"Stay Home?" Doctors Charge Into a Crisis

Physician volunteers rush into Hot Zone to treat embattled community during a pandemic.

Pain and Movement | Oct. 29, 2020

"Stay home, stay safe." That was the terse but crucial instruction shared in communities and around the world in an effort to curb the ravages of the worst pandemic in 100 years.

That was clearly not an option, however, for the many responsible for making sure others still had access to life's necessities. And certainly not for healthcare providers who were testing, treating and comforting the sick and dying. Overwhelmed hospital emergency rooms and urgent care units, especially in large cities, were working beyond overtime with too little assistance and a too-limited understanding of COVID-19, especially in its early days.

While most of us were staying safe by staying home, others were traveling to intensive care units at the epicenters of the virus to volunteer their time and skill, in a risk-filled effort to help in any way they could.

Abbott spoke to three physicians who have worked with us as part of their chronic pain management and movement disorder practices:

Dr. Nicholas Bremer, a pain management specialist from Charleston, W.Va.

Dr. Brian Kopell, a neurosurgeon from New York.

And Dr. Paul Lynch, an anesthesiologist from Scottsdale, Ariz.

All left their families, practices and quarantines to treat COVID-19 patients in New York City at the height of the outbreak. They are not the types of people to wait to be invited. Their backgrounds and personalities informed their decisions to put themselves in harm's way when needed most.

"Always Running Toward the Fight"

Bremer served as a Commander in the U.S. Navy and was a Naval Flight Surgeon who was part of the humanitarian effort following the 2011 Japan earthquake and tsunami. He had considerable intensive care experience which, combined with his understanding of operational risk management concepts, gave him an advantage when assessing and mitigating the inherent risks in entering what "was literally a city in crisis. I'm the kind of person that's always running toward the action, toward the fight."

Kopell felt a similar need to be part of the solution. "Given the severity, voluntary vs. involuntary sort of goes away. Having COVID-19 foisted upon us wasn't voluntary, so it's a funny way of putting it. Could I have chosen to stay home? I suppose I could have, but it wouldn't have been the right thing to do."

Lynch had seen New York in a life-threatening crisis before. He answered the call then. There was never a doubt he was going to answer it again. "What drives people to go into healthcare? We want to help people. We want to save lives. On a deeper level, I was in New York City during 9/11. I was finishing up medical school doing rotations in Queens and I saw the towers fall and I jumped on a subway and just ran to ground zero trying to help. And there was no one to help."

This time, there were plenty of people he could help. Many of Lynch's friends and mentors that he had trained with, and under, contracted COVID-19. "We had 900 people from Bellevue Hospital where I used to work get sick. Calls started going out, 'Hey, are there any docs that can come back and help?' Literally the department was just being decimated: 50% of our anesthesiologists got sick, which makes sense because we're kind of on the front line and there's lots of aerosolizing procedures and stuff in the air. …

I couldn't just sit on the sidelines."

So Many Added So Much to the Effort

As they settled into their work, they were surrounded by kindred spirits.

"There was not one person from the same place. We turned the entire hospital into an intensive care unit, so, as I would go around and say, what's your name, where you from. Everyone was from somewhere different," Lynch said. "The nurses really stood out. They came from Louisiana, North Carolina, Michigan, Oklahoma, Texas, Washington, California. Some of them came completely to volunteer."

Kopell worked out of one of New York’s largest hospitals, which took a "big picture" perspective on the crisis. "Our institution mobilized all of its resources to address this. They built hospital wards in the lobby of the hospital with rebar and plumbing. They mobilized this in a week or two. That's impressive," Kopell said.

"There were people that were 60 years old who came to help and put their life at risk," Lynch added. "It reminded me of firemen running into a fire. They know they're at risk, but this is what they were called to do."

Lessons Learned

While the work was exhausting and consuming, each experience reshaped their views of their profession. "We just learned the entire time," Bremer said.

Patients presented myriad medical problems. Staff determined whether symptoms were being caused by COVID-19. A person with heart failure was discovered to be suffering COVID-19-related myocarditis. Another had renal failure caused by COVID-19.

"Just to be on the front lines of arguably the most important emerging disease or special pathogen in the world has been a tremendous privilege," Bremer said.

Kopell found a new perspective on his professional life. "It really made me realize that what I do for a living is a privilege. It's certainly instilled a sense of gratitude about what I do."

Even a self-described "storyteller" like Lynch found himself gaining new levels of empathy in the unique world of the COVID-19 unit. "I wanted to know who they were, where they were from. I was acutely aware that this might be the last time that they spoke to someone. It totally changed the way I interacted in intensive care and the way I talked to the families. But now, coming back, I think it's made me even more acutely aware of the preciousness of life."

Three healthcare professionals from around the country. None decided to "stay home, stay safe." Each with his own motivation and each experienced singular challenges and revelations as a result.

"What you come to realize is how fragile life is but also how resilient people can be after being essentially decimated by this disease," Bremer said. "Families and patients, everyone still has hope. Healthcare workers still have hope."

