Lessons from an ongoing pandemic

The beginning of June represents the home stretch for the academic year. This month will be filled with a number of transitions, most notably our residency and fellowship graduations. At the end of this month we will begin the welcoming and onboarding of a new class of interns and more than a few new faculty appointments. June is a busy time, but it is also a month for assessment. The end of the 2021–22 academic year represents the end of a second academic year under pandemic conditions. The majority of our graduating fellows and residents this year are the last ones to have interviewed for their spots in person and the last class to have trained at all at a pre-pandemic UI Health Care. When any of us think about what those days look like, it can feel like a different era, even if only more than a couple dozen months have passed. At this moment, even as we have grown used to greater amounts of uncertainty about the future, our eyes squinting for a better glimpse of the shapes ahead, I thought it might be heartening to look back and see just how far we have come. We should acknowledge the lessons, whether hard or easily won, and feel proud of what we have achieved and confident that no matter what comes next, we are stronger and more prepared every day.

Rather than me telling you what we have learned, I thought it better for you to hear directly from each other. I asked a handful of faculty, staff, and trainees to answer a question: What is a lesson that the COVID-19 pandemic has taught you? My thanks to all for their insightful and generous responses.

Cindy K. Batzkiel (Program Administrator, Internal Medicine Residency Program)

Kindness Goes A Long Way – I’ve learned that actions and words can lighten or dampen someone’s mood or state of mind. We never know what someone is going through, so it’s best to be kind to everyone. Small acts of kindness like complimenting someone, helping the elderly or offering to return a grocery cart to the cart rack for a stranger can boost feelings of happiness and optimism, and may even encourage others to repeat the good deeds they’ve experienced themselves.

Christopher Benson, MD (Professor, Cardiovascular Medicine Clinical Director; Interim Head, Heart Failure Section; Chief of Cardiology, VA Medical Center)

While I believe we have managed the disease of COVID-19 reasonably well, it has exposed just how fragile our health care systems are. As lean as we run our systems—in our efforts to maximize profit—we now see how the whole system resembles a house of cards.

Sydney Bowmaster, MD (Chief Resident, Internal Medicine)

The COVID-19 pandemic brought a sense of fear and vulnerability to many. With the necessary limitations in social gatherings, the past two years have resulted in a greater appreciation for the smaller moments, such as brief conversations with lifelong friends or outdoor walks with family. Having completed residency training during the pandemic, life’s milestones seem to take on a deeper meaning as well. Throughout it all, our added responsibilities as role models to the public or advisors to friends and family can be challenging. Nevertheless, the mutual support from friends, family, and colleagues has shown that we have and can continue to endure.

Sanjana Dayal, PhD (Associate Professor, Hematology, Oncology, and Blood & Marrow Transplantation; thrombosis researcher)

We all know that to run a research lab successfully, it’s the teamwork that matters most. I realized the value of my research personnel even more during the pandemic. Two of my postdocs had left just before the pandemic, and the arrival of two others got delayed because of the same reason. We were opening a clinical trial early in the pandemic, and I was left with just two part-time research assistants in the lab to take care of samples from COVID-19 patients. There was also a need of getting other studies going, including a new project that got funded during the pandemic. We got delayed in some tasks, but we pulled it together: we published the clinical trial led by Dr. Lentz and Dr. Perepu, published two other research works, got an NIH R01 funded for COVID-19 studies, and are about to submit the manuscript on basic research findings in COVID-19.

Ultimately, I learned that there is no such thing as failure, and lessons are learned in different ways.

Daniel Diekema, MD, MS (Clinical Professor, Infectious Diseases)

On a global level, I’ve been struck by the disconnect between remarkable scientific advances on one hand, and massive public health failures on the other. Despite development of vaccines, treatments, and overwhelming evidence in support of prevention approaches, our economic, political and healthcare systems present major barriers to pandemic response. Just-in-time global supply chains, underfunded public health systems, absence of surge capacity, and massive disparities in access to prevention, diagnosis, and treatment are just a few of the issues we will need to address if we hope to lessen the impact of infectious disease outbreaks in the future.

