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COVID-19 UPDATE

October 15, 2020

HealthChannelsTV: Episode 2

Part 2: Experiencing COVID-19 in a New York ED, with Dr. Lee Donner

 

We continue our conversation with Dr. Lee Donner, an emergency physician on the frontlines of the COVID-19 pandemic in New York. In the second part of our interview, Dr. Donner shares how the quick escalation of the pandemic affected him and his fellow emergency providers.

 


 

Full Transcript

[00:00:00] Michael Murphy, MD: [00:00:00] Welcome to our, our second episode of HealthChannelsTV. I hope you enjoyed the first episode with Dr. Lee Donner and myself. This next episode really gets into kind of how he got over his illness and was going back to work and really how it was just a night and day difference, just in 10 days time of him being outside of work and then going back and actually, having his resident, as a teaching facility, almost have to show him the ropes a little bit, because he had kind of been in the trenches – and I saw that a lot in the military.

[00:00:58]Somebody who would go back from [00:01:00] leave and come back. And sometimes the junior enlisted person would have to show them – the corporal or the specialist or the Sergeant – the way of maybe the training that had already gone up to speed. Maybe we were going out for a mission or being deployed somewhere.

[00:01:14] And so, you know, talk about the military and, you know, in mention of that is our drink of the month. In the military… it’s really hot in South Florida -it’s like, in real feel it’s like 105 or something like that, with hundred percent humidity. And so the way we used to stay hydrated was they would make us put sodium tablets in our canteens, when we were out marching or whatever the case may be.

[00:01:37] So here is a full jug of water, with sodium tablets. So if you’re ever out in the middle of somewhere and you’re running out of water, if you do have a set of tablets when you go hiking, it’s a great way to stay hydrated. It keeps the the water retention in there.

[00:01:50] And so, Dr. Tony Andrulonis, you’ve practiced medicine a lot longer than me. I’m sure you’ve had many instances where, you know, you were kind of burning the candle [00:02:00] from both ends in a very stressful environment. Do you mind sharing with us, any of your experiences.

[00:02:05] Tony Andrulonis, MD: [00:02:05] Sure, great to be back with you, Michael. And I got my water again. I put a little bit of table salt in there. That’s the best I could do to match.

[00:02:16] I did not serve in the military, but I did spend a number of years working with FEMA and being a medical director. And we certainly saw a lot of disasters, whether it was Katrina or 9/11, but as I think about what Lee is going through and the closest that I can relate to, that was really probably about

[00:02:36] a decade ago when we were dealing with the swine flu in the emergency department. And we’d have young, healthy appearing people come in that you just thought was run of the mill flu and you’d send them home.

[00:02:46] And lo and behold on the next shift, the next morning, your buddy saying, Hey, you remember that person you discharged home and, of course, they bounce back and they need intubation. And it was, it was a really challenging time and trying to [00:03:00] figure out who was really sick and who wasn’t. Who was going to bounce back and nothing at all compared to COVID and what we’re seeing, it was probably just a small slice of that.

[00:03:09]But that was certainly a very, very challenging time and something I clearly remember from, you know, a decade ago.

[00:03:15] Michael Murphy, MD: [00:03:15] Yeah, I can only imagine – I did not have to experience that. And, we both didn’t have to experience COVID from an emergency physician perspective. So just, just from the outside looking in, but, with that, that was a great story. I appreciate it. Without further ado, let’s jump into the final episode with Dr. Lee Donner.

[00:03:38] Lee Donner, MD: [00:03:38] Going back to work. Well, my first shift back at work was the worst. Everything got much worse in those, I think I was home for eight or nine days based on my schedule. And at that point it became clear that ventilators were going to be a scarce.

[00:03:56] And so part of the text thread, and maybe [00:04:00] in retrospect, The text thread caused too much anxiety, and we should have just not communicated with each other.

