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COVID-19: A roundtable discussion with front-line medical workers

Published May 07, 2020

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Season 1, Episode 5

Is necessity the mother of invention? What might be the silver linings of this pandemic, if any? Alex and Briarley chat with Dr. Akhilesh Sista, Dr. Michael Schaefer, and ICU Nurse Katie Taylor, all affiliated with NYU Langone Health at the center of the epidemic in NYC, on topics spanning from the nature of the disease, to its widespread medical and financial impacts on a very uncertain future. Amidst the chaos of the moment, we unpack the positive implications of dramatic change in a world forever altered by the novel coronavirus. We also discuss how doctors are confronting their student loan debt during these trying economic circumstances.

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Transcript

Alex [00:00:07] Hey, everyone, this is Alex.

Briarley [00:00:09] I’m Briarley. And you’re listening to financing ambition. A Laurel Road Podcast.

Alex [00:00:15] Hello, listeners, and welcome to today’s episode. We are very happy to have you with us. We have a distinguished panel of medical practitioners from NYU Langone Health who took time out of their busy schedules to be with us today to discuss the COVID-19 pandemic, its current state, how things are looking promising, and what we’ve all learned from this very challenging experience.

Briarley [00:00:37] Yes. And as we begin to see the curve in New York City flatten, it was really encouraging to hear the stories of those who have been a part of the teams that have really made this happen. So without further ado, let’s get into today’s conversation.

Alex [00:00:54] I would love to have each of you introduce yourselves to our listeners.

Dr. Sista [00:00:57] My name is Akhilesh Sista. I’m the section chief of interventional radiology, at NYU Grossman School of Medicine. Really looking forward to the discussion.

Katie [00:01:08] Hey, everyone. My name’s Katie. I am a registered nurse at NYU Langone. I’m currently working in one of the many ICUs that we have running right now at NYU.

Dr. Schaefer [00:01:21] I’m Dr. Mike Schaefer. I’m a non-invasive cardiologist, also affiliated with NYU. My practice is primarily outpatient, so I spend most of my time in the office. However, lately I’ve been recruited to help out at the hospital during this COVID pandemic.

Alex [00:01:37] Thank you all for your service and thanks for being here. It’s so great that you could take the time. Doctor Sista, I’ll start with you. Could you tell us what are your recent experiences in treating the virus?

Dr. Sista [00:01:47] Wow, this is unprecedented times. You know, I’ve been a physician since 2004 and nothing have I seen that compares to what we’re dealing with. While I may not be on the front frontlines in terms of being in the ED or the ICU, we are called upon to treat patients that have complications of COVID and COVID pneumonia and disseminated COVID infections. Specifically, our interventional radiology team is skilled in doing minimally invasive procedures so our most direct contact with COVID patients has been to go to the ICUs and place central venous catheters either for infusion of whatever medications are required for maintenance of critical care or to put in catheters when patients kidneys fail and they need dialysis or hemodialysis to these coffers. And I have to say, I have been very humbled by how sick these patients are and also the incredible care that’s being administered to them by the critical care teams consisting of doctors, nurses and support staff, respiratory therapists. It is an incredibly well-coordinated effort to try to get these patients out of the zone of danger.

Briarley [00:03:10] So, Katie. I’d love to hear from your perspective as a nurse in an ICU is really the epicenter of all of this, being in New York. What is the general feeling and how is the morale looking amongst the nurses there?

Katie [00:03:24] This is what I think week number five that we’ve really been just kind of like full-blown steam in this covered crisis. And, you know, I think the morale is honestly better than one might expect. I think, you know, the first couple of weeks, everybody had to just go right into this and just put their best foot forward. And, you know, we were inundated with patients and it wasn’t just, you know, acute patients. These were very, very, very sick patients. So I think the initial thing was to really band together. They had created these ICU teams from nurses who were dispersed across the hospital. I mean, even like myself, I was an ICU nurse about six years. I took about two years off. And I’m working in intervention radiology. And, you know, the second they were like, we need ICU nurses I, similar to many, many other people, you know, stepped up and we offered to move, moved to the ICU. And we had to expand from basically two ICU, to up to four ICUs at 34 beds each. So I think that the initial influx of patients and just kind of this never-ending was just a testament to the organizational skill at NYU and the nursing staff and the medical staff that just, you know, they knew it was hard, but everyone stepped up in just such an amazing way. The teamwork has just been incredible. People have been basically saying it’s like in the trenches, you know, and you just make those friendships and you make the teams work as best as you can in those moments. And I think that, you know, with the way NYU has run everything that we’re seeing now five weeks in just what our hard work is doing, we’re seeing people getting better, albeit some of them are slowly. We’re starting to discharge some patients that were very, very critical at the beginning. And I think that’s always. Encouragement to everybody putting in all those extra hours and work and all of that.

