Reflections from a dermatologist on a COVID-19 medical ward
DW Weekly talked to John G. Zampella, MD, from the Ronald O. Perelman Department of Dermatology at the New York University School of Medicine, about his experiences on the front lines of the COVID-19 pandemic.
DW Weekly: How did you get involved treating COVID-19 patients?
Dr. Zampella: New York City was the epicenter of the coronavirus pandemic in the United States and the hospitals were overwhelmed. The email arrived late on a Wednesday. The covid-army — an email account set up by NYU Langone Health to disseminate information related to coronavirus — was requesting volunteers of the full-time faculty to leave the outpatient world and help on the wards. I saw the memes urging people to stay home unless they wanted to be intubated by a dermatologist — I chuckled, but secretly wondered if I could still intubate someone. As I thought about the state of the pandemic and the urgent need for health care professionals, several questions were going through my head. What were the obligations of a dermatologist during a pandemic? Would I expose myself and endanger my family? Did I remember enough internal medicine to treat patients on the wards? I contemplated, debated, and finally decided: I would enlist in the covid-army.
DW Weekly: You said you contemplated and debated before deciding to join the COVID-19 army. What was going through your head at that time?
Dr. Zampella: Before deciding to enlist, I was torn by competing senses of duty. On the one hand, as physicians we take up the mantel to help the afflicted when we say the words from the Hippocratic oath, “[I will] use treatment to help the sick according to my ability and judgment.” On the other hand, my family’s well-being was my highest priority and given the high risk among health care workers, I didn’t want to bring home a potentially deadly virus. The decision was challenging, and the heart-wrenching stories of family members giving coronavirus to parents or spouses who later passed away did not allay my fears. Nevertheless, working to reunite families who had loved ones affected by this disease seemed to be the least I could do. I was resolved to take every available precaution to protect myself and my family while still trying to do my part for families affected by coronavirus.
DW Weekly: What were your experiences like at first and how did you get up to speed?
Dr. Zampella: In the nights leading up to my deployment, I also reflected on the skills needed to take care of medical patients on the wards. Dermatologists are required to do a transitional or medical intern year prior to starting dermatology residency. This year is meant to give dermatologists a broader foundation of medical knowledge on which to build an understanding of skin diseases. My internship seemed ages ago — seven years to be exact — and inpatient medicine was not part of my day-to-day life. It’s like riding a bike, right? Yes, sort of — after a few days, my medical knowledge, though rusty, returned. With the UpToDate app on my phone and my pocket medicine guide, I was admitting patients from the emergency room, navigating the electronic medical record, and writing A&Ps — living proof that dermatologists could treat medical inpatients. Something was different though; COVID-19 was a new disease and even the seasoned hospitalists were depending more on the art rather than science of medicine. Published guidelines seemed to change daily and new discoveries from clinical trials were quickly implemented into practice. The real-time changes were testament to the medical and scientific communities’ efforts to mobilize resources toward understanding this disease and it was inspiring to witness firsthand.
DW Weekly: How do you think being a dermatologist prepared you for this new challenge?
Dr. Zampella: Dermatologists have historically cared for patients with infectious diseases like
DW Weekly: What was it like working in lockstep with physicians in other specialties, and other health care workers?
Dr. Zampella: Doing my part reinforced my decision to enlist, but these were not normal operating procedures for a hospital. If I was in the covid-army, then the hospital was the battlefield and all forces were mustered. Teams consisted of physicians from every specialty along with nurses, medical assistants, and staff from all areas of the hospital. We relied on each other, and something I learned during my intern year rang true again — the nurses are the true heroes. Not only were they the first to recognize when trouble was afoot, they spent the most time with the patients, selflessly exposing themselves and risking infection due to the national shortage of PPE.
DW Weekly: What did you come away with after serving your hospital in this regard?
Dr. Zampella: Witnessing the tragedy of COVID-19 was an intense experience. Typically, in sick patients, family members are able to provide emotional support. In this situation, lonely patients were robbed of their family ties, relying on the nurses and doctors as a substitute. The mid-gasp plea from a patient as she grabbed my arm mouthing, “I don’t want to die,” made me wish I had an emotional on-off switch. Grappling with the gravity of these encounters in the moment was not possible, and often didn’t hit me until I could debrief after I got home. During my reflections, I realized the pivotal role frontline workers could play.
DW Weekly: What are your thoughts going forward?
Dr. Zampella: Coronavirus has tested the limits of our health care system. This crisis was an enlightening experience and I have a new-found appreciation for our medical system. I continue to be astounded by the good will and generosity of the hospital staff, local businesses, and patient families. The tenacity with which personnel from all areas united is not only admirable but demonstrates courage and fortitude that has not gone unnoticed by both patients and the public. In the end, I remembered enough. Despite the risks, I remain healthy but with the knowledge that, although small, I played a part in this pivotal time in our world’s history. Sometimes it takes extraordinary situations to compel us beyond our comfort zones and I would do it all over again. See you on the frontlines.
Dr. Zampella serves in the Ronald O. Perelman Department of Dermatology at the New York University School of Medicine.
Are you on the front lines managing COVID-19 patients? Share your story with DWW. Email dweditor@aad.org.