Podcast 1 Transcript: "I've always run toward the fight"

Dr. Nicolas Bremer

Salma Jutt (00:01): Hi, I'm Salma Jutt, Divisional Vice President of US and Global Marketing for Abbott's neuromodulation business. At Abbott, we are working across our company to support communities with resources and technologies to fight the evolving impact of COVID-19. Getting new molecular antigen and antibody tests and rapid tests into the hands of frontline workers so people can receive the critical results they need. As the COVID-19 global pandemic unfolded in the United States, New York city was the hotspot and by April hospitalizations were into the thousands each day. As hospitals in the city, were reaching capacity. The call went out for volunteer physicians to contribute to the care of patients. One of these doctors who stepped up to the challenge is Dr. Nicholas Bremer. Dr. Bremer is a pain medicine specialist and anesthesiologist who recently practiced at the Spine and Nerve C enters of the Virginias in Charleston, West Virginia. He left his young family to head up to New York city. Dr. Bremer is no stranger to global disasters as a commander in the US Navy, he was a Naval flight surgeon that participated in the humanitarian effort in the wake of 2011, earthquake and tsunami in Japan. When the call went out in New York, he knew his experience would benefit the thousands of sick patients being admitted to New York city hospitals. Keith Boettiger, president of Abbott's neuromodulation business, sat down with Dr. Bremer to discuss his experience.

Keith Boettiger (01:38): I've just been impressed with some of you guys who kind of gave up your private practice and made the decision to go, go to New York city and work kind of in the middle of this whole thing. And I think that just takes a lot of courage and a lot of guts, and it takes a lot of risks. You have a, you have a wife and a super young child at home right now. Right? So you kind of gave up a lot to go, go help a lot of people. So I thought we, I have, you know, four or five questions. I just thought, I thought we'd go through, but I really want to do this because I'm impressed with you guys. I always, I'm always impressed when people take risks or kind of do do things that are kind of outside the norm. So, you know, I just thought I'd start with, you know, what really, what drew you to go to New York city to kind of jump in the middle of the pandemic and kind of like the hotspot for the whole globe.

Keith Boettiger (02:24): I mean, I know you got a super successful practice in West Virginia, and I know you guys, weren't seeing a lot of patients and doing a lot of procedures, but still it's a big deal to leave your family to go to New York city and work with really sick people.

Nicholas Bremer (02:37): You know, so that's a good question. I mean, you know, I'm, I'm kind of the type of person that's always run, sort of ran toward toward the action toward the fight. And, um, I saw things happening and, uh, you know, the other side of it is I, I had a great deal of experience with intensive care, um, or, you know, with critical care in residency. So I, I, you know, I felt extremely comfortable in the intensive caring and that sort of combined with, you know, my sort of a willingness to put myself in sort of, you know, more uncomfortable situations. And then with my Navy background, with this thing called operational risk management, we're always taking risks and everything we do and trying to mitigate those risks over time. I don't know. I, you know, it was at the time anyway, it was literally a city in crisis. And I would talk to people here and kind of hear your stories and, um, you know, the skillset that I possessed partially due to my training and pain, actually, you know, with, you know, using ultrasound and being able to put lines pretty much anywhere. And, you know, just in general anesthesiology training was extremely and, uh, you know, high demand. So it just, um, you know, I talked to my wife about it and, you know, we sort of went back and forth and then, uh, she eventually said, you, you just gotta go, you know, so that's, that's how it kind of came about really.

Keith Boettiger (04:03): How has it all evolved since the day you got there? Cause I mean, you got there kind of in the middle of it, right? And it's gotten to kind of hit the top of the curve.

Nicholas Bremer (04:12): So, uh, I guess when I first got here, it was, um, what I would call controlled chaos at Bellevue. Um, you know, Bellevue hospital center is essentially the flagship hospital of the New York city, HHC health and hospital corporation, uh, public hospital system, which, which incorporates us into 11 hospitals around the city, I believe. Um, and each hospital has an academic affiliation with some university in New York city seemingly. So, um, you know, so HHC was, was in really a tough spot. And I think Bellevue did an amazing job in terms of preparedness. Um, you know, whether it be physical plant, you know, infrastructure, making ICU beds available literally out of thin air inventing ICU beds, new units, just expanding. So I got here and it was a, you know, kind of controlled chaos. Other hospitals, um, were, you know, maybe not doing quite as well, but , Bellevue was a, it was a controlled chaos. And, uh, you know, as I sort of sort of integrated into the intensive care unit, so the anesthesiologists were placed in all, all types of units. Most, most anesthesiologists were placed with, um, the anesthesiology department. I was placed in the intensive care unit with the COVID NICU so, so actually integrated into the, uh, the teams, you know, sort of over the course of a week, really, you know, it became something called an uptrend attending where I would be kind of in the role of an intensivist. Um, and that has sort of grown over the, over the past, you know, six weeks where, you know, I sort of run my own teams and, you know, things like that. So if people were placed in different roles and so as, um, time went on, you know, you, you know, the disease was really unknown. Like we didn't really know what to expect. Was it, was it going to be like a traditional ARDS type picture or not? And then we, we, we just learned the entire time. I mean, people would come in with a, you know, otherwise, you know, standard medical problems. And we would ultimately find that they would be COVID, people who come in with, you know, heart failure. And we would find that that would be COVID myocarditis. People would come in with, with renal failure. And we would find that that would ultimately end up being due to COVID. People come with all types of problems and end up in the intensive care unit. And so many people would end up there, their presentations were due to COVID and, um, it was really interesting. And, um, you know, sort of beyond the, the front lines of trying to figure out, like, what is this disease and what is it doing and what does it mean? And we were really making it up as we went along, um, and so and so to be in that, in the center of that really, you know, uh, you know, sort of infrastructure was, was really one of the highlights of my career. Really. I consider it to be a high privilege to be really, you know, trusted with the care of these patients, um, with the disease that was essentially unknown in the epicenter of the, of the, of the COVID crisis in the world. So really that just a huge learning curve. And then as things progressed, um, you know, we, we of, we sort of understood the disease a little bit more. We understood we could, we sort of needed to be done in terms of anticoagulation in terms of treatment in terms of outcomes. Um, so I think we have a, a little bit of a better sort of handle on it now. Um, I think the rest of the world, um, probably would, you know, do well to, to really, you know, pick up on the New York city experience. Cause it's just, it's just been so instructive here. We have so many papers, you know, pending that we want to publish and, uh, you know, and, you know, we're still learning as we go, but, um, yeah, just to be on the front lines of literally, uh, probably the most important emerging disease or special pathogen in the world has been, uh, just a tremendous privilege.