[00:04:06] There’s this whole conversation on my work thread about how many vents are left in the building. How many vents did we use today? How many people did you intubate on your shift?

[00:04:15] And so when I went back to work where like, you know, never in my life, wouldt I think we’re counting vents. The look on everybody’s faces the intensity, the purpose, the drive, The way that people worked was different. And I think it was scary and it was, there was a lot of it anticipation anxiety about where we’re going and when I came back.

[00:04:36] If we were there, I don’t want to make analogies to, to battle, military, cause I don’t know what that’s like. I was never in the military, but if you try, and that was the battle I got to the battlefield that day. and everything else was the march there.

[00:04:55] I had a senior resident working with me who had probably done like five shifts in a row, [00:05:00] in this, environment. And she was just like, don’t worry. Like, I know, I know how to do this. We’ve been doing it. Like, I’ll, I’ll help you into it. You know, this is someone I’m training telling me in the course of a week. Yeah. She became wise and I’ll never forget it. I made sure she knew exactly how I felt when it was done.

[00:05:22]And before she moved away after she graduated, this metamorphosis was intense. So we walked around with a clipboard and we just started writing down vent settings and oxygen saturations. And we just basically did that. The whole night until every time a new patient came in, we dealt with it.

[00:05:42] And everyone who came in was, was pretty sick. if you would probably have a hard time believing what the space looked like from our training and a place that for the commodity, and just imagine it being like four or [00:06:00] five times worse, and then everybody’s sick and everybody needs attention. But to get back to your question, the way people were working and the, you know, I’m, I’m at a lack of vocabulary for it.

[00:06:18] You know, I’d never seen anything like this before. Just the purpose, the purposefulness of all of the workers, you know, I’m talking like environmental workers, people who are cleaning up, it was an experience I’ve never had, it lasted for awhile. it’s not – we’ve kind of like, I don’t want to say regressed, we’ve been able to rest a little bit, and things look almost normal now, with the exception of PPE, but, that was probably the most impressive thing.

[00:06:46]Then I can remember. It’s just the difference of when I went out to, when I came back …

[00:06:54] Michael Murphy, MD: [00:06:54] I just couldn’t even imagine – you know, I remember going through that with you [00:07:00] and the texts that we were doing back and forth and, you know, and I think that, I think the whole American people can really relate to this and everybody, at least within healthcare within theHealthChannels and people like there was this area of yeah, it’s happening.

[00:07:18] And then it was like, it’s really happening. And the whole country shuts down. And that’s basically when you went back to work. And, what I always said is, you know, it’s kind of like, it was kind of out of sight, out of mind, for a lot of people,

[00:07:32] My last analogy I’ll do for the military. When I came back from a deployment, we were gone for four weeks. And it was a hard four weeks. And, our unit was a little bit different than, than everybody else’s. We got deployed in, for shorter amounts of time and than say six months or something along those lines, we got deployed, came back. We were planted in Fort Stewart and the drive to Hunter Army Airfield was just Savannah, which was just about 45 minutes. And you [00:08:00] got into downtown Savannah to Hunter Army Airfield. And, we pulled a five ton truck, the covers up. And, I’ll never forget this. And there’s like, you know, it’s Friday night and it’s just cars zooming around, like nothing had ever happened. And there’s these, you know, at the time Brittany Spears, back in 1998, Britney Spears was a big deal . Boom – big Brittany Spears, billboard. And I’m like, no one really knew what just happened. No one knew what we just did, what we just went through and the reality . And I know you said you didn’t want to make an analogy cause you weren’t in the military, but I can just tell you, like, I know you guys were stressed.

[00:08:40]People were dying left and right. And you know, the media told us one thing, but it was absolutely, just, a disaster like devastation. I would say that you guys, what you guys had to go through and no one really knows unless you’re in those trenches with your colleagues. And so, I can only [00:09:00] imagine I try to every day, remind myself and feel so grateful.

