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Behind the Mask Covid -19 by Wilma Bulkin Siegel, MD

The Truth Behind the Mask COVID-19, Testimonies that inspire

Shalom Kalnicki

SHALOM KALNICKI, M.D. Professor, Radiation Oncology and Urology, Einstein; Chair, Department of Radiation Oncology, Montefiore; Coordinator of Clinical Activities, Montefiore-Einstein Center for Cancer Care

Dr. Kalnicki was one of my students when I practiced oncology at Montefiore. When COVID-19 hit, he could not engage in patient care directly because of the institution’s mandated age restrictions, so he supervised the operations of the Center for Cancer Care from his home and an isolated office. Under the onslaught of the virus, his job soon became overwhelming. Sometimes he worked 18 hours a day, overseeing the work of his frontline staff. The floors of his clinic were converted into COVID-19 cardiac-care units, and cancer patients were not admitted; this meant rescheduling chemotherapy and postponing treatments. Radiotherapy, too, was contraindicated at times because of the virus. Dr. Kalnicki gathered information from every available source, from local colleagues to experts in China, to solve decision-making challenges, including how to address the initial lack of personal protective equipment. He honors the leaders of Einstein and Montefiore for modeling effective, coordinated teamwork. Both house staff and medical students, Dr. Kalnicki says, have been heroic in their work. He is inspired by their ingenuity, which bodes well, he feels, for the future.

Serife Eti

SERIFE ETI, M.D. Associate Professor, Family and Social Medicine, Einstein; Medical Director, Palliative Medicine Program, Montefiore

Dr. Eti, who is Turkish American, trained initially in Istanbul; she continued her studies at NewYork- Presbyterian / Weill Cornell Medical Center and at Einstein. She had a fellowship in pain medicine and palliative care. At Montefiore, she has worked to develop the department of palliative care; we bonded over our shared experience in the field. COVID-19, Dr. Eti says, has served to expand her knowledge. The biggest challenge with this disease, she feels, lies in determining just what is treatable, given that the coronavirus can lead to multisystem failure, and how, specifically, to treat its symptoms. Dr. Eti remembers in particular the case of one physician who contracted the disease; he was delirious and was on the point of giving up. He requested hospice care because he feared death. She sat and talked with him in the intensive-care unit. Dr. Eti noted, as they spoke, that his oxygen levels were returning to normal. Convinced that his case was not terminal, she ensured that he’d have a team that could treat him with every resource available. And, she is glad to report, he survived.

Fernando Camacho

FERNANDO CAMACHO, M.D. Assistant Professor, Oncology, Einstein; Director, Community Oncology Program, Montefiore-Einstein Center for Cancer Care

Dr. Camacho was my student when I worked in oncology at Montefiore Medical Center. COVID-19 forced him to adapt his practice to telemedicine, but because he had seen oncology patients in an outpatient setting without protection in the earliest days of the pandemic, he contracted COVID-19 himself, and was profoundly tired and febrile for hours. His wife, who is the administrator of the outpatient community oncology unit, also came down with the illness, but she had fewer symptoms. The experience, he says, has made him reevaluate his career. He is an advocate of Eastern philosophy and mindfulness therapy, and has used mindfulness with meditation to diminish his own apprehension of death. Dr. Camacho is an expert on Buddhist holistic care and has gone on retreats to expand his knowledge. He oversees meditation and spiritual-insight training at a wellness program at Montefiore, holding meditation sessions for doctors and staff. He feels that this practice should be a major part of medical school training. Death is part of life, Dr. Camacho says, and the Eastern tradition can help teach us to accept it.

Randi Kaplan

RANDI KAPLAN, L.M.S.W. Director, Arthur D. Emil Caregiver Support Center, Montefiore

I consider Ms. Kaplan my “virtual daughter”; I feel she represents the heart and soul of Montefiore. A social worker, mother, and widow, she is the founder and director of a caregiver support program that has grown to encompass three centers. A significant pioneer in the family-care aspect of patient care, she was a major source of support for the family of the conjoined twins whose separation was achieved by a team led by Dr. James Goodrich, which was viewed worldwide. Dr. Goodrich was one of the first physicians to die of COVID-19. With the onset of the virus, Ms. Kaplan and her team were assigned to provide emotional support for all the hospital campuses, since no family visits for COVID-19 patients were allowed. The caregiver centers became a significant source of nutritional and emotional support, receiving more than 30,000 visitors from mid-March to mid-May. Ms. Kaplan supervised her team from home; she was available 24/7 to make decisions and provide guidance. She oversaw the staff “emotional support line” and the support centers for refreshment and respite, and expedited referrals to psychiatric professionals for short term treatment related to COVID-19.