On the local level, I’ve been extremely proud of how our department has responded: rapidly expanding telehealth and home treatment options, creating COVID-19 treatment teams in MICU and hospitalist services, establishing a clinic to evaluate and treat those with post-acute sequelae of COVID-19, advancing the science around COVID-19, and being part of vaccine and other clinical trials. The list goes on and on!

Wendy Fiordellisi, MD (Clinical Associate Professor, General Internal Medicine; Clinic Director, Iowa River Landing General Medicine Clinic)

I hope that the COVID-19 pandemic has shown us that models of care delivery can and should be innovative. Caring for patients does not always require an office visit. In fact, care for patients often very appropriately takes place between office visits, via patient portal messaging, telephone calls, and video visits. The U.S. healthcare system needs to find a way to reimburse these models of care, so that providers have the opportunity to offer care in a patient-centered way that aligns with reimbursement structures.

Vicki Kijewski, MD (Clinical Professor of Psychiatry and Internal Medicine; Geriatric Inpatient Services Medical Director; Director, General Hospital Psychiatry; Fellowship Director, Medicine-Psychiatry)

For me, the COVID-19 pandemic has been longer, more disruptive, and more intense than I ever imagined.

Twenty-eight months ago, I was convinced that this would all be over by the end of spring break, and we would return to our usual lives after some minor disruptions. I was so wrong.

Loneliness is bad for physical and mental health. Community is important.

Visitor restrictions can have negative consequences on patients and the care they receive. We need to explicitly ask patients how we can best meet their needs for communication with family and recognize the need to obtain collateral information.

I am a more engaged, thoughtful, and compassionate physician when I get regular sleep, food, exercise, and take vacations. I am a better listener and less judgmental when I practice self-care.

Telemedicine has proven its worth.

My colleagues are smart, compassionate, innovative, and caring. They are generous with their knowledge, and I know they have my back.

Virtual interviews with residency applicants work. We have outstanding resident physicians who are bright, empathic, hard-working, and dedicated. Despite the challenges of the pandemic, we continue to train outstanding medical students and resident/fellow physicians. I learn from them daily.

Health disparities exist and the COVID-19 pandemic made the disparities more apparent.

It takes a team (nursing, OT, Speech, PT, SW, RT, dietary, radiology, housekeeping, phlebotomy, physicians) to provide excellent patient care. It takes all of us, and we all function better when we are working together. None of us can do this alone.

We have a through-put problem in our hospital and it has worsened during the pandemic. Too many patients spend too long in the emergency department.

Masks work. Vaccines work. PPE works. We can spend time with our patients, colleagues, and loved ones without becoming infected.

Asking “what happened to you” is more effective than asking “what is wrong with you.”

I learn more at Grand Rounds when I go in person.

Rethy Krishnamurthy, HRM-SCP (Human Resources Director, Internal Medicine)

COVID-19’s effects will cast a long shadow for many more years, but I am hopeful HR will continue to disrupt, adapt, and change priorities accordingly to align with and to best support the business outcomes. We learned early that human touch by means of kind communication and empathy was invaluable in addressing flexibility, wellness, and turnover. HR played a key role in listening and gathering information from employees to ensure strategies met both organizational goals and addressed what employees most needed, wanted, and valued. With the rise in requests for hybrid virtual remote work and to work part-time, HR was instrumental in sharing detailed guidelines, policies, expectations, and approaches. In the coming months, we will need to monitor how this new model of future work evolves. In addition to the shortage of healthcare workers, resignation rates continue to set records in 2022. HR has been at the forefront to help leadership retain, reassign, and help re-skill the talent that already exists; the work, however, is far from done. As we better understand the effects of stress and exhaustion on the body, it is apparent that we need to address health at work. Although many employers have wellness programs, research shows less than 10% of the employees use their benefit. HR will need to continue to partner with supervisors to prioritize and customize employee well-being, as this would be the primary manner to reduce burnout. Last but not least, as a strong proponent of streamlining/automation, I was impressed to see how swiftly projects and initiatives moved from the idea stage to rollout during a pandemic. Be it to provide virtual healthcare via telemedicine, put together a labor reassignment platform for several months, or to streamline vaccine distribution within a few hours. When we all have the desire to do the right thing, we work together to do amazing things fast, and there is no holding us back.

