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Alumni on the Front Lines

During a time of national crisis, Touro Alumni from across the country are doing all that they can to uphold our mission To Serve. To Lead. To Teach.

These are Our Alumni.

Dr. Richie Dueñas, COP Class of 2009 front page front lines

COVID-19 drive-through testing Day 2. People are sick and scared. Telling people to stick a 5” a swab down their nose doesn’t help.

For people who believe that we are out of all this...WE’RE NOT. STAY HOME.

 

 

 

Dr. CJ Quach, COM Class of 2016front page front lines

As a hospitalist at Mount Sinai Morningside, my schedule and workflow have changed a lot. Most of my patients are Covid positive; about 2/3, and I have enough PPE. Thankfully, nonhospitalist physicians have come in to help us with the increased load. Hospital administration has recruited many residents/PAs/NPs from different services (surgery, ophtho, path, etc) to help us as well. We are largely running low on oxygen delivery systems, which include HFNC, NIPPV, and vents, and we have to ration and decide who gets these modalities.It feels terrible having to decide who you think is sicker and honestly, on whom you believe these modalities would be wasted. Covid patients are cohorted into isolated rooms and wards with a strict no-visitor policy, and many of them are dying alone. We've been facilitating video chats with their family members, which is better than nothing, but it's sad to see so many patients and their families suffering. I consider myself lucky to still have my health and job.

Overall, I'm doing okay. Just hoping people will continue to stay home and help this thing blow over.

Dr. Roozehra Khan, COM Class of 2008
Alumni On the Front Lines

How many days are you working this week? Asked a friend.
Uh... 7.
With the grueling hours I’ve been enduring I still take the time to pay attention to the little things like sunsets
🌅
Here are some major COVID wins from last week:
3 patient’s oxygen requirements went down and I sent them out of the ICU!
4 patients on life support are weaning well and should be extubated this week!
1 patient gets a fighting chance after being sent to another hospital for ECMO!
Countless other patients in the hospital who never saw me 🙃 You never want to see an ICU doctor 🤷🏻
I have PPE, rationed but I have it!
Reframe your perspective and the whole world changes
🌎
It’s not all doom and gloom.

Dr. Jason Chao, COP Class of 2019front page front lines

All entrances/exits to the entire hospital have been blocked off except one. ALL hospital employees are currently mandated to get their temperature checked prior to work every day. A new sticker is given each day so we can identify that HCPs have been checked. Thankfully, overall, California has done a great job of “flattening the curve” by implementing early shelter-in-place, and at least at VMC, we have not seen more COVID patients than we are at capacity to handle.

Dr. Ben Abo, COM Class of 2011front page front lines

As an emergency and EMS physician in Florida, I am seeing a roller coaster. I see denial of sound science and understanding countering patients and practitioners scared. I see blurring of lines and boundaries but also sturdy lines being drawn in the sand. I see fear but also a sense of invincibility. I see strength in healthcare workers in the form of healthy pride, but I also see defeat and skepticism and silo-ing of the definitions of heroism.

One of the scariest things that I am seeing is Covid19 is popping up everywhere. From the closed head injury in the elderly to the young and supposedly healthy. I’m seeing a lot of cases and a lot of worrying, however I am also seeing a lot of gratitude and respect.

Dr. Brenda Sokup, COM Class of 2018

Life is returning slowly. Times are changing. It feels as though the first surge at our hospital is over, but I say that with hesitation. I fear there may be more surges to come, as New York is too  populated and too close together for this to be nearing an end. Patients are still coming in front page front linesvery sick but less each day. We are more prepared now than we were one month ago even if we haven’t figured out the exact treatment. We have come together as a hospital and a community. I’m very proud and deeply honored by the community you have all helped create. A little over two weeks ago, I posted asking for donations to help connect patients with families, and the response was overwhelmingly positive.

Today was a day I will never forget; it will possibly be the most meaningful day of my career. Your generosity and donations allowed our patient’s family to video chat their mother during the last moments of her life. The gift of having these iPads, chargers and ear phones gave the family a lengthened amount of uninterrupted, private time with their mother to say their goodbyes. It allowed three sisters across three boroughs to gather at one house to pray with their mom for the last time. They were able to say goodbye as we held her hand and she passed.

