By Tiffany Nuño, PA-C

I flew into the epicenter of the Covid –19 Pandemic as a new graduate Physician Assistant, frightened, excited to put my newfound knowledge to work, and anxious about the uncertainty I was about to be stepping into. I signed up with an emergency staffing company that advertised through social media, a recent MSU PA classmate of mine had posted it to our class page. I did not know much of the company, I called the phone number at the time they indicated until I got through the line and I verbally agreed to go to New York City for 21 days to assist with medical relief efforts. I gathered my things, nervously packed my bags full of textbooks I’d never use and flew out approximately 30 hours after that phone call; I returned home 94 days later.  I didn’t know it at the time, but I would be assigned to the Medical Intensive Care Unit at the designated Infectious Disease flagship hospital in the epicenter of the pandemic during the peak weeks of Covid-19 infection.

Since I’ve been home, I’ve been asked to account for my time in New York by nearly every person that has contacted me. Before I left, I remember talking to my physicians team about what to say when this happened. I reviewed with them the take-home points to know about Covid-19 and the pandemic. I thought I was prepared to answer these questions. I even studied for it like any good student of medicine does, but when I got home and that first opening question was presented, “what was that like?” I felt my preparation stumble and fall down around me in shambles. It seemed like it would be easy to conceptualize the medicine, and verbal academic response I had prepared, but the first reaction is never an organized cognizant presentation, it’s a visceral emotional response. We enter the field of medicine to help heal patients, and in that process, we bond with them as people. It can be devastating to lose a patient, especially in the volumes that we lost to Covid-19. I learned more than anything else to focus on the little wins and to hold onto the success stories of our survivors.

I came home to the Midwest, that had not been affected by Covid-19 as New York has. I came home to a place where wearing a mask seems more of a political statement than the preventative life-preserver it is in New York City. Since then, I’ve given my academic and emotional reasons to people arguing with me, why they think it is beyond reason to ask a person to wear a mask in public as a common courtesy to the preservation of life around them. This argument was shocking, to say the least; while in New York there never seemed to be a question of if wearing a mask were appropriate. I hardly saw the city outside of the ICU but an image stays with me when discussing masks. I was riding our company bus back home when I saw a homeless man trying to stay dry and sleep under a store window overhang. The homeless population already has so many challenges and now a pandemic has left them without a place to shelter away from disease. The thing that struck me the most about this man was not his sad situation, but the fact that even though he slept on a window ledge in the rain with all of his belongings in a bag under his head, he still wore a mask.

More prevalent than the devastation of this disease, is the constant reminder of humanity at its best when faced with what feels like insurmountable circumstances. The moment I let others know that I was preparing to go to New York City, I had friends, acquaintances, and even strangers, offer me medical and home-made masks. I had several preceptors, teachers, and Missouri State University alumni reach out to me to offer advice and support. My recent classmates were supportive as ever and sent cards and care packages while checking on me as frequently as my family.

It was inspiring to be a part of a national effort of medical professionals that came together to help subdue a pandemic. Walking through the ICU was a myriad of accents, southern, western, Spanish, Russian, and many more. I was amazed that for nearly every patient that used a language other than English, we were able to find a member of the medical team that could speak with that patient in their native language, as well as, using the translator phone. I watched Nurses effortlessly navigate tangles of cords, tubes and machines, as we added on yet another necessary medication, all the while treating the patient with compassion. I watched physicians and advanced practice providers congregate in the care of the most ill patients I’ve ever seen and bring together a depth of knowledge from every corner of medicine to help our patients.

We had providers from every specialty working together in the ICU at once, which is unprecedented.  Physicians and advanced providers usually only tend to patients with a complaint specific to their specialty, but because so much help was needed in the ICU providers from all specialties all around the country came to help. I was placed alongside advanced practice providers and physicians of every level and specialty in the provider role equivalent to an internal medicine year one resident physician. We were overseen by the house Internal Medicine and Pulmonary/Critical care physicians.

It was an intimidating scene for any provider not accustomed to daily critical care patients, but we realized quickly that it was amazing to have so many variable specialists in the ICU working as a team.

If we couldn’t stop a patient bleeding, there was a trauma surgeon in the next room.

Need to place a patient on a ventilator? There’s an anesthesiologist right here, or an Attending Emergency Medicine Physician beside them.

Can a pregnant patient with Covid receive anti-viral therapy? Ask the OBGYN that’s helping on your team today.

Have a question about how much pain medication to give a patient with a previous tolerance? We just so happen to have a PA that usually works strictly in pain management, right next to you.

I was very worried that as a new graduate, I would slow my team down more than I would help, but that was not the case. I was with wonderful physicians that were trained at directing and educating other medical professionals. My education at Missouri State University was repetitively helpful in the routine information I needed to know to be effective in caring for my patients. As our strictly covid patient population declined, I was allowed to move my role to the cardiac ICU due to my recent rotation in interventional cardiology during school and my background with EKGs as a paramedic.  I was exposed to seizure monitoring through video EEGs in my pediatrics rotation, a skill I never anticipated using again, but I found myself monitoring four epilepsy patients in the cardiac ICU in one week. My surgery rotation was helpful as I assisted in arterial line placement, chest tube placement and suturing. I had previously been teetering between the decision to pursue cardiology or critical care medicine and this experience has shown me that I really love critical care medicine, but I may be able to do both. As the world proceeds forward with the anticipation of a new normal, I hope to see PA schools integrate critical care medicine basics into the regular curriculum, including ventilator management, initiating vasopressor therapy, sedation management and weaning. Practical skills such as using IV pumps, troubleshooting arterial lines, and using swan-ganz catheters were essential and could be easily integrated into any program. I had luckily been exposed to these things as a critical care paramedic prior to PA school, but many advanced practice providers were nervous about their prior lack of education and experience with ventilators as most schools are geared towards a family medicine perspective.

I will be forever grateful for my experience in New York and the education I received. I was lucky enough to arrive with the cavalry, but even with the amazing team we assembled, all the help from around the country and all the support we received, it was still barely enough. Listening to the experiences of the physicians in the weeks preceding our arrival was nothing short of frightening. I know of more than one hospital staff member that was lost to Covid-19 as the hospital physicians and nurses struggled to take care of one their own. Medical supplies of every kind were difficult to obtain at different times. The sheer number of patients was nearly too much to handle even after the emergency staffing arrived and we were forced to put two patients in every ICU room, meant only for one.  I know that as New York cases continue to decline, other states cases are peaking with attempts to reopen. I have no input as to how the country should proceed with reopening, but I do know that the medical profession cannot sustain this effort for long, we won’t have the personnel or medical equipment necessary. I learned to be thankful for my health and for the opportunity to help others in the fight for theirs. I am thankful for all the frontline workers keeping our country afloat. I am thankful to my school for the education they’ve given me that allowed me to help in this effort. I am thankful to my friends and family that have supported me, but most of all, I am thankful to everyone that chooses to wear a mask.