personnel—they are really on the frontline. The ICU doctors—they are the ones who really deserve our gratitude. They are the ones who are taking the brunt of this. They are doing the lion’s share of all the work and they deserve all the credit.”
Usha Anand, who spends her working hours with Covid-19 patients and in the hospital Emergency Room, showers in her basement bathroom, wears a mask at home and frequently washes her hands. “At home, I’m mostly in the basement, but I just come up to hang out with [the kids] so that I don’t miss them and they don’t miss me. When I am there, we go for a walk, and they are on the bike, on the side. Mentally, I feel I have to be away from them, but I can’t, so I’m working midway. I can quarantine completely in the basement but it’s so hard for me and the kids. So, we settle it this way; but I do feel guilty.” Husband Nithi sums it up, “What we thought was safe today, is not safe the next week. It’s certainly a cause of fear and anxiety, even at home. We just don’t know what the right thing is.”
Amidst the uncertainty of their days, the children seem to have adjusted well. Online classes from school keep them occupied during the day. While social restrictions are frustrating for teenagers, many of them keep busy with community service projects from school. Sachin Goel says,” My daughter has done her part with 3D printing face shields etc., which they supply to various medical facilities.” His wife, Mini, adds,” They’ve seen the emotional side of being a physician, so I think they’re used to that when we talk to them about patients passing from Covid-19. They know the right thing to do. I think, that knowledge is helping them, and that it’s ok as long as they follow certain basic rules.”
Dentist Nalini Kataria’s children share her passion for making improvised face masks for use by healthcare workers. Neelima Kothari’s younger son, works with a school group using the school’s 3D printers to make face shields for medical professionals. Says Neelima: “I want to stress that the next gene-ration is very thoughtful and I appreciate their understanding of the circumstances.”
A new appreciation for healthcare professionals
Paulomi Shroff hopes that the pandemic will alter the popular perception of medical professionals as people who make money out of others’ misery. “This will at least change that image of the healthcare professionals in people’s minds. They will more likely be respectful of healthcare workers where previously, they were not,” she says. It’s not only the doctors whose efforts and sacrifice must be acknowledged. Sahir Shroff says: “Especially nurses and the EMS personnel—they are really on the frontline. The ICU doctors—they are the ones who really deserve our gratitude. They are the ones who are taking the brunt of this. They are doing the lion’s share of all the work and they deserve all the credit.”
Pathologist Mini Gupta is even more emphatic, “I think that a lot of people on the frontline who were not appreciated till now—the cafeteria workers, the environmental people who work with lower wages, but don’t get the glory for working as hard as any-body else—will be truly appreciated. Imagine if I had to sterilize a room after it was occupied by a Covid-19 patient, who just passed away? I thank them every day! People who feed us, the nurses who serve continuously for 12 hours or more; while us doctors come and go on schedules… they all need to be appreciated. To me, they are the real heroes.”
Viren Mayani is a finance executive by profession, a prominent liaison in the Atlanta Indian community, and a musician. He is a senior contributor at Khabar who frequently interviews leading personalities in arts, entertainment, business, and politics.
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