The Emotional Journey of COVID-19: An Interview with Dr. Jonathan Whiteson

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In this issue, we talked to Dr. Jonathan Whiteson of Rusk Rehabilitation in New York, NY. Dr. Whiteson has been working on the frontlines during the pandemic, helping to reshape his department, and educate others on Rusk's learnings through this time, as is their mission. The following article is based on his experience as of late July 2020.

Dr. Jonathan Whiteson

Jonathan Whiteson, MD, FAAPMR
Vice Chair, Clinical Operations
Medical Director, Cardiac and Pulmonary Rehabilitation
Rusk Rehabilitation

I don't think anyone across our country can say that COVID-19 hasn't affected them. It's brought a rollercoaster of emotions and the ride hasn't ended yet. Personally, as physicians, we've had to worry about our own health and that of our families; professionally, we've worried about the health and well-being of our patients. Not only are we concerned about our existing patients, but also our new patients coming through due to COVID-19 and access to future patients who need us.

And of course, we worry about the health care system. Can it survive? Can rehabilitation medicine survive? How do we evolve through this time and learn lessons from prior disasters and know how to respond?

I'm going to take you back to essentially the beginning of March when things started to take off here in New York with sporadic cases. We had a sense that we were going to be, along with California, the hotspot but we had no idea what was going to come in the middle of March, when the caseloads started to take off and lockdown orders were put in place. Everyone had to shift into high gear in terms of how we functioned, personally and professionally, and how we coordinated and structured our department. It was exhilarating, terrifying and satisfying all at the same time. 

I still think back on it with some degree of shock, but it was not a paralysis. On the contrary, it mobilized us. We became so efficient and fluid by need, necessity, dedication, and adrenaline.

We weren't used to working at that breakneck speed and in that kind of way - with the type of background fear and concern for our own safety and our patients' safety. At that time there were no orders for masks in public, no precedents, and a lack of PPE, so we were sort of walking blind.

Adding to that, it reached a point very rapidly where whatever you were thinking, your thoughts were no longer valid by the time you spoke them. What was true and relevant in the morning, was old news and irrelevant in the afternoon. When before has the practice of medicine changed at such break-neck speed? For our department, we instituted daily discussions where we would cover all the changes we were seeing. It was non-stop communication and I think that was the key to our ability to adapt and morph from the pre-COVID-19 era to the COVID-19 era and take care of our patients.

It was emotionally very challenging yet motivating because we went into rehabilitation to honor individuals with disabilities. Honor them with out dedication, our expertise, and our commitment to enhance their lives and level the playing field. That sense of service overcame our sense of self-preservation or fear for ourselves or our families. That's why we were able to respond as the number of cases rose exponentially.

For example, very quickly we started to notice that there were patients who were becoming COVID-19 positive on one of our inpatient rehabilitation floors and no matter how hard we tried to transfer those patients off and reduce the speed, we weren't able to succeed.

This facilitated the creation of COVID-19 positive and COVID-19 negative units. We created criteria for admission for our COVID-19 negative-never-positive unit and worked to ensure that it remained that way by coming up with a set of criteria for monitoring patients on the inpatient rehabilitation unit. This criteria indicated deterioration and therefore transfer back, and also signified safety for discharge home, which all related to the COVID-19 pathology we were learning about.

Against all odds, one of our COVID-19 negative units remained to throughout the surge of the pandemic, ensuring that our rehabilitation and transplant patients were safe.

COVID-19 has further proven the value of physiatry. Physiatrists have always been the best physicians and the best team for the recovery phase because we see the whole person. We don't just treat the broken leg or the injured spinal cord or the damaged brain. And this disease impacts the whole person as we've discovered. COVID-19 affects every single organ system and there's only one specialty that deals with every single organ system. We may have a specialty in spinal cord or brain injury, but we are skilled in the multi-disciplinary approach to the management of patients. We understand the physical, functional, medical, emotional, and cognitive - what it takes to make a whole person. And that's our passion.

There is no physician and no training program that provides our perspective better than physiatrists. And the value of physiatry is not just to the individual patient, but it's to the health care system in general. We know that the sooner rehab services are involved in patients, the patient's trajectory changes in a positive way, and that has great impact on the Triple Aim.

Telehealth is a boost to our field as we face this new normal. Having continuous access to patients is critical. Telehealth opens access to patients that we didn't have before, whether because of limitations due to location or a patient's inability to physically get to us.

One of the missions here at Rusk is education. We feel there's no point in just educating ourselves, we want to share that education and we want the same back from our colleagues. We want to learn from them. Great research is only great if it's shared and published and great learning is only impactful and helpful is it's shared with others. We've been fortunate enough to spread the word on what we are doing through podcasts, webinar series, and short soundbites.

COVID-19 is devastating, there's no minimizing that. But as a specialty, this is an opportunity to learn, evolve, build new programs and to recognize different approaches to care. Out of the ashes the phoenix rises.