In early March, Edgemont resident Daniel Fenster was standing in front of his first COVID-19 patient at New York-Columbia Presbyterian. He was focused on the task at hand, but he couldn’t hold back the thoughts flooding his mind:
“Am I going to be okay?”
“Is my family going to be okay?”
“What if I die? How is my family going to get by?”
“Am I doing enough for my patients?”
“Am I doing enough for my staff?”
“Will life ever get back to normal?”
Fenster grew up in a household of physicians. His father and older sister were both doctors and what initially drew him to the profession was the humanitarian aspect of care and making people healthier and happier. In medical school he gravitated toward pediatric care with the idea that preventative care for children early on would benefit them later in their adult lives. During his medical residency he developed an interest in acute, high stakes emergency care for children, and found satisfaction in being able to “save the day.”
After he graduated his fellowship in 2013, he eventually became assistant medical director for the pediatric emergency room at Morgan Stanley Children’s Hospital at New York Presbyterian. He already felt like his life was stretched thin. Beyond balancing his busy three-shift-a-week work schedule, he was juggling his three kids. At the same time, his wife Tam was a practicing Ob-Gyn at New York-Presbyterian Cornell.
Then in March, COVID-19 hit the hospital system hard and Fenster’s world turned into a new, unimaginable reality. Work ramped up and overtook his everyday life. Although the pediatric emergency room was relatively quiet, the adult emergency room was all hands on deck. Fenster reduced his pediatric emergency room shifts to two, and took on a third shift treating patients in the adult ER. After 10 years treating children Fenster said he felt an inherent anxiety in moving to treat an adult population.
“Am I going to be a good doctor? Am I going to provide good care to this population?” he asked himself.
He quickly realized though that he integrated well into the hospital’s team model that helped support the adult care physicians. But COVID-19 didn’t let up and on top of his regular clinical shifts he was spending between six and eight hours a day writing and doing administrative tasks.
“I really put a focus on mental health and wellness for our department very early on,” said Fenster, who said he helped coordinate his colleagues in the psychiatry department to provide services for the mental health side of COVID-19. “[The mental toll] is by no means gone.”
During his first few weeks of treating COVID-19, Fenster would experience a “maybe” symptom and anguish in a tug of war on whether his illness was real or psychosomatic.
“Is this really a sore throat that I have? Or is this just because I’m worried about getting sick?” he thought to himself.
Luckily, he said, he never experienced any real symptoms, thanks to the personal protective equipment (PPE) he donned every time he treated patients. He also had to be careful about not bringing the virus home and got into a regimen of putting his clothes in a bag at the hospital and immediately depositing them in the laundry when he got home.
“Now that there is a little bit more known, a little bit more data out there … and seeing the overall trends improving in terms of new cases, new hospitalizations and deaths, there’s definitely less fear going to work, which is good and bad,” he said. “Mentally, it’s much better. Mentally we know that we’re better off. We have good mental health support, we have each other … but on the other hand we can’t let our guard down.”
Whenever Daniel and Tam were in their house together, much of their conversations surrounded COVID-19.
“My husband is my hero,” Tam said.
For the first month when COVID-19 hospitalizations began to skyrocket, Tam’s reality shifted to full-time mother instead of full-time obstetrician gynecologist. More than 150 of her patients’ elective surgeries were postponed and she performed only emergency procedures, while covering the OB/GYN emergency room.
“Now all of a sudden you’re like ‘Wait, I’m not doing my scheduled … surgeries, where do I find myself?’” she said. “How can I help?”
Seeing her husband come home from work and continue to work until 3 in the morning inspired her. She couldn’t ignore the toll of the virus when she was “living with basically a human hero.”
“You can’t stay home and read a book,” she said. “There’s too much tragedy and crisis going on and your husband is doing such incredible work, you have to do your part too.”
Tam has been obsessed with medicine since she was 5 years old. Her father was a paramount inspiration in her life and encouraged her obsession, often bringing home bones and anatomy books for her to look at and dissecting frogs with her. When she was 12, her father cut his arm on a glass fish tank and she sutured up his wound. At 16 she joined the Scarsdale Volunteer Ambulance Corps and eventually made her way to medical school. Tam loved surgery and felt that as a female surgeon in the field of gynecology, she could make a tremendous impact on her patients.
“I think there is a familiarity [for women] in talking about these issues with a female surgeon,” she said.
But when COVID-19 struck and health officials halted all elective procedures, Tam felt she needed to do more, she needed to make some sort of impact. She attempted to volunteer her time treating patients in New York-Presbyterian Cornell’s intensive care unit, which had a high volume of COVID-19 patients. She was prepared to be a boots-on-the-ground ICU doctor; she trained, prepped and even had an apartment in the city to live in. But the hospital had received so many ICU volunteers from around the country that Tam’s help wasn’t needed. But she said she noticed something that was different in the ICU due to the coronavirus.
Usually, the ICU allows family members to be bedside 24/7, but due to the highly contagious nature of COVID-19, the hospital banned all visitors. “All of a sudden you’re in this new reality where there is no family. It was surreal,” Tam said. “As a physician, especially as a women’s health physician, family is one of the cornerstones of patient well-being.”
She said she saw nurses heroically standing beside COVID-19 patients to hold their cellphones while on speaker or FaceTime so they could connect with their loved ones. But those nurses were increasing their time in contact with coronavirus patients, and putting themselves at risk of getting the virus.
“[Communication] is an essential part of healing for the patient and healing for the family and healing for the clinician,” she said. “It was hard for clinicians to call family every day.”
Realizing patients were missing “one of the foundations” of treatment, Tam created Critical Care Connect, a physician liaison program for the ICU. Program volunteers would make rounds with ICU physicians and call family members for patients as assigned by the ICU doctors. During the phone calls, though, family members were requesting to talk with their loved ones in the ICU. With so many patients being intubated and sedated, Tam felt she had to find a solution. She teamed up with Marc Schiffman, an interventional radiologist, to design the Voice Love Program, which utilized a walkie-talkie in a safety case next to a patient’s bed to connect to an application on a smartphone. Family members could download the phone application and talk to their loved ones who listen through the walkie-talkie. People of all ages, anywhere in the world, could use the program to connect with loved ones in the hospital.
“They were able to sing and pray to their loved ones,” said Tam. “In a time of COVID, it was usually a way that they could say goodbye.”
Tam said people who used the program told her it reshaped their future by overcoming communication barriers with their loved ones. As of May 30, the program has since been rolled out into seven units within the hospital, including for patients who are not intubated and are rehabilitating from COVID-19.
“If somebody is critically ill and the medical team has done everything they can [to provide] lifesaving measures, then the value … turns to what [we can] do for the loved ones to make them feel some degree of closure,” said Dan Fenster.
Tam said she feels the program has made a difference for patients and family members and she received “tremendous positive feedback” in surveys she sent to people who used the program.
While she’s still able to do emergency surgeries, Tam continues to manage the walkie-talkies program and install additional units. She said she would like to eventually conduct formal research on the program’s effectiveness and is writing up a paper about the program.
One thing both and Tam and Dan Fenster agree on is the amount of collaboration going on because of the pandemic. Not only within the medical field, but also within the Edgemont community, which has supported the family through a time of great strife.
“What the Edgemont community has done … for my family is so above and beyond,” said Dan, who didn’t have to make dinner for six weeks, thanks to the outpouring of meals provided by the community. “This is a great community, but when things got really rough, people just stepped up.”