Working through a societal turning point

I would like to dedicate this to my colleague Dr. Beth Potter ’89 and her husband, Robin Carre ’85, who tragically died at the end of March 2020.  Life is clearly too short, and these two lights were lost prematurely.

From ​Mary Stoffel, ’82, OB/Gyn in a woman-owned independent private practice (proudly successful and thriving in an area where large medical systems dominate!), Madison, WI

Tell us about your work, your duties and responsibilities, prior to the COVID-19 pandemic. 
​I work doing women’s health and the full range of obstetrics and gynecology, both outpatient and in the hospital.  It is an honor and a privilege to take care of women, but also many times an added worry to have two patients in one during pregnancy. I am a senior founding partner of my medical practice, and just finished a two-year term as president of the medical staff at UnityPoint-Meriter Hospital, which is the hospital delivering the most babies (5000/year!) in Wisconsin. It’s also an honor to serve and represent my fellow clinicians in the rapidly changing world of healthcare systems.

To that end, it is imperative that the public listen to and abide by the recommendations of epidemiologists and public health officials, no matter the inconvenience.

Has the pandemic changed your role at work, and if so, how?  ​
The COVID-19 pandemic, fraught with little initial knowledge and no time to do quality research, kept everyone in healthcare moving at a very rapid pace as we have all tried to learn, do, care, and protect. It is especially nerve-wracking in obstetrics, as even the best research in medicine is rarely done well in pregnant women, and the degree of anxiety is high, the effects often delayed in discovery. In addition, as a medical practice and small business owner, there were lots of sudden pivots to make to provide safety to our patients, our staff and ourselves. We had to quickly begin a telehealth program and also revamp everything in the hospital environment. 

More broadly, how is the pandemic affecting what you see at work on a regular basis, e.g., employee workloads, the number of patients seeking help? 
​Oddly, our patients (and most patients) have seemed to take the cue that routine things can wait, which gave us the time and energy to deal with care that can’t wait! Our patients were also appreciative of our workflow design to keep them safe and still provide compassionate care. Our employees and staff were courageous, grateful, and calm despite their nervousness and some early COVID-19 exposures. Our employees, recognizing the financial impact of all of our practice changes, voluntarily worked out an appropriate coverage schedule that also was sensitive to the fact that our intention was to continue to pay all of them without furloughs or lay-offs. I am proud of how we have treated them. As much of a crisis as this has been, it has been extremely heart-warming to see the amount of cooperation, mutual care, and sense of community that we always knew was around us.

What is a fact and/or piece of advice you can offer to people to help them understand what is happening and how they should respond to maintain their health as well as they can?  
This “clever virus”–as one of my virologist acquaintances called it–can be devastating to those who suffer the worst consequences. The medical and scientific world is still learning to identify why some COVID-19 victims are completely asymptomatic carriers and why some traverse the entire course to severe respiratory distress and even death. Age, underlying conditions, and viral exposure load seem to be clear risk factors, but so much is not understood. To that end, it is imperative that the public listen to and abide by the recommendations of epidemiologists and public health officials, no matter the inconvenience.

By the same token, diligence, common sense and listening to reliable sources (as this information changes daily) will help keep most people safe and well, and it is important to extend this to protecting those who are at highest risk.

Is there any way in which your Knox education has helped you adapt to the current moment? 
I am grateful for my Knox education giving me the ability to think critically (in evaluating the reliability of various sources of information), the ability to think creatively (in helping to come up with solutions to problems never faced before), the humanity to compare the ethics of various courses of action when none seemed optimal, and the resilience and tenacity to work quickly and thoroughly (I’m lookin’ at you, Freshman Preceptorial!). I firmly believe that a liberal arts education provides these skills much more completely than a more proscribed STEM education, as valuable as that is.