Ethan Kuperman, MD (Clinical Associate Professor, General Internal Medicine, Hospitalist Program; Medical Director, Presurgical Evaluation Clinic)

My role in the COVID pandemic was serving as the Iowa representative on the Hospital Medicine Reengineering Network—a national think tank of academic hospitalists across the United States. Working with national leaders in my field, I saw many of my collaborators struggling with the same issues that we were:

  1. A rapidly increasing population of potentially infectious patients
  2. Fluid national messaging on protective equipment and “bending the curve”
  3. Providers concerned about keeping themselves and their families safe

As part of that collaborative, I integrated what other institutions were doing into our white papers and guidelines for triaging patients, inpatient management of COVID-19 patients, and our Home Treatment Team outpatient surveillance program. The pandemic is when I internalized something that I had been telling others since I came to Iowa: We are world class. Our problems and challenges are shared by our colleagues at other academic institutions. Their solutions can improve our ability to care for our patients—and more importantly our discoveries and insights will help those institutions become better, too. As we begin the 3rd year of the pandemic, I stand confident knowing that UIHC internal medicine is as capable as any hospital in the world to meet the challenge.

Evelyn Ross-Shapiro, MD (Third-Year Resident, Internal Medicine)

The past two years have highlighted fractures in our society on every level, including in the workplace. We’ve had to grapple with provider shortages for illness, exposure, school/daycare closures, caregiving leave, and loss of loved ones. It’s forced us to be flexible, and it’s forced us to recognize what we take for granted. I’m hopeful that these challenges will help us move forward with a better understanding of what we need to create a stronger work environment.

On a more personal level, I’ve learned how incredibly important it is to check in with your coworkers. As providers, we have seen so much grief, misinformation, and so much unnecessary death. Prior to beginning residency in 2019, I would have never in my wildest dreams imagined a goals-of-care discussion with family members demanding ivermectin for their ventilated loved one. The weight of bearing witness to situations like this one on a daily basis can feel really heavy; and it is often difficult to convey these unique experiences to family and friends outside of medicine. The strength of our co-working relationships and the atmosphere of interdisciplinary camaraderie can make or break the hard times. I’d be remiss to think a single one of us has not struggled over the past two years; but I believe we’ve grown more resilient through our shared experiences. And if I had to choose to repeat residency during a pandemic again . . . I’d still choose Iowa.

Kim Staffey, MD (Clinical Associate Professor, Cardiovascular Medicine; Vice Chair for Clinical Programs, Internal Medicine)

COVID-19 did not teach me the incredible importance of family and friends; however, COVID-19 reinforced how absolutely essential and important my family and friends are to me—the simple pleasures of being together, giving someone you care about a hug, having a meal together, and spending time with the ones you love should never be taken for granted.

Professional thoughts:
This pandemic has been very scary, and these questions have been present throughout for me: How long will it continue? What does the future hold for other pandemics? How do we stop or slow these possibilities?

UI Health Care is amazing because of the people who make up our wonderful system. We still have work to do to—improving our system and access to care for all who need us—we must continue to make our world better. I am thankful to be part of such an amazing place made up by amazing people who give so much every day. Kindness really matters.

Peter Szachowicz, MD (Chief Fellow, Pulmonary Disease and Critical Care Medicine)

– We as humans are capable of such incredible triumphs when we work together on a common goal, but subject to so much suffering at our own hands when we are divided.

