Vital Signs

My City is Hurting

Episode Summary

Early medical school graduate Dr. Gabrielle Mayer went directly from diploma to deployment during the world’s biggest pandemic outbreak in a century. The new doctor faces challenges she never imagined.

Episode Transcription

Season 1 Episode 2 - My City is Hurting

Feature: Dr. Gabrielle Mayer, MD

Narration: Maggi van Dorn

Dr. Gabrielle Mayer: This was the first time I was really scared. I definitely had a moment where I thought never when I signed up for a career in medicine did I think that my life was going to be part of what was on the table. I took a walk in the halls of the hospital and I, I  just, I felt nauseous. I didn't know what to do with myself. 

Maggi van Dorn: You may not remember the first time you heard about the novel coronavirus, or COVID-19. But you probably remember when you realized it was going to change your life. That it was going to change all of our lives. 

(news announcers) Developing right now, new coronavirus cases spreading across our area, the United States, and across the globe. Over a million have been infected by coronavirus worldwide since the start of this outbreak. In New York City, the sounds of sirens are haunting. Healthcare workers are already grappling with life or death decisions. 

GM: The thing that was different about COVID relative to anything I've encountered before, was the fact that patients were declining quite rapidly. My name is Dr. Gaby Mayer. I'm a first year internal medicine resident at NYU Langone.

MVD: Like many health care workers on the frontlines of the coronavirus crisis, Doctor Mayer didn’t hesitate to jump right in whenever, and wherever, she was needed. But unlike most of her peers in medicine, Dr. Mayer wasn’t quite a doctor when this all began. 

GM: All of a sudden I got this email in my inbox and the email said, we are asking if you'd be interested in volunteering to be an early graduate.

MVD: From SiriusXM and NYU Langone Health, this is Vital Signs, where medicine is made personal. I'm your host, Maggi van Dorn.

MVD: Some people dream of working in medicine their entire lives. Maybe a parent is a doctor or a nurse, or a profound medical experience as a child inspired a desire to help others. For Dr. Gaby Mayer, it was something else entirely. 

GM: I'd always been someone who was very tied to storytelling. I was someone who really found a lot of relief and joy in reading. Kind of serendipitously, I worked with a doctor in high school, a radiologist actually. And he taught me anatomy through these beautiful CT scans of the body. It was this really cool experience. You can love anatomy, and you can also have these moments when you're really connecting with somebody over their story. And so I, I sort of wondered how to bring these two parts of myself together, this interest in healthcare and in helping people. And the reason I chose primary care specifically is because it is a place where the patient in front of you and everything they bring to the table, their symptoms, but also how they felt seeing other doctors before, how they grew up, all these things influence how you give them care and the type of care you want to give them.

MVD: Still not sure of her career path, in college Dr. Mayer majored in art history, while quietly completing pre-medical requirements and working as an EMT on the side. 

GM: We really worked with students and faculty on campus pretty much exclusively. On Saturday nights, you can imagine the kinds of radio calls you got. It was a lot of going to parties and checking on people who didn't feel well. And so that's a very unique part of working as a college EMT is, um, seeing sort of your younger classmates at different moments in time and assuming the role of a healthcare professional. 

MVD: But it wasn’t the Saturday night shifts that Dr. Mayer longed for. 

GM: I really, really liked the Wednesday day shifts. I like those shifts because the kinds of people you would see the people who needed an EMT on campus during those hours, it was the grandparent of a student who was visiting and slipped on the ice as they walked into the campus museum. It was the little sibling of a student who maybe ate a peanut and had a, an allergic reaction. So the moments when I got to interact with those kinds of patients were, to me, very meaningful because it was a moment to really connect. It was both an affirmation that I really enjoyed the day to day of what I was doing, but it was also very much a moment when I learned who I would maybe become as a doctor, what my practice might look like. That’s why I liked those shifts.

MVD: Something else she learned as an EMT was just how difficult some of the most straightforward parts of medicine can be. 

GM: I had a really hard time learning how to take blood pressure, which is a really important part of being an EMT. I just couldn't get it. And I found that so frustrating, and so at times demoralizing. And it was such a minor thing, but it, it was a moment for me to realize both the importance of persistence in medicine. Because I had these moments where I thought, well, if I can't take blood pressure, I'm not going to be able to listen to a heart. I'm not going to be able to prescribe a medication.