What are you looking forward to once life returns to something more closely resembling “normal”? 
I am looking forward to being able to safely see my father (Don Stoffel, ’54), who has been isolated in his senior apartment complex for several weeks. I am looking forward to seeing my grown children more (including Eva Marley, ’13). Having just down-sized and moved to a downtown apartment, I will selfishly love having access to all the arts venues, restaurants, farmers markets, and other life joys that are currently closed down. Most importantly, I will enjoy not having to worry if every weird clinical situation could be an atypical presentation of COVID-19. And I will enjoy delivering a baby without full hot and uncomfortable PPE. It’s the little things …

This pandemic will be a turning point for society, and many things will likely never be the same. “What were you doing during the pandemic?” will be a common story for grandchildren to come, and how this is managed will affect us for many generations. I hope science and reason will take hold over societal and political motivators.

Natural and integrated global community

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

From Stephanie Hasan Detterline ’98
I am an internal medicine program director for a regional healthcare system in the Mid-Atlantic, MedStar Health. I oversee the largest community-based residency program in the US–150 trainees with a future in internal medicine here in Baltimore, Maryland.

My work is in four Baltimore hospitals, all under the MedStar umbrella. We live in Phoenix, MD, in Baltimore County.

Instead of creating a fear of “other,” Knox provided an atmosphere that supported everyone’s right to be different and allowed our differences to be interesting and intriguing and not scary and threatening. It is now more important than ever to see our global community as natural and integrated.

Tell us about your work, your duties and responsibilities, prior to the COVID-19 pandemic.
Before the pandemic, I spent most of my time in administrative work, overseeing the educational curriculum of the residents and making sure our teaching faculty are high quality and satisfied. I met with residents regularly and filled my days with meetings, scheduling, planning events such as orientation and recruiting our next class of trainees.

Has the pandemic changed your role at work, and if so, how?
The pandemic has changed everything. Now our meetings are online, and we spend our time thinking about personal protective equipment (PPE), moral distress, and protecting our trainees from excessive strain and exposure. We are meeting over video instead of in person, making alternate plans for orientation, graduation and recruitment next year, and trying to figure out how to hug people from afar.

More broadly, how is the pandemic affecting what you see at work on a regular basis, e.g., employee workloads, the number of patients seeking help?
In Maryland, the pandemic so far has been more anti-climactic than anything … and that is a blessing! We spend a lot of time in preparation and we are now waiting to see where things go. There are more worried, well, anxious patients who need reassurance and to know they will not be abandoned in their time of greatest need.

What is a fact and/or piece of advice you can offer to people to help them understand what is happening and how they should respond to maintain their health as well as they can?
I would say people should attend to their health, make sure they are exercising daily and maintaining a healthy weight. Any chronic conditions should be well-controlled. They should seek out evidence-based sources of medical information and always seek out the truth.

Is there any way in which your Knox education has helped you adapt to the current moment?
My Knox education has been tremendously important during all of my career and, particularly, at this moment. Knox was the first place I was exposed to people of many cultures and different belief systems. Instead of creating a fear of “other,” Knox provided an atmosphere that supported everyone’s right to be different and allowed our differences to be interesting and intriguing and not scary and threatening. It is now more important than ever to see our global community as natural and integrated. We don’t have time to be afraid of people who are different as we must band together to fight a global pandemic.

What are you looking forward to once life returns to something more closely resembling “normal”?
I am so looking forward to my kids going back to school so I don’t have to be their teacher anymore! I have gained a new appreciation for our educators during this crisis.

I have been so impressed and inspired by the love and goodness of our providers during this time. It can restore anyone’s faith in humanity.

Take the virus seriously

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

From Dr. Adam Nader ’07
I currently live in Miami, Florida, and am employed in a private practice cardiology group. I currently see patients in the office and in the hospital.

Tell us about your work, your duties and responsibilities, prior to the COVID-19 pandemic.
I have been involved in the care of COVID-19 patients in both settings. Prior to the pandemic, I would perform outpatient clinical cardiovascular services which include clinical risk assessment, echocardiogram (both non-invasive and invasive echocardiogram studies), stress test, electrocardiogram interpretation as well as inpatient care of patients with cardiovascular disease and illnesses.

