Happy Asian and Pacific Islander American Heritage Month!
I’m delighted to join in on celebrating the achievements and contributions of Asian Americans and Pacific Islanders in the United States. My 13-year-old Asian American self would never have dreamed of seeing so many Asian faces in such a wide variety of sectors, including but not limited to business, academia, medicine, media and entertainment…
This year, APAHM is celebrated against the backdrop of the COVID-19 outbreak. In New York, where I am based, death counts and hospitalizations have fallen significantly from when the shelter-in-place was announced in early March. As a privileged, young, non-essential worker, I get to reap the benefits of our heroes working tirelessly to create a safe world. Our heroes, for the most part, remain unnamed, quietly carrying out their duties they vowed to uphold when they took oaths upon graduating medical school.
This is why this interview means so much to me. I chose to highlight one Asian American female anesthesiologist who I believe has an incredible story to tell. I share it in the spirit of celebrating APAHM, celebrating the momentum we’re gaining fighting COVID-19 and celebrating Asian American women making a difference in our local communities.
V is an anesthesiologist at a New York hospital. She’s a Chinese-American raised in the south now based in New York. Outside of the hospital, she enjoys baking and traveling.
What does your role entail?
As an anesthesiologist, I have always prided myself in medical adaptability and range, this pandemic has stretched those limits further every day. Though the public might think of my profession as “that doctor who puts you to sleep” we consider ourselves airway and critical care experts- a role uniquely suited to the current healthcare crisis. In early March, I was part of the intubation team. This means that I coordinated the placement of breathing tubes for patients who were rapidly decompensating from lack of oxygen. This is a routine procedure for us, we place breathing tubes multiple times a day for surgical patients. But coronavirus has added new challenges. The process of intubation is one of the most dangerous ways to spread the virus, to not only myself but anyone else in the room. Every airway placement is a carefully coordinated dance to keep a critical patient alive and minimize exposing a handful or more healthcare workers to aerosolized viral droplets, all within the seconds to spare as his or her oxygen saturation bottoms. These days, my time is spent in the COVID+ intensive care unit. I now manage all of those patients with breathing tubes on ventilators to support their poor lung function. This disease is one requiring prolonged time on ventilator support and has stretched our hospital resources and staffing capabilities thin. My role and my workplace are barely recognizable to me these days, especially looking out from multiple layers of hazy PPE (personal protective equipment).
What was your motivation for becoming a doctor?
I have always been interested in healthcare but I initially thought I would pursue International Relations. I envisioned a life dedicated to evaluating public health issues and creating policies to fix the problems that plagued nations. This led me to working in a rural healthcare clinic in sub-saharan Africa. Though my interest in the political arena remained, I discovered that I thrived in a clinical context — I loved working with individual patients. The ability to connect with another person, especially in the vulnerable context of illness, and be even the smallest part of their healing process has been a powerful motivation for me. That foundational purpose has given me strength throughout medical school and my rigorous anesthesia training and continues to encourage me through these challenging days.
What has your experience been like with COVID-19 thus far?
This question is one that I imagine will take me years, post COVID, to truly unpack. The entirety of my experience seems like an ever changing storm — some days the sun peaks through the clouds, but mostly I feel untethered in a vast ocean of dark waters. Every day there are new dilemmas, be it clinical, logistical or personal, to tackle. Though this is the unavoidable consequence of our changing understanding of this disease, and the best way to medically and socially respond, it has left me, and my colleagues, on shaky ground. Altogether, the days are long, the intricate critical care of increasing numbers of patients is overwhelming, and the task of relaying this information to concerned and desperate families, unable to see their loved ones, heartbreaking. Even so, I remain hopeful. In these past weeks, I have witnessed heroic bravery, sacrifice and determination — both in and out of the hospital. I am so very proud of the healthcare community as it rises to these challenging times and I am sure everything we are individually doing, at home and on the front lines, will help to carve out a better tomorrow, today.
What are the ways anesthesiologists are contributing to the medical community during COVID-19?
- Creating policies for airway and critical care management
- Leading ICU care- overseeing care teams of nurses/respiratory therapists/nutritionists/other medical specialists to dynamically treat COVID patients
- Logistically creating and staffing newly created ICUs to meet patient demands
- Advocating for PPE- both materials and safe practice policies
- Creating educational resources for non-critical care physicians and healthcare workers to understand how to care for COVID patients
- Acting as the liaison between patient care and hospital administration on the needs of both patients and staff in this ever changing environment
Who are you seeing come through the hospital doors?
This disease does not discriminate, young, old, previously healthy or ill, everyone is affected. Patients are also showing up at various stages of their disease course. Some are brought into the ER already suffering from dangerously low oxygenation levels and require emergent intubation. Others are mildly ill and can be managed with much less aggressive measures, some are even well enough to go home to self quarantine and have virtual monitoring.