GM: I worked on it incessantly. I would play music and take the blood pressures of all my friends. One of my friends and I had this really bad habit, or maybe it was a good habit, of just feeling for our own pulses all the time, so we would just be in class feeling our own pulses on our wrists. Little physical tricks help you, you know, aligning yourself with a pinky as you go up the arm is, is helpful. And so after a few weeks I had to take blood pressure somewhere where it was going to be hard to hear the sounds. And I put my finger on the arm and I felt the pulse and I put my stethoscope and I blew up the cuff and I heard sounds. And I was on the call with the senior EMT and he looked at me and he said, I'm going to check it. And it was the right number. I had gotten it right. 

MVD: Finally confident that she wanted to become a doctor, Dr. Mayer, a native New Yorker, applied and was accepted to medical school in the city she had always called home.

GM: First and foremost, this is a New York institution at NYU, Bellevue, the VA. This whole block of hospitals really feels like a really a part of the city in a very profound way. And since I knew I'd be rotating at all three, that really appealed to me, as someone who is very committed to my community and is committed to serving the city. And I think the other big part, which is not to be understated is the fact that NYU medical students felt like they were really well trained when I talked to them. And I thought, as someone who really came into medicine to work with people and to do that clinical work, it felt really important to me to start to hone those skills at the beginning of my medical school career.

MVD: Medical students take in a lot during the course of their training. They read, and study, and apply what they learn in clinical settings on actual patients, over and over again. They make mistakes, and they learn from them. But actually becoming a doctor - assuming the identity - it’s an entirely different process.

GM: The first time I thought about the idea of physician as an identity was when they told me I had to think about it in medical school. Because it was going to become something that I had to grapple with. And that was in a first year lecture hall, we were talking about professional identity formation, and I kind of scratched my head and said, what do you mean I have to assume this identity? What's that going to be like?

MVD: But soon, Dr. Mayer started to notice friends and family acting differently around her.

GM: I remember getting a call from a friend saying, we think so and so has fainted. And the first thing I said was go find a real doctor and get this person checked out. But I also knew the followup questions to ask. It was in my third year of medical school, and I had already done an emergency medicine rotation, so I knew to ask: Did this person fall, did this person hit their head? How are they now? Are they shaking, you know, might they be having a seizure? All these different questions that are part of your standard workup. And as they waited for the paramedics to come and for real care to come, I realized that I actually had a lot of, sort of, know-how around an issue like this. I started to realize that I was using terminology with my friends, adapting medical lingo to our common day speak. I was being asked by relatives to look at a rash when I really didn't have any sense of what a rash should even look like. And that was really surreal for me, to have this moment to realize that I definitely had taken a step towards that medical identity, that doctor identity over those few years.

MVD: Dr. Mayer had slowly started to assume the identity of a doctor, growing into it at her own pace. But neither she  nor her peers could have anticipated how quickly they’d soon be thrown into the role of doctor, as life everywhere began to shift in unimaginable ways. 

GM: So, while I was at NYU Grossman, I studied for a board exam called Step 1. And on Step 1, you learn about a bunch of viruses. One of them was coronavirus, which is the first time that I heard about such a virus. Coronaviruses, broadly speaking, the way we're taught them for our board exams are viruses that cause colds, and some of them can mutate and cause other things is what I learned in my textbook. SARS is an example of one that we learned about when I was studying for my board exams. And so I kind of, I chuckled to myself sometimes to think that that was my first exposure to this virus that would, in some ways, materially change the course of my medical career. 

GM: It was February and I was doing an infectious disease rotation. So I was seeing patients who had all kinds of infections, skin infections, pneumonia, infections of their stomach and learning a lot throughout the process. It was the last month that I was going to be on the wards before I graduated in May. Halfway through February, I started to hear tricklings of coronavirus might be coming to the hospital. And I heard from some of my friends who were still in the hospital, that they were being sent home because things didn't seem quite safe. It was starting to become an infectious risk to be in the hospital, given the rise in cases.

MVD: Quickly, everything was on hold. The third and fourth year medical students stopped their rotations. Classes that could be were conducted online. And many of  the traditions associated with the end of medical school were canceled, including a cherished rite of passage known as Match Day.

GM: The ceremony where we learn where we're going to be for residency, and we celebrate with our family and our friends and our classmates. All of these things were on hold, because we were really worried about the possibility of infecting each other or loved ones with this virus that was starting to make its way through the city. And so I really felt sad to lose that, but on the flip side, it was pretty abundantly clear that there wasn't a safe option. And I could not stomach the possibility of putting my own desires to have this ceremony before the public health and safety of not only our community, but the city, right, because it, things spread. So I matched in a socially distanced manner on the East River of New York City on, there’s a, there’s a sort of like a biking path on the East River. And I stood there with my best friend from medical school and we stayed six feet apart and we both opened our emails. And I learned I'd be going from an NYU Grossman student to an NYU Langone Health resident. And I was thrilled and I sort of air high fived my best friend who’s now in Denver for his residency. And then we said goodbye, and I thought that was the last time I would see him.