Salma Jutt (08:27): As time has passed since the earliest days of the pandemic and hospitalizations have begun to ease, Dr. Bre mer reflects on some of the things he learned from his days on the front lines and what he can take forward with him in his practice, from those experiences.

Keith Boettiger (08:42): What have you learned kind of, what would you, what have you taken away? What would you apply back to practice when you went back and you just seem like you've kind of, you know, even though it's a difficult experience, seem like you've enjoyed it and it's humbled you and, and, uh, it's been an overall you great experience for you, right?

Nicholas Bremer (08:57): So in terms of, uh, you know, what I've learned, I mean, you know, like other than like the basic critical care type of, you know, skills and learning kind of, you know, I've learned how to really, you know, interrogate an emerging special pathogen, uh, you know, the, I mean, that's been just amazing. So I've learned systems based practice in disaster medicine that in real life, that's something that you wouldn't even imagine, you know, the, the complexities in terms of just, I mean, from everything from scheduling to manning, to, uh, you know, making changes on the fly to making teams, putting teams together, it's really just been a unbelievable experience in that way. I've taken away. It's just really, you know, I guess a couple of things, one is how fragile life is, and, but also how, you know, resilient and people can be after being essentially decimated by this disease, you know, families and patients, you know, you know, everyone still has hope, you know, the healthcare workers still have hope. We still have hope that we can help people. Um, the family still have hope that we can help people, you know, they have so much faith in us and we literally have no, you know, or very minimal understanding of what, of what we're doing even sometimes. So it's, it's just a very humbling, um, as well as just in New York city, you, you know, I can't walk down the street with, without someone saying they're essential worker, thank you so much. I, you know, thanks so much for what you're doing or, you know, so hooting and hollering, you know, sharing, and, uh, it makes you feel good about what you're doing. So, um, just, you know, the, you know, the grace, you know, really just the grace of people for, you know, kind of understanding that we don't know what we're doing, but we're trying our best and you know, that they know that they are, and they know that, that we are type of thing. Um, in terms of what you can apply to practice. Um, I mean, really the teamwork elements of this are just not to be understated. I mean, if, if we were able to, you know, kind of create a system that we can accommodate so many patients with the most infectious probably virus in history, I mean, sky's the limit, what we can do on our private practices back home in terms of just, you know, teamwork in terms of making, making our systems better. Um, and, you know, as in terms of returning to practice, I mean, COVID is not going to last forever. We hope I'm always going to be ready and willing to help with any, you know, one who wants any advice on kind of how to deal with it. But I mean, ultimately I'm, you know, so I'm an anesthesiologist I'm trained in interventional pain specifically, um, love that love helping people in that, in that situation as well. Um, but, um, you know, also would love helping people that suffer from COVID-19. So, you know, my plans are to return to the practice of painful time, and hopefully we don't have, you know, second waves and you're coming in and, you know, we don't have mass, you know, shutdowns again. And, you know, because of this and people are going to, they're going to practice there, you know, uh, you know, going to wear their PPE, they're going to, they're going to do physical distance and do all the things that, that we need to do. Um, but if it does come back, we need to be ready, you know, and we need to have people that are willing to kind of raise their hand and step up. And, and I think we do, I think we have a good amount of people that are gonna be willing to do that.

Keith Boettiger (12:43): So when are you gonna, when are you going back home? Do you know?

Nicholas Bremer (12:46): Not sure. Um, we're sort of, uh, constantly reassessing every week kind of, uh, the needs of just the, you know, the different units and systems and, and all of that. So, um, that's kind of up in the air I would like to return this month. Um, that would be great, you know.