Please help the vulnerable, those in the healthcare field, and society at large by staying home.

Has the pandemic changed your role at work, and if so, how?
The pandemic has changed the landscape of my profession. In addition to taking care of COVID-19 patients, the pandemic has caused us to change the method of which we interact with our patients. This has led to the usage of telemedicine widespread for the first time (previously only used for rural medical practice). I find myself engaging in this method frequently now instead of personal face to face interaction with my patients. Also in the hospital, the constant use of personal protective equipment (PPE) and disinfecting medical equipment has become even greater of a necessity than it was before.

The pandemic has also led me and others in my profession and field to be concerned and disappointed at the availability of PPE. This is more of a concern for certain members of the healthcare field than others, of course, but it is distressing to feel that my colleagues are being placed on the lines without adequate means to protect themselves from a highly contagious virus. The Washington Post reported to date 9,000 members of the healthcare profession have been infected from COVID-19.

What is a fact and/or piece of advice you can offer to people to help them understand what is happening and how they should respond to maintain their health as well as they can?
My biggest piece of advice for people is to take this virus seriously. It can affect the young and old and you can even spread it without realizing it to a vulnerable person. Handwashing, avoiding touching your face, social distancing, and wearing facial covering is extremely important during these times. Please help the vulnerable, those in the healthcare field, and society at large by staying home.

I am truly looking forward to the day when I do not have to worry about bringing the virus home to my family.

Long-term commitment to fighting the virus

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

Sam Jarvis ’09 works in public health/emergency preparednessas a community health manager.

I live in Iowa City and work at Johnson County Public Health (the county Health Department).

Tell us about your work, your duties and responsibilities, prior to the COVID-19 pandemic.
I’m the community health manager and oversee several programs which include tobacco cessation and prevention, integrated testing (for Hepatitis C and HIV), communicable disease prevention (which includes tuberculosis), emergency preparedness, employee wellness, and the department’s community health needs assessment. My role is primarily administrative. Prior to my current role, I was the department’s emergency preparedness planner.

Has the pandemic changed your role at work, and if so, how?
Yes, and dramatically. The community health division has our communicable disease and emergency preparedness program, so we’re directly engaged in the response. As a health department, our director is the incident commander for the county response which involves coordinating with several dozen agencies. Our emergency management agency has opened their emergency operations center seven days a week and is coordinating a lot of other operations and logistics as well. It’s a key player in this.

My ad hoc emergency response role is liaison officer, and was operations section chief until we expanded. Much of our work in the division is health education and outreach. With social (physical) distancing mitigation measures in place and county offices closed to the public, that has altered. Many of my coworkers have shifted their duties to assist with the response either to perform disease investigations, collaborate on public information projects, or a variety of other tasks to support the response. Government agencies work a 40-hour week Monday through Friday typically, but since our first case, there’s a good amount of us directly engaged, putting in a bit more hours and working various shifts, or adjusted schedules, and through weekends. It’s been necessary to stay on top of the workload and the changes either in disaster declarations or state or federal guidance.  

We have scheduled meetings internally and externally that are solely dedicated to the response and much of what goes on in those meetings throughout the day drives our schedules. It’s always difficult to describe in detail what “coordination” is, but keeping everyone up-to-date and on the same page when making decisions takes time.

More broadly, how is the pandemic affecting what you see at work on a regular basis, e.g., employee workloads, the number of patients seeking help?
We make contact with every positive case and conduct the investigation and contact tracing. Since there’s evidence of community transmission in Iowa (and everywhere in the United States) we know there are lot of ill persons who don’t get tested, but those that do and, especially as we see more testing options become available, we see more cases, and that directly impacts our workload. When mass testing at a facility due to an outbreak occurs and those persons are residents of our jurisdiction, that impacts our workload, but that’s also why we’ve onboarded other internal staff to assist.