[00:09:03] You know, in a sense I felt bad. I really kind of wanted to go and work. And I signed my, put my license back up and New Jersey and try to volunteer for telemedicine shifts and they never called me. so, but I was trying to, you know, volunteer my time that way, but, you know, and I don’t think anybody should – like, we sign up for what we do.

[00:09:23] You know, whether it’s emergency medicine or going in the military. And that’s what we do. That’s our job and not everybody’s cut out to live that that was 12 hour shifts and see the things that you saw and what we saw together and in our situation. So, but. I’m very grateful for what you did. I’m very grateful for your whole team and how you guys treated everybody.

[00:09:44] And I’m sure just, I know you’re not even, I know you’re just touching the iceberg of the emotions and the stress that you had while you were there. I remember one time, you know, I don’t know if you want me to say this, but I remember one time, you know, I texted you and reached out. I said, how are you doing? And you [00:10:00] said, I want to build boats or something like that. You’re like, I’m so stressed. It was like, just, you know, you were just in the middle of a thing, four shifts, night shifts or something like that. You said, and I’m sure one night shift equals like five of our night shifts that we used to do – just from the stress level and whatnot. How does this change you? I know it sounded like you said you had a reprieve – the volume after COVID kind of, you know, we look at the cases in New York city they’re down. Thank God. And, but I, I assume that burnout, everybody I talked to the burnout was just massive from the ER docs in New York city and other States like Louisiana and Georgia and different areas of, big hotspots.

[00:10:41]you got some reprieve. How do you feel now? and do you think, emergency medicine changes, moving forward?

[00:10:49]There’s a lot to unload there. Lee Donner, MD: [00:10:52] So, you know, for a few weeks, maybe months, I think there was, a lens on emergency medicine that [00:11:00] I had never experienced before – a very positive lens. You know, the country’s shut down, at a very minimum, the whole New York city area shut down and I was driving to work and that feeling of driving and there being very few cars on the road and thinking like, oh these are all other central people on the road that -what it did was make us think or made me think like we’re the the backbone of, of all of humanity, of all of society, which has to stop everything that it’s doing so that we all don’t disappear. The doctors and not specifically ER, doctors, but that’s what I do. and then, you know, Everyone else who has to keep doing their jobs, bus drivers, and people who clean things and people [00:12:00] who work in food kitchens. that’s what, essential is. And it, it gave me a sense of purpose. And I think that a lot of people who never thought about it before thought of emergency positions as like, wow, that that group of people they’re there for us. And when things go wrong in an unbelievable, unprecedented way, they’re going to be there for us. And I think without ever having experienced that in training, but we talk about all the time, but without having actually experienced the need to do what I do, I never thought of it myself as so important that, you know, we kind of were like, All right. If I don’t show up, like someone else will get called in and take care of maybe a handful of sick people today, and then another boatload of people who are, who are not that sick. and you know, the reality of emergency medicine is most of what we do is not emergencies – you know [00:13:00] that – and that I think contributes a lot to burnout.

[00:13:02]So during this time, I’m only taking care of people who absolutely need me and absolutely need to be there. And the fact that I’m doing it makes me feel like I’m doing something for even the people who I’m not seeing. You know, like my family is better off because I’m doing something that’s important for society.

[00:13:22]I felt very motivated and very positive about that. And it helped. Like I was trying to get to this before, when I went back to work, I felt much better than when I was home. And I heard the same thing from other colleagues who were like, I just want to get back to work, but I didn’t have that thought when I was home.

[00:13:41] And I thought that I was sick. I was like, I’m afraid. I’m not afraid to say that I was scared. You know, people are getting very sick. Healthcare workers are getting sick. You’re seeing it all over social media. Doctor died that resident died. This nurse died. Young people dying. I was afraid of all that.

[00:13:58] And then, [00:14:00] you know, I have a sense of purpose. So there was never a chance in my mind that I wasn’t going to go back. But when I went back, I got over that first shift, which was really transformative. And then I felt like, okay, when I went to work.