Keith Boettiger (13:06): All right. I thought that's all I got. I mean, look, I'm super impressed with, I'm super impressed with you going up there and doing that thing. I mean, it just seems like you're, you're engaged, you've done. You've kind of, you've enjoyed your experience. You've learned a lot. And I just, I just, again, I just I'm impressed by what you've done and kind of how you think about it and kind of how it seems to have impacted you. So I'm glad I'm, I just, I'm thankful you've taken the time to talk to me, and then I'm thankful you went up there to help a lot of people. I don't know if there's anything else you'd like to say?

Nicholas Bremer (13:37): So I will, I will just, you know, say something that I think is important. You know, certain companies, um, stepped up and certain companies didn't. And I think the fact that Abbott, which I was surprised to hear the name Abbott, you know, uh, came up with a point of care test that what that would help with the ability to, to identify patients suffering from COVID-19 in the, in the setting of a pandemic, literally within, I don't know how long it took weeks or days, or it was, seemed to be like right away. Um, it really just shows the, uh, you know, dedication and I'm just proud to be affiliated in some way with company that is going to, uh, you know, sort of take on that role, that kind of responsibility, um, you know, kind of raise their hand and kind of make up a test that can help us. Um, and I know that it did cause I heard that test being used in.

Keith Boettiger (14:31): That was the, that was the rapid diagnostics group, but they, yeah, they spent, I don't know how many days they worked, but they worked 24 seven, you know, for a week or two to get that thing, to get that thing done. So, I mean, there, there was a lot of, a lot of work to get that done and now just scaling, just scaling it from a manufacturing standpoint, to be able to provide number of tests they need to provide. I mean, I think we've hired or their process of hiring 5,000 people and opening two manufacturing sites. So they can, instead of manufacturing, 50, 50,000 tests a day, they can do millions and millions of tests. So they can, we can test many people need to be tested. So yeah, it was an impressive feat. It really impressive feat by the, by the corporation. So, Hey, I, one last question. So what do you miss the most about not being home?

Nicholas Bremer (15:17): Well, you know, I miss the family. I miss, uh, you know, baby girl, wife and dog. Um, you miss it all. I miss my house, miss my bed, miss my shower. I would jacuzzi over there. Don't have that here. Um, you know, I miss the patients, you know, I miss the staff I work with at all my different locations, uh, you know, St. Francis CMC, uh, you know, Logan, Logan actually sent me a card, which was, you know, very sweet, um, you know, checks on me from time to time. Um, I don't know, I just sort of miss it all, you know, it's sort of hard to be away, but I sort of view it as a military deployment where we're going to do, we're going to do what we need to do regardless, and we're going to get through it. And at the end of it, we're going to be able to, uh, you know, really sit back and kick back and reminisce about, about, you know, the good work we've done. So anyway, that's the hope.

Keith Boettiger (16:08): I'm sure you'll validate. Hey, look, if there's anything you need, feel free to reach out. I mean, they will do anything we can to help you.

Nicholas Bremer (16:16): Thank you, sir. Appreciate it.

Keith Boettiger (16:17): Alright, well, dude, have a good night and thanks. Thanks for doing that.

Salma Jutt (16:21): Since that last interview, after spending three months at Bellevue hospital in Manhattan, Dr. Bremer continued practicing critical care in COVID-19 intensive care units across the country, most recently in Atlanta, Georgia. He was the senior author on a publication studying an investigational agent with potential activity against COVID-19, which resulted in an FDA investigational new drug approval and a follow on large multicenter randomized control trial. He plans to continue his COVID-19 research and clinical critical care practice as future surges may require. But currently he's looking forward to the possibility of returning to the practice of interventional pain medicine in November. Thank you for listening.

Podcast 2 Transcript: "Given the severity of the crisis, voluntary and involuntary sort of goes away"

Dr. Brian Kopell

Salma Jutt (00:02): Hi, I'm Salma Jutt, Divisional Vice President of US and Global Marketing for Abbott's neuromodulation business. At Abbott, we are working across our company to support communities with resources and technologies to fight the evolving impact of COVID-19. Getting new molecular antigen and antibody tests and rapid tests into the hands of frontline workers, so people can receive the critical results they need as the COVID-19 global pandemic unfolded in United States, doctors from around the country, rushed to New York city to assist in any way possible. Today we hear from Dr. Brian Kopell. Dr. Kopell is a professor of neurosurgery, neurology, psychiatry, and neuroscience, and the director of the Center for Neuromodulation at the Mount Sinai Health System. For Dr. Kopell, this was unfolding in his backyard and he was at the epicenter of the pandemic at that time. He felt compelled to help with the crises in any way he could during those early months of COVID.

Brian Kopell (01:05): Obviously when the COVID crisis, um, was gearing up, you know, elective surgery was shut down and obviously my practice is focused around elective surgery. And so I couldn't do the things that I, you know, I'm there to do. So, you know, I want to be useful. Um, and, um, you know, I have colleagues that were really in the midst of it and, you know, if my presence with them helped them in any way, then, you know, so be it, then that's a good thing.

Keith Boettiger (01:42): Was it optional for you to go work in the ICU or was it a decision that you personally made?