My day usually consisted of meeting with other programmatic staff and community partners in the various programs I mentioned before and project planning, but now it is entirely devoted to the COVID-19 response. While we’re managing the issues that arise during the week we also plan for next steps, but it’s a bit difficult to predict when something like this hasn’t happened before.

Public health primarily plays the role of strategist or “connector and convener,” so while we don’t directly treat patients we coordinate with many agencies that do direct services.

What is a fact and/or piece of advice you can offer to people to help them understand what is happening and how they should respond to maintain their health as well as they can?
Be patient. Most understand the importance of distancing, hand hygiene, and cough etiquette, but we’ve got to keep that up. Our efforts to fight this need to be thought of as long-term commitments and that becomes more difficult every day many of us are at home. Physical distancing and stay-at-home orders have had a dramatic impact on everyone, but especially teachers, caregivers, and families without daycare, so keep them in mind too.  Humans are social and to tell everyone to stay physically apart is hard so reach out to friends and family and often. COVID-19 is a part of our lives now and its going to be difficult to adjust to, but we’re all in this together.

Is there any way in which your Knox education has helped you adapt to the current moment?
I was biochemistry major so having that background helps tremendously. Public health is a broad interdisciplinary field, but having a strong science foundation is important, at least when dealing with communicable disease.

Another major part of Knox that carries with me as a professional was the experience taking Intro to Gender and Women Studies with Dr. Kelly Shaw. Developing and continuing to develop that perspective has been crucial to being a thoughtful public health and emergency preparedness professional.

What are you looking forward to once life returns to something more closely resembling “normal”?
Going out to dinner with my spouse, Dr. Kate Jarvis ’12–it’s one of our favorite things to do here in Iowa City.

Visiting friends from Knox–I keep in touch with a lot of classmates and guys from the fraternity.

Visiting home in Galesburg and cruising the strip as I did in high school.

People watching too … to sit and relax at an outdoor event and feel the energy would be nice.

Is there anything else you would like to add?
Take time to unplug from the news and social media and take time for yourself. This disruption and shift in daily life is stressful if not traumatic, so go easy on yourself and others. The weather is getting nicer in the Midwest, so I’ve been running here in Iowa City. It’s certainly not the same as going for a run in Galesburg though.

Adjust your mindset and get used to the “new normal”

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

From Stephanie (O’Brien) Schmidt ’08, director of operations Women’s & Children’s, Academic Medical Center Oregon Health and Science University (OHSU), Portland, Ore.

Tell us about your work, your duties and responsibilities, prior to the COVID-19 pandemic.
OHSU has 576 beds including 151 devoted to Doernbecher Children’s Hospital. Reporting to the vice president of Women’s and Children’s, I support the operations of our children’s hospital and women’s services. This includes both strategic projects like expanding service lines and community partnerships as well as managing over 30 staff members from child life specialists, echo sonographers and a group dedicated to pediatric population health.

Leadership only works if people feel supported and the baseline communication skills are critical as the environment changes every day.

Has the pandemic changed your role at work, and if so, how?
The work from home mandate was established for all non-essential employees including management almost a month ago. This was challenging because a majority of my staff are “critical employees” who are required to stay onsite. Those who were deemed non-critical got placed into a labor pool to help support other areas of the hospital like logistics and food services. All strategic work has stopped including any expansion projects or those that required additional resources like capital or new employees.

Every night OHSU communications sends updated information on how we are responding to the pandemic including paying people for their time, appropriate personal protective equipment (PPE), new visitor policies, etc. All work has shifted to ensure frontline staff are equipped with the latest procedures and PPE.

