Work: Internal medicine and pediatric hospitalist at the Cleveland Clinic
How have you served the community during the COVID-19 pandemic?
I remained working clinically seeing both COVID and non-COVID patients that were hospitalized in the Cleveland Clinic main campus. I was deployed from the pediatrics inpatient service to the medicine side in the expectation of a patient surge. We published two articles, one about the inpatient management of patients with COVID in non-ICU units, as well as blood management optimization during the COVID surge.
In addition to my clinical engagement, I became very strongly involved in academic activities supporting the creation of curriculum designed for non-internal medicine providers (pediatricians, surgeons, psychiatrists, etc.) who would have been potentially engaged and redeployed to care for internal medicine patients. I also participated in a national effort called POPCoRNetwork (Pediatric Overflow Planning Contingency Response Network), creating and curating material designed for pediatricians to care for adult patients, and (with) the Society of Hospital Medicine curating literature and creating a list of resources available for hospitalists to provide care to patients with COVID.
In addition, I organized grand rounds and academic activities, bringing COVID experts to speak to our colleagues at the Cleveland Clinic. As part of my international academic engagement, I also helped experts at the Cleveland Clinic be speakers and present at the Mexican College of Internal Medicine, providing guidance to our international colleagues on best practices in medical management of COVID.
What has been the most challenging part?
Witnessing the suffering of patients with very elevated mortality rates in the nation was very challenging. But also acknowledging that our colleagues in health care nationally (physicians, nurses, paramedics, firefighters) were struggling to keep up with the pace of patient surge.
Aiming to find the best way to protect ourselves was also challenging – learning how to “don” (wear all the personal protective equipment) or “doff” (remove the PPE) without contaminating ourselves was very challenging. We had to adapt to a new style of rounding in order to protect our health care providers. We rounded (or regularly checked on patients) using scrubs (surgical uniforms) and changed to street clothes at the end of the day. This became a routine to minimize potential exposure to our families.
Both my wife and I are physicians. She is a pulmonary and critical care doctor. Rounding every day on critically ill COVID patients became psychologically demanding. We started sleeping in different rooms, showering upon arrival to our home, and wearing KN95 masks at home all the time. We did not see our family for many months as well.
In addition, the lack of evidence and clear cut guidelines to provide care for our patients was also very challenging. The information has been erratic with non-evidence-based practices being recommended at the beginning (for example, treatment with hydroxychloroquine, azithromycin, ivermectin), with a tsunami of articles that had not been peer reviewed yet. Still today, my challenge is to fight against misinformation and lack of evidence.
What has been the most rewarding part?
The building of a strong team was unparalleled. The Cleveland Clinic created a surge hospital called Hope Hospital. The entire leadership, both medical and administrative, worked smoothly to create outstanding protocols for isolation, treatment, prevention, etc. Those protocols have been continuously refined and updated. Incredible continuing medical education material has been created and available for any Cleveland Clinic provider to use and learn all the different aspects of medical care of both critically ill and non-critically ill COVID patients.
The hospital medicine team was inspirational. Everybody – 200-plus hospitalists in six hospitals – was engaged and ready to fight a large COVID surge. We had daily huddles among the leadership team and continuous situational awareness of the different staffing needs, as well as of the current process of care. The servant and transformational leadership from our chairman and vice chairmen was inspiring and a true role model for all of us. They had our best interest and our patients’ best interest as their top priority.
I loved to see the creation of the education material by our internal medicine residents. I helped curate the material and it certainly was a joy to see the superb academic quality of our trainees. In a similar fashion, our pediatric colleagues at POPCoRNetwork were inspiring – we all supported each other.
We were able to publish the Cleveland Clinic hospital medicine recommendations for management of COVID patients in non-ICU areas, as well as an article (on) blood management best practices during the COVID pandemic.
How can Clevelanders continue to support frontline workers?
I love Cleveland and its people. I don’t want anybody to die unnecessarily from a preventable disease. We are in 2021 and are so lucky to have a vaccine available. Please vaccinate yourself and your loved ones. Hopefully, children will be able to get vaccinated too. Please continue to practice excellent hand hygiene and wear a mask when you are in closed spaces. This is not a political issue; it is common sense. The rate of influenza and respiratory viral infections plummeted (this past year) due to the excellent hand hygiene, but also the use of masks.
What are you most looking forward to doing this summer in Northeast Ohio now that you are vaccinated and everything is opening up? (I) will continue using a mask outside and won’t change my behavior. I will still avoid public places as there are a lot of unvaccinated people. We have not conquered the pandemic yet; we need to vaccinate all our children, too. Until that happens I can’t trust that things are already under control.
I plan to continue enjoying the Cleveland Metroparks, zoo, the botanical garden, Lake Metroparks Farmpark, the arboretum, the Lake Erie beaches and coastal line. Ohio is beautiful and we’ll continue to enjoy its outdoors.
What local restaurants are you most excited to visit?
I will still order to takeout. I love Taza at (Eton Chagrin Boulevard) and Anatolia Cafe close to Cedar Lee Theatre. Kantina in University Circle has the best burger in Cleveland. And I discovered a place that has delicious Israeli-like pitas and sandwiches called Arova.
What Cleveland activities are you looking forward to this summer?
Hiking in the Metroparks, enjoying Lake Erie and going to the Cleveland Orchestra Blossom Music Festival – still with a mask and keeping social distance.
Meet more of Cleveland’s frontline workers at jstylemagazine.com/frontlineworkers.