Brian Kopell (01:47): I think that it's, that's a funny question. I think that given the severity of, of the, of the, uh, of the crisis, it, you know, voluntary and involuntary sort of goes away. I mean, it's a crisis, you have to deal with it. So, you know, it's just, uh, you know, I mean, I would say it was voluntary, but, you know, having COVID foisted upon us, wasn't voluntary. So it's a funny way of putting it. You know what I'm saying? I mean, can I chosen to stay home? I suppose I could've. Um, but, um, it, it wouldn't have been the right thing to do.

Keith Boettiger (02:29): Were you on it? Were you working shifts? Were you working during the day at night and kind of, what was it like day to day?

Brian Kopell (02:34): Well, you know, we would have shifts that we would back up the people in the ICU, some of us took overnight call. I actually didn't do any overnight call, but, you know, I had some day shifts. Some people actually had overnight shifts, et cetera. And we, we were there to supplement the critical care docs.

Keith Boettiger (02:55): Just from a human human nature, kind of a human perspective. What did you, I mean, what did you see every day from your colleagues and the nurses and, you know, everybody got up and down the chain of a hospital that was most impressed that you were most impressed by over the course of a pandemic or, and I know it's still going on, but I think it's lessened up a little bit.

Brian Kopell (03:20): I think that what was impressive is showing up in the face of a lot of fear and uncertainty and they, and they did it without question. And also the way that Mount Sinai really, I mean, again, it's hard for me not to sound, you know, too proud or, or you know, about my particular institution, but, you know, that's the only thing I can make a comment on about what I saw about mine and, you know, clearly Mount Sinai mobilized all of its resources to address this. I mean, they built hospital wards in the, in the, in the lobby of the hospital with rebar and plumbing. I mean, they mobilize this in weeks, you know, a week or two. I mean, that, that's, that's impressive. You know what I'm saying? I mean, in terms of, you know, how we normally think of big bureaucracies taking forever to do things, and it was impressive to see the vast mobilization of all resources at Mount Sinai to address this crisis. So that was very, very impressive.

Keith Boettiger (04:30): That is impressive. So they learned, so they actually in the lobby of the, of the hospital built, built infrastructure?

Brian Kopell (04:36): Yeah. Plumbing, yep. Everything, electrical plumbing, and, and, you know, those of us that have undergone, you know, contracting services in New York city know how long that takes and for them to do this in such a short period of time, I think was very impressive. It, you know, it definitely goes to show what we are all capable of doing if, if the political and the other aspects of things are put aside, and we are mobilized in a single unified effort.

Salma Jutt (05:13): As time progressed and elective procedures began to start again, Dr. Kopell wanted to ensure that his practice was as ready as it could be to safely re-open. He chose to take some of the key learnings from his time on the front lines, during the center of the pandemic and applying them to how he approached his practice as patient concerns about the Corona virus continued.

Keith Boettiger (05:35): Anything that you, that you'll take away they'll impact the way you'll practice going forward?

Brian Kopell (05:40): This may sound selfish, but first of all, it, it really made me realize that what I do for a living as a privilege, you know, like I recently started doing DBS cases again. And I remember thinking to myself, I did it my first case after two months, and I was really happy do it. It may, you know, and I realized, you know, at the end of the day, this is a real privilege to be able to operate, you know, small, uh, you know, in that, in that fashion, you know, to do that on a daily basis. So it certainly, reinstilled a sense of gratitude about what I do, which was nice, um, going forward. Um, I think clearly telemedicine now is here to stay. It was it, you know, it, you know, we've been sort of circling around telemedicine for years, but there wasn't really a catalyst to make this, you know, um, truly something that is reached critical mass to the point of, and that's clearly here to stay for sure, in one, in whatever form it is. We are never going to be free of telemedicine, nor should we, I mean, this is a technology that's really helped.

Keith Boettiger (06:53): Yeah. So how are you, how are you using telemedicine right now?

Brian Kopell (06:56): So typically, you know, typically I'll just give you a very small example and the thing is it's, it's, it's, you know, especially in our business - movement disorders, it's a little tricky because movement disorders as a field is such a hand on field. I mean, if anything, you know, it's probably the single most dependent field in neurology that is still dependent on the classic neurological, physical examination, more than anything else. So there's the biggest probably challenge in doing that in terms of my own practice. Typically before I operate on a patient, I usually have two, two in person meetings with them. Um, one to have the initial discussion about surgery, and then usually I within a week or so before surgery, because sometimes there's usually a month or two before that first consult in the second, I just think it's really important for their own wellbeing and their sense of calm to see me see my face again, very shortly before surgery. I think it definitely settles people down. It makes them feel like we're on the same page. So that meeting I tend to do via telemedicine right now, the second one. I still feel like if I'm going to operate in somebody's brain, I have to meet them face to face. And it's very surprising is that our surgical volume so far is ramping up very, very quickly. I have yet to see a patient, there've been some patients that say I'm a little nervous, but there is no patient yet that has said, I don't want to do it yet. And that not one, not one yet.

Keith Boettiger (08:45): So there's no. So you're not seeing, you're not seeing a fear for a patients coming back to the hospital for a surgical procedure at all.

