Featured Response

Cardiologist on getting COVID and missing his son’s birth

My name is Yair Lev. I am a cardiologist at the Jefferson Heart Institute.  I am the Medical Co-Director of the inpatient Cardiology Unit (5W, 5NW) and the Director of Quality and Safety for the Cardiovascular Department.  I was asked to tell my story.

During the month of March, I recognized that Philadelphia would be hit hard by COVID-19.  I reached out with concerns and ideas to the Mayor of Philadelphia, the Governor of Pennsylvania and the President of the United States.  At TJUH, in coordination with the Chair of Cardiology, Dr. Rene Alvarez, I took responsibility for leading and preparing the Department of Cardiology for COVID-19. Given my military background, I felt confident I could help make positive, quick and effective changes in both inpatient and outpatient work flows.

We started all of this implementation mid-March.  Therefore, I spent every day morning to night––including weekends––in the hospital and in the office. We knew that there was a risk that I would be exposed to the virus. At the time my wife, Bari, was 9 months pregnant. We decided together that she would leave the house with our 2-year-old daughter, Aviv, and temporarily live with her parents (in Bucks County) until the baby would be delivered.

A few days after they left our home in South Philadelphia, I started feeling ill with concerning symptoms, such as fever of 103 despite Tylenol, and shortness of breath. Within 24 hours of the symptoms starting, I biked to the ER, as my wife had our car and I wanted to avoid exposing any taxi or Uber driver to my potential illness. Although my lung exam was not normal, the ER team ultimately decided there was no indication for admission and they tested me for COVID. I biked home and isolated myself.  The next day I continued feeling worse and slept most of the day, unable to communicate with my wife who started having contractions in the morning.  In the evening, her mother took her to Abington Jefferson Hospital as it was closer than TJUH, where we initially planned on the delivery.  As they were about to get in the car to drive to the hospital, I received a call with the positive COVID-19 results.  I was absolutely crushed that I would miss the birth of my child and subsequently have to be in quarantine for a long period of time.

Bari was treated extremely well at Abington.  The room was in full isolation given Bari’s exposure to me days prior.  As the evening progressed, I was feeling very sick and had continuous fever and had to sleep. My mother-in-law told me that she would video chat me at time of the birth.  When they called me at around 4 a.m., I felt worse, and, in fact, was delirious.  Sadly, I do not have any recollection of this unbelievable event. The delivery fortunately went well, and our first boy was born. We named him Shai Lev, which means “gift of the heart” in Hebrew.  After monitoring of 24 hours they were discharged from Abington back home to Bucks County.

I remained in Philadelphia at our apartment without seeing anyone. I am a very healthy man and yet the virus attacked me very aggressively.  I was the sickest I have ever been in my life.  Almost every night I woke up around 2 a.m. feeling short of breath, sweaty, and confused.  At times it took me a few minutes to remember where I was.  My symptoms included extreme fatigue, feeling ill, having absolutely no energy to do anything, and significant shortness of breath, especially on exertion, even minimal. I was overall febrile for almost 3 weeks.

I had colleagues who leant me equipment including a blood pressure monitor and pulse oximeter, and so I monitored my vital signs and specifically my oxygen level very closely. I also forced myself to drink plenty of fluids.  I am fortunate that my colleagues from work took care of me. One of our cardiologists, Dr. Berko, made me a giant pot of chicken soup; another colleague went grocery shopping for me and dropped off medications; yet another colleague got me medical equipment.  In an amazing act of kindness, the Jefferson cardiology fellows bought me a huge box full of delicious types of food that really helped me recover as well (and they mailed one to my wife postpartum to her parents’ house!).

I had been in touch with the infectious disease physicians at Jefferson who guided me through the process.  At about day 7, things were not getting better and in fact I felt worse.  My oxygen levels were lower as well and I was close to coming in for oxygen treatment. At the time, as this was early on in March, the decision was to treat me also with antibiotics and hydroxychloroquine.  Retrospectively, I believe that taking these medications made me worse.  After initiation of these medications I felt nauseated most of the time and lost all appetite.

