Caring for All

The coronavirus pandemic has made the U.S. health care system’s faults more visible, but young medical professionals are redoubling their commitments to serving those in greatest need

Story By Heidi Koelz      Illustration By Anna & Elena Balbusso

As a resident at the Icahn School of Medicine at Mount Sinai, Milgrim rotates at two hospitals in Manhattan and at Elmhurst, in Queens, where he witnessed the disproportionate devastation of the Jackson Heights neighborhood. He considers Elmhurst “an incredible place to train and work.” It’s the clinical setting that most interested him when he was considering residency programs. When the media negatively compared patient care during the pandemic at Elmhurst, a public hospital, with private institutions, he took offense. “We have the same residents, the same capable doctors and nurses taking good care of patients, but the outcomes are different for so many reasons,” Milgrim says. “City hospitals are inundated with sick, uninsured people without access to primary care, affected by systemic racism, suffering from unequal wealth. We have such a robust emergency medicine practice in this country out of necessity. The ER is our answer to public health — for a lot of people, we are it.”

A 2019 graduate of the Boston University School of Medicine, Milgrim belongs to a generation of young medical professionals who were just finding their footing in the chaotic world of emergency medicine when the pandemic began. He says being a first-year resident was “probably the best time” to encounter the turmoil: He had enough experience to meet the demands of the crisis, and he needed, and found, opportunities to improve his skills. “There weren’t enough hands to do critical procedures, so we got to be involved in a lot more than even more senior colleagues,” he says.

The pandemic has tested what emergency medicine professionals can bear, even as they affirm their commitment to caring for all who come through the ER’s doors. In New Bedford, Mass., emergency physician Kara Huston ’03 works for Beth Israel, staffing the ER at St. Luke’s Hospital. She appreciates the “energy and teamwork” in the emergency department, she says: “I like building rapport quickly. I like taking care of people, and I like puzzles. It’s a hard job, but I find it very rewarding.”

The U.S. health care system, how- ever, leaves her baffled. Like Milgrim, she says emergency departments end up offering care that could be better provided elsewhere, such as for psychiatric patients. “There are so many smart, hardworking, caring individuals, but people in health care know that at every layer — not just insurance — the system is a patchwork that doesn’t work,” she says.

COVID-19 exposed the gaps. Initially, Huston says, staff at her hospital were discouraged from using masks in an effort to preserve supplies. Slowly, it became clear that everyone interacting with patients should have an N95 respirator. But, as at hospitals across the country, St. Luke’s staff had to reuse them time after time. When Huston was provided gowns labeled “not for medical use,” she purchased her own personal protective equipment (PPE). “There’s a huge difference when a hospital is run by a physician,” she says. “Most hospitals aren’t, and their priorities are different than those established with a doctor’s mindset.”

As traumatizing as battling the pandemic has been, Huston has been most affected by what she’s unable to do for non-COVID patients. New protocols to limit the spread of the virus include banning standard aerosolizing treatments, for example.

Ioannides is a fellow in the National Clinician Scholars Program at UCLA, whose goal is to train clinical researchers to act as change agents to improve health care and reduce health disparities. He’s researching which health conditions were most exacerbated as ERs across the country experienced a steep decline in visits this spring. Knowing systemic change will take time, he focuses on what’s within his control. “I think about my biases when I’m seeing patients, and how they translate to other providers,” he says. “A lot of them come out in charting and notes, in ways we pick up on before even seeing patients.”

The core of emergency medicine, Ioannides says, is “taking care of any- body — and for us, that has always been and will always be disproportion- ately folks with fewer resources. That’s what we’re passionate about. In some ways COVID is no different, it’s just more visible.”

Londono wants to become a trauma nurse, and perhaps eventually train in psychology. “Patients are dealing with so much in this tragic time, not just with illness but with how to survive,” she says. “I want to be able to counsel people.” She takes pride in being able to use her Spanish language skills to put Spanish-speaking patients at ease, and she hopes for positive change in the medical system, she says, “for more empathy, because people becoming practitioners now are more educated and care more about a person’s whole well-being.”

Starting their training at the low end of the hospital hierarchy may help future providers see that bigger picture. In North Carolina, Lindsay Klickstein ’15 works as a medical scribe, reviewing EMT records for doctors, writing patient records, and recording medical decisions. She moves among three UNC Health campus emergency departments, and she is also the emergency department site coordinator at UNC Health’s main hospital. Klickstein is a part of the medical staff more than she had anticipated, even helping to interpret imaging and lab results and assisting in response to strokes and traumas. Early in the pandemic, scribes weren’t issued masks, though now they wear them daily. The job pays minimum wage and provides no health insurance or paid time off.

Already certified as a wilderness emergency medical technician, Klickstein trained as a scribe for two months before going solo on March 3, a week before the World Health Organization declared the coronavirus outbreak a pandemic. After one ward at UNC’s main hospital was converted to a COVID-19 unit, more than a third of the scribes on staff quit. Klickstein stayed. She’s applying to medical schools this year and considers her work excellent training. “I love emergency departments,” she says. “I function well in a state of high intensity. In the ER, I feel really comfortable — I know what I can do to help, and that’s how I always want to feel. It’s what drew me to search-and-rescue, too. I’ve learned so much watching ER physicians tackle the pandemic.”

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