Brian Kopell (08:52): I think that they're sort of it's their mind. Yeah. But, but I think it's, you know, look when a patient decides to electively have brain surgery for their Parkinson's disease, it really shows how debilitated they are and how they really are motivated. I mean, look, these are extreme. I've always said these are some of the bravest people that I've ever encountered because they're voluntarily undergoing brain surgery to make their lives better, to really not only make their lives better, but make their family lives better. So that they're, they're easier to take care of, you know what I'm saying? So it's like, it's not surprising to me that they're just, you know, this incremental risk on top of that they're willing to face, you know, I think they're brave. They're just brave people

Keith Boettiger (09:46): Are you un-fettered right now on your ability to do surgery, or is it, are you, is your block time smaller?

Brian Kopell (09:54): So it was for like a week or so, and then they basically just have at it essentially. Which again shows how efficient my particular hospital, um, is, um, you know, um, you know, our leadership, um, you know, specifically at Mount Sinai West where I particularly work has been really extraordinarily strong. I mean, it's, it's, it's a, it's a really nice community. Um, and they've, you know, they've shifted as, as, as radical as they shifted gears to deal with the COVID crisis. Now that we can, we can go back to our primary mission, which is great.

Keith Boettiger (10:39): So after you put a lead in a patient, are they spending the night in the ICU?

Brian Kopell (10:43): I never had My patients go to the ICU unless there's a complication. So I usually have my go to the regular room anyway. Um, so, and then they go home the next day. So, um, what was nice. Right. So our ICU's now have been completely cleaned and, um, and re re you know, re revamped from the COVID crisis. It's, you know, also look, by the way, you know, when we started this crisis, there was this feeling that surfaces could be contaminated. And I don't know if you notice this, but the CDC has walked that back a week ago.

Keith Boettiger (11:22): What can be contaminated?

Brian Kopell (11:23): Surfaces. Right, because we were like, no, Amazon mailed you a package and you were wiping that down. And it turns out that's not in fact the case. So that's, you know, as we learn more about it, you know, it's not that we become complacent, but that we, we understand what is and what isn't a danger, and then you can mitigate it, you know? So our ICU's are pristine. I don't, I don't, I don't really feel like there's an true danger to going into these rooms that have been cleaned out.

Salma Jutt (11:57): Since that interview, Dr. Kopell is now seeing deep brain stimulation patients again at Mount Sinai in New York and continues to help people live better lives. Thank you for listening.

Podcast 3 Transcript: "Every one of them was putting their life at risk"

Dr. Paul Lynch

Salma Jutt (00:01): Hi, I'm Salma Jutt, Divisional Vice President of US and Global Marketing for Abbott's neuromodulation business. At Abbott, we are working across our company to support communities with resources and technologies to fight the evolving impact of COVID-19. Getting new molecular antigen and antibody tests and rapid tests into the hands of frontline workers so people can receive the critical results they need. It's difficult to forget the news that came out of New York city in early April when daily coronavirus hospitalizations reached into the thousands . To aid the city's health care workforce, the governor appealed to volunteer physicians for aid during the crises and healthcare workers from across the nation answered the call. They risked their own lives to help care for those affected by this devastating disease. Among those physicians was Dr. Paul Lynch, an interventional pain specialist and cofounder of Arizona Pain, PainDoctor.com, Holistic Pain and Boost Medical. Dr. Lynch is no stranger to healthcare crises as a young medical student in New York city on 9/ 11, he vividly recalls catching a train downtown to help potential survivors. Dr. Lynch recently spoke with Keith Boettiger, president of Abbott's neuromodulation business about how his experience in 2001 inspired him to return to New York, amid COVID-19.

Keith Boettiger (01:29): I've just been incredibly impressed with a lot of the pain physicians that we work with that have really stepped up in this pandemic and this crisis, and, you know, made the decision to leave their practice for some time and go, you know, out of selflessness, go help people in New York city, which was, you know, the hotspot around the globe for, for COVID-19. And you're, you're one of those people. And I, I just, I think it's impressive when people take risks with risks in their lives. One, you know, you've got a beautiful, you've got a great practice. You've got a beautiful family. You really didn't have to go to New York, but you did so out of some sense of duty. Um, and so I just kind of want to get a better understanding for, you know, why, why you made that decision, why you made that decision to go to go to New York.

Paul Lynch (02:16): Thank you for saying that, Keith, I appreciate it. I think you, uh, I know you're a nurse and we've talked about your experiences with patients and I think what drives people like you and me to go into healthcare. Um, uh, I, I think at the end of the day is we really like making a difference and we, uh, we want to help people, we want to save lives. Um, and so I think for, um, you know, for me, um, what drives me every morning is, you know, the difference I'm going to make for my patients and, you know, um, and impacting society. I think on a deeper level, I was in New York city during 9/11. Um, my wife was a first year dental school at NYU and I was finishing up medical school. I'm doing away rotations in Queens. And, um, I saw the towers fall and, uh, you know, I jumped on a subway and just ran to, you know, ground zero, um, trying to help. And there was no one to help. Um, they basically sent us away and said everyone was dead and there were no survivors. And that wasn't completely true there. I found out later that the few survivors, they have went to Bellevue hospital, which is where I ended up training for my anesthesia. And so as this COVID thing kind of played out, um, my, uh, my mentors and teachers and a lot of people that, you know, trained me, I ended up doing my anesthesia at NYU as well. And, um, they all started getting sick. So we had 900 people from Bellevue hospital, or I used to work, get sick with COVID. And so we all kind of started going out on social media and through email and text messages saying, Hey, any, uh, any of the docs that can come back and help. Like literally the department was just being decimated. Um, 50% of our anesthesiologists got sick, um, which makes sense, cause we're kind of on the front line innovating and, um, you know, there's lots of aerosolizing procedures and stuff in the air. And so, um, so I decided to go and they, um, they fast tracked it for me and got licensed and, and I went and helped, um, helped the anesthesia department, helped in the ICU. And I didn't really think twice about, I mean, I did talk to my family about it and pray with them about it, but, um, you know, there's an emergency that needed an anesthesiologist. I couldn't just sit on the sideline.

