New Haven Register (New Haven, CT)
Doctor ‘never worked so hard in my life’
Palliative care focused on COVID patients
As a palliative care and oncology specialist, Dr. Elizabeth Prsic was not planning to become a caregiver for COVID-19 patients.
But when the coronavirus hit Connecticut in the spring, “we were asked by Yale New Haven Hospital to create the unit for end-of-life care for COVID patients,” she said.
Between April and June, almost
100 patients were cared for in the newly formed Supportive Care Unit. Prsic spoke Tuesday to express her concern about the rise in COVID cases, in support of doctors who signed a letter to the governor asking for suspension of indoor dining and gym closings. She said she signed the online petition that contains the letter.
Prsic is director of adult inpatient palliative care and firm chief for operations and quality in medical oncology.
Before COVID, end-of-life care was not centered in a single unit at the hospital, she said, and until the Supportive Care Unit was formed, professionals from other specialties were caring for end-of-life patients, supported by the palliative care team.
The new unit cared only for COVID patients until June, when nonCOVID patients were brought on.
“It was really challenging because the hospital was full and most of the hospices weren’t taking patients,” Prsic said. “The largest need was communication and support for families” and for patients who “may not have seen their families for weeks or months.”
Patients went from nursing homes to the hospital, some dying without having a family member present. “We have to be the surrogate family for them,” Prsic said.
The staff of the Supportive Care Unit created biographies of the patients and played music for them.
Before the Supportive Care Unit was formed, “It was like all hands on deck,” Prsic said. “I think it caused a lot of extra distress for the staff because they weren’t practicing in their usual expertise. … We served as consultants to help support these teams. We worked with hospice but we created our own end-of-life setting.”
The new unit freed intensive care beds for patients who needed that care, she said. “We felt privileged and grateful to serve but this was a lot of work,” she said.
In addition, the top three floors of the Smilow Cancer Hospital were taken over for COVID patients because the rooms have negative air pressure, forcing air outdoors. “We moved our entire cancer hospital in less than 48 hours to make room for a COVID unit” between March and late July, Prsic said.
The cancer patients were moved to the St. Raphael campus and physician assistants and nurse practitioners were reassigned to COVID care.
“I wish every day that this [pandemic] never happened,” Prsic said. “I feel lucky that I have the potential to do such important work and to protect and serve our patients in our hospital. I’ve never worked so hard in my life.”
Among the difficulties has been keeping her family safe, including her 4-year-old. At one point she quarantined away from her family for 21⁄
2 weeks.
“I’m away from my family for a long period of time and you just feel kind of contaminated. It’s kind of scary,” she said. “I’m here by choice. I definitely have a lot of anxiety and feel like this definitely has been a traumatic experience.”
Prsic said of the virus and the hospital visitation policy, “It’s more pervasive in the community and in families” now than in the spring.
“It’s heartbreaking, but we can’t take care of our patients unless there are limits,” she said.
She said she would be concerned about staffing if the number of COVID patients were to get too high.
“We don’t have nursing to staff it,” she said. “Back in the first surge, we would be getting floats from wherever. We don’t have the staffing for it and the thing that’s different this time … now it’s everywhere. … It’s not just from the patients or folks in nursing facilities. People don’t know where they’re getting it.”
Prsic said she doesn’t want restaurants and gyms to be hurt financially but that it’s important to contain the pandemic before it gets out of control. “I don’t know the answer because I value small businesses,” she said. On the other hand, “I want to have a functioning health care system to take care of patients. If you get a stroke or a heart attack or you break your leg, there’s a very real possibility that soon we won’t have the capacity to take care of them.”
The months-long battle “feels like a bit of PTSD,” she said.
“It’s like worse than April in many ways and yet people are acting like things are normal. What’s going on? … The numbers are looking terrible. I feel like I’m in a car with somebody who’s driving blindfolded and not listening to me.”