– The selflessness, hard-work, and compassion I saw demonstrated by all members of the healthcare team was awe-inspiring. It was sad to see the inevitable burnout take its toll on so many incredible healthcare workers, but witnessing them tirelessly take care of patients under such difficult circumstances day after day was a constant reminder of the beauty in medicine. I wish everyone could fully understand the sacrifices that were made by those caring for the sick during the pandemic, and I think it is unfortunate that many will never get the recognition they deserve for all the good they did, and continue to do daily.

– Great healthcare rarely involves a single magic bullet or miracle cure. It is the innumerable seemingly minor things that coalesce into the larger whole that ultimately provides the greatest healing for the patient and their family.

Raul Villacreses, MD (Clinical Assistant Professor, Pulmonary, Critical Care, and Occupational Medicine; Post-COVID Clinic)

It is difficult to put words in how I feel about the COVID-19 pandemic. Most of the memories are still quite fresh and still hurt, but I certainly learned many things.

I learned how vulnerable we are. As a critical care physician, I have seen a great number of unfortunate cases, but this pandemic made me realize even more that we have little control of our lives.

The pandemic reinforced my feelings of how important the human touch is. Seeing my patients in their bed alone while they are suffering has been one of the hardest things that I ever had to witness, even more on those who were not able to communicate with their loved ones.

I learned how harmful disinformation could be. I personally witnessed the feeling of regret from our unvaccinated patients while they were admitted to the intensive care unit, but still, there were many patients who were reluctant to receive the treatments that we could offer them.

But not everything is a bad memory . . .

I learned that we are also capable of unity and working as hard as we can to achieve the same goal. Although these were tough times, I always felt that we had a great team that was willing to give everything to help the ones who needed the most.

I learned that through science we can achieve unimaginable things. I remember the feeling of relief and joy that I felt when I received my first COVID vaccine shot and knowing that my co-workers were going to be protected as well. This experience reinforced my thoughts of how much we still need to learn.

Although we lost some battles, we also won many.

Allison Wynes, ARNP (Nurse Practitioner, MICU; Lead APP)

The pandemic has been long, with never-ending highs and lows, decisions and actions I am proud of, and those that I would do differently again. For healthcare workers, the pandemic has been a non-stop challenge in all aspects of life, nearly inescapable, between parenting, family, friends, and work. It’s easy to get overwhelmed with these challenges. Therefore, I have chosen 3 things to share that have brought me relief, joy, and pride over the past 2.5 years.

Help where you can, and know your limits. There were many times during the pandemic where it felt like there was not enough go around, not enough hospital beds, workers, equipment, resources, or myself. In these times, I learned to focus on what I can do, and do it well. We may not have been able to help every patient we wanted to, but those who did come got the best care we could give, and that is enough. I may not have been able to answer every COVID question that came at me via social media, or neighbor or friend, or give to the community the way I would have liked to, but learning to say no allowed me to be able to do a few things well, instead of several things subpar. It also saved my own well-being. 

I learned to ask for help. Sometimes it was from my co-workers, sometimes from my own friends and family. And people said yes. Lots of people. Lean on your community when you can, and give back when you are able. I have several examples of people who reached out to help with my kids when the schools were closed and I had to work. Thinking about my neighbors and friends rallying around to send gift cards, Diet Cokes, a listening ear, and wellness checks meant the world to me. In a time when the world seemed very divided, I learned that we live in a supportive, loving community, and I am grateful. 

Lastly, I learned that UIHC is capable of amazing things when we are all focused on one goal. I will forever be in awe of how fast we were able to create an ICU expansion to care for additional COVID patients. In a time that felt so dark, so many rallied to be part of a solution to help. I hope UIHC keeps that spirit moving forward, knowing we can move mountains when our community needs us.

Leave a Reply