Briarley [00:05:10] The dedication is pretty remarkable. I’d love to hear more about what that looks like.

Katie [00:05:16] The average ICU, you know, six or seven weeks to go. It was, you know, the same team you’ve been working with for potentially years, the same medical ICU, doctors, respiratory therapists, everyone kind of knew each other. I mean, now I think what are the main things is, is that very rapidly everyone had to kind of make new teammates, make new teams and just really band together, get that organization going so that we’re just like a well-oiled machine now. And I would say just the acuity of the patients we’re seeing in normally in like a let’s say a medical ICU. You know, you see a lot of these diagnoses. You kind of say OK, it’s another pancreatitis patient. I know I need to do X, Y, and Z. I need to watch out for this. You know, you kind of know it’s coming to anticipate. So now as you’re treating these patients, that is really just kind of unprecedented. We don’t really know the proper just like algorithm sort of care for these patients. So I would say that’s one of the other struggles that, you know, everyone kind of faces right now.

Alex [00:06:08] Yeah, you said banded together and it’s been pretty remarkable seeing how this has seemingly banded together so many disparate functions within the medical community and so many perhaps unrelated areas coming together to treat the same disease. Dr. Schaefer, as a cardiologist, can you tell us what your experience has been?

Dr. Schaefer [00:06:26] Sure. My practice is primarily office-based. So I see a wide range of ages and conditions, people coming in for everything from simple chest pain that’s not heart-related to people that have extensive and advanced heart disease that need to see on a regular basis. I remember in New York, the first confirmed case was March 1st. I remember that because it was a Sunday and I was messaging with a colleague of mine about how we’re going to prepare for this in general. And before I was asked to come to the hospital and help out there, I had seen some cases in the office of people coming in with related COVID conditions. Nothing serious that required hospitalization at that point, but primarily young people with mild cases of COVID that were having chest pain related to the inflammation that the Coronavirus causes. As time went on, it became clear that the magnitude of this was going to be great. And our administrators and my division chief reached out asking those of us that would be willing to help out at the hospital to sign up and be a part of what now we call the COVID army, which is a big group of health care workers from all different specialties, all different practices, all different locations within our health system that are coming to the central hospital to help out. So early in April, I was asked to take over a ward at the hospital of COVID patients, non-ICU patients. So these are patients that are what we call a stepdown kind of in between mild case and a severe case, requiring ICU. These were patients that needed to be in the hospital primarily to get oxygen supplementation and good supportive care. So everybody was requiring oxygen either through a simple what we call nasal cannula, which is a small device that puts oxygen through the nose all the way up to people requiring that plus a mask over their face to give them as much oxygen as possible. That was a unit that I was on for about four days before it had to be converted to an ICU because so many people in the hospital were requiring intubation the tube into their mouth to breathe for them, that they had to be escalated up to an ICU level of care. And I can echo a lot of what’s already been said. Katie, with the morale of the hospital and the kind of rallying around that we saw. I was fortunate to be part of a great team. I was an attending physician that was overseeing a group of medicine residents that were really on the ball. They had been taking care of patients for weeks at the hospital, working six days a week, very familiar with the disease. And I was able to slide right into that and provide them some support and oversight. They really made my job easy. And there’s no doubt that this is a very serious illness and nothing like we’ve ever seen. But everybody is working together and collaborating to make sure that we’re doing everything we can for the patients.

Briarley [00:09:33] I think it’s really incredible to hear your story of pivoting so quickly to help on the front lines, which I am sure many are doing right now. Dr. Sista, what are some of the anxieties and fears that you are hearing from your patients or even just your friends and family during this time?

