Dr. Richard Steinmann is the Associate Medical Director and Vice Chief for Emergency and Urgent Care Services at Crouse Hospital. Asked how the coronavirus is impacting the work he does, he replied simply, “It’s turned everything upside down.”
The hospital has prepared for what Dr. Steinmann characterized as “a great tsunami” of desperately ill Covid-19 patients as happened in New York City, but that level of surge has not yet come to pass. It is unclear if it will. Ironically, the actual volume of patients in local hospitals has markedly decreased, particularly since elective procedures have been cancelled. “The potential was very ominous, but that hasn’t yet happened,” he explained. That created another problem. People having other serious medical problems, like heart attacks and strokes, are afraid to come to the hospital. “They’re riding it out at home and not doing well.” Dr. Steinmann points out that the number of non-Covid-19 medical emergencies has not diminished, and that “if it made sense in January to go to the emergency room, it still makes sense now. People who have chest pains or other symptoms should get advice from their doctors, but they shouldn’t stay home with something bad.”
One of the most psychologically unnerving aspects to the coronavirus pandemic is the effect it has on medical personnel. Dr. Steinmann explains, “Most emergencies are not things that are going to get me. I won’t get hurt, I will be calm and professional. But with Covid-19, what’s hanging in the air is that every time I walk into a patient’s room, I may be putting myself and my family at risk. That doesn’t happen under normal circumstances, and it’s an extra element of the whole situation that’s emotionally and psychologically wearing for practitioners.”
“What we need is information,” Dr. Steinmann emphasizes. “And we also need to know how to interpret the information – the studies, anecdotes and reports. The interpretation of data is Talmudic. The discipline of poring over the research data and interpreting its meaning feels very much like interpreting scripture. Does it mean what it says it means? Are the data reliable? What does reliable mean? We need to look at information line by line, as opposed to reading the headlines. For me, this process very much derives from the atmosphere in which I grew up. Analytic thinking was (almost literally) in my mother’s milk (she went to the Jewish Theological Seminary before women were ordained and got her degree in teaching.)”
“Sometimes things in the Emergency Department get overwhelming,” Dr. Steinmann notes. “It would be easy for doctors to say, ‘I can’t do enough. Why do anything?’ But Judaism teaches us that someone who saves a single life, it is as if they saved the world. So you take it one at a time, and you do what you can do, and it makes a difference.”
Dr. Kathleen Steinmann is a nurse practitioner and the Director of Education and Professional Practice at Crouse Hospital. Part of her work involves educating the hospital staff about the use of personal protective equipment (PPE). The coronavirus pandemic has significantly impacted that work. “We have to assure that people are meticulous in donning and doffing PPE,” she says. “We have to treat this situation as we would measles or tuberculosis.” In collaboration with infection prevention, sterile processing, and senior leadership, she and her teams have created posters to illustrate proper infection prevention protocols, have instituted special sterilization processing so that N95 masks can be reused, and have provided ‘just in time education’ throughout the hospital as CDC and Department of Health protocols have rapidly changed. Their goal is keeping the patients, community, and staff safe through the optimization of protective equipment and knowledge expertise.
The most stressful part of her position right now is not knowing what is coming next. “As a country, we’re storming,” she says. “It’s continuous change and chaos. How do you manage chaos? As an organization, we must be agile and manage the chaos.” She is coping with many workforce management issues, including furloughs and reassignment of nurses from surgical services to the bedside and other settings throughout the organization. What she wants people to know is that “this is really real. The virus is very much alive and well. Social distancing and sanitation protocols are really helping. We cannot let up on that. We’re learning something new about this virus every day, hour by hour, minute by minute. We need time, and we need to pay attention.”
Another enormous challenge is helping patients who come to the hospital with Covid-19. “We greet them with masks, face shields, gowns, gloves; they are placed in an isolation room away from family and friends. They are physically isolated, but we don’t want them to feel emotionally and spiritually isolated. We have an obligation to provide the best care we can for them. This is the art of nursing. Our commitment to them is to make them feel that they are loved and cared for and to help them get better.”
Dr. Steinmann emphasizes the continuing need for people to focus on their health and to do what is necessary – washing their hands, eating well, sleeping enough, getting exercise – to stay healthy. She cites an ancient piece of Jewish wisdom, from the medieval Sefer Hasidim: “Who is a wise doctor? He who knows to warn his patients how to avoid becoming sick.”