Salma Jutt (04:27): Despite having not worked in the ICU setting for more than a decade. Dr. Lynch said, one of the toughest aspects of volunteering in New York city was the sheer volume of patients who sought treatment for COVID-19 and how transmissible the virus is. Within a week of working at the hospital, he became one of the first people in his unit to contract coronavirus. He estimates that at least 50% of the people he worked with also contracted the virus.

Keith Boettiger (04:54): So what were the most impressive things that you you saw or experienced with other health care workers or just other people while you were working in New York?

Paul Lynch (05:06): It's a good question. You know, I'm, I'm by nature a, like a storyteller. I like, I like to document, take pictures and you and I, and I talked a little about Africa. Um, when I go to Africa, I really like to meet the people and tell their story. Um, and sometimes that's just being in their environment and taking pictures of them and watching them and understanding who they are. When I went to New York, um, you know, the, the story teller part of me wanted to document the experiences of those around me. And so, um, what I would do is when there was downtime, which wasn't a whole lot, or after my shift, um, I would, uh, I would ask questions that people around me and I would intentionally, um, you know, ask them who they were, where they were from, why they came. I would photograph them, I would write some notes down. Um, and I did this a little bit, um, in conjunction with, uh, um, with the hospitals, so they knew what was going on. And so, um, uh, I, it was, it was incredible, Keith. There's not one person was from the same place. Um, and specifically the intensive care units, our intensive care unit had 12 beds and, it's a long story, but we turn basically the entire hospital intensive care unit. Um, but I was on one of the classic, uh, you know, surgical, intensive care units. We had 12 beds, but we turned it into 24. So we had two patients in each room. Um, and so then you had twice as many nurses and twice as many texts and twice as many doctors. So the floor was just teaming with people. And as I would go around and say, you know, what's your name? Where you from? Everyone was from somewhere different. The nurses really stood out, you know. Um, I, six beds in a row, there would be six nurses and it would be Louisiana, North Carolina, Michigan, Oklahoma, Texas, Washington, California. Um, and it wasn't, you know, the money that was driving them. Um, some of them came completely to volunteer. They were retired, they had just retired and they said, I'm going to go back and work on extra mile. Um, most of it was, they had a personal story. Um, and, um, it really, uh, it touched me a lot because every one of them, you know, really was putting their life at risk and they weren't all young, you know, I felt like, you know, I'm fairly young in the big picture. I don't want to say that much longer, but I felt like if I got sick, I'd be,

Keith Boettiger (07:27): But when we were, I remember when we were all young.

Paul Lynch (07:29): Yeah. We used to be a lot younger that's for sure. But, uh, there were people that were 60 years old that came to help and, you know, put their life at risk. So I was, um, I could go on and on about their stories, but it all was very similar, which is, they felt they needed to come. They had family in Brooklyn, they had family in Queens. Um, they're their, uh, wherever they left, the people were very anxious and sad, but supportive. Um, and they were gonna do everything they could. It reminded me of like firemen, you know, running into a fire to, you know, they, they know they're non-risk, but this is what they were called to do.

Keith Boettiger (08:02): So I know you contracted the virus, so, but it would be before I ask about that, how about the people that you were working with, the, the, the, uh, the ship that you were on? I don't know if it was the same people every day, but how many of the people that you work with also contracted the virus?

Paul Lynch (08:18): I don't know. Um, at least two more after I got sick and the people I was working with. It just depends on who you say you're working with. We had a team of about probably 12, maybe not 12, maybe, maybe like 10 physicians that were taken care of 24. It was a real team approach. And I would say of those 10, probably 50% of us got it. Either before I got sick or after I got sick. Um, the two physicians we both showed up on the same day. It was me and an intensivist from Pittsburgh. She was a lot more helpful than me cause she was like a full time attending in the ICU. I got sick. And then two days later she got sent home. She was sick and we were both volunteers. Plus my, my two attendings that trained me, both of them got sick, so probably 50%. And the number was around 50% in our anesthesia department.

Keith Boettiger (09:05): Okay. So what was that how, I mean you're better now.

