The summer 2020 issue of Medicine at Michigan magazine covers the experiences of frontline heroes who have led Michigan Medicine’s response to the COVID-19 pandemic. Three IHPI members are among those featured -- here are their stories.
“THIS COULD BE US”
Vineet Chopra, M.D., associate professor of internal medicine and chief of the Division of Hospital Medicine, served as medical director for the Regional Infectious Containment Unit (RICU) as it opened, along with co-directors Valerie Vaughn, M.D., and Chris Smith, M.D. In March, one of the first patients in the unit was a physician who had trained at U-M and contracted COVID-19 while working at the Detroit Medical Center.
“He was transferred to us for ECMO,” Chopra said, noting that Michigan Medicine has the highest number of ECMO machines in the state. “The anesthesiologist caring for him was his classmate. We all had the sense that, ‘this could be us.’”
Disconnected from the outside world, the patient’s spirits were brightened one day when his daughter sang “You Are my Sunshine” to him over the phone. Weeks later, the physician had recovered and was discharged.
Many of the patients in the RICU didn’t survive the grueling disease. Some had preexisting health conditions, while others were healthy before contracting the virus. “This disease spares no one,” Chopra said. “In these last moments, we are the patients’ family. I’ve personally held hands with several of them when they were in the unit.”
Chopra was an intern in New York City during 9/11. He worked on H1N1 flu cases. He volunteered to treat Ebola patients. “COVID is unlike any of those,” he said. “Just the sheer number. The resources these patients need. I don’t think any of us fully appreciated the complexity of caring for COVID patients in the beginning.”
In spite of that complexity — or perhaps because of it — Michigan Medicine was able to shift into high gear quickly, Chopra said, with all relevant specialties coming together and “operating with agility.”
On a day in mid-April, Chopra was leaving the hospital around 6 p.m. when he saw a man in his late-50s leaving with his family. He recognized the patient as someone he’d treated in the RICU. “I quickened my step and talked to him. I had the incredible privilege of walking him out of the hospital,” Chopra recalled. “He said, ‘I’m going to go home and have a big steak.’
“Then he turned around and said, ‘Thank you for saving my life.’”
“WHY DID ONE DO OK AND NOT THE OTHER?”
In late April, Valerie Vaughn, M.D., treated two patients who had COVID-19. Having arrived at the hospital at roughly the same time, they were in the same room on the seventh floor. Neither of them needed to be in the ICU, but they still had major oxygen needs. Vaughn had helped create a new type of moderate-care room, where patients like this could make use of heated high-flow oxygen devices without having to be in the ICU.
When it was time to examine the patients, Vaughn suited up: n95 face mask, face shield, gown, and gloves. Vaughn made a habit of passing out her business card while caring for COVID-19 patients, so they would know what she looks like behind all the gear. “By the time you walk in, you’re already sweating,” she says. These two patients had been faring equally all week, neither improving nor deteriorating. Until this day, every time one of these patients stood, their oxygen would dip, so they were both confined to their beds.
On this day, however, her first patient was finally well enough to be taken off of the heated high-flow oxygen. When she entered the room, he stood and walked around, joking and showing off his new mobility by doing squats. Vaughn realized in that moment that he would go home. She was flooded with “absolute joy.”
Then Vaughn visited his neighbor, a man who had lost his wife a year ago and had had long conversations with health care workers throughout the week about his end-of-life choices. She knew he did not want to be kept alive on machines. But his fate had changed in the opposite direction of his roommate. His oxygen needs were higher, and it was time to intubate him and put him on a ventilator, or acknowledge that this was the end.
The team called his daughter. “It’s one of the toughest phone calls to make.” Vaughn felt like she knew this woman after their phone calls over the course of the week, but they had never met in person. “We don’t get to meet the families anymore.” The only exception was for end-of-life visits.
“She got a chance to come in and say goodbye to her dad. She took his wedding ring and his cell phone. … I got to watch as his neighbor was wheeled out of the hospital to the loving arms of his wife.
“Why did the one do OK and not the other one? … It’s just so random how coronavirus affects people.”
THE CLINICIAN/ RESEARCHER: A COVID-FIGHTING DOUBLE THREAT
Mahshid Abir, M.D., M.Sc., was leaving her house one day in mid-April when her 10-year-old son heard the garage door rising. He yelled to her from a second-floor window: “Mom, don’t get COVID!”
His concern was genuine; Abir is an associate professor of emergency medicine, and she had direct contact with COVID-19 patients during most of her shifts for the month leading up to that day. “Every time when I come home, I go right from the garage to the laundry room, then straight to shower. I don’t hug my kids; I don’t kiss my husband,” she says.
Abir was relieved that Ann Arbor was not hit initially with the same patient volume as Detroit or New York. Even so, she says, the pandemic will have a profound impact on how Michigan Medicine operates. She is sure of that because of her experience as a clinician, as well as her role as a researcher who studies health services through a joint appointment at U-M and the RAND Corporation. For 10 years, she has studied hospital preparedness — a topic that is always important, but never more so than during the first wave of COVID-19.
“Think of the social unrest and political change around the world. The geopolitical climate is changing,” she says. “This is not going to be the last pandemic. This is not going to be the last disaster. We, as researchers, need to be nimble. We don’t have months; we don’t have years.”
Abir has been impressed with Michigan Medicine and U-M’s responses to the COVID-19 pandemic, particularly the rapid switch to video appointments for many patients, the creation of a PPE disinfection process that uses a UV-light-based treatment, and the rapid establishment of special units just for COVID-19 patients. “The pandemic is forcing innovation out of desperation,” she says.
A more profound silver lining of the pandemic, she says, could be a change in the way people within and outside of health care reconsider all processes, actions, and behaviors.
“Do we want to go back to normal, or do we want to reevaluate some of those societal rituals? At least based on conversations with family, friends, and colleagues, people are spending more time with family. They are spending more time reading. They are thinking more, and reflecting more,” she says. “I wish we would do more of that. In a world of social media and people not talking much to each other anymore, perhaps this is an opportunity to hit that reset button. Perhaps we can leverage the situation to create positive change.”