MVD: Relieved of her clinical duties, Dr. Mayer participated in online classes. She spent time with family outside the city, and helped gather personal protective equipment, known as PPE, for distribution to frontline workers. She was grateful for more time to herself, but she was also restless.

GM: A few of us had emailed in to different administrators that we were close to, deans or mentors and said, hey, we're fourth years and we're going to be on the wards in July as interns. It sounds like you really need people in the hospital. Could we be of service? Medical students at the time were doing all kinds of volunteer positions that felt safe and important. Uh, you were screening people, you were doing telehealth in terms of checking in on patients and calling their families. Really, really important stuff. But we, as fourth years felt like we had a different skill set that we might be able to bring to the table. We weren't sure, but we had a feeling. 

MVD: With all that was going on in New York City at the time, and particularly as the hospitals were starting to fill up with COVID patients, Dr. Mayer didn’t expect to hear back. After all, her superiors at NYU Langone and Bellevue were busy. And was it even possible to graduate and get licensed before technically finishing medical school?

GM: And then all of a sudden I got this email in my inbox and the email said, we are asking if you'd be interested in volunteering to be an early graduate for eventual, sort of, deployment to the wards. And I sent that in. And just like that I was going to graduate early.

(news audio) Gaby Mayer and Evan Gerber are fourth year students at NYU’s Grossman School of Medicine. They were set to begin their internships July 1st, but now they’re starting their careers three months early. And their help is urgently needed. When it comes to the war against Covid19, there is no question that healthcare workers are on the front line. 

MVD: Like Match Day, Graduation Day also looked very different from what Dr. Mayer had expected. 

(audio) I’m Dr. Linda Tewksbury, Associate Dean for Student Affairs and I’m thrilled to welcome all to this very special event to recognize a most remarkable group of medical students who on this day...

GM: I watched a WebEx and that was, it was great to see my classmates on that. But not too much changed. I think the fact that I could call myself Doctor after that felt surreal. Because it was just a ceremony 

(audio Dr. Tewksbury) We’re in the midst of an unprecedented pandemic

GM: But it still felt like almost just a you're flipping a switch and all of a sudden I'm a doctor… and before I was just a medical student. 

(audio Dr. Tewksbury) And now it is time to recognize you, our new graduates from the NYU Grossman School of Medicine, who will be receiving a Doctor of Medicine today. (names) Please unmute your phones at this time. (celebratory audio)

MVD: Fifty three fourth year medical students from NYU Grossman School of Medicine graduated early to help treat patients with COVID-19. It was the beginning of April, and the virus was spreading like wildfire. At the time, upwards of six thousand people each day - and sometimes more - were testing positive for coronavirus in New York City. PPE was in short supply, and healthcare workers were also falling victim to this disease. It wasn’t exactly how most future doctors dream of starting their residency. But Dr. Mayer couldn’t imagine being anywhere else.

DM: This is my city and if my city is hurting, it felt like a really intuitive, natural, organic decision for me to go into the hospital.

(hospital sounds)

MVD: So, what does it look like to go into a hospital to work - everyday - during a pandemic?

GM: So I'd show up around 6:45. At 7AM, I would find the person who was covering my team overnight, and I would hear about how my patients did. So, so and so may have spiked a fever. Everybody else was good overnight, or unfortunately we had to for X, Y, and Z reasons, send this patient to the ICU, or happily somebody got discharged at 8PM. And then I would check on my patients on the computer. It's called a pre-rounding. So I would log in, check their vitals. And that's the moment when things became a little less normal. 

MVD: Under normal circumstances, Dr. Mayer would then go into each patient’s room to get a sense - in person - of how they were doing. 

GM: But during COVID times, what you do instead is you make a judgment about whether a patient is really sick and needs to be seen by a doctor in that moment, or whether it can wait until you as a team huddle together to look at all of the patients and then split up and go see them. We wanted to make sure the patients were safe and seen, but we also wanted to minimize exposure risks for the healthcare providers who were seeing them. But ultimately, if I felt like a patient's oxygen requirements were going up or their vitals seemed a little off to me, I was able to go in and, and check them out myself. 

MVD: Though times were strange, Dr. Mayer and her peers were still grounded in routine. Chatting about patient cases with senior residents and attending physicians, devising a care plan, attending daily educational conferences. But it was impossible to escape their highly irregular surroundings.