[00:14:13] And when I was home and I would, put the TV on after the kids are in bed with Sarah and watch the doom and gloom on the cable networks, it was much worse. My anxiety, it was much worse. And then I would go back to work and, and feel good about what I do. And I think that a lot of people really did. I have a friend who’s an ophthalmologist. and we never talked about emergency medicine, you know, as a, as a service or as a career, or he’s just a friend that didn’t know him from med school.

[00:14:44] And he starts texting me during this whole thing kind of frequently. just like how – not proud. I forget what it was – but he was just, you know, all struck with what we do and why we don’t get paid more. And why we don’t get more respect. You know, [00:15:00] he had to shut his office down. and not because of COVID, but because he couldn’t afford to keep it open. No patients were coming in. So. Yeah, then secondarily it’s due to COVID. so there was a lot of, that kind of thing where I think people really respected emergency medicine in a way that they hadn’t before. I don’t like to think I’m an optimist or a pessimist – I think I’m a realist. I think people’s memories are short and we’re going to go back to, making sure that we are – the service industry that the healthcare industry at this time wants and needs in order to keep the wheels turning. And during the time of the surge in New York, we practice medicine the way that you’re taught to in medical school. And then when you get to real life, it’s not like that. So, we just [00:16:00] did what we thought was necessary for people.

[00:16:02] And we made our best attempt and our best guesses at doing the right thing with, you know, limited resources, nothing egregious. there was no fear of, of error, outside of what, you know, you don’t want to hurt anybody, but there was no fear of error on the end of, I’m going to get sued for this. No, I’m making a decision that is going to come back and bite me, you know, you worried about people and then you did what you had to do. we were only allowed to do that, or we only did that because it was, a special circumstance and we had to, and we, you know, now we’re back to getting, ankle x-rays on people who are dancing in front of us cause they waited for 15 minutes.

[00:16:51] So. I unfortunately don’t think that the longterm will keep us as the central people, but I also understand [00:17:00] finances. there’s a lot of people working in the ER and it’s not because we take care of a lot of sick people. It’s because we take care of a lot of people and anyone who walks in and there’s a lot to be said that’s good about that too. it’s just a different. Different experience. but I do think that we gained a lot of respect in the hospital. I think that everybody really pitched in, you know, the whole hospital changed from top to bottom in order to get through that. And I think our margin of like how much more we could do was razor thin.

[00:17:37]And there’s a whole host of reasons why it went down that way, that we won’t be able to get into, but, it was a really interesting thing to experience, but it wasn’t just the ED – I would love to give credit to everybody that helped out A. nd you know, those patients – they spend time in the ED and until we got our flow figured out and opened up more ICUs [00:18:00] around the hospital – some of them spent a day or two in the ED, and then unfortunately a lot of them spend weeks, or more upstairs. So there’s a, there’s a whole body of people that did a lot more work or maybe even a lot more soul crushing things than I did.

[00:18:19] Michael Murphy, MD: [00:18:19] Right. Do you- last thing. And, they got, we got fall and winter on our horizon – any thoughts about the flu and COVID? You know, there’s a lot of discussion about vaccines. there’s some front runners, there’s people applying for application in October. I’m confident that there’s going to be some type of vaccine and by the end of the year, at least from the data that I read all the time – what do you think about the flu and COVID? is it going to be a disaster or do you think we’re going to, from [00:19:00] what we learned and what you guys learned in April, May, June, like, we’ll be better prepared to handle this?

[00:19:08] Lee Donner, MD: [00:19:08] I think we’re going to be much better prepared if, if it happens again, I don’t think that it could ever reach the magnitude of penetrance that it did in the New York area. Again, unfortunately, if you’re sitting on a population in a city that wasn’t hit that hard, you know, it could happen there.