As you can imagine, this time was very difficult for me personally and certainly for my family.  One night, around day 10 of the disease, I started becoming worried about whether I was going to die. It was by far the worst I had ever felt in my life. This disease took a toll on me mentally. I could barely get out of bed and also felt very lonely.  I was saddened that I missed the birth of my son and I missed my family so much. My wife was so busy with our newborn that communicating by phone or video chat was very hard for her.  It broke my heart that I could not be there for my family.

After almost 3 weeks, finally the fever broke.  I still felt very weak, and shortness of breath especially upon exertion continued into recovery.  With consultation with the infectious disease physician, I waited 7 more days since I had symptoms to go and see my family.  At the end of the 7 days, I was tested again, and was praying that it would be negative.  Unfortunately, the test came back positive.  We did not know how to interpret this exactly.  Did this mean that I still carried the virus and was infectious?  Or was it all dead and these were just RNA fragments?  The infectious disease team thought it was probably safe to reunite with family.  I was terrified though, because my wife was just postpartum, and at that time there were several reports of death of young infants from COVID-19.  I waited a few more days, and ultimately we made the decision together that I would come and reunite with family in Bucks County.

My father-in-law picked me up and drove us to their home.  I took extreme measures to protect my family. I will never forget the moment that I entered the house, and saw my son for the first time in Bari’s arms.  And at the same time, Aviv ran over and literally jumped into my arms.  For a few minutes, I forgot all precautions as I could not stop hugging and kissing the three of them. It was the happiest moment of my life.

Looking backwards a few months later this all feels like it was a big bad dream.  We are now reunited, I took a couple weeks of paternal time and spent every minute of the day with my family.  I am feeling close to normal, started exercising again, and am happy to go back to work and treat sick patients in the hospital.

There are many questions about this pandemic.  Many expert opinions saying that we have seen the worse and others that say the opposite.  I am in no way an expert.  But I just wanted to share my story with you and ask you to take every precaution you can to protect yourselves, your family, your friends, and our wonderful community.

– Dr. Yair Lev, Medical Co-Director of Inpatient Cardiology Unit and Director of Quality and Safety for the Cardiology Department

Featured Response

Medical Student Ellen Solomon on Sitting with Uncertainty

One of the challenging experiences in this season is to accept an uncertain future.

As a second year medical student, the pandemic hit in the middle of “dedicated” before taking the infamous Step 1- a season I couldn’t help but anticipate all year, a schedule laid out weeks in advance to maximize every resource at my disposal, every moment micromanaged (or at least attempted), all to culminate in a day of testing I chose (and agonized over) in the fall. Then in what felt like a blink of an eye, Philadelphia closed, the nation closed, and – what felt most relevant in my self-consumed bubble of Step 1 prep – testing centers closed. Indefinitely. A halt to the all my preoccupation with staying “on schedule.”  My illusion that my stamina, discipline, and time management would propel me from pre-clinical to clinical education was shattered.

So here I am, 4 weeks after my original Step 1 test date with no clear end in sight, sitting in uncertainty and quarantined in my little Philly home with lots of time to think. And I can’t help but think about how Step 1 could’ve been behind me, how I had planned to be on my family medicine rotation this month, caring for patients, developing my clinical skills, thriving (I hoped) in the hands-on learning environment of clerkships. I can’t help but grieve that loss, feeling impatient for my clinical education to bring the last 18 months of intense basic science education to life.

But what if one of the most important lessons I can learn, one of the greatest “clinical skills” I could gain, is what I am doing in this moment - sitting with my uncertainty? Not pushing it away, not falsely pretending I can predict my future, not simply distracting myself, but accepting this season for what it is- wildly uncertain.

