Healing professions have been wounded

Knox reached out to some of our graduates who are working in the healthcare industry for their perspectives on the COVID-19 pandemic.

From James C. Salwitz ’76, physician, multiple offices and hospitals in Central New Jersey.

My work is roughly divided into several separate, but complementary and overlapping areas. My primary practice is as a medical oncologist and hematologist for adult patients, with Regional Cancer Care Associates (RCCA), a large (136 doctors) physician-owned and -managed practice, with offices throughout New Jersey, Connecticut, and Maryland. In that role I see adult patients with a wide range of primary cancer and blood diagnosis. It has been the great honor of my life to serve the community in which I live.

In addition, I serve as the elected president of the medical staff of Robert Wood Johnson University Hospital, the largest academic medical center in New Jersey. In that role, which I have held for more than five years, I help to coordinate the medical care given by some 2,000 clinicians in a wide range of medical specialties. I serve on the hospital board and on the board of the RWJ-Barnabas Health system. The latter is a network of 12 hospitals, several hundred outpatient facilities, and is the second largest employer in New Jersey.

Finally, I have the honor of teaching as a clinical professor (volunteer faculty), at Robert Wood Johnson Medical School. There, I have taught topics around death and dying, and medical management for some 25 plus years.

In addition, in a connected sort of way, my wife (a Rutgers grad) serves as a New Jersey Assemblywoman, where she chairs the Environmental Committee and is co-chair of the Health Committee. I have the opportunity to support her work at the state level, much as her work complements mine.

Nonetheless, we must be conscious that for many, who have watched members of their community, friends and colleagues suffer and die, this event will leave a deep wound in all the healing professions.

The COVID-19 crisis has resulted in a radical change in our state, community, and in the work that we do. At the medical practice level, RCCA has required a radical reconstruction. We needed to protect our active cancer patients, especially those on chemotherapy, radiation, or needing/recovering from complex surgery. If the virus “took hold” in any of our offices it could devastate patients and potentially our staff (sub-specialists such as chemotherapy trained nurses are critical). At the same time we must continue to give care to thousands of patients who need to monitor their disease, outpatient treatments, and labs. Therefore, we stripped our offices of staff who did not need to be physically present, moving several hundred computer workstations to homes, so that staff could work. We rebuilt our office schedules, so that only active treatment patients are allowed. We changed the density of both patients and staff in the offices. We developed a rotational schedule for nurses, nurse practitioners, and physicians, to decrease the probability of losing several simultaneously. We shifted heavily to a telemedicine platform.

The hospital experience has been, to some extent, the opposite. There, we have done everything possible to defer providing conventional medical care (which in our case includes level-one trauma, complex neuro and cancer surgeries, as well as heart, kidney, and bone marrow transplants) and moving the hospital to about 80 percent COVID. This requires complex cooperative planning to balance acute medical need with risk in a rapidly changing environment. We have restructured people, space, equipment, and flow. Fortunately, in our immediate area, and because of superb leadership, as well as our size, we have been able to keep up and stay ahead of demand.

However, it is a challenging time, as this disease threatens not only our community, but our caregivers as well. They work in frightening environment full of unnatural death. We are blessed with a fabulous team and are saving, on the inpatient and outpatient setting, thousands of lives.

How do you protect yourself, other than taking this highly contagious virus extremely seriously by social distancing, masks, and a lot of handwashing? Get rest, exercise when possible, eat well. Understand that this will pass and that the changes we make going forward will protect us. Pace yourself. Expect change, and adjust. This is not your fault, but it is your responsibility.

Knox taught me that I will fail, and that in that moment, to focus, learn, and rebuild. The school taught me the value of methodical work. Knox taught me the value of being a continuous learner. It taught me about curiosity. It added to my faith in my fellow man.

We are moving into a new normal. Some things will never go back. It is hard to believe that people will not get the message that high-quality virtual communication, whether it is running teams in crisis or telemedicine, is not a vast and efficient improvement. Much of the trust and collaboration created during this event will be the foundation on which we build new innovation, investigation, and discovery. Perhaps, the pain we have shared, through the terrifying journey, will make us better people and leaders.

Nonetheless, we must be conscious that for many, who have watched members of their community, friends and colleagues suffer and die, this event will leave a deep wound in all the healing professions. Our youngest learners, medical, and nursing students, now look at their chosen profession with fear, instead of wonder. We will have to consciously rebuild and heal each other in order to find hope and build future dreams.

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