Lessons Learned on Rotation at COVID-19 Inpatient Service at New York City Hospital
AS I WRITE TO YOU, I am happy to report I have just completed a 7-day rotation at the COVID-19 inpatient service at my hospital in New York City! Overall, it was a positive experience, despite the occasional sad and scary moments. I left the service feeling uplifted and fulfilled. I am glad to have been on the front lines of the war against this life-changing virus, making a contribution.
Ting Bao, MD, DABMA, MS
The most important lesson I learned through this unique experience is things are not as bad as I thought they would be. I started the service with 11 patients; all tested positive for COVID-19 and had cancer. Most of them had received chemotherapy within the previous 2 weeks, and some had low white blood cell counts and other comorbidities. I thought most of them might deteriorate rapidly, but to my amazement, nine patients remained stable and improved over the next 7 days. Among them, seven went home, and two remained in the hospital with minimal COVID-19 symptoms but waiting for placement to a subacute rehabilitation facility.
Two elderly patients with end-stage cancer ultimately died peacefully, with their family members able to visit the bedside one by one. I am glad our hospital was able to make the exception for our dying patients who were COVID-19–positive by allowing their family to pay tribute as the end approached. As such, it makes this process much more humane.
We admitted eight new patients over the week. Six were stable on the floor and would be going home soon. One patient quickly went to the ICU the same day of admission but miraculously did not require intubation, improved significantly over 2 days, came back to the regular floor, and was discharged 3 days later.
Another patient with metastatic cancer, who had received chemotherapy about 10 days prior, came in with COVID-19–induced respiratory failure. Initially, he was classified as “Do Not Resuscitate/Do Not Intubate” after extensive discussion with the family about his poor prognosis and essentially zero chance of coming off the ventilator. The family members then reversed his code status back to full code (requiring chest compression and intubation) when he was actively dying. The whole process was painful for everyone, especially the family members. My observation is that COVID-19 significantly shortened the time remaining for some of our patients with end-stage cancer, and often the family members were not ready for the inevitable end, not having had time to fully process their impending loss. We must be supportive in these cases and call in psychosocial support for the family when available.
Even though my service is over, there are a few moments that keep resurfacing in my mind.
“COVID-19 significantly shortened the time remaining for some of our patients with end-stage cancer, and often the family members were not ready for the inevitable end.”— Ting Bao, MD, DABMA, MS
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A Heartwarming Moment
ONE OF THE ATTENDINGS in infectious disease not only saw patients and gave advice on COVID-19 management, but also helped us with code status discussion, which is completely above and beyond her duty. One of our patients was not a native English speaker, but this attending happened to speak the patient’s language. She helped us clarify the patient’s code status while spending lots of time in the room with the patient, not worrying about her own risk of being infected.
When I thanked her for doing this, she responded: “No problem. He reminded me of my dad.”
A Nerve-Wracking Moment
ON MY SECOND DAY in the COVID-19 service, during our afternoon call, the resident told me the new intern was sent home early because of shortness of breath. The intern had just come off the ICU rotation in a hospital with many COVID-19 patients 2 days before. While I was listening, my mind was racing, recalling every moment I was standing close to her, touching her phone while talking to our patients. Over the next few hours, while her COVID-19 test was pending, I tried to recall what I did after my close contact with her over the previous 2 days, almost reliving every moment, preparing for the worst, and considering what to do if she tested positive. Finally, her COVID-19 test result was negative. I was so relieved.
A Heartbreaking Moment
“WHY DON’T YOU monitor his heart rate or his oxygen level?” the patient’s daughter came out of the room, asking us with teary eyes.
My reply: “Because he is actively dying. He has too many underlying conditions and now severe respiratory distress.”
“But he is a fighter. It just takes a few days; then he will get better. He will overcome this.”
Again: “He is actively dying. We are trying to make him comfortable. Look, he is very comfortable.”
“He will get better.” She started crying, and I got teary too—for her and for the helpless situation.
Life After Rotation
BEFORE I KNEW IT, the rotation was over, and I am back to normal life. No more wearing scrubs, rushing to the hospital; no more wearing double-layered face masks that would leave a mark on my nose and face; no more FaceTime sessions with a patient right outside the room; no more going back and forth to the laundry room four times a day; no more wondering every time anyone around me sneezed, coughed, or complained of a sore throat “Did I catch it? Did I spread it to my family?”
I am glad I worked on the front lines and helped some patients with COVID-19. I am no longer living in fear that most of my patients with cancer will die if they become infected with COVID-19, as I have seen that, truly, most of them improved with time and treatment. I will continue to be cautious, though, as some of them could become very sick and die quickly.
The best moments usually came at 7:00 PM every day, when my daughter would join her friends on our building’s terrace, cheering for the health-care providers. She would always add a sentence at the end, “I am cheering for my mom! She took care of patients with COVID-19!”
Stay safe and well. Let us stay connected during this isolating pandemic.
DISCLOSURE: Dr. Bao has served as a consultant or advisor to Eisai.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.