The last few months of the coronavirus pandemic have been an incredibly difficult time for all of us. I don't know of anyone that has not been affected by this at some level, some much more than others. What I want to do today is share a letter of one of our colleague's experiences in one of the hardest hit areas during the pandemic. Alyssa Zantello, I am proud to call you my colleague and I admire your dedication to the profession and your courage in the face of a very dangerous situation. To all of you who have continued to practice in similar situations, I salute you and thank you for your dedication and selfless practice.
Here is Alyssa's story in her own words:
This is what we were trained for.
My journey from the world of outpatient orthopedics in Michigan to emergency medicine
on the COVID frontlines in New York City began with one unexpected and brief conversation at
the end of March from a great friend and PA mentor, Stacie Graves Skiano, PA-C. She said,
“I’m on my way to New Orleans to help with the COVID crisis... I can’t just sit at home and do
nothing. You should look into it and maybe you can come too. I feel like this is what we were
trained for.” That brief conversation sparked a fire in my soul. The phrase “this is what we were
trained for” kept running through my mind.
At the time I applied to work on the frontlines, the need had shifted to New York City.
The thought of going to NYC was intimidating and frankly quite frightening, but with each
passing moment I felt increasingly compelled to go. Within 48 hours I was on a flight from DTW
into the world of the unknown.
Six years ago, on the first day of my PA program, I would have never believed I would
be here today. Yet here I am among the thousands of other frontline workers, working endless
hours in the mission to care for the most vulnerable humans affected by COVID-19. It is an
incredible honor and privilege to be able to both represent my profession and offer assistance in
this time of need. How humbling it is to work alongside some of the most incredible medical
providers and join with them in their fight against this pandemic. This is, in my opinion, one of
the greatest things about being a PA - we are trained to be adaptable and to meet the needs of
any medical specialty.
My assignment was to the emergency department of a busy hospital in Bronx, NY. The
tour I received on my first shift demonstrated the dire need of an influx of healthcare providers.
The emergency department was overflowing with patients. The ED pods were filled with
stretchers of intubated patients and patients on non-invasive ventilation. Ambulatory patients
were seated in chairs while receiving treatment. Most floors of the hospital had been converted
to intensive care units. There were holes drilled through the walls to keep IV lines and
drips/pumps outside the patient rooms to avoid unnecessary room entrances and exposures to
healthcare providers as any exposure is a possibility of viral transmission. Video monitors were
used to monitor patients from outside their rooms. The floors were filled to such capacity that
the ED was backed up with admitted patients waiting for a bed upstairs to become available.
Evaluating new patients seemed to just be case after case of COVID. At first, testing
was limited to admitted patients only. Patients stable for discharge home were treated on a
presumptive diagnosis based on chest x-ray results, oxygen level, and clinical symptoms.
I began to see first hand the rage this disease has on the people and community
affected. Young or old, healthy or sick, COVID seemed to arbitrarily attack some people more
voraciously than others. I listened as providers recounted their experiences with patients
decompensating quickly - making me nervous about decisions regarding who I would discharge
home versus who I would admit.
I witnessed patients come to the ED alone and afraid after suffering for a week or longer
at home until they could no longer bear their symptoms. They didn’t want to come into the
hospital and face the likelihood they might die alone. Their family members were not allowed
inside. They were met by hospital staff covered from head to toe in personal protective
equipment. They conversed with their healthcare providers through a barrier of masks and face
shields, gowns and gloves. The personal touch of human interaction stifled by the necessary
precautions to avoid disease transmission. I reminded myself that I can’t help others if I become
a COVID casualty. I faced my own mortality as I engaged in patient care daily. I understood the
risks but pledged to do my best to protect myself while engaging in my mission to combat
COVID-19 every day.
There was a near palpable weight felt each day as I entered the ED area fully knowing
that any patient I encountered that day could (and likely would) have COVID. By the end of my
shifts I was fatigued from the extensive PPE I wore for 12 hours each day. I avoided removing
my mask to drink water during my shift for fear of contaminating myself. My face hurt from the
pressure of wearing my N95 all day. Strangely enough, I was thankful for that discomfort
because it was a reminder of the protection my equipment offered me from this virus.
As the case numbers began to plateau and decline we were left wondering what was
next. Would there be a quick second surge? Would we be inundated with other medical
emergencies? Would people just stay home and decline to seek medical care? The explosive
blast of that first wave was over, but the shattered debris of NYC began to settle and the
assessment of covidlateral damage (medical, psychiatric, and economic problems occuring on
the periphery of the COVID pandemic) began. How would the local healthcare workers hold up
after weeks of intense mass influx patient care? How could we continuously adapt our patient
care to improve outcomes? The only consistent thing to do was to return each day to the ED to
see what that day would have in store.
As my career as a PA has thus far been strictly in the outpatient orthopedic surgery
realm, I found the ED to be somewhat of a medical culture shock. I needed to very quickly learn
the hospital’s patient flow, electronic medical record, available resources, as well as reorient
myself to the thought patterns utilized in assessing and treating a patient in the emergency
The words of my mentor kept replaying in my head, “this is what we were trained for.” I
was trained as a PA to treat patients with respect and dignity while providing the best possible
medical care. I was trained to take a good history and evaluate a patient thoroughly. I was
trained to recognize a sick person and advocate for them. I was trained to have good clinical
decision making skills and to utilize appropriate medical resources for additional guidance and
information. I was trained to be a part of a collaborative healthcare system and work together
with a team of doctors and nurses and support staff. I was trained to recognize my own
limitations in knowledge and utilize the vast knowledge of those around me.
Never in my life did I imagine I’d be fighting a pandemic as part of an incredible team of
healthcare providers, and never in my life have I been more proud to be a part of a collective
effort to help those who need it most. I am especially thankful for the doctors here who trust me
to provide care for their patients and who have embraced me as a teammate in this battle
against COVID-19. I am forever grateful to all those who have supported this effort.