More broadly, how is the pandemic affecting what you see at work on a regular basis, e.g., employee workloads, the number of patients seeking help?
All elective surgeries have been postponed at OHSU to respond to the surge in projected patients. Oregon’s quarantine response has resulted in a dramatic dip in actual cases. We continue to work to be prepared but the volume of cases in Oregon is manageable therefore our hospital census is low. On the ambulatory/outpatient clinic side we are finally seeing the push towards telemedicine where over 80 percent of our visits are now done virtually. This is a huge win for the industry and our patients who travel for hours to receive specialized care.

Due to the decrease in volume OHSU is projecting over a $400M loss this year. Our president has guaranteed that everyone will receive pay until June 30, the end of our fiscal year. Thereafter we could see layoffs or cut salaries to offset the financial impact. It is a Catch-22 because once restrictions are lifted we will be flooded by all the non-emergent care that has been postponed and we will need to maintain staffing levels to respond.

What is a fact and/or piece of advice you can offer to people to help them understand what is happening and how they should respond to maintain their health as well as they can?
Oregon is a fantastic example of slowing the spread, the West Coast took the mandates seriously closing hiking trails, bars, salons, etc. After about a month in, people are starting to feel the social pressure of needing to get out but we need to learn from other countries that have “opened” up too soon. Advice would be to adjust your mindset and get comfortable with this new normal for the foreseeable future.

Is there any way in which your Knox education has helped you adapt to the current moment?
Knox provided a strong foundation in critical thinking and communications through the liberal arts education. Leadership only works if people feel supported and the baseline communication skills are critical as the environment changes every day.

What are you looking forward to once life returns to something more closely resembling “normal”?
Our communities will rally around small businesses to keep them open. I am eager to see how this “distancing” will impact the healthcare industry, if telemedicine really becomes the new normal rather than a sexy new strategy. It is akin to the education industry which is going through a similar shift moving from in person to online. Healthcare has always had a long road to become a “millennial centered” industry and COVID-19 is the exact push to get us out of the past. Healthcare still uses pagers and fax machines!!

Is there anything else you would like to add?
Healthcare workers are brave and work really hard to serve our community. Each frontline worker should continue to be honored for their commitment to humanity.

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.

Inside a skilled nursing community

From Elizabeth Smith ’01

I work in a skilled nursing community as the social services director. Every staff member in our community is vital to providing care for our elders. Aside from the obvious infection control measures we are working as a team to find creative ways to keep elders connected with friends and family. We are also figuring out the ways we can support our staff from an overall well-being standpoint during this stressful time.

Remote medical care–trust science!

From Lisa Gould ’81

As a plastic surgeon specializing in wound care, I am working daily to keep my patients safe at home if possible. My clinic has instituted telephone prescreening and in-person screening for all patients as well as telemedicine to provide care to those who should not be coming to clinic.

We firmly believe that wound care is an essential service and that continuing to care for our patients in the safest possible manner will help to reduce hospital admissions, thereby allowing more room and resources for the COVID-19 patients. I still have patients who need operations, but we are not performing any elective surgeries, which I have defined (based on guidance from the American College of Surgeons and from our colleagues in Spain and Italy) as any surgery that can safely be put off for two months.

We are working to expand telehealth capability and encouraging CMS to relax the rules so that we can continue to care for our patients remotely. The CARES act is a tremendous start to this effort.

I wish all to stay safe, act responsibly and trust science.

Providing medical supplies

From Steve Suskin ’72

I am deep into the COVID fight. As director of development for the Afya Foundation in New York, our mission has pivoted from international medical relief to providing desperately needed medical supplies to hospitals, federally qualified health centers, and organizations which serve the elderly. We are sorting, boxing and shipping thousands of pounds every day throughout the N.Y. area. We are classified as an “essential” service organization in Governor Cuomo’s office.

Very intense…Steve Suskin ‘72.

Go to www.afyafoundation.org to lend your support.

Stay home!

From Li Ann Marco ’13

I am helping where I can, donating what I can, and making sure I am STAYING HOME. with my mother in the hospital at the worst possible time, I make sure to spread the message that people need to do all they can to stay home.