Dr. Sista [00:09:53] I think one thing that we have to remember in this time of this COVID crisis is that there are a lot of patients that don’t have COVID that have significant disease. For example, I treat chronic venous disease, which occurs when patients have blockages in their veins of their legs and their legs swell up and become painful, and as a minimally invasive surgeon, I’ll go in and open up those blockages. But this doesn’t rise to the level of the emergency that we were confronting with the COVID crisis. So a lot of my counseling actually occurs with these patients who I have to sort of describe this situation in the hospital and help them understand why they can’t be treated right now. And so when we talk about flattening the curve, it’s not just flattening the curve for the patients who will come into the hospital with COVID, but it’s for the entire health care system, because there are so many patients that rely on high-quality care outside of those patients who don’t have COVID. There is the friends and family part of it. I have an elderly father who lives in the city and he’s always asking me how bad it is and I describe it to him. You know, it becomes very sobering. And it’s that sort of thing that can reinforce all people to stay indoors and socially distance and follow the guidelines that the city, state, and country are recommending.

Alex [00:11:17] That’s remarkable, yeah. So on that note, Dr. Shaefer, you’ve been inside a New York hospital for quite some time now, treating these patients and also probably communicating with their loved ones. What experiences have you had in communicating a patient’s condition?

Dr. Schaefer [00:11:33] That was one of the most difficult things to see in the hospital is patients sitting alone. Normally, when you’re in the hospital, of course, you can have family members with you there to support you. But in this case, patients are all alone in their room. And they’re not only isolated from family members, but even doctors and nurses have to limit their time from going into the room and being with the patient, because the longer you’re in that room, the greater at risk you are. So it’s it was a very difficult thing to see. Fortunately, you where we are with technology, there are ways around that. So probably one of the things to remember is to make sure you do bring your phone and your charger with you if you have to go to the hospital, because that is a great way to communicate. We would often do face time with patients and their family members in the room. NYU has the capability of doing that through the modules that they have in the room, that was a big help. Also, what hospitals are doing is designating specific health care workers to contact patient family members on the outside. For instance, NYU has a program that they call Family Connect to make sure they’re getting updates on a daily basis as to how their family member is doing. So it’s a very difficult thing to see. And even more difficult to live through if you’re that patient that has to be in the room all alone. So it’s very important as family members that you reach out to them as often as you can and stay in touch with the health care team as often as you can.

Alex [00:13:06] Yeah, I’m sure Katie, you have had some deep experience in this as well. From what you’ve learned, what sort of advice might you give to any aspiring nurses that may be studying to become one or are thinking about becoming one?

Katie [00:13:19] So most people, I’d say, you know, go into nursing school and, you know, they want to help people. You know, the science of medicine fascinates them. You know, the caring for people and, you know, being that advocate for a patient to the physician, there’s really no way, I think, to really prepare somebody for this because you can only be so prepared. But I do think now that this has become a reality to us and could unfortunately very well happen again in either a second wave or in some other, God forbid, some other illness. But I would think that since it is so worldwide and it’s been known now that I would hope that most nursing schools will put this into their curriculum. Just so everybody really is fully aware that, you know, you are going in to help people. But there are times when you are called upon to kind of put your own life, you know, at risk. And that’s so hard to conceptualize until you’re really in that situation. And then again, also some nurses, like at NYU, we were really well taken care of with our PPE and everything like NYU has gone above and beyond to make sure that we’re really safe. There are, unfortunately, other facilities where these nurses are being asked to literally put their lives on the line while they’re helping these people and they don’t have the proper PPE. And I think the question is then, you know, where do you draw the line with that sort of preparedness? I don’t know the answer. Other than that, you really can’t be prepared. But if you really do feel that calling, I think that you do need to just not idealize it and you really need to make sure that you’re prepared to enter into something like this. You know, when you dedicate yourself to this field and career of medicine.

Alex [00:14:58] Yeah, wonderful advice, thanks.

Briarley [00:15:00] All right. Dr. Sista, turning things away from health care for a moment and over to finance. So we’re really all feeling the effects of a contracting economy. But I’m wondering, are there any financial concerns unique to residents, doctors, and nurses that have been exacerbated by this pandemic?

