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Feature Goucher News Feature

Goucher alumnae/i dive head first into the pandemic

Front line workers

By Natalie Eastwood

Aly Schwartzbauer ’07 and her husband both work in a hospital, and their three children under the age of three don’t understand why they can’t hug their mom and dad when they get home. Even though Schwartzbauer changes clothes at work, she’s still contaminated from being in the hospital, so she and her husband have a system. “We come home. We strip down, leave all of our dirty clothes and shoes and things in the garage, and go straight up to the shower. I’ve got some wipes in the bathroom, so I wipe down anything that was touching my body, like my watch or my phone, even my hair clip. Then I take a shower.”

Schwartzbauer is a nurse practitioner for Howard County General Hospital, which is part of the Johns Hopkins Health System Corporation. She is not part of a COVID-19 team, but because anyone can be an asymptomatic carrier, she takes precautions.

A typical work morning for Schwartzbauer involves wearing a mask from the car to the hospital, which she then removes and keeps safe from hospital contamination. Then, she dons an n95 mask, which fits tightly around the face. She also wears a second mask to preserve her n95. On top of everything, she wears a face shield. Sweaty doesn’t begin to describe what it feels like to be under what Schwartzbauer jokes is 10 pounds of personal protective equipment.

The multiple layers of protection not only are uncomfortable but also get in the way of communicating. Schwartzbauer works with many patients seeking end-of-life care, so having that barrier makes it difficult to deliver sensitive information. A family member of a patient was deaf and read lips and therefore couldn’t understand anything Schwartzbauer said. She brought the family into a teleconference room so she could remove her face coverings and communicate more effectively.

When there’s so much fear and uncertainty, creating that sense of humanity is essential, says Beryn Rachel Golub ’07, a physician assistant in the emergency medicine department for Lehigh Valley Health Network. “Patients come to seek our help, human to human. They don’t want to be treated like they are contaminated,” Golub says. “I try to do everything I can to let them know there is a person, just like them, underneath the masks and face shields. So much communication is transmitted through subtle facial expressions that is now lost behind the material we need to keep us, our families, and our other patients safe.”

After watching interactions between several medical staff and a disoriented patient, Golub realized the patient was confused because he couldn’t tell any of them apart. “From then on, I pinned a picture of myself to my scrubs with my name printed largely. Patients in those situations benefit from seeing human features,” she says.

Because Golub works in the emergency room, she sees patients at the earliest stages of their diagnosis when they have no idea who may or may not have the coronavirus. “We are the ones who identify those who are suspected of infection, and we quickly learned that the signs and symptoms are much more variable than originally thought,” Golub says.

Family medicine physician Dan Stein ’07 says that because the symptoms are varied in type and severity, COVID-19 is challenging to diagnose and educate people about. Stein’s dual roles as a clinician for Kaiser Permanente and a public health officer in Olympia in Washington State means that he experiences medicine from both sides—individual care and public wellness.

He became a public health officer six months before the COVID-19 outbreak, a broad role involving identifying and responding to health risks, as well as managing public health emergencies and disaster preparedness. Once a position that required a day of work each week, it has turned into a second full-time job in the pandemic. Most recently, he has been facilitating an area command center and overseeing the reopening plan approved by the state.

Stein says that some people in his community have resisted wearing masks in public spaces and don’t fully understand the infectiousness of the virus. Collaborative efforts seem to be most effective for the public’s health, Stein says, and the community is creating a coalition of stakeholders to focus on social, behavioral, and physical impacts on health.

Educating the community requires Stein to review and communicate the most up to date research available. “Something that we’ve learned in this pandemic is that the shiny new thing is not always the best.” The U.S. was slow to adopt coronavirus testing, and in an attempt to rectify that mistake, Stein says the market was flooded with testing methods that were not scientifically tested for efficacy. Stein hopes that officials are learning from these mistakes. The next time a pandemic or natural disaster overruns the health care system, he wonders how we’re going to equitably dispense resources—masks, ventilators, hospital beds—and how we’ll ensure we have the resources in the first place.

“A lot of times, we’re scared to do something new because we have to throw out the old system,” Stein says. “Right now, we have an opportunity to innovate because we are forced to throw out the old system of our economy, society, and medicine.”

Leah Cohen ’07 is an assistant professor of internal medicine at the University of Texas Southwestern Medical Center. In early March, Cohen was moved from her regular clinic duties to a COVID-19 unit of critical care physicians, nurses, and technicians. “I was scared. Initially, we felt like we were going to war and that we’re still in a war on some levels,” Cohen says.

Cohen has since resumed her work in the clinic, but she is still caring for patients in the COVID-19 unit, which won’t be disbanded until December 2020.

The COVID-19 unit works four 12-hour shifts with eight days off, so she generally sees patients with coronavirus at the beginning and end of their care. Cohen greatly respects the nurses on her team, who interact with patients much more frequently and for longer durations than the physicians do. The nurses have found ways to maximize their efficiency with patients while still providing the human aspect of care, she says.

Cohen and her team are very familiar with treating respiratory problems, but the coronavirus is an unknown entity. Every four days, the COVID-19 unit meets to discuss what they’ve learned from their patients and others’ research from around the world. At first, they were rapidly changing procedures based on new information, but they’ve learned to evolve more cautiously. For instance, in the beginning, her team was quick to put patients on ventilators, and now they observe the patient before immediately resorting to a ventilator.

“I’m privileged to be a part of this team, even though it wasn’t something that I expected. I became a doctor because I wanted to help people and learn new things every day,” Cohen says. “This pandemic isn’t something that I, or any of us, ever thought would happen in our lifetimes.”