Pandemic Physiatry: Adapting to the New Normal
by Evan R. Zeldin, MD
For the last few months, we’ve watched the world transform into a place that would have been unimaginable just a few short months ago. First there was China, then Italy, and then New York. Here in North Carolina, we started to prepare once it became clear that what was happening worldwide could happen even in our rural neck of the woods. As society was beginning to close down all around us, we too made changes. We closed our clinics, we limited and then eliminated visitors to our hospitals, we masked personnel, and we moved to a modified schedule to prevent unnecessary resident and attending exposure. It seemed that the needs of a physiatrist would not be important in the acute crisis- we started to prepare for our new future to be “redeployed” into the COVID units- perhaps functioning as a modified ICU physician. We waited and waited for the worst to come. And waited.
Fortunately, it seems that society committing to social distancing and self-isolation spared us from the worst. Our hospital saw our fair share of cases but nothing close to overwhelming our healthcare system like the experiences of northern Italy or New York City. It became more and more apparent that we were going to experience what our hospital was calling a “plateau” − a steady stream of cases that our hospital system could manage.
It was therefore time for us to figure out how to return to our role as physiatrists in this new world.
We began reopening our clinics- entirely by phone at first. Then we started prioritizing the essential visits- the patients who needed to be seen in person. We learned how to minimize patient exposure to each other by limiting the numbers that could be seen each day and masking everyone in waiting rooms. Slowly but surely, more and more patients are being scheduled for in person visits — using what we have learned so far to keep both the patients and our staff safe. The experience in these clinics is surreal- temperature checks, everyone in masks, half schedules, and the fear that anyone could be transmitting a deadly illness makes for a vastly different experience than a few months ago.
In the inpatient hospital, we been starting to admit our first patients who’ve survived COVID-19 and are in desperate need of rehabilitation due to both general debility but especially pulmonary rehabilitation. These patients are required to be symptom free and have multiple negative tests before admission to our hospital. So far, these patients have been doing well, making both improvements medically and making physical gains with our therapists.
But the future is uncertain. I hope that things will get better or continue to remain with this steady plateau. As society attempts to grapple with the current situation and determine how and when to re-open, I wonder if we may return to the way things used to be — fearing that our system will be overwhelmed and therefore making us as physiatrists sidelined yet again — unable to take care of the multitude of patients who need our help now. This fear is hopefully unfounded, over the last few months both our healthcare system and our society has learned how to adapt — hopefully allowing us to be prepared for whatever comes our way. And most importantly, there are signs every day of how things are getting better in terms of current treatment but also progress towards the ultimate goal — the vaccine that ends this crisis.
But until then, we’ll continue on with the way things are, doing the best that we can as physiatrists in this new normal.
Evan is a PGY-2 resident at East Carolina University/Vidant Medical Center.