GM: The thing that was different about COVID relative to anything I've encountered before was the fact that patients were declining quite rapidly. And so someone might come in and have a cough, shortness of breath, fever, things that just imply a lung infection. But all of a sudden their oxygen requirements go up a lot. They go from needing a low stream of oxygen through their nose to needing a mask applied to them, and a lot of oxygen being rushed into their lungs. And that might happen within a matter of hours or even within an hour. And sometimes patients declined even more rapidly than that. And we had to call codes more rapidly and more often than I'd seen before. 

MVD: Calling a code refers to anything that feels like an emergency. A heart attack, loss of consciousness, trouble breathing. With COVID, there were a lot of codes.

GM: Typically the codes that we saw had to do with somebody, their vitals being very abnormal. So very, very fast heart rate. Or very, very fast breathing or very, very low oxygen levels that we were able to detect. Or alternatively, they just weren't breathing at all. For the first few weeks, I was mostly on the outside of those codes. I was printing out labels and offering to bring lab drawing supplies over because they wanted to again, protect the new interns and give us the ability to sort of ease our way into things. And so for a while that was my experience of codes. And then we were short people and they needed extra hands. And so I went into a room where there was an active code happening, and I remember working almost mechanically to do the things that I'd watched people do for the past few weeks. And I was on autopilot and I left the room at a certain point. Then things were still happening. Everybody was still busy. There was really nothing for me to do past what I'd already done for the patient. They were being transported. And I left and I took a walk in the halls of the hospital and I just, I felt nauseous. I didn't know what to do with myself.

MVD: All along, Dr. Mayer had been willing to assist in any possible way to treat patients and support her more senior colleagues. She hadn’t really stopped to consider how the onslaught of the pandemic might be affecting her mental health, too.

GM: It was this crazy experience to come down from the adrenaline rush and have to deal with all the emotions that bubbled up afterwards. But it also became a really important moment for me to realize that in smaller ways, that had probably been happening the entire time that I was in the hospital. And I needed to start talking about it and really opening up about the really intense experiences I was seeing. My line to myself for so long had been, well, I'm just happy to help. I'm just happy to be there and grateful I can step up. So I'm prepared to see the worst. But just because you're prepared, doesn't mean that the impact isn't there. So I can't say my coping strategies are anything novel. I talked to my partner. I spent a lot of time cooking really elaborate meals because that gives me joy. Baked a lot of things. I think the biggest change for me in those moments was just giving myself the time for myself, even if it was lazy coffee in bed on my day off, as opposed to getting up, taking advantage of my day. Those things made a world of difference for me.

MVD: In some ways, coronavirus was an equalizer among medical professionals. No one had ever seen this particular virus before. None of them had treated it, or had immunity against it. And yet, years and years of training and research had prepared many healthcare workers for this very moment.

GM: I looked at them and I saw the ways in which those years of experience were going to pay off both for the patient in terms of the instincts that those senior doctors had. They were just sharper and able to pick up on things that I wasn't able to. But also more broadly in terms of science.Yes, I think everybody was baffled by COVID in terms of how to treat it, so many aspects of it. But also there are people with a lot of expertise who are working on it. It made me much more optimistic that these really smart people who I was seeing be so much better at handling this uncertain new thing, that those people would find a way to get us out of this whenever we get out of it.

MVD: Like the virus, uncertainty was rampant in New York City through the spring of 2020. For Dr. Mayer and her colleagues, there was little to be sure of when they entered and exited the hospital each day. But there was always 7PM.  

GM: Ah, so the, the famed healthcare celebration at 7pm. Sadly, the hospital that I was in was so well insulated that I didn't get to hear it because it happened right at shift change. So I left at 7:15 or 7:20. A couple of times my partner actually recorded it so I could hear it, which was really special. 

MVD: Every night during lock down, New Yorkers emerged from their apartments to bang on pots and pans, blow air horns, shout and cheer for the city’s essential workers - those taking care of COVID patients and keeping hospitals running. But also the delivery people, sanitation workers, public transit employees, and so many others. 

GM: It made me feel great. It made me feel like not just like people appreciated what we were doing, which is always really great, but also like they understood the importance of this whole sort of crazy thing. The importance of staying home and they were doing their parts to keep infection rates low and flatten the curve.

MVD: There was no precedent for this pandemic for any of us, and certainly not for these early medical school graduates. They were floating in and out of wards and rooms where they were needed, simultaneously trying to help and learn - and to cope with the harsh reality that this job - being a doctor - now came with very real risks.