This virus is a horrid disease that rips people away from their lives and families without goodbyes. Today, with all of your help we were able to change that for one family. Thank you all for sharing these messages and helping us create connection during a monstrous time in the world and in this family’s life. Please continue to share your hearts and gifts with each other. Thank you for creating this compassionate community.

Thank you for helping me become the doctor I’ve always wants to be. Thank you for helping one family. Many more will follow. And again, stay healthy, stay safe, please stay home.

Dr. Edward Rippe, COM Class of 2019front page front lines

“Either things have died down or chaos has become normalized. We went from having 1 ICU with at most 12 ventilated patients to 5 ICUs and an ED with a total of 70+ vented patients in our hospital. Those that aren’t on vents are Covid positive or Covid rule out patients. Many of them are “pre-ventilator” as many will have to go on them.

Finally, there is much death. I have never seen so many deaths occur day after day after day. There are codes overhead every hour it seems. Even worse many younger people are going on vents. Men in their mid to late 30s with one comorbidity like high blood pressure or diabetes requiring vents with FiO2 and PEEP maxed out. Many of them are dying, leaving behind spouses and children. The stories you hear about Covid in New York are true. It really does feel like we’re practicing in a war zone.”

Dr. Ben Khuc, COM Class of 2016

front page front lines

"Over the last few weeks, COVID-19 has really changed the fabric of not only our healthcare system, but the whole community. Although many small businesses have had to close their doors, they have still managed to support our healthcare workers by feeding us, securing us PPE, and sending us letters of encouragement. These small sacrifices have brought us closer together even in this age of social distancing."

Shalisha Maddela, MPH Class of 2015front page front lines

It’s been a wild roller coaster ride, to say the least, filled with wins, L’s, obstacles, and surprises. Last week we thought we were going to run out of hand sanitizer entirely, and our next shipment was on backorder due to the high demand. Thanks, Alameda County, for donating hand sanitizer just-in-time. With help from our Infection Control Manager, EVS supervisor, and Executive Director of Operational Excellence, we were able to create a production line to repurpose empty bottles with the new supply of hand sanitizer. In the world of hospital operations, everything that can go wrong probably will, so it’s essential to take the win when you can. During these unprecedented times, we realize how much we’re #inthistogether.

Dr. Jasmine Singh, COM Class of 2016 front page front lines

Physical distancing is necessary to limit the spread of COVID-19, but this shift can also cause adverse effects such as loneliness and anxiety. Countless studies have shown that humans require social connection to maintain their mental health and well being. Data has shown that feelings of loneliness and social disconnection are risk factors for suicide.

Many psychiatrists, like myself, have switched to telemedicine and are fortunately able to see patients while working from home. Now is the most convenient, accessible, and important time to invest in your mental health.

Dr. Geoff Luecker, COM Class of 2018front page front lines

An ER in a NYC hospital is typically a loud, raucous place. Whether that means people screaming, fighting, crying, laughing, or smiling there is a constant flow of emotions between the patients and staff. It no longer feels like this. The walls are cold, the hallways empty, and the hospital staff members smiles are covered with masks. Viral HEPA filters hum in every corner of the ED. Over that, all we can hear is a combination of beeping monitors, moans, and coughing. During my last 2 shifts, there were an average of 100+ patients in our 95% of the patients require some level of oxygen. If it wasn’t for the names written in sharpie on the hazmat suits of hospital staff, I would barely know who those exhausted eyes lie behind the mask, goggles, and face shield.

We are entering into the longest mass-casualty incident in the history of modern medicine. As a country, we are not ready for what is coming. As a hospital, we are woefully underprepared for this. The best way to lessen the blow on the current over-stressed healthcare system is for EVERYONE, those who have COVID-19 symptoms and those who don't, to stay out of public places, cover their cough, only go out to shop for essentials and groceries once per week, and wash their hands. JUST. STAY. HOME.