Oren M. Tepper

OREN TEPPER, M.D. Associate Professor, Plastic and Reconstructive Surgery, Einstein; Director, Craniofacial Surgery and Aesthetic Surgery, Montefiore

Dr. Tepper’s training and expertise are in surgery, but when COVID-19 hit, he quickly learned as much as he could about the disease. Feeling as though he were on a military mission, he pivoted and became a leader in another field: critical care in the intensive-care unit. With his surgical training, Dr. Tepper was qualified to be part of the team led by Dr. James Goodrich in the separation of conjoined twins. He feels keenly the loss to the coronavirus of Dr. Goodrich, whom he considered a great mentor. At the outset of the pandemic, Dr. Tepper sent his family from New York to Michigan, concerned for their safety. He is now considering leaving Manhattan to raise his family in the Connecticut suburbs, and has begun the search for a new home there. When he is not on the front lines with patients, he enjoys broadening his horizons by taking “masterclass” programs in multidisciplinary areas to further his interest in such subjects as business, music, the arts, and sports.

Laura Tocci

LAURA TOCCI, AU.D., CCC/A Director of Audiology, Montefiore

Dr. Tocci began her career at Montefiore 30 years ago as a clinical fellow in audiology. At the onset of the pandemic, she was assigned to the front door of the main lobby to greet people and to give out scrubs and personal protective equipment. As the number of deaths increased, Dr. Tocci, a widow and a mother, drew upon her reserves of compassion and empathy to comfort the families who had come to pick up the personal belongings of patients who had died. She feels that these encounters have made her more spiritual. Dr. Tocci was called to the intensive-care unit several times to provide hearing-aid batteries. Masks can interfere with a patient’s ability to understand what staff members are saying, so having effective hearing aids is crucial. COVID-19, she realizes, has “changed everything” and caused everyone to reevaluate their priorities. From her position in the lobby, she witnessed many dead bodies being wheeled by. This brought home to her the need for bereavement counseling, not just for the families who come to retrieve the belongings of the deceased, but also for the staff members who experience the families’ sadness and their fears.

Nidhi Shah

NIDHI SHAH, M.D. Palliative Care Attending Physician, Palliative Care Fellowship Coordinator, Montefiore

Dr. Shah is from Mumbai, India, and did her internship and residency in geriatrics at Mount Sinai Beth Israel in New York. COVID-19 arrived in the Bronx after an outbreak in New Rochelle. It was a huge learning experience, Dr. Shah says, when the onslaught came on suddenly, within a week. At the beginning, she recalls, personal protective equipment was so scarce it had to be reused until the situation improved. At a peak in the pandemic, the hospital faced as many as 27 deaths a day. Palliative care had many consults, and families were in shock. Dr. Shah and her colleagues became a source of support for the medical team. Dr. Shah has two children, ages 7 and 5; her husband has been their primary caretaker, but she cooks. She was afraid of spreading COVID-19 to her family—and then she contracted it. Her symptoms lasted three weeks. After she recovered, she returned to work. What they have all been through, Dr. Shah feels, has made her family bond even stronger. “COVID-19,” she says, has “taught us all to be nonjudgmental” and has helped her team work as a unit.

Marjan Rahmanian

MARJAN RAHMANIAN, M.D. Assistant Professor, Critical-Care Medicine and in the Saul R. Korey Department of Neurology, Einstein; Critical-Care Physician, Cardiac Surgery Intensive-Care Unit, Montefiore

With a background in anesthesiology in Iran, Dr. Rahmanian arrived in the United States and completed her internal medicine residency and critical-care fellowship in the Mount Sinai health system. She has been at Montefiore for the past six years as a physician in the cardiac surgery intensive care unit and now serves as its associate director. With her expertise in caring for critically ill patients, especially those on ventilators, she became an essential worker when the pandemic struck. She contracted COVID-19 on the front lines, and she feared bringing it home; despite precautions, her husband and two children also came down with the virus. But Dr. Rahmanian did not abandon her duty to her patients; as soon as she recovered, she went back to work. She found that learning how to battle the foundation and sequelae of COVID-19 has left little time for medical workers to worry about themselves. Dr. Rahmanian and her colleagues became substitute family members for patients who were alone and dying, struggling with the emotional and physical trauma of the pandemic.

Lourdes Cruz Mendez

LOURDES CRUZ MENDEZ Administrative Assistant, Arthur D. Emil Caregiver Support Center, Montefiore

Ms. Mendez provides administrative support at Montefiore. With the onset of COVID-19, the center where she works became a crucial hub for emotional and nourishment resources for the staff. She started as an administrative assistant and secretary in a nursing home. Ms. Mendez chose to transfer to Montefiore after noting the compassionate care offered by the staff at the Moses and Weiler hospitals. Ms. Mendez, who hails from the Dominican Republic, has two children, ages 6 and 9, and a 10-year-old stepchild; they are cared for by a babysitter while she is at work. The pandemic has caused many changes in her daily life. She found herself hesitant to take public transportation, and reports that the staff sometimes came in feeling desperate fears. For her, prayer and her family are calming forces. Ms. Mendez is proud of the emotional support the frontline workers, no matter what titles they hold, provide to all. The center, she feels, has become a home and a place to relax. It offers referrals to a meditation hotline with Dr. Fernando Camacho, and she and her colleagues offer aromatherapy and information on breathing exercises and therapeutic art.