GM: I definitely had moments where I thought, wow, um, part of my job sometimes is going to be putting myself and my health at risk. And it's something I've thought about before, of course, because I see patients using these N95s and those patients had tuberculosis. And so I was often thinking about disease transmission and contagion. You think about it when you hear, you know, you hear about patients who have other infectious diseases. It’s not uncommon. But this was the first time I was really scared. And I, I had a lot of faith in the PPE and I had a lot of faith in the systems that were being set up by the people who were calling us into the hospital. But I definitely had a moment where I thought never, when I signed up for a career in medicine, did I think that my life was going to be part of what was on the table. 

MVD: When the coronavirus descended on New York, hospitals in every pocket of the city were pushed to their limit. Frontline workers were using all of their knowledge and resources to help very sick patients and still a lot of people died. So much effort, and not a lot of reward. It could demoralize a profession, and we know that many medical professionals suffered and struggled. But in some instances the opposite happened.

GM: There were these moments when, because everybody was coming together, it really felt like the victories were shared by everyone. Um, and I felt them so much more profoundly. I had a joy that I feel like I don't normally have when we send somebody home. But it was such a cathartic moment. A couple of times I had some patients who had been through the ringer. So people had resiliency too physically, um, as they recovered from the virus.

MVD: This resiliency was contagious. If there was one thing healthcare workers held onto, it was hope. Every  patient that came off a ventilator, or left the ICU, or was discharged was a reminder to never stop believing.

(music: Don’t Stop Believing)

GM: The hospital decided to start playing music over the loud speakers to signify a good event. And they chose “Don't Stop Believing”, which was, I love that song. So we heard it scattered throughout the day. The first few times it caught me by surprise and it was interspersed with code calls, you know, come to this room because someone is not doing well. It was this interesting moment where you heard the good and the bad together being broadcast. 

MVD: And then finally, cautiously, the tide started to turn.

GM: I remember we were starting to get sick of “Don’t Stop Believing” because it kept playing. And that’s, that was a beautiful moment too, to realize that I was kind of overhearing the good news. The tide did turn while I was in the hospital. And we saw a lot of people stop coming in and we saw the numbers of patients in the hospital slowly but surely go down. And the system as a whole felt less strained. That was really a very special thing to see.

MVD: Newly-minted Dr. Gaby Mayer spent five weeks treating patients in the COVID wards at NYU Langone Health. And while she and her fellow early graduates were surrounded by support from their peers and colleagues, it was impossible to ignore how lonely and isolating this experience was for the patients.

GM: Those moments were great opportunities for me to be able to step in and, and provide that connection. Um, and it's not the same. I wish people could come into the hospital and hold the hands of their loved ones during these really hard times. But I think it's keyed me into the importance of getting to know what buoys a patient outside of the hospital, because that tells you so much about how you can help them succeed. I started to ask questions, like, what kind of support do you have when you go home? Or, do you have stairs in your home? And these things matter during COVID because some of the patients we were discharging weren't back to their baselines. 

MVD: The recovery process after a COVID infection can be long, and it isn’t linear. It’s not clear when, or if, these patients - or any of us - will be back at baseline again. It’s an extraordinary time to become a doctor - even if you’re still adjusting to that title. 

GM: I'm getting more and more used to calling myself Doctor. Still feels incredibly surreal. And sometimes I'll say Dr. Gaby instead of Dr. Mayer, because it just softens how formal it sounds. So I'm making habits, I guess, towards becoming more of a doctor. But I think in other ways, the experience has opened my eyes to the fact that I have so much learning still to do. 

MVD: And for someone who loves storytelling, it’s safe to say she now has quite the story to tell. And many stories left to hear.

GM: I think this experience with COVID has made me incredibly grateful for some of the day to day things that I didn't have when I was working as an early graduate. Just the ability to stop by and see patients when I wanted to. I used to love going by in the afternoons when things were quiet to check in on my patients. It was fun for me to get to know them in that way, because then I wasn't so focused on information gathering and doctoring. I could, I could just chat with them.

MVD:This episode is dedicated to all of the healthcare workers and support staff around the world working tirelessly on the frontlines of the COVID-19 pandemic. We are in awe of you, and we thank you.

MVD: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, Rob Schulte and Keith King with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producers are Beth Ameen and me, Maggi van Dorn in partnership with Allison Clair and Jim Mandler of NYU Langone Health. Don't miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world renowned doctors at NYU Langone, tune in to Doctor Radio on Sirius XM channel 110 or listen any anytime on the SiriusXM app. For the Vital Signs podcast, I’m Maggi van Dorn. Join us next time as we bring you the stories of medicine made personal.