If I am unable to sit with my own uncertain future, how will I sit with a patient in his fear and uncertainty upon receiving a new cancer diagnosis? Or with the mother whose newborn was just admitted to the NICU, her mind flooding with questions- “When will I take my son home? How long will this last? Will everything be ok? Do you know why he’s deteriorating? Will there be lasting damage?”

And what if the answer is uncertain? Will I run from that uncertainty by trying to explain away unanswerable questions with medical jargon that feels more comfortable spewing out of my mouth than simple words of empathy? Will I give her a false sense of certainty just to avoid the raw fear I see in her eyes? Will I simply cut these conversations short to avoid the discomfort of unanswerable questions altogether?

Or, will I have the courage to simply sit with her, in the pain, grief, and disorientation of her son’s suffering, his uncertain future?  Will I withstand the temptation to offer false certainty and instead admit “We don’t know” - and not evade her gaze?

Most patients and their families are far more experienced in dealing with uncertainty than my privileged self. And although an uncertain timeline for my medical education is disorienting, it pales in comparison to the uncertainty many patients and their families live with every day, sometimes for years. And maybe, in a strange way, in this season I can learn from so many resilient patients that I have yet to meet. I can learn to accept that life is wildly uncertain, that I do not know what tomorrow will bring but instead can ask for my “daily bread” rather than living for my 10-year timeline.

They say patients are your best teachers; I’m learning this to be true, even in a season of quarantined medical education.

 – Ellen Solomon, Medical Student at SKMC

Featured Response

Medical Student Mary Blumenfeld on When COVID Became a Reality

On the morning of Friday, March 20, my sister called me to tell me two things. First, our dad was in isolation because he had been in court for two weeks with another lawyer who had just tested positive for COVID-19. Second, our mom was in the hospital, but it wasn’t COVID. 

I texted a few of my closest friends that I was a little worried about my dad having been exposed because, at 67, he was in an at-risk age group. They all responded with optimistic support: “I’m sure he’s going to be okay!” Worrying about my dad wasn’t quite when COVID became a reality for me, though. It was still, luckily, only a possibility. I hadn’t even mentioned my mom being in the hospital because it didn’t seem like a big deal, relatively speaking. She’d been to the hospital numerous times in the past several years and it always turned out to be “nothing,” so to speak. But on Saturday morning, my sister called me again. My sister never calls me, so seeing her name light up on my phone two days in a row was cause for alarm. “Mar, so I just talked to Mom’s doctor at the hospital. She’s in pretty bad shape. He thinks there's a good chance she’s not going to make it.” What? Why are we talking about Mom? I thought Dad was the one we were supposed to be worrying about. 

When I called the hospital, my mom’s doctor confirmed that things were not looking good. “Unfortunately, we can’t allow any visitors in the hospital right now.” Excuse me? My mom is literally about to die and I can’t visit her because of a completely unrelated virus? This is unreal. “If things continue to go downhill, we will allow you to come in to say your goodbyes, but we can only let one of you in the hospital at a time.” I asked him how long he thought she had left. I was in Center City, but my mom was in the hospital in Wilmington. I didn’t want to be 45 minutes away when I got the call saying it was time, but I couldn’t exactly go wait at my dad’s house, and I didn’t want to go to my sister’s house because she has two little kids. “Honestly,” the doctor said quietly, “I would start driving to Wilmington if I were you.”

And that was the moment COVID became a reality for me. That was the moment I became acutely aware of how the virus could make you short of breath in more ways than one.

By the time I got to the hospital, my sister had already been allowed in, which meant my mom’s condition had deteriorated. I knocked loudly on the hospital door, noting its unusual locked state, and a man donning a full suit of PPE came outside to ask what I needed. “My mom. She’s sick. I mean, she’s not sick, she’s dying. I mean, she is sick, but she’s also dying.” I stopped to try to catch my breath and my thoughts. “She’s in there,” I pleaded. “I need to get in there.” He asked me if I had been feeling any flu-like symptoms or had a sore throat recently. “No and no.” “Have you had any shortness of breath?” Only because my mom is dying. “Have you had a fever?” “No.” “Have you been around anyone with a suspected or confirmed case of COVID in the past 14 days?” “No.” “Have you been outside the country in the past 14 days?” “No.” He stepped aside to let me in, and I headed straight back to the information desk and told them who I was there to see. 