Mary Berry

MARY BARRY, R.N. Patient-Centered Care Nurse, Cardiac Surgery Intensive-Care Unit, Montefiore

Ms. Barry’s skills were much needed at the onset of the COVID-19 pandemic in its major epicenter, the Bronx. She further developed those skills in the cardiac surgery intensive-care unit. Previously, she had worked in finance on Wall Street. She decided she wanted to become a nurse and enrolled at St. Vincent’s; her graduation was at St. Patrick’s Cathedral. St. Vincent’s, which has since closed, has an outstanding reputation for nursing training, and Ms. Barry is proud of the compassionate education she received. When the coronavirus hit, she says, it was difficult for everyone, especially because of the lack of access to sufficient personal protective equipment. She was one of the nurses assigned to Dr. James Goodrich when he was placed on a ventilator, and she remembers trying to comfort him. She left after her shift one weekend, thinking he would survive, but he died the following Monday. We spoke just after the hospital, one of the hardest hit in the early days of the pandemic, had discharged its 5,000th patient.

Danielle Quinn

Danielle Quinn. Surgical Nurse. North Bergen, N.J.

Danielle is a 2-year graduate nurse, working as a surgical nurse in North Bergen, N.J. as part of Hackensack Meridian Group. She is pregnant, and was working on the medical-surgical division at the onset of COVID-19. In April she got sick with COVID-19 for 4 weeks but all symptoms were manageable. She is due in one month, and according to her obstetrician, the baby is fine. The studies show that COVID-19 does not affect the fetus. She hopes that she will be able to return to work since her husband from Senegal is out of work as the general manager of a restaurant business and she is now the breadwinner. Her husband’s employer was paying for their healthcare, and since he was laid off, they are now paying for the same healthcare out of pocket. They will have multiracial child, and with the present protests she looks forward to a better world.

Dr. Benjamin Salter, DO

Dr. Benjamin Salter, DO. Assistant Professor. Anesthesiology, Preoperative & Pain Medicine. Mount Sinai

Benji is an Anesthesiologist at Mount Sinai Hospital New York City. His specialty is in Cardiothoracic Anesthesia and he was on the vascular access team. His expertise was tremendously needed. Benji had had a lymphoma recovered cure in his youth, and he is designated as a major force in the care in this Medical center. He has been on national and international media because of his experience. The team at Mount Sinai became a smooth working force rapidly as many of the main centers in NY city epicenter needed. Education was on the spot; learning and decision making was only through previous experience. What they had heard was not always the case, young people died as well as old. The emotions of sudden death were taxing on the whole staff. His fears were not to bring the disease to his wife and son, two-year-old Oliver. He took care of the father of a college friend who died without family there, and it hit home for him the distress on their part. Because of his own experience recovering from Lymphoma, he was reminded how fragile life is. I interviewed him with his family finally at the decline of COVID-19 at his hospital so there is respite from the emergencies but he worries about the future. It is important for all to respect social distancing, Hand washing and wearing of masks.

Dr. Sharon Weissman, M.D

Dr. Sharon Weissman. M.D. and Chief of the Division of Infectious Disease at University of South Carolina Prisma Health.

Sharon is the daughter of a close friend of mine. She is an M.D. and Chief of the Division of Infectious Disease at University of South Carolina Prisma Health. Her main interest has been in the care of AIDS until the Corona Virus 19 Pandemic. Early in January she had heard of a case of a young man who had the symptoms of an unusual flu, 100 miles away in the rural country side, who had travelled from afar and nothing was done despite information given to CDC. He exposed others with his travel. COVID-19 spread via a groomer in a horse show. By March, she learned that her daughter at MIT was asked to leave Boston because of the onset of the “plague”. Her daughter and her boyfriend had a difficult time getting air flight to South Carolina but arrived before the shutdown and they were all sheltered. At work preparation was creative. Initially not enough PPE’s, but within a few weeks despite the rise of illness things got better for supplies and testing. Initially testing was not as available and rapid decision making was her forte. At first the administrator was furloughed, and she did double duty work, as happened in other health care facilities. Administrative Manpower was assigned late on so that she could give appropriate on hands care. She was relieved that the patient load never got beyond capacity. It was difficult for the experts to admit their ignorance and learning on the spot. From this experience she is optimistic of the change in medicine with the learning of bureaucracy interference and the onset of Telehealth and has hope for a better future for all. As for her personal life-living with her daughter and her boyfriend, she sees life in a more positive way through their eyes with cleaning of the air and a renewal of the animals and flora and less consumerism. She became closer with her family.