Dr. Sista [00:15:20] The financial impact of COVID on New York City hospitals is really substantial. You know, each one of these hospital systems is losing hundreds of millions of dollars per month. And it is stressing the system not just in terms of resources, but finances. And unfortunately, that has a trickle-down effect ultimately to all the physicians who are a part of this. Now, you know, there’s already funding in place for residents and there are physicians that are being redeployed into the hospital like Dr. Schaefer. But there are physicians that are not being redeployed. And, you know, just like a lot of businesses rely on people coming in for services, these physicians in the community have seen a marked downtrend in the number of patients they’re seeing. And so those physicians that Bill, based on the number of patients they see, the number of outpatient procedures they do, the number of inpatient procedures they do are being furloughed because there is not enough work for them to do in the traditional sense as these hospitals are losing a ton of money caring for these COVID patients. So the fact that this is taking such a financial toll on hospitals really does affect both physicians and residents.

Alex [00:16:34] So, Dr. Schaefer, we recently read a NBC News article. It was reporting on an E.R. doctor in New York who was working against the front lines like you folks, and he was facing a mountain of student loan debt. He’s really pleading for more loan forgiveness from the federal government during this time. Do you think that the CARES Act didn’t go far enough in helping doctors like him and his wife?

Dr. Schaefer [00:16:59] From my experience to fund medical school, I took out a total of five different loans, two of which were smaller private loans and three of which were essentially government loans, federal education loans. So I’m currently paying back loans and will continue to pay back loans for several years. That is a common issue with a lot of medical students, no doubt. That’s why I was so happy last year to see that NYU was able to raise enough money to make their medical school tuition-free for all students going forward, which is a remarkable feat. And I hope other medical schools are able to raise the funding to be able to do that for future students, because the burden that a lot of doctors have in terms of paying back loans like this couple you just mentioned is great in terms of the CARES Act. I think the priority of taking care of people right now that are without work and that have them laid off that have no source of income, that’s the number one priority. But I would hope that if this continues, that hopefully some money can be carved out to help those frontline workers that are dealing with educational debt, that some money can be put towards their loan forgiveness to help them pay it down. And I think a lot of people, society, in general, would be OK with helping out the people that are in the front lines right now and really putting themselves at risk. So I think that would be a good idea going forward. And obviously we have, you know, a lot of policymakers to get on that. There’s a lot of issues going on right now, but I think it’s certainly a reasonable initiative.

Alex [00:18:37] Yeah, I absolutely agree. Dr. Sista, what has been your experience with student loan debt?

Dr. Sista [00:18:42] You know, I think one thing people don’t think about when they think about physicians is really the opportunity cost. Our entire 20s are spent either earning nothing as we go through school and accumulating debt while we’re earning nothing. And then while in residency, really making a minimal salary. And so you’re talking about 10 to 12 years when you don’t have the opportunity to save money towards retirement, to really build equity in various instruments. And so when you talk about student debt, it’s not just the debt that’s being piled on to a decade of a lack of earning. And I completely agree with Dr. Schaefer that, you know, physicians are generally well-paid. They’re in a stable profession that’s not going anywhere soon. And you know, I’m always cautious to not, you know, play that violin too much because there are people that are genuinely in financial hardship and suffering. And I think in times like the COVID crisis, when a physician sees mounting debt on top of the fact that they’re risking their life, potentially if they’re on the front lines, there’s a question of fairness. And, you know, isn’t there something that can be done to acknowledge the risk that’s being taken.

Alex [00:19:58] Yeah. Great, thanks for sharing that.

Briarley [00:20:00] Katie, do you want to share your kind of story, with student debt as well?

Katie [00:20:06] Well, I mean, I think we can all say that it’s less dramatic than going to med school. But I do think coming out, you know, you’re still paying for a four-year degree. Usually, people go on to get their nurse practitioners. Now they’re DNPs, things like that. I would say there’s loans and whatnot that you need to forgive. But I would say that the biggest thing is that often, in my opinion, and it’s pretty much globally accepted that nurses are just underpaid in general and especially now just given that we are asked to put our lives on the line and things like that. So similar to what Dr. Sista was saying was, you know, there is loan forgiveness, but there’s also this point when we’re being asked to go just above and beyond what is fair in terms of is there a chance for us to get some sort of a, you know, a federal tax break or, you know, just a couple of months of hazard pay or some sort of thing to actually really give back to the nurses and similar stuff to us.

Briarley [00:21:02] Yeah, obviously the pandemic is really going to be a catalyst for change. So this is really an open question for you all. Do you feel like this pandemic has changed medicine and how you’re going to work moving forward and when things return to somewhat normal?