Paul Lynch (09:09): Yeah. Yep. For the most part I'm like, I would say I'm like 95% better. Um, I only had three symptoms. Um, I had a fever, I was super tired and my oxygen saturations fell low. Um, if, if you care, it's just interesting. I'll text you a video cause people wouldn't believe it. If they didn't see it, I was SATing in the eighties for just days at a time and really just baseline in the eighties, but I didn't really feel short of breath. And you saw some of that reported in the media, um, early on, but there's, it's like a silent hypoxemia. And so I was really low SATs, but I wasn't really short of breath. And matter of fact, I wasn't breathing very much. So I started testing. I was in a hotel room, basically taking care of myself. And so, um, I started, um, tracking my respirations. And as you know, as a nurse, you know, your normal respirations between 12 and 16, you know, a minute I was breathing at like five, like legitimately five, four, like wow hours. And I didn't have a drive to breathe. And so I'd have to make myself breathe, but then you forget, that's the beautiful thing about breathing is you don't have to tell yourself to breathe. Right. So you forget. And then my oxygen would drop. So for about 48 hours, I was satting off and on in the eighties. Um, and then, um, so I basically had a fever. I had low oxygen, I was tired. I, my fevers went away in like 48 hours. And then, um, to this day, if I throw in a pulse ox, it's like 93 or 94, not 99, which is a little concerning. Um, and then I'm still a little tired, but I'm getting better. Um, today, what is like June now? I got back, um, the beginning of May or into April and for the first, almost month I took a nap every day. Like every day, you know, I'd be working, I would say, I gotta go lay down for like 30 or 40 minutes. I just couldn't work anymore, but I haven't taken a nap in about four or five days, which so I feel like I'm finally coming out of it.

Keith Boettiger (11:06): How many days were you, how many days did you work?

Paul Lynch (11:09): I was there total about three weeks, but I worked about two weeks and then was in quarantine for a week. And then, uh,

Keith Boettiger (11:16): And then when you came back, how long were you? How long were you in quarantine?

Paul Lynch (11:20): I did another week. We thought about doing two weeks, but we looked at all the CDC guidance because I had a blood test that showed, I had IgG antibodies. It's very unlikely that I could transmit it. So all in, I was in, I was about two weeks, a quarantine a week in New York and then a week here.

Salma Jutt (11:35): Well, the experience was harrowing at times, Dr. Lynch said he would not hesitate to return to the front lines, if called upon. The experience has made him even more aware of how precious life is and how important his role is as a physician to protect his patient.

Keith Boettiger (11:51): So if you think about experience now, Like what, what, what are the learnings that you'll take away? And I mean, what kind of impact will that have on like your decisions and the way you treat patients and your coworkers going forward?

Paul Lynch (12:05): I mean, that's probably the best question of the interview. So nice work, Keith. Um, it definitely changed me, but I noticed, um, I actually think becoming a pain doc and the way I've treated patients in the last, you know, 12 years changed me as I went back to New York. And, um, when I got there, what I noticed was when I was a doctor before, if there was a code and someone was dying, I mean, I went in and did my job. I didn't know who they were. I would literally, the only reason I would know their name was to put it in the record or to, uh, write a note. Um, it's not like where you want to be making friends is someone, you know, dying. Uh, I think 12 years of talking about mom or dad type medicine, when I got called to a code on that first day, I mean, I want to know who they were, where they were from. I would talk to them. I was acutely aware this might be the last time that they speak to someone was me. Um, and then I want to have an impact. And so I think it totally changed the way I interacted in intensive care. Um, and the way I talked to the families, you know, about their life, you know, their dying loved ones. Um, but now coming back, I think it's even made me more acutely aware of, you know, the preciousness of life. And, you know, when I have a patient sitting in front of me, which hasn't happened a lot with COVID, but on the computer, I'm just thankful they're alive. They can talk to me. And, um, I'm really aware of protecting their life. And I don't, it's not, it's not really fair to docs who haven't seen it. You can't hold them to that standard, but when you've seen someone rapidly dying because they can't breathe and then you have a 75 year old on your telemedicine, they ask, well, can I come in and see you next time? You're like, no, let's do this over the phone for a walk or let's let this truly pass. And so I would say that my, the biggest impact on me as kind of like the leader of our group is, uh, we're way more conservative than some of our competitors. I, we're just not reopening. We're still seeing 90, 95% of our patients last week by telehealth. And that might not be great for the business, but I just want to make sure when we look back on this, that I made all the decisions based on what was right for, um, for the health of the patient and that public health. And then we worry about the business second.

Keith Boettiger (14:15): Would you hesitate that if this happened again, would you hesitate to even go back and do what you did this time?

Paul Lynch (14:21): No, no, no. I'm already actually planning on going back in the fall. I don't think, um, I don't know how it's going to play out. If they need me here, I'm going to stay here and work in the hospitals we wrote while I was there, my mentor and I wrote like a 16 page handbook that hospitals could use like a disaster preparedness, like handbook. And it's like my checklist. So if the hospital down the street gets overwhelmed, I'm going to show up and say, this is what we did in New York. Um, I think it really could help. I mean, it's really detailed about which medications, which drugs, how to run the ICU, how to do the teams, how to, um, take a negative pressure room and turn it into a positive pressure, how to convert your ORs, like really good details. So I'm kind of planning on whatever I learned there I'll use here, but if for some reason it kind of misses here and hits New York again, I'm going to go back in the fall.

Speaker 4 (15:06): Since that interview more from Dr. Lynch. Thank you for listening.