“Have you had any flu-like symptoms?” Seriously? My mom is dying. I didn’t develop flu-like symptoms in the three seconds it took me to get from the entrance to this desk. 

“No.” 

“Have you had a sore throat?”

“No.”

“Have you had any shortness of breath?”

“No.”

“Have you had a fever?”

“No.”

“Have you been around anyone with a  suspected or confirmed case of COVID in the past 14 days?” 

“No.”

“Have you been outside the country in the past 14 days?”

“Still no.”

“It looks like your mother already has a visitor. I think it’s your sister, or maybe her sister. She needs to exit the hospital before we can let you up. You’ll need to wait outside away from the entrance, past the walkway.” My sister and I wouldn’t even both be allowed in the room with our mom in her final moments. How were we supposed to choose which one of us would be with her at the end? Our brothers lived in Minnesota and Arizona; there was no point in them even trying to get home, so at least it was a choice between two rather than four. What an odd thing to be grateful for. 

Fortunately, my mom’s two sisters lived close enough to meet us where we were waiting outside the parking garage, and we all took turns going in and out to be with her. While one of us was in the hospital, the other three shuffled between sitting and standing and pacing in a construction site about 100 yards away from the hospital entrance, careful to maintain six feet between each of us. An awkward triangle desperately wishing to collapse into a single point. 

When it was clear that my mom didn’t have much time left, the oxygen mask was removed, the morphine drip was started, and the medical team very graciously decided to let all four of us be in the room with her until the end under the condition that we all maintained an appropriate distance between each other. My mom died early Sunday morning. Against protocol, the four of us were there next to her, and I am so grateful for that. But we didn’t get to have a proper funeral or sit shiva. We still haven’t been able to hug each other. My brothers haven’t been able to come home. Going through the grieving process in a period of physical and social isolation is a grief all its own. 

Through this grief, I learned too well how COVID has the ultimate control, capable of invading not only your respiratory tract but every aspect of your life. Somehow these invisible little particles together formed a colossal barricade against the things we might usually take for granted, still invisible but in no way inconsequential. Physiologically, my mom’s death was unrelated to COVID, and yet her death was so intimately tangled with these tiny but formidable particles, a marionette with its strings manipulated by a puppeteer who was both invisible and merciless – an utterly dangerous combination. COVID isn’t what killed my mom, but her death is what made COVID a harrowing – and humbling – reality for me.

– Mary Blumenfeld, Medical Student at Sidney Kimmel Medical College

Featured Response

Resident on Adding Color to Patients’ Lives

We recently had two patients on our family medicine inpatient team at Abington Jefferson Health who were roommates at a group home for people with intellectual disabilities. They were very close. They both came in with symptoms related to COVID-19. My co-resident, Morgan Katz, deserves a shoutout because she took care of both of them with care and good medical skills before I got there. One of the patients was recovering nicely. The other, sadly, as with many patients, was doing poorly, no matter what we did for her. The difficult but compassionate decision was made to allow her to go to hospice care so that she could be as comfortable as possible. I eventually took over the care for the other patient. She had no idea that her friend was dying. We decided it would be best to wait for someone at the group home to tell her since they knew her better. In the meantime, she was feeling much better and was bored in her room. I asked her what she liked to do - she said she liked to color, particularly flowers. I went down to the pediatrics floor, where I knew they have coloring supplies, and picked up some crayons and coloring pages. I printed a few more coloring pages and brought the supplies to her. I am a firm believer that medicine is about physical, emotional, mental, and spiritual health. This patient needed some coloring in her life, so that's what she got.

– Evan Gooberman, Resident Physician, Abington Family Medicine