What is it like being on the front lines of the pandemic?
Meet Dr. Evans Crevecoeur
____________________ Ten years ago Dr. Evans Crevecoeur, Choices Director of Anesthesia, was interviewed by OnTheIssuesMagazine.com on his experiences in Haiti after the devastating earthquake there on Jan. 12, 2010. He was born in Haiti and has lived in the U.S. since he was 10. He has many relatives there and returned on an emergency basis as a volunteer physician to help. “When I learned the extent of the damage,” he said in that interview, “I knew I had to go. From the air it looked like an atomic bomb had hit Haiti. I haven’t seen an atomic bomb, but I couldn’t imagine anything worse…everything was like dust…people under the rubble.” This year, Dr. Crevecoeur (Dr. Crev, as colleagues call him) has been in another frontline battle, this time at Jamaica Hospital, Queens, during the peak of the COVID-19 Pandemic in NYC. In addition to his responsibilities at Choices, located in Jamaica, Queens near the epicenter of the COVID-19 crisis in NY, Dr. Crevecoeur has served as the Director of Anesthesia in Jamaica Hospital’s Labor and Delivery Department for 20 years, and is no stranger to medical emergencies. Following are questions posed to him and his answers about fighting the COVID-19 pandemic as it hit Jamaica, Queens, one of the hardest-hit neighborhoods of NYC and not far from Elmhurst Hospital which was considered the COVID epicenter of not only New York but the entire country.
You have been in emergency situations before–including on the ground in Haiti shortly after the 2010 earthquake. How did the situation at Jamaica Hospital in Jamaica, Queens during the peak of the COVID-19 pandemic in NYC compare with that? Dr. Crevecoeur: In a nutshell, this has been even more traumatic. I arrived in Haiti after the earthquake with a medical team to help the survivors. We were immediately able to help people medically and surgically. Here, dealing with COVID-19, you felt so helpless. Presently we are still uncertain about the manifestations of this virus. The present therapies administering to patients are all based on a trial basis. We have no idea which medications will be beneficial or harmful to the patients. In this scenario, we treat the symptoms. We administer oxygen and intravenous medications to keep patients alive as long as possible until hopefully, the patient’s immune system eradicates the virus. Many medical workers feel helpless, demoralized, and depressed because we can’t give assurances to the families about the prognosis of their loved ones. The medical staff provides support and hopes for a good outcome, however, when they are placed on a ventilator the prognosis worsened.
Obviously, news reports are not the same as direct experience, but I think they gave a sense of how massive and overwhelming the medical needs were at the peak of the crisis in New York City, along with the true heroism of the doctors, nurses and other medical workers. How did you feel, being in the midst of this? Dr. Crevecoeur: There were so many patients at Jamaica Hospital. And so many did not survive. Several floors of the hospital were evacuated for COVID-19 patients. Morgue trucks were stationed adjacent to the hospital to accommodate the deceased. In this unfortunate scenario, there was no definitive treatment in our armamentarium to save these patients. Uncharacteristically, these patients will be conversing and within minutes may experience severe respiratory difficulty requiring oxygen therapy or even being placed on a ventilator. Unfortunately, because of the poor prognosis of an intubated patient, it is most likely that he or she will be the last person the patient sees. It is indeed a frightening and depressing moment. I was also infected with COVID-19, but fortunately, my illness was mild. I felt weak, tired, and exhausted. I was given a couple of days off and recovered rather rapidly. I returned to work as soon as possible to join my colleagues in their struggle to save patient’s lives. When the pandemic began, we were not adequately protected with the face masks and other protective gear, through no fault of the hospital. I don’t think any hospital was prepared for such an increased need for the PPE. Jamaica Hospital sought aggressively to meet the needs of its medical staff. Thus presently we are well equipped with PPE. Emergency physicians, anesthesiologists, critical care physicians, and respiratory therapists perform intubations. This a procedure required to connect the patients to the ventilator. To minimize the exposure to my family, upon entry to my house, I will wash my hands and take a shower before I join my family members. I refrained from visiting my parents during the pandemic because of the infection risk. Elderly patients have not done well once infected with the virus. Most health care workers have faced this dilemma. While taking care of these patients, we have a fear of being infected but this is the risk we have to accept. This is our chosen profession and we enjoy taking care of patients. For most of our dying patients, we are the last ones that they see. During the pandemic period, no visitors were allowed which makes it even more depressing to the patients, families, and health care workers.