Dr. Douglas Reifler, MD

Dr. Douglas Reifler, MD. Associate Dean of Student Affairs and Medical Humanities at Temple University Medical Center in Philadelphia.

Doug is Associate Dean of Student Affairs and Medical Humanities at Temple University Medical Center in Philadelphia. As a physician his duties are for outpatient care in Internal Medicine. Temple was the center for COVID-19 infection, but because of a proactive pulmonary specialist, they kept the mortality rate at less than 3%. The classes in the Med School were postponed but the Medical Students took it upon themselves to service the hospital giving out masks to the community and doing nasal swabs and delivering food to the needy. PPEs were not available, and they reached out to try to get plastic shields and PPEs from industry. Postponement in their career plans with medical internships and residencies which added to their psychological wellbeing. He is interested in music as a healing process, and he gathered the graduating class and did a zoom singing project, which his daughter Erin put together. She is an expert in performance art and technology and she melded single voices into one group via zoom and the computer. “I was privileged to see and hear that wonderful performance which is inspiring.” He has learned, in his own practice, that the future will be Tele Medicine which he believes will be important, especially for the elderly and disabled. Med Students with their iPads did visit and returned details.

Eileen Stark, Nurse Practitioner

Eileen Stark. Nurse Practitioner. New York Presbyterian Hospital in Hopes and Heroes Clinic

Eileen is a Pediatric Neuro Oncology Nurse Practitioner at the Children’s Hospital of New York Presbyterian. Working in the oncology clinic deciding therapy against cancer while fighting COVID-19 was a question no one had an answer for and so they worked as a team guessing with the best of their knowledge titrating the acute illness with the question of the growth of the tumor when to give the chemotherapy. It was a guessing game and to admit that they did not know was so difficult for them. Eileen was alone (she has 3 grown children, a daughter and twin boys, 2 grandchildren, 4-year-old boy and 2-week-old granddaughter) and she was isolated even from her family. She is a woman who loves life and it was a challenge for her to face the fears of disease and be on the forefront as a trailblazer. There was a need to trust her fellow workers with a faith in their knowledge of experience. She is taking an online course in pain management in her private time. She has learned to listen harder and look at body language. It was difficult for parents not to visit the child since only one visitor was allowed with a dying patient. We had to console the left-out parent. It has been hard for Eileen as for all without being able to plan for vacations which she has always looked forward too.

Mary Barry, Cardiac ICU Nurse

Lia Camion, Art Therapist

Lia Camion. Art Therapist at Lenox Hill Hospital. Manhattan

Lia is an art therapist at Lenox Hill Hospital in Manhattan. She was first introduced to art therapy in Claremont, California, where she received a major in psychology and a minor in studio art from Scripps College. In NY she did many jobs, first in a marketing and design firm and then in a restaurant where she met her husband. With COVID-19 he is out of a job since his French restaurant closed. He has found refuge in focusing on fitness with a personal trainer and marathon training. She received her Master’s in Art Therapy at School of Visual Arts. She initially worked with children and young adults with developmental disabilities and medical conditions, and finally found her job for the past three years at Lenox Hill Hospital in the psychiatry department. She has two young children. At Lenox Hill, with the pandemic, she has worked in several new capacities. One of which has been joining the Team Lavender, which is a group of staff that are called in when staff need support. Team Lavender has had on a greater presence during this unknown world of COVID-19, offering items of self-care like lotion and mints, a safe space to process, as well as information handouts on support for staff. In this role, Lia was able to engage the medical staff, as well transporters, housekeepers, security staff, among others, all of whom have been at increased risk coming into the hospital to do their jobs. Lia's role continues to shift and change as the needs of the community change. She has recently started an initiative to engage the staff in making at least 1000 rainbow- hued cranes for healing the community.

Dr. Brian Saltzman, MD

Dr. Brian Saltzman, MD. Infectious Disease. Private Practice. NY/Presbyterian Hospital

Brian Saltzman is a physician in Infectious Disease in private practice. He too was a student of mine at Montefiore when he was in his fellowship in Infectious Disease at the beginning of the AIDS epidemic when I was starting the Hospice at Beth Abraham and I worked with the first AIDS team, then teaching the care of terminal illness and Palliative Care. He is an expert in HIV and has a large practice initially at Beth Israel and now at NY-Presbyterian Hospital. He continues to care for long term chronic HIV and with the new Pandemic he has to protect himself. He had suffered a previous life- threatening illness and has recovered with minimal sequelae. He himself has been protected and is negative. Brian is most unusual since he is the owner of a well- known restaurant. He has had to close it with Lockdown and is now struggling to plan a reopening with safety for staff and clients, a challenge beyond Medicine.

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Devorah Sasha
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