Whether it’s caring for patients, designing new surgeries or embracing new technology, medicine will never be the same in the wake of the COVID19 pandemic. In part 2 of Follow Up Visit, we speak with Dr. Eduardo Rodriguez, Dr. Sean McMenomey and Dr. Gabby Mayer about the changes they’re dealing with and the changes they’re choosing.
Vital Signs - Follow Up Visit - Part 2 Transcript
Beth Ameen:
Hi, I'm Beth, Executive Producer of Vital Signs. Welcome to part two of Follow Up Visit, catching up with our doctors from season one. The COVID crisis over the last year and a half has challenged and inspired many in ways they never anticipated. At NYU Langone Health doctors and healthcare workers have seen unprecedented advancements in areas like surgery and technology. During the summer of 2020, Dr. Eduardo Rodriguez was up against the greatest challenge of his career. The first ever face and double hand transplant in the world, made even more difficult by a global pandemic.
Dr. Eduardo Rodriguez:
So the gentleman that needed this type of operation was a 22 year old male who was involved in a rollover motor vehicle collision where the car basically exploded resulting in 80% of his body being burned. Third degree burns, which is full thickness burns. He was initially treated at an outside facility, an acute burn care facility and recovered well, however, even the life, as he knew it was forever changed... And had complete loss of his face, including his forehead, his eyelids, his nose, ears, lips, neck skin, really horribly deformed. But in addition to the face had loss of his fingers, significant scarring of his arms with limited use and was completely dependent on his parents for daily care. And with that, the only way that we could improve the quality of his life and get him back to some sense of normalcy was with a face and bilateral hand replacement, which is something that had been attempted in the world twice, but none of the attempts were successful.
And then we practice in a simulation laboratory and eventually in our operating room for approximately 10 months. And it occurred, it was difficult to find the ideal donor for this patient because of the amount of burn injury that he had. He received numerous blood transfusions and skin grafts that actually raise his antibody level, which means that we would make it very difficult to identify a donor for him. But because of a nationwide search, we were able to identify the ideal donor for him outside of the state of New York. And when the donor presented himself, we were able to transport that patient from their state to NYU hospital, to complete our, our workup. And we also have to keep in mind that this was all in the midst of a major pandemic coronavirus.
Our last rehearsal was in March and all of a sudden, you know, we have, we had been hearing rumblings about coronavirus, but then the pandemic crisis was declared the world health organization. And finally, governor Cuomo put a shutdown in the state. At that point, we changed gears from focusing on our daily practices as surgeons to becoming basically critical care doctors, caring for patients with COVID. And the primary focus was to save as many people's lives as we could and help out our fellow physicians at NYU Langone Hospital. And although Joe was not our primary attention, he was still in the back of my mind. And donors were still being presented to us, not to the same amount as they were pre-pandemic, because all of a sudden donation and concerns about performing transplants in the midst of coronavirus, that changed. But as soon as we got a better handle on managing patients with coronavirus, we returned to our rehearsals.
We wanted to make sure that our donor was COVID free. So our donor was tested at their primary facility where he was identified and then was brought here and we tested him several additional times just to make sure. And then with Joe, Joe was also tested several times to make sure, there would be no possibility of COVID transmission because at that time, no one really knew what would be the potential consequences. We were not in a position to take that level of risk. That's why we tested them multiple times to ensure that neither the donor, nor the recipient in this case, Joe had become COVID positive. And we maintained all the safety guidelines to ensure not only safety of all of our personnel, but of our patients as well. And we performed this operation within 23 hours, incredibly successful in a rapid amount of time. And he's doing remarkably well with a new trajectory in his life.
Hand transplant are challenging. First of all, when they're both hands, we want to make sure that simple things, they have similar color match, but they also have to be matched in length. We want to make sure the hands, when your hands are by our side, they have the same length and the arms lie where they should be. You also have to ensure that you appropriately align them so that the hands can work normally. And the reason for that, there are many different tissues that have to be reconnected. In the hands, we connect two major arteries, four major veins, three very important nerves that provide sensation and motor function to the hands, two bones that have to be stabilized with plates and screws in the appropriate rotation. But more importantly, 21 tendons that move the fingers, inflection extension, as well as the risks in flection and extension supination pronation.
So there are a lot of intricate movements and we have to be able to set those tendon repairs, inappropriate tension so that everything works harmoniously. The goal was to first perform the right hand since he is right-hand dominant. Then once that part of the operation is moving and progressing well, then we go ahead with the procurement of the left donor hand. And once both hands were moving along well that we felt that I felt that they were healthy and we were at a certain margin of safety. Then we procure the face and continue with the face transplantation. And those three major sequential operations were performed within 23 hours, which was a major record for us. I had previously performed two face transplants at NYU and each one of those took approximately 25 hours.
Beth Ameen:
Newly minted hearing aid, recipient, and otolaryngologist. Dr. Sean McMenomey has seen the great benefits of telehealth. But, some medical issues just can't be addressed over a video screen. So when the COVID vaccine came along, it was more than just a shot in the arm, it was a shot of hope.
Dr. Sean McMenomey:
We've gotten vaccinated, which was a huge, really a huge kind of emotional day when that happened for us, really to have come through that and make it out and get vaccinated, so we can keep doing this and keep helping people was really huge. You know, life goes on outside of COVID. People still need cochlear implants, they still have ear infections that need to be dealt with. And, you know, for awhile there, we saw people delaying medical care out of a fear factor, right. That didn't want to come in. They don't want to be potentially exposed to COVID. And, uh, so I think one of the things we can do on the radio channel is helpfully alleviate, to the extent possible, that the fears about coming into the hospital and getting your, your heart dealt with or whatever it is you have to get dealt with, that stuff still needs dealing with.