What can we learn from this? Dr. Crevecoeur: This situation is far from being over, we have to be aware that the virus is still dangerous and virulent, we have to prepare ourselves accordingly. We have to reopen gradually. Public places such as beaches, churches, stadiums are fertile grounds for the spread of the virus. At the hospital, we are opening up for some essential surgeries and making sure staff will be safe as well as patients. We are still seeing COVID patients in the hospital and using the necessary PPE [Personal Protective Equipment], we have special precautions in the operating rooms, special air filters, face shields, gowns, everything. We are taking gradual steps toward opening. This approach is very good. Hospital staff will be tested for the disease, and patients as well. We’re not even sure that having COVID antibodies means you’ve developed immunity to the virus. It’s a guessing game, so you have to continue to be very careful. I understand the point of view of people who want to open up, to work, enjoy life, but you have to understand the health issue as well, be concerned about other people because you are jeopardizing lives. If you know about risk and are willing to take it that’s fine, but this is different because you jeopardize other people’s lives, you do it at the cost of hurting other people. We should open up safely and gradually. Some people are not willing to do that, so that’s why a second wave is possible. When I went to Haiti in 2010, the earthquake was something that came and went. We set up makeshift hospitals, we treated survivors and knew we were helping them. This has been very different, over days, weeks, and months, with no clear end and no certainty about what you were doing. Just hoping that things would work, and people would live. We don’t want another upsurge of cases. It could come back, be more virulent. If there is also a flu outbreak, both COVID-19 and the flu coming together will add to the problems. When the pandemic began, we were not adequately protected with the face masks and other protective gear, through no fault of the hospital. I don’t think any hospital was prepared for such an increased need for the PPE. Jamaica Hospital sought aggressively to meet the needs of its medical staff. Thus presently we are well equipped with PPE. Emergency physicians, anesthesiologists, critical care physicians, and respiratory therapists perform intubations. This a procedure required to connect the patients to the ventilator. To minimize the exposure to my family, upon entry to my house, I will wash my hands and take a shower before I join my family members. I refrained from visiting my parents during the pandemic because of the infection risk. Elderly patients have not done well once infected with the virus. Most health care workers have faced this dilemma. While taking care of these patients, we have a fear of being infected but this is the risk we have to accept. This is our chosen profession and we enjoy taking care of patients. For most of our dying patients, we are the last ones that they see. During the pandemic period, no visitors were allowed which makes it even more depressing to the patients, families, and health care workers.
You described how traumatic this situation has been for health workers. Not only are they concerned about catching the disease but the stress and anguish of dealing with this new situation takes a toll. Do you have any suggestions for how medical workers can best deal with this? How did you and your family cope? And what do you say to people who are afraid to go to the hospital now for other care? Dr. Crevecoeur: People need to personally prepare by strengthening their immune systems – make sure they eat well and exercise regularly – and continue washing their hands frequently and keep social distancing. Hospitals now have the protective equipment they need. With fewer COVID patients, they are able to take care of people coming in for other medical problems. People shouldn’t postpone going in for emergency care – chest pain, trouble breathing, severely elevated blood pressure. People should consult their personal physician and not be afraid of going to the hospital. My family has basically stayed at home. So far, we’ve done okay. We use masks everywhere. I couldn’t sleep for a time. I have never had a problem before with sleeping. It could have been from stress or depression. Our hospital set up special sessions for people who felt they needed help. People should avail themselves of mental health services if they need assistance. Eventually, in order to cope, I just concentrated on knowing we had to help people, and that in whatever circumstances, you just have to do the best you can. And this too shall pass.