Rising to the Challenge

Mark Pochapin, MD
Sholtz/Leeds Professor of Gastroenterology
Vice Chair for Clinical Affairs, Dept of Medicine
Director, Division of Gastroenterology & Hepatology
 

It started with a simple email to the fellowship program directors: “Would your fellows be interested in volunteering for additional training so they can help out in the ICUs?” The pulmonary critical care staff had already been activated and were functioning at maximum capacity, the pulmonary fellows were already fully involved in their COVID effort, but what about the other fellows who are board certified in medicine? The response was quick and resounding: “Yes, tell us when.”

Our fellows are a mirror of us, and their commitment, dedication, and desire to help their colleagues also represent the values that are present throughout the institution. As an example, there was an email chain that started because ICU help was urgently needed in Brooklyn. Here was the response: “We solved it. Will send a senior fellow who is upgraded to an attending and can lead his own team.” This has been a time when problems are solved and solved quickly.

How have our physicians who normally work in an ambulatory setting responded? A survey that was sent last week to our medicine faculty asking, “What role would you feel comfortable performing?” yielded hundreds of responses within a few hours. Who knew that the medical service would grow from 13 teams to 19 two weeks ago, and to 32 beginning last week? In order to fill 32 medicine services, we needed to find 60 additional doctors. Within two days, 30 physicians stepped up to join their colleagues in the COVID reserves. Here is how one doctor responded, “At dawn we ride.” It is hard to believe that just a few weeks ago our biggest problem as a profession was burnout, because now we have an unprecedented level of engagement. We are all in this COVID-19 battle together.

At 7 p.m. each night, there is noise coming from the streets of New York City. It is cheering. Cheering for something that we as medical professionals have always known to be true: the fundamental ethos of our profession is to care for others, and our job as physicians is to protect what is most precious – one’s health.

We too are being reminded why we entered the medical profession in the first place.  And there is no doubt, when we get through this storm, we will emerge with a renewed appreciation for the calling we chose.

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The artwork above is "Super Salute" by Josef Lee. Used with permission of the artist. Find him on Facebook and Instagram

Above: Some of the members of the COVID Army: Carmen E. Chitu (Primary Care, Outpatient), Karin Katz (Endocrinologist), Stefanie Cardamone (OB-GYN), and Caren Behar (Primary Care, Outpatient) are now on the KP8 COVID unit
 

In the Arena: The COVID Army

Crisis can bring out the best in people. It strengthens community, reinforces humanity, and sparks creativity. Nowhere is this more evident than in the work of those who are caring for patients—and their families—during this unprecedented situation.

Dr. Katherine Hochman, director of the hospitalist program and assistant chief of the Medicine Service at Tisch Hospital, has been at the forefront. Though she has spent the the past two weeks recovering from COVID-19, she has been working to make a difference even from quarantine.

Over the past several weeks, the Medicine Service has grown from 8 teams to over 30 teams to accommodate the surge in patients urgently needing care. This expansion would not have been possible without a number of physicians and house staff volunteering to be redeployed and, in some cases, retrained.

Dubbed “The COVID Army,” these physicians have come from all areas to join in the fight, stepping in to act as team leaders or to support the teams as ‘hospitalist extenders.’ They include subspecialty attendings from many of the divisions in the Department of Medicine, residents from other specialties. physicians who have been working in outpatient settings for decades, fellows pressing pause on their specialty training in order to serve as acting hospitalists and team leaders, and others. “It’s a massive redeployment of man- and woman-power,” says Dr. Hochman. “It really shows how people are willing to serve, and how much they want to make a difference.”

Dr. Hochman has been working to keep the team spirit up, through daily emails that not only contain pertinent information but also quotes and tips to encourage self-care during an extraordinarily trying time. COVID virtual educational programs, which include rapid-fire journal club sessions and updates on clinical protocols, have seen a boom in attendees.

In addition to the stressors on our front-line medical staff, the need to isolate patients with COVID-19 has also placed a new burden on families, who would normally be able to visit their loved ones in the hospital and get updates on their condition. To fill this void, Dr. Hochman and colleagues from the Patient Experience Office have started NYU Family Connect, which officially launches today.

The goal of NYU Family Connect is to deliver timely, accurate, and personalized clinical updates every day, thereby reducing the anxiety that patients and families are currently experiencing. A team of volunteers—currently comprised of 56 radiology attendings paired with 50 medical students—will review the patient’s chart and then dial in to virtual rounds in order to hear directly from the patient’s care team and have the opportunity to ask clarifying questions. Then, with the help of a script, they call the patient’s family to provide an update on the patient’s condition. This is then documented in the patient’s chart. A second wave of attendings from Dermatology, Pathology, Neurology, Orthopedics, and other specialties will start training today.

There are so many people who deserve thanks during this seemingly impossible time. Dr. Hochman was quick to credit Drs. Kevin Hauck, Brian Bosworth, Mark Pochapin, and Sandy Zabar; Katy Wesnousky; and Gretchen Glynn from the Hospital Operations Project Management Office (HOPMO) team for getting the COVID Army together. The NYU Family Connect project owes thanks to Dr. Myles Taffel and the radiology team; the medical students led by Marissa Alsaloum, Charli Karpel, and Sneha Sharma; Regina Grinblatt from Patient Experience; Jaya Sondhi and Rachel Ramsey from project management; Kathleen DeMarco from nursing; and Dr. Karin Karpin from the Hospitalist team.