How are you dealing with PPE shortages?
Though not always in keeping with what we know about viral spread, I have done my best to follow hospital issued PPE policies. This has, in recent weeks, involved reusing N95 masks and going without full suiting for aresozing procedures. Often, it has been a time consuming, red-tape laden process to just receive one new mask or a hunt around the hospital for the right kind of gown. Shelves that were once stocked full with supplies were stripped bare overnight. Though this was a natural reality of the surge in demand, this created frightening and disappointing working conditions. During the early weeks, when PPE shortage was most prevalent, I worked to solicit personal and professional contacts for donations. I also advocated for practices that would expose the fewest individuals to high risk procedures in order to conserve PPE use. Many residents have also purchased their own supplies at a very high markup in order to feel safe at work. Thankfully, we are told that there is adequate PPE supply in our hospitals at this time. But many continue to run into daily battles over procuring said supplies.
Editor’s note: This was written at the apex of COVID-19, and while PPE shortages remain a challenge, in recent weeks we have seen the gap improve gradually. The United States healthcare system is still in dire need, and you can help by donating large-scale stock to your local hospitals or medical facilities.
Can you share any memorable moments you’ve experienced lately?
The most impactful interactions I have had involve communicating with patient’s families. Though these conversations are often raw and painful, I am able to convey the full extent of the care we are delivering, the heroic efforts of our staff in the life saving work of their loved one. I can not imagine the distress of having a loved one in critical condition and not being able to see or visit them. With my words, I seek to elucidate and calm what fears I can and give hope where possible. I am humbled that families have put such faith in our care teams and, even in their grief, find ways to support, appreciate and encourage frontline workers.
My residency has daily Zoom meetings to check in and discuss policy updates, best clinical practices and newest evidence based studies. This has been one of the most dynamic and educational experiences of my career. I have found that healthcare workers, at every level and in every specialty, are grappling with big issues, both ethical and clinical, and this is leading to very meaningful and honest conversations about patient care and self care. I am honored to work amongst individuals who are willing to keep going amidst some very foundational uncertainties and even more willing to build each other up during this fight, it has been truly encouraging. For example, seeing a full time orthopedic surgeon leave his home state and busy practice to “learn and help” in our makeshift OR ICU’s, a place certainly out of his comfort zone, reinforces that everyone is doing their best and coming together for a common cause.
What are you doing to keep yourself and others safe?
Now, more than ever, I recognize that my actions not only directly impact the health of others but also send a clear message about my estimation of the virus. I am vigilant about not only my use of PPE but more importantly, my proper transitioning in and out of PPE — the sequence and sanitation is just as important as the actual materials. When I am not at work, I am doing my part to practice social distancing and minimizing my interactions with others. I am washing my hands frequently and following public health recommendations as they are being updated. On a personal note, though I have not experienced significant symptoms to date, I do not take my high risk exposure lightly. I will not plan on seeing anyone outside of a professional context until I have the ability to be tested for antibody conversion and there is reliable evidence of conferred immunity.
Has being Asian American influenced your ability to treat patients lately?
Thankfully, I have not personally experienced any discrimination in my work place and have not had my background play a role in my ability to treat patients. This is not the case for all healthcare workers and I am privileged to work in an environment that celebrates and thrives off cultural and individual differences. My Asian American background has certainly informed my cultural competence and personal worldview and I hope it continues to help me better connect with all my patients, no matter the circumstance.
Right now, medical professionals desperately need a break, even though that’s hard to do. What are the ways in which you’re taking care of mental and physical health?
We need to be gentle with ourselves and others and exercise a little more grace in every circumstance. Everyone is dealing with this crisis in different ways and that’s great. Day to day, what I need in terms of self care might change — if it’s a (socially distant) run in the park or an extra episode on Netflix — I try to make space for that activity. With work being so demanding, there isn’t time for true restoration but I make sure to give myself at least a moment in the day, however short, to take stock of the things I am thankful for and connect with a loved one. Sometimes that’s a planned Facetime date with an old friend or a quick encouraging text exchange with my mom. If I have that extra time to spare, I squeeze in a workout, my favorites are HIIT (high intensity interval training) and yoga (thank you POPSUGAR fitness) because being active has always helped me reenergize and regroup.
What advice do you have for anyone who is interested in a medical profession?
It has been the challenge of a lifetime to be in the medical profession during this pandemic. Even so, I have seen incredible acts of strength in the healthcare community and know there is so much more brilliant work to come about. I feel incredibly honored to be a part of the healing process and witness firsthand the grainy, sometimes unpleasant, details of recovery, for our individual patients, our profession and society. I think it is often misunderstood and misrepresented work but I am certain that this is a worthwhile purpose and true calling.
