Following a Thanksgiving surge that led to record numbers of admissions of patients with COVID-19, residents and fellows from multiple disciplines have come together under the direction and supervision of critical care attendings to provide the best care to critically ill patients in Vanderbilt University Medical Center’s COVID-19 Intensive Care Unit.
In addition to the physicians and nurses staffing the unit on the eighth floor of Medical Center East, fellows and residents from at least 12 programs, including Pulmonary Critical Care, Cardiovascular Medicine, Anesthesiology Critical Care, Anesthesiology and Surgery, as well as residents from other programs provide additional support to the Medical Intensive Care Surge Team.
“As physicians we are trained to meet patients where patient needs are, and we don’t always get to define that. I’ve been very proud of these residents and fellows who have stepped up to care for patients in a global crisis,” said Kyla Terhune, MD, MBA, associate professor of Surgery and Anesthesiology, vice president of Educational Affairs and associate dean for Graduate Medical Education.
“In some ways it’s a historical opportunity to serve as a physician and provides a great deal of learning, but it’s certainly also a tragedy and not what anyone anticipated or wanted. For those residents and fellows where it falls within their educational curriculum and skills, they are appropriately contributing the most – but they need support when the patient numbers surge like this,” she said.
Kevin Seitz, MD, a Pulmonary Critical Care fellow, worked in the unit for two weeks between Thanksgiving and Christmas. Since he is subspecializing in the lungs and critical illness, he’s already been trained to take care of critically ill patients with failing lungs, but in many ways, the work is very different, he said.
“Learning to care for patients with respiratory failure is a core part of our fellowship training, and that is what we do in the COVID ICU, but this is an unsettling and unpredictable disease process where we don’t totally understand the disease progression. It’s tough to care for these patients because they are so sick.”
Seitz said when he’s taking care of a patient with bacterial pneumonia, for example, he has a “decent handle” on whether the patient will improve.
“When a patient with COVID gets worse, it’s hard to know whether to blame COVID or something else. And is it something we would normally see in a patient with pneumonia who is very sick or is it something unique to the virus? It’s often unclear who’s going to get better and who’s not; some take weeks and months to get better and others continue to deteriorate,” he said.
Different disciplines working together to care for patients with COVID-19 requires improvisation and open communication, Seitz said.
“As much as it’s a horrible context that brought us to these circumstances, it’s a positive, collaborative environment in there. It requires a lot of communication to figure out how to make the most of everyone’s skills,” he said. “I know we’re up against this awful pandemic and I wish the disease weren’t here, but there’s camaraderie in that.”
Greg Roop, MD, a third-year Anesthesiology resident, left his pediatric anesthesia rotation when he was asked by a chief resident to help staff the COVID-19 ICU during Thanksgiving week. He was paired first with a Pulmonary Critical Care fellow, then with a Cardiology fellow after that.
“Anesthesiology residents are uniquely positioned to transfer into this type of care — so much of what we do in the OR can be transitioned to the ICU setting particularly in terms of ventilator management and hemodynamics,” Roop said.
“The transition was great. I have to give a lot of credit to the pulmonary critical care faculty and staff and the entire internal medicine department. They realize that residents from other specialties don’t necessarily care for these patients all the time and they were very patient as they taught us how to manage them. The credit goes to them for their patience and being willing to share their knowledge with us.”
Roop said his experience left a positive impact upon his training as a physician. Working with others from other specialties and seeing how they approach a situation was invaluable. It was an opportunity to learn in ways he never imagined.
“It was really interesting for me to interact with Pulmonary Critical Care faculty and fellows. While every specialty has the best interest of the patient in mind, we all approach these problems from different perspectives.”
Roop said while there was “some fear of the unknown” in caring for patients critically ill with COVID-19, he feels grateful to have contributed to their care.
“It’s a very unique situation and it was definitely a challenge. We’re navigating the unknown and we have to put our heads together and try to come up with different ways to treat these patients,” he said.
“The clinical course of some of them was unlike anything I had seen previously, and it’s like our hands were tied a bit. But I am very honored to participate in their care.”