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Words of wisdom from Dr. Hochman’s COVID Daily update:
A reminder to do something wonderful for yourself tomorrow. Not your child, not your neighbor, YOU. Is it a yoga pose, or a sci-fi thriller or an on-line tour of the MOMA, or a delicious sesame bagel with lox, cream cheese, thinly sliced onion and succulent tomatoes?

From President Theodore Roosevelt’s “Citizenship in a Republic” speech, well known for its “The Man in the Arena” passage:
It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.  The credit belongs to the man who is actually in the arena, whose face is marred with dirt and sweat and blood; who strives valiantly… who knows great enthusiasms, the great devotions; who spends himself in a worthy cause.   

Saluting Our Early Graduates

In this moving tribute, NYU Grossman School of Medicine faculty salute 53 members of the historic class of 2020 who have chosen to graduate early to help fight the pandemic. "We taught you how to write notes," says Michael Poles, MD, Assistant Dean of Medical Education for Pre-Clinical Science. "But you possess attributes that are far more important—compassion, empathy, professionalism and determination—that will shape the rest of your careers.""  Click here or on the image above to watch the video.

NYU Med Student Joins COVID Fight: 'Time to Step Up'

Gabriel Redel-Traub, who was among the early graduates of the class of 2020, writes movingly of his decision to join in the fight against COVID-19: "To my surprise, when I decided I would join 50 of my peers at NYU, graduate early, and volunteer, my mind settled. The more I thought about it, the more I was overtaken by the selfless beauty of the profession I'm entering. This is what it means to be a doctor." Read the article.

COVID-19 Links

Resources for Managing and Surviving the COVID-19 Crisis
Thanks to Dr. Sandy Zabar and her DGIMCI team for sharing this guide of resources to help us all practice a bit of self-care during this trying time. Explore links that include mental health services, podcasts, virtual book clubs and museum tours, and more.

Department of Medicine intranet site
Department of Medicine COVID-19 blog

Inside Health (atNYULMC) home page, for daily posts and articles

Covid-19: What You Need to Know - Information Hub

Click here to learn more about recent changes and accomplishments from Fritz François, MD, MSc, FACG, Chief Medical Officer, NYU Langone Health

Video: Robert I. Grossman, MD, Dean and CEO, expresses his deepest gratitude for the courage, perseverance and unity of all NYU Langone employees during this unprecedented crisis.

The Historian Is In: Typhus

David Oshinsky, PhD
Professor of History and Medicine
Director, Division of Medical Humanities

The history of past epidemics can provide important perspective on the current COVID pandemic. In each issue of the newsletter, we will revisit a past epidemic, from Yellow Fever to Ebola.

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When historians recall the epidemics that ravaged New York City, typhus rarely makes the list. Yet the typhus outbreak of 1847-48 probably killed more hospital workers, percentagewise, than any epidemic before—or since. The disease went by several names in this era—Irish Fever, Ship Fever, Jail Fever—but physicians called it typhus, the word originating from the Greek typhos (or dizzying state). A bacterial disease spread by a body louse, typhus is best known for decimating Napoleon’s army during the brutal Russian campaign of 1812 and for the millions of soldiers and civilians it killed in Europe during the two world wars of the 20th Century.

Oddly, typhus has rarely appeared naturally in the United States. There are few instances of a serious outbreak that hasn’t involved immigration from abroad, even under the most unsanitary conditions, such as military encampments during the Revolutionary or Civil Wars. Research suggests that the eco-system of North America has somehow failed to nurture the vector—the body louse. But no one is certain why.

Typhus likely came from Europe on the so-called famine ships carrying Irish peasants to Canada and the East Coast port cities of the United States. But unlike cholera or yellow fever, it didn’t cause much panic in New York City as a whole, because it rarely expanded beyond the immigrant slums. There were no mosquitoes or contagious victims or contaminated wells to spread the disease widely. Many typhus victims died where they lay during the Great Epidemic of 1847-48, but hundreds more wound up at Bellevue Hospital, where they were treated, for the most part, by doctors and medical students from the medical school of New York University, recently created in 1841.

No one then knew what caused typhus or how it spread. Beds were shared at Bellevue, and “pest tents” were pitched on the back lawn along the East River (SEE PHOTO). The patient death rate at Bellevue soon exceeded 40%, and for the staff it was even higher. So many resident physicians fell to the disease that medical students were asked to fill the void. Their dedication was extraordinary. There is no record of anyone fleeing. All did their job, sometimes rising from their deathbeds to train others to carry on.

To scroll through the names of those who died while serving their patients is akin to reading a war memorial. Here is a sampling:

• “John Frame, MD … died in New York City in 1947. Cause: typhus fever, contracted while on duty at the hospital…”
• “Elihu Hedges, student of medicine, died in New York City in 1848. Cause: typhus fever, contracted while on duty at the hospital…”
• “Gorham Beals, MD… died in New York City, January 9, 1848. Cause: typhus fever, contracted while on duty at the hospital…”
• “David Seligman, student of medicine, died in 1848. Cause: typhus fever, contracted while on duty at the hospital…”

Serving selflessly and heroically in time of crisis is an NYU tradition—one well worth remembering.