It's hard to know if a patient has an ear infection on a video visit, but for cochlear implants and hearing impaired patients in general, it's been fantastic because we don't have to wear a mask and they can also have family members, as many family members as they want in the room with them helping them take notes or asking additional questions, and so I think that has been just a advantage for patients that are hearing impaired. And we're still doing a number of cochlear implant evaluations via video format, and even activating some patients after surgery remotely, so they don't have to come in for activation. I can look at their incision via telemedicine and they can get programmed via telemedicine. And patients, you know, when it's appropriate, patients love it because we have patients that come from all over, so if we can cut out a two hour drive each way and get the same result for the patient, they're extraordinarily happy.
Beth Ameen:
When we last spoke with Dr. Gabby Mayer, she had graduated early from NYU Grossman School of Medicine to treat critically ill COVID patients in the heart of the pandemic's first hotspot. Now she's wrapping up her first year of residency at NYU Langone Health. And as she advances in her career, the way she practices medicine will always be influenced by her experience during the pandemic.
Dr. Gabby Mayer:
The days are long, and then the weeks and the months are very short being a senior resident. There's a little more of a sense of ownership, I think understandably so, because the knowledge that you learn is directly applicable. And so I'll be sitting... Literally, I had a lecture from my senior supervising doctor a week ago on aortic stenosis. And then I had a patient who had that. And, you know, so there's kind of a direct transference of knowledge to use. Which is really... it raises the stakes in a fun way as a learner, because all of a sudden, you really have to keep your eyes open and your ears open. And I think, you know, you walk into the room and you're a doctor and you're THE doctor for the patient. So they really view you as their primary doctor in the hospital. Uh, and that's, that really... Fills me with a lot of joy that comes with a lot of really wonderful interactions and moments.
I do think the patient interactions that I missed are much more present now. I can pop into the rooms of many of my patients without having to gown up and check on them and chat with them. And I can see the ways in which those frequent touches are so, so, so helpful for them. And I think keep me looped into the human side of the care, right? It's really the case that when the COVID rates go down in the hospital, it's much more joyful to practice medicine.
Since I've gotten the vaccine. And I'm, I'm very fortunate to be vaccinated. I don't feel quite as scared, not even close, even before I got the vaccine. My trust in PPE has grown exponentially because I'd been wearing PPE, faithfully, and I tested negative for COVID repeatedly. And so that's made me feel much safer. And then having that extra layer of immunological safety has made me feel a lot better in patient rooms, which for me is really gratifying because I can focus on the person in front of me and can take any of my needs out of the picture.
I don't think I'm ever going to be the type of person who goes by Dr. Mayer. I think sometimes I have to introduce myself that way so people know that I am a doctor... because sometimes they don't think that they've seen the doctor because I go by Gabby. Finding that balance between your professional identity and your identity outside of medicine is a lifelong question that doctors must answer for themselves. But I think it would still be something that I'd be struggling with and would be grappling with even if the pandemic weren't happening.
I think one thing is, is the importance of the role that doctors can play for their patients in terms of communication and contact. When the pandemic happened, we were the only point of contact for our patients in so many ways... Literally the only person who could visit them, we were the only person who could reach out to their family members and give them updates. And so we were so, so critical and now I'm thrilled to see family members at the bedside. It's the best thing in the world. It gives you such a preview into who a patient is. You know, I had a patient the other day who was like, I take care of my daughter and the daughter was like, no, I take care of him. And you know, it's like cute to see that kind of dynamic. Right? And so I think that's great that we can have that now, but there are still patients for whom you as a communicator and you as a sort of the agent of information, that's going to be key. And so for me, it's really the ways in which doctors can help keep a patient informed and invested in their own health narratives.
I've really enjoyed my time in the hospital and I've enjoyed all parts of my training, but my heart is totally in the clinic. And I think perhaps COVID has informed that because even tele-clinic is fun for me. Like a lot of people say, oh, I don't really love talking on the phone. I love all clinic. I'm really an outpatient person. So primary care is where my heart is. So I'll probably after residency ditch the in-patient hospital side and settle into a primary care practice somewhere. And I think the other thing COVID has taught me that I'll take with me in my future career plans is that I love teaching and I love learning. And I think I was watching medicine learn in real time as I came into be an early graduate. And it's really, for me sparked what was already a strong love for education, but it's continued. And so, I can't wait to be working as a primary care doctor in a place where I can talk to medical students and residents the way that I am now, because I think that curiosity is what keeps people really happy and engaged in the work they're doing with their patients.
Beth Ameen:
The Vital Signs team could never have anticipated the challenges and rewards of working with these extraordinary doctors and staff during this historic time. Our thanks go out to everyone we featured in season one and our partners at NYU Langone health. And we look forward to bringing you season two later this year.
CREDITS:
Vital Signs is a co-production of NYU Langone Health and Sirius XM. The podcast is produced by Jim Bilodeau, Julie Kanfer, Keith King and Rob Schulte with sound design by Jim Bilodeau and writing from Julie Kanfer. Vital Signs' Executive Producer is Beth Ameen in partnership with Allison Clair and Jim Mandler at NYU Langone Health. You can listen to all of Vital Signs, Season One on the SXM, Stitcher and Pandora apps or wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone Health tune in to Doctor Radio on Sirius XM, channel 110, or listen anytime on the SXM app and be sure to subscribe as Vital Signs, Season Two is coming later this year.