[00:19:28]I could be wrong. It could get that bad in New York. I think that we fear the flu. at our core this year, it will be very hard to distinguish flu patients from COVID patients. The tests are not quick enough. but on the optimistic front, I think most people are doing the right thing and in social distancing and wearing masks, and that will obviously prevent transmission of flu as well.

[00:19:54] The other things are, you know, I, I would send my kids to [00:20:00] preschool with a runny nose before -you know, I think that happened for a century. People did that. They just, kids don’t have a fever. They don’t look sick, send them to school. Well, here we are. I don’t think at least for the next few years, parents will behave that way.

[00:20:19] The emergency physicians are going to try not to go to work with URIs. When you called out of residency with a cough, my God. Right? People’s consciousness aboutt what’s the right thing in a scenario where we’re all connected, whether you like it or not. We’re all interconnected. People’s consciousness about what has to be done to prevent a catastrophe is better now.

[00:20:49] Michael Murphy, MD: [00:20:49] Lee, I know you’re busy and I know you work a ton of shifts still and got the twins. And so taking an hour plus out of your day to [00:21:00] hopefully educate and, you know, inspire and just, you know, let people know what you went through and what everybody else went through. And I mean this in one of the busiest inner city hospitals in New York, during COVID. I’m just really grateful. It’s awesome just catching up with you and seeing your face again. So I look forward to us getting together and getting the kids together. you know, when this is all over. So until then, thank you.

[00:21:28] Lee Donner, MD: [00:21:28] Yeah, my pleasure.

[00:21:31] Michael Murphy, MD: [00:21:31] Wow. I hope you found those two episodes to be very impactful and hope you got a chance to actually feel kind of like you were working shifts with Dr. Donner there for a little bit. You know, there’s that – one of the things that stood out the most to me was kind of that guilt and that uncertainty of sending those patients home.

[00:21:54] And, you know, as an emergency doc, those are the things that keep you up at night. you’re you’re thinking throughout the [00:22:00] entire night that, Hey, I sent those three patients home. Should I have kept them? Should I put them on observation status. Then you magnify that by 10 with COVID on top of it. And so, you know, Tony, I’m sure you had similar things. We tried to address the, kind of the uncertainty in the future of what this flu season looks like.

[00:22:22] Tony Andrulonis, MD: [00:22:22] I mean, what an amazing story that he told us. Just absolutely heroics, what we talked about last time. And you’re right, Michael. I mean, all emergency medicine physicians fear that. You know, you remember that patient, you discharged home and just that uncertainty of not knowing, what potentially some of these outcomes could be from some of the patients and living in that type of environment, having to practice medicine. And that type of environment is just incredibly stressful.

[00:22:51] And then you’re right. It is, as we look forward or there’s just so much uncertainty and what this winter is going to bring. You know, what happens with the flu? Is the flu vaccine a [00:23:00] good match, are we’re going to see a spike in flu? Is there a second wave of COVID? And just, again, a lot of this uncertainty I see with my colleagues, just a lot of the anxiety this is bringing about with them as they’re trying to prepare for potentially the worst case scenario. And so it’s just a unprecedented time, right now, certainly in the medical field.

[00:23:21] Michael Murphy, MD: [00:23:21] Yeah. Go get your flu shot.

[00:23:23] So, anyways, well, yeah, thank you so much, everybody for, for spending these last two episodes with us, a big thanks to Dr. Lee Donner for opening up and being vulnerable, with the whole HealthChannels family. We have a few episodes on the docket. We’re going to look at nursing , and the stressors that they have in burnout – exciting episode. The nurses are what makes or breaks a hospital and, excited to look at that.

[00:23:48] And then we’re going to dive into technology, AI, predictive analytics, and how do we bridge and how do we think of healthcare moving forward in this new kind of post COVID era. So I hope you’ll join us. We promise to [00:24:00] keep the episodes less than 20 minutes, and until then be, well, thank you.

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