Dr. Jeremy Mosher, COM Class of 2018

The past month has been one of the most challenging of residency thus far. I was the senior resident for our inpatient team when COVID-19 hit Chicago last month. Since then everything has changed. Now COVID is constantly at the center of our minds, driving change on a daily basis. As the cases of infected patients increased, everything had to be revamped, we created new COVID units in the hospital and expanded our ICUs; new protocols for seeing, screening and treating patients, going from testing only the sickest in the hospital to now testing for every patient who walks through the doors; new PPE recommendations daily, first masks, then gowns, then face shields, then N95s; and even new teams, as residents and attendings get infected and have to be
front page front lines quarantined.

The number of sick patients is only increasing. At UIC, we went from 10 to 20 to 40 to now over 60 COVID+ patients in the hospital, with over 20 on ventilators, and over a dozen who have died. And it’s still ramping up. Illinois now has over 25,000 positive cases with over 1,000 deaths. Even more heartbreaking is seeing the differential impact it has on our most vulnerable patients. Chicago’s communities of color have been disproportionately impacted, with African American’s making up 70% of deaths, despite being 30% of our population, exposing the consequences of a system plagued with chronic inequality and disenfranchisement. Similarly, a homeless shelter we staff has almost 50% of residents infected, and with nowhere else to go, they wait helplessly to see their fate as to whether a severe or not-so-severe infection unfolds.

In many ways I feel fortunate, managing the general floor and only sending patients to the MICU if they worsen, not having to work in the day-to-day struggle of seeing intubated patients decompensate despite our best efforts. It’s often been demoralizing to realize that even with the many clinical trials and medical interventions we use, we have only limited tools to combat this insidious disease. But despite this, the bravery of the patients and medical staff alike has been a constant beacon of inspiration and hope amongst a sea of heartbreak and difficulty. Their relentless care for patients, their camaraderie in the chaos, and their determination to make things better, outmatches the virus every day. And fortunately, most patients recover, and provide a much-needed shot of optimism that our efforts are paying off, and that through our collective efforts, we will make it through this, one day, one patient at a time.

front page front lines

Dr. Richie Dueñas, COP Class of 2009

There is fear in our community. People that have underlying health conditions risk coming to the pharmacy and may not have a choice. We deliver. We come to them. However, we must protect them from others and help calm those fears. Reinforce the guidelines. Smile through our eyes. Be kind. “Front Line Workers” are also the people that care for people in any setting. They come to the pharmacy, and we help shoulder the care and expedite the process.

ER Physician Introspective in the Los Angeles Area

Alumni on the Front LinesThough my particular hospital seems to have been luckily spared for now of "NYC hospital outbreak ground zero" crisis type situations, I'll admit there is a creepy tension on shift lately. Likely in anticipation of the next shift being the "one," when it starts. ER staff, (physicians and our ED RNs alike), are not an easily spooked bunch. But it's also been hard not to think about it when we have had daily email updates on new cases and mortality counts going up locally in the LA area at a decent rate waiting for us in our email inboxes. I believe our site has approximately 20 current positive results, two or three ICU admissions that are COVID related, and one or two code blues with positive Covid infections, or PUI code blue (persons under investigation) at the moment. That's where we're at. Overall, the situation still feels pretty manageable, and my local ER and has been fairly lucky for the time being. Before my last shift though, my fellow ER doc admonished us all that at his other ER where he works at nearby (15 miles away), he managed about six patients in an 8-hour shift that required intubation and came in by EMS critically ill, coded and all died as per him. All were apparently COVID related complications. He said he wanted to warn us all to "get ready, because it's coming." Not really what you want to hear before starting a fresh shift, but who knows, maybe an anomaly. I try to maintain a healthy perspective and take things as they come, one solution at a time. So If/when it ramps up, we will just deal with it, and undoubtedly get through and help as many and save as many people as we can. That's what a good ER team does. I'm confident my team and I will rise to the challenge if need be and for now try not to dwell on anything counterproductive.

My most recent ER shifts were during the COVID 19 case global spike in positive Covid infections and rise in critical Covid 19 cases/complications & deaths. So about the time we all started self-isolation/self quarantining, practicing social distancing, and avoiding large gatherings to slow/stop the spread COVID 19, is when I noticed the first big changes in the hospital and Emergency Department set up. In response to the COVID outbreak, the hospital now has tents set up outside the ERs ambulance bay entrance. There, new patients are screened for possible COVID infections in an attempt to prevent any possible infected mild to minimally symptomatic patients from coming inside the hospital walls to prevent spreading to our high-risk elderly patients and hospital staff. My first shifts in the ED during this peak pandemic time went as well as ER shifts could have gone pre COVID. No onslaught of patients overwhelming the ED with severe viral respiratory symptoms or code blues followed the typical ER flow on either shift.

