COVID-19

A Cath Lab Technologist’s Story During COVID-19

Richard Casazza, MAS, RT(R)(CI), Maimonides Medical Center, Brooklyn, New York

Richard Casazza, MAS, RT(R)(CI), Maimonides Medical Center, Brooklyn, New York

The first quarter of 2020 has been less than stellar, to say the least. The COVID-19 pandemic has completely turned the lives of healthcare workers upside down. In the United States, there has been over 831K cases with 46K deaths attributable to COVID-19 at the time this article was written. These are sobering numbers in the midst of one the most devastating pandemics we as a nation have ever seen. 

As of May 19, the following was recorded in New York City alone1

  • Cases: 191,650
  • Hospitalized: 50,618
  • Confirmed deaths: 16,059
  • Probable deaths: 4,828

The rate of hospitalization in New York City between March and May hit exponential numbers, and the impact it has had on the healthcare system has been overwhelming (Figure 1). This is especially prevalent in New York City. In Brooklyn, New York, Maimonides Medical Center has been one of the epicenters of care for coronavirus patients. A 780-bed tertiary hospital with a history of excellence, especially in the field of interventional cardiology, has now completely transformed into a giant intensive care unit. Based on the latest reports from the New York State Department of Health, Maimonides is #1 in the state for cardiac angioplasty and stents. Furthermore, Maimonides is the only hospital in the state to receive the prestigious two stars in two categories, placing the heart program in its own elite category.2 However, these accolades are put on the back burner as physicians from Maimonides Cardiology and Cath Lab staff members have been redeployed on the front lines to fight a non-discriminating, invisible enemy. As we struggle to “flatten the curve” (Figure 2), some of the same people that have contributed to our laurels have suffered from COVID-19, including attending cardiologists, cardiology fellows, nurses, technologists, and their family members. Among them, Jignesh Patel, MD, and Jesse Greenberg, MD have even been featured on national television on CBS News to tell their stories.

As a cardiac cath lab radiographer with 20 years of experience, I was redeployed to radiology to shoot portable chest x-rays on the sickest patients in the hospital (Figure 3). Thrust into doing something you haven’t done for over 20 years in a dangerous situation is quite daunting. However, I had to put my “big boy” pants on and get to work. Like my colleagues, the biggest fear I had was not for myself, but my children. For my asthmatic child, the risk of hospitalization and/or much worse outcomes is greater than for a child without a risk factor. That being said, I dove into a modality I hardly remember. 

It became real when I reached two consecutive rooms to perform chest x-rays for endotracheal tube placement, and both patients had expired before I reached the room. The exams were ordered within an hour to an hour and half before I arrived. The team that was treating the patient told me, “we don’t need you; the patient died” in a manner that indicated this was happening frequently and despite our best efforts, there was nothing we could do. 

Before each run I make to the units with a stack of requisitions, I don two pairs of sterile surgical gloves, inner sterile gown under an outer plastic gown, and fabric surgical cap under a disposable bouffant cap, heavy duty googles, surgical booties, and a N100 mask under a regular surgical mask. This is the same routine also for any patient with a ST-elevation myocardial infarction (STEMI) or acute coronary syndrome (ACS) who makes their way to the cath lab. Despite these personal protective measures, working in close proximity with these patients, essentially face to face, is terrifying. On my first run, running the portable x-ray machine, I found myself in tight quarters. As I approached the patient’s room,  I accidentally knocked into an IV pole stacked with what seemed like hundreds of drips, and it toppled over only to explode with pieces of plastic from the IV pump flying everywhere. A nurse helped me get the pole up and situate all the pumps back where they needed to be. Normally, I probably would have been chewed out, but a great comradery has overtaken our institution, where everyone is there to pick everyone else up in the darkest of times.

One of the biggest tolls it has taken on me is mentally. Even when taking the greatest precautions, you are constantly thinking about the various surfaces you touched, and if you have missed any steps in your cleaning algorithm and thus contaminated yourself. Wash, rinse, repeat has taken on a whole new meaning for me. It has gotten so bad that I disinfect the soles of my shoes every time I remove my surgical booties. A technique I use to maintain sanity while walking various places in the hospital is to glove and carry a sani-wipe to touch every surface I come in contact with. This may seem trivial, but doing it for 8-10 hours per day, everywhere you go, is exhausting. 

Every day upon reaching home, I use a small, cordoned-off section of my garage to disrobe and decontaminate before making my way to the shower. This process is repeated over and over every day, all in hopes of avoiding contraction of a virus. Despite donning and doffing of PPE hundreds of times, and cleaning ourselves and the objects around us an obscene number of times, as healthcare professionals, we strive to continue to give the best of care under the harshest of circumstances.  

You would think that one of the most prevalent topics of conversation at the moment would be what we want to get back to in our everyday lives. Alarmingly, it’s not. Every floor I go to, and every worker I come in contact with, is concerned about the second wave. One of the senior RNs I spoke with said, “I’m going to retire early. I can’t take another round of this.” We would like to think there is a light at the end of the tunnel, but as experts say, the inevitability of a second wave is highly probable, so we have to brace ourselves to absorb the brunt of it. This thought in the back of our heads has also taken its toll on frontline responders.

I saw a tattered surgical mask one day on the way to my car (Figure 4). To me, it was symbolic of our situation. Although somewhat broken and beaten, we still are strong at our core. After 9/11, New York endured a travesty that will hurt our hearts forever, but we came out stronger on the other side. New Yorkers have again shown their true colors at this time of despair. Coming together at the darkest times defines us as a city. Compassionate despite a rough exterior, warm despite our cold winters, and always tough as nails. We will continue to fight for our community. To borrow a line from Governor Andrew Cuomo, “We’re gonna kick coronavirus ass.”

Disclosure: Richard Casazza reports he is Director of R&D for Tesslagra Design Solutions. 

Richard Casazza, MAS, RT(R)(CI), can be contacted at all4ugq@aol.com or on Twitter at @Tesslagra.

References
  1. 2020 coronavirus pandemic in New York City. Wikipedia. Available online at https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_New_York_City. Accessed May 28, 2020.
  2. New report shows Maimonides has best heart attack patient outcomes in the state. June 7, 2018. Available online at https://www.maimonidesmed.org/news-events/news-stories?&news=151. Accessed April 24, 2020.