Dr. Sista [00:21:18] So I do think that this has changed medicine forever. There are these opportunities when a crisis hits and you see new policies that come into place that actually can be applied beyond the current crisis. So, for example, at NYU, we have really transitioned to video conferencing with patients, telemedicine. And I’ve done this personally as part of my clinical responsibilities to my patients. And I think that it has really been outstanding. The infrastructure that’s been created by telemedicine and you start to realize that for both patients and physicians, this is a very viable way of communicating. And it really is possible to get a lot out of a visit, even if the patient is not in the room and then has a lot of implications for health care in general. And then the novel therapies that are being rapidly developed to try to combat this very, very serious threat to human life will certainly play a role in how research is performed. At NYU, for example, there are three novel therapeutics that are being actively tested. I think the implication is not just that these can be therapies that will help the disease and maybe other diseases, but how quickly these are getting off the ground. There’s a lot of bureaucracy associated with a lot of what we do in medicine and how these walls have been torn down in the face of a crisis can give us clues as to how to get to the right therapies faster compared to how we used to do things.

Dr. Schaefer [00:22:53] Yeah, well said, Dr. Sista. You know, I really do hope that this is a catalyst for change for many different things. Necessity is always the mother of invention. And I think this is gonna bring forth a lot of different innovations from the top down. And although many things need to change after this, everything from probably our federal spending and public health to how we actually implement those policies on the ground, my hope is that one of the biggest changes out of this will be that this era really inspires a lot of young people to go into the fields of infectious disease, immunology, virology, all these different areas where we have much to explore, much to learn and much to accomplish. So I really hope this provokes a lot of young people to take this up and see this as an opportunity to advance biomedicine and advance the way we prepare for health conditions and the way we treat health conditions. And obviously, only time will tell, but that’s probably one of the things I look forward to most that comes out of this is just a young generation of people that are inspired to lead the way in biomedicine.

Alex [00:24:07] Yeah, that’s a very exciting prospect that could come out of this and a wonderful result of something truly horrible. Katie, did you have some final words?

Katie [00:24:15] No. I mean, it was well said by both Dr. Shaefer and Dr. Sista. The only thing, I might add, is that it’s been obvious that we need more ICU nurses. So I’m kind of wondering if they’re going to advance some of the education that we have at some of the hospitals now to incorporate some of the more acute med surge-type nurses, give them some more training, you know, with things like ventilators and handling endotracheal tubes in, you know, different invasive active medications and central lines and, God forbid, ECMO again. But, you know, things like that, just kind of increasing education amongst nurses.

Alex [00:24:50] So we want to thank our guests for being here today. We really had a robust conversation and we’re very lucky to have had them to take time out of their very obviously busy schedules, taking care of those who need it most. So we are very grateful to all of you. Thank you so much for being here.

Dr. Sista [00:25:05] Thanks for having us.

Dr. Schaefer [00:25:06] My pleasure. Thank you.

Katie [00:25:07] Thanks, Alex.

Alex [00:25:14] So Briarley, how fortunate have we been to have had this wonderful panel with us today? Certainly, things that I could have never known otherwise had we not spoken with such experts.

Briarley [00:25:23] Yeah, I totally agree, Alex and I also thought it was really encouraging to hear some of the stories that they were sharing. And one of the things that I also took away is just another kind of layer of appreciation for what they are doing out there on the frontlines. That also extends to the other essential workers that we didn’t get to talk to today. You know, without them, we wouldn’t be able to be in the position that we are in as well, being safe at home right now.

Alex [00:25:54] So true. And I hope that all of them have heard us banging our pots and pans out of the window at 7 p.m. every day here in Manhattan to show little sign of appreciation. It’s the least we can do for these true everyday heroes.

Briarley [00:26:07] Yes, absolutely. I know it’s been like for a few weeks now and it does not get old. And it is quite a quite emotional thing, isn’t it?

Alex [00:26:15] It is. Yeah. So for more information about how Laurel Road is supporting health care professionals directly visit Laurelroad.com/Covid-19. Now let’s get the legal out of the way. Any opinions, findings, and conclusions expressed in this podcast are those of the participant(s) and do not necessarily reflect the views of KeyBank. In providing this information, KeyBank is not acting as your agent or is offering any tax, financial, accounting, or legal advice. Laurel Road is a brand of KeyBank N.A., Member FDIC and Equal Housing Lender. NMLS #399797.

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