Joy Dugan, Joint MSPAS/MPH Class of 2012

Joy DuganI work one day a week at the Queen of the Valley Emergency Department in Napa CA. I have dawned the gown, mask, gloves, and goggles required to protect myself and patients from the COVID-19 virus. The hardest thing about this invisible enemy is the fear of bringing it home to my family. I now have a meticulous hygiene regimen at the end of my shift to prevent spreading the COVID virus outside the hospital.

I am originally from New York and many of my family members work in the frontlines. I actually sent my cousin Mary, a PA in Philadelphia some N95 masks because she had to wear the same mask for over three weeks at an urgent care. My other cousin, Katie, an ER nurse in NYC, described the overwhelming number of patients on ventilators and witnessing the decision of who gets the ventilator to stay alive.

My ER colleagues in Napa have been so fortunate. Because of all the shelter in place measures, we have not seen a surge of COVID-19 patients. I want to applaud the Napa and Solano county residents for staying home to prevent the spread! I am so thankful for our Provost, Sarah Sweitzer, who has personally donated handmade masks to my ER group. I have used my handmade masks outside of my clinical work to stay safe and prevent the spread of COVID when I have to leave my house for essential needs.

Please continue to stay home! And if you can’t, make sure you practice social distancing, wear a cloth mask, and wash your hands!

Joy Dugan is an alum and full time faculty member at the Touro University California Joint MSPAS/MPH Program.

 

sokupDr. Brenda Sokup, COM Class of 2018

Patients are getting sicker and younger. It is getting more personal talking about their disease -COVID-and the damage it has caused… It feels more hurtful each time we tell someone that this is probably the end, that they should call family and friends to tell them they love them. This conversation is most of our day now. There is no cure for covid.

The best thing to do is stay at home and love each other from a distance, stop spreading this monster. If you don’t think it is going to happen to you… think about our patients. Please take this virus seriously.

Dr. Geoff Luecker, COM Class of 2018

In my last few shifts, I've begun to bear witness to one of the greatest human tragedies I can imagine. I have watched as patients struggle to breathe, knowing that based on labs and xray findings, they will not survive even if this intubation goes perfectly. I have watched as patients I admitted yesterday are found pulseless and not breathing, after having been talking and laughing not 15 minutes before. I have watched as young people have called their family members to give them their love, and then I have checked on them in the morning only to find out they had gone into cardiac arrest a few hours after I left.

As predicted, we have seen a significant increase in the number of COVID-19 patients over the last few weeks, but the mass-influx has yet to truly begin here in NYC. My Emergency Department is seeing almost exclusively COVID-19 patients (either suspected or confirmed).

Geoff Luecker, COM 2018In the ED, all the EM residents are required to wear Tyvek suit, hair cover/hood, eye protection, double gloves, respirator/N95 with surgical mask, and are advised not to bring stethoscope or any personal items out. We are also advised to wear hospital scrubs, change into hospital-specific shoes, do a "bird bath" in the sink before leaving for home, and shower immediately when getting home. With the exception of the gloves (hospital issued), ALL of the equipment was either bought by residents or sourced from friends/family from across the country.

The COVID-19 patients all seem to present in some form of respiratory distress or respiratory failure, all require escalating amounts of supplemental oxygen, and the vast majority requiring admission to the hospital (even just to coordinate a home pulse oximiter and a home O2 concentrator).

In my last two shifts, I have watched as the hospital ran out of portable oxygen tanks (normally ordered once per week, now ordering 1-2 times PER DAY). We then ran out of hospital gurneys, IV pumps, paralytic medications for intubation and sedation, and vasopressors like Norepinephrine and Epinephrine. Then we began to run out of wall oxygen, and we were instructed to turn down every patient's oxygen mask (if possible, VS-permitting), because we couldn't run everything (the ventilators, the non-invasive machines, and the oxygen masks) on what little oxygen we had.