Suresh K. Pavuluri, MD, MPH
The weekend of Saturday, March 14, marked a turning point for Suresh K. Pavuluri, MD, MPH, a second-year resident in Emergency Medicine at the Mount Sinai Health System, who was working in the Coronary Care Unit (CCU) at Elmhurst Hospital, a Mount Sinai affiliate. It was when the national discussion about the rising number of patients with COVID-19 became a deeply personal experience for him, and “everything just shifted quite dramatically,” he says.
Early that weekend, Dr. Pavuluri noted a couple of patients with suspected COVID-19 were being treated in the hospital’s Emergency Room and Medical Intensive Care Unit (MICU). That was consistent with his experience a week earlier, during his rotation at The Mount Sinai Hospital, where that hospital’s first COVID-19 patient had been treated and released.
But the trickle of patients at Elmhurst Hospital quickly changed into something very different as more patients started arriving. “It seemed to come out of nowhere,” he says. “Suddenly, everyone had COVID. It was as if this huge avalanche hit us and we were trying to dig our way out of it, trying to cope with all these patients. Initially, all the people who were under investigation for COVID were sent to the MICU. And that quickly changed because we didn’t have enough beds. So, then some of the floors were converted to handling these patients and others who had difficulty breathing.” The sickest patients, who required intubation to assist them with breathing, were sent to the intensive care units and what had been the CCU, where Dr. Pavuluri was busy tending to them.
Within days, the policy changed to not allowing any visitors or family members into the units with the sickest patients. “It was a way for us to protect the public, but it was also a way for us to protect our patients,” he says.
“So, all of a sudden, I could no longer have face-to-face conversations with family members, and we had to have discussions over the phone. It was difficult for the patients to not have their family members there because in intensive care there are so many nurses and doctors coming in and out. The lack of personalization was one of the hardest things about this. You can’t really comfort someone through a phone. The other part was that we spent a lot of time on the phone. We were receiving multiple phone calls a day from different family members. Obtaining consent to treat intensive care-level patients meant we had to track down family members as quickly as possible. Sometimes critically ill patients require multiple procedures. The patients were already intubated by the time they came upstairs. Some of the coronavirus patients were going into renal failure and needed dialysis. That is typical in the intensive care unit, but we never see the sheer volume of it. We never expected so many patients to require all of these things or this much attention. These were people in their 30s, 40s, 50s. We saw people in their mid-thirties with no prior medical problems. When this pandemic began, we thought it was going to be mostly elderly patients affected by this. Then we realized it’s anyone and everyone.”
During that turning point of a weekend at Elmhurst Hospital, Dr. Pavuluri says he began to hear the code “Team 700 to B4” on the overhead paging system more times than he could keep track of. It meant that a patient’s heart had stopped. At that point, Team 700 would rush into his unit and perform their assigned duties, from administering chest compressions to providing the medications needed to rescue the patient’s heart. “Before coronavirus took over our hospital, I may have heard this code once or twice a week,” he says. “But it became all too familiar. Sometimes, after several minutes, just when we felt defeated, the patient’s heart would start beating again and we’d sigh with relief and look at each other, acknowledging that it was just a matter of time until our next code.”
As the volume of patients entering Elmhurst Hospital increased, Dr. Pavuluri’s work schedule changed to meet the demand, from working every four days to 12-hour shifts. “We simply had to be resilient,” he says. “We had to be flexible and adapt to best serve our patients.”
More than a week later, Dr. Pavuluri developed COVID-19 too, and went home to nurse his splitting headaches, low-grade fever, exhaustion, chills, muscle aches, nausea, chest heaviness, congestion, and shortness of breath. He began to recover after five days. Eleven of his colleagues at Elmhurst Hospital also tested positive. By early April, Dr. Pavuluri was back at work, splitting his time in the Emergency Departments at Elmhurst Hospital and The Mount Sinai Hospital.
While he was home recuperating from COVID-19, Dr. Pavuluri had time to reflect.
“I can definitely say the experience will leave an impression on me and my colleagues for as long as we practice medicine. We did not anticipate this, and we were not prepared for this. I am really close to my family and they have been a great sounding board. My colleagues at work have been my great resource because they understand, they’ve been there. To be among the young doctors coming in and fighting the good fight—it’s been really gratifying. I am so proud to be among the nurses and doctors who are risking their lives every day in this pandemic. But there will be scars. It has been an experience like no other.”