Michigan State Medical Society > About MSMS > News & Media > Michigan Medicine Magazine > July-August 2020 > On the Front Line Against COVID-19: Michigan Physicians Share Their Stories

On the Front Line Against COVID-19: Michigan Physicians Share Their Stories

Front lines.

It’s phrasing we cannot seem to escape these days, and that alone is telling.

The “front line” is a military term used to describe the position where opposing forces meet. It’s where the battle is. The conflict. The struggle. The tip of the knife. It’s where any confrontation is most dangerous, terrifying, and chaotic. And it’s the perfect language to describe the environment in which physicians responsible for treating patients with COVID-19 currently reside.

Health care workers around the globe are at war with COVID-19.

There’s nothing hyperbolic about that statement.  In the span of a few short months, millions of people have contracted the novel coronavirus and hundreds of thousand have succumb to it. Meanwhile, physicians everywhere are working around the clock to better understand the virus and to treat the afflicted who are suffering.

And for many of those engaged on the front lines of that effort, that’s been a harrowing experience. Often understaffed, overworked, and under protected in the fight against COVID-19, physicians everywhere have remained steadfast in their commitment to providing quality care to those in need despite the risk the highly contagious virus poses to their own health and the health of their loved ones.

It’s been a challenge to say the least.

For all intents and purposes, the past few months have been unprecedented—it’s been over a hundred years since a pandemic has so firmly gripped the world. Health care providers everywhere—both those directly treating COVID and those on the periphery who continue to provide care, treatment and medicine for patients with countless other ailments—have been forced to adapt to the fluid and rapidly changing circumstances surrounding this pandemic. Patient interaction has changed. The delivery of care has changed. Medicine in general has changed.

Despite these challenges, physicians continue to lead. And members of the Michigan State Medical Society are trailblazing patient care during these critical times. With more than 15,000 members responsible for providing care throughout a state hit particularly hard by COVID-19, there are likely countless stories of Michigan physicians stepping up to the plate and finding ways to continue to deliver outstanding care and support to patients in need.

These are the stories of just a small few.    

Warren Lanphear, MD, FACEP (Kent County)

It’s been a strange and stressing time for emergency medicine physicians. Normally, these physicians see a whole host of patients presenting with any number of acute illnesses and injuries, all in need of immediate care. Heart attacks, strokes, severe trauma—these are the sort of everyday, life-threatening events emergency department physicians typically see and treat.

COVID-19 changed everything.

For many emergency departments around the state, the past few months have been feast or famine—overwhelming COVID-19 outbreaks or a concerning lack of non-COVID patients. As the president of the Michigan College of Emergency Physicians, representing more than 2,000 emergency medicine physicians across the state, Warren Lanphear, MD, FACEP, is keenly aware of the impact COVID is having on emergency departments.

“It’s been a challenge to treat and diagnose patients acutely ill with coronavirus while also treating any and all other patients presenting to our emergency departments—we have to treat everyone as if they might have COVID-19 when they first present,” says Doctor Lanphear.

As such, Doctor Lanphear and his colleagues are outfitted in PPE at all times, and trips in and out of patient rooms are minimized as much as possible.

“Pandemic care has meant limiting our time spent in rooms on some of our usual customer care practices like simply sitting and talking with our patients or making repeated visits back into the room to check on them, and that’s been tough,” said Doctor Lanphear. “That connection is definitely important to patients and physicians alike.”

He is just as concerned about the patients they’re not seeing though.

“Overall, emergency department volumes dropped dramatically in March, likely due to the stay-home orders and fear of contracting COVID-19 in the hospital,” Doctor Lanphear said. “We’re starting to see patients return to the emergency room, but still in lower number than what would be typical for this time of year, and that’s definitely concerning.  Strokes, heart attacks—these kind of health events are still happening, so it’s important that patients know they can still safely seek care for these kind of life-threatening emergencies at their local emergency room. That’s a message we need to continue to push out.”

Juliette M. Perzhinsky, MD, MS.c. (Saginaw County)

Juliette Perzhinsky, MD, wears many hats.

When not busy splitting her clinical time between working in an urgent care facility and an outpatient primary care practice specializing in integrated complex pain management and medicated-assisted treatment (MAT), there’s a good chance she’s busy teaching patient safety or MAT as an Associate Professor of Medicine at Central Michigan University College of Medicine.

The work certainly hasn’t stopped—it’s just changed.

“With the clinical practice, the big change over the past few months has been shifting much of our patient care to virtual and audio visits, which has been a real challenge for many of our older patients,” Doctor Perzhinsky says. “However, we’ve managed to establish successful phone encounters with these patients, ensuring there’s been no interruption in the medication these patients need to manage their chronic pain condition and/or opioid use disorder.”

On the other end of the spectrum, face-to-face encounters have gone uninterrupted at the urgent care clinic.

“The key to ensuring everyone’s safety in the urgent care clinic is to treat every patient as if they have SARS-CoV-2, the virus that causes COVID-19,” said Doctor Perzhinsky. “That’s the safest way to approach direct patient interaction.”

As such, she and her colleagues have adjusted their standard protocol, requiring health care personnel to be outfitted with masks and personal protective equipment (PPE) in the exam room.

“It’s certainly been tough—you can’t really maintain 6 feet of distance when examining a patient,” she said.

In addition to staying outfitted in the appropriate PPE, Perzhinsky has done her best to practice good hand-hygiene and has taken steps to minimize potentially exposing those around her.

“I leave my shoes in my car and immediately shower and wash my clothes upon arriving home,” said Doctor Perzhinsky. “I don’t kiss my husband or my son on the face or cheeks anymore, and we do our best to maintain some distance in the house—it’s been extremely hard to not be around them as much as I would like to be, but that’s just the safest course of action right now.”

S. Bobby Mukkamala, MD (Genesee County)

As an otolaryngologist who typically treats children with chronic ear infections, recurring sore throats, and sleep apnea due to large tonsils and adenoids, S. Bobby Mukkamala, MD, is among the large group of Michigan physicians whose work has largely been on pause since the COVID-19 crisis began.  

“I’d say about 90 percent of the work I do would be considered non-urgent, and all of that has ceased since the COVID outbreak began over two months ago,” says Doctor Mukkamala.

However, despite the dramatic drop in patient volume, Doctor Mukkamala has made it a point to keep his office open, both for his patients and his employees.

“I felt it was important to stay open and continue providing care to the 10 percent of our patients who really do need to be seen,” said Doctor Mukkamala. “Providing those patients with care in the office helps mitigate the risk of them potentially getting more ill and ending up in an already stressed hospital. And it’s also a nice thing to be able to do for my employees. I don’t want any of them to feel any financial strain due to COVID, so I’m thankful that we have been in a position to remain open and fully staffed.”

To keep those patients and employees safe, Doctor Mukkamala has implemented new precautionary measures to help everyone maintain an appropriate level of social distance. In addition to the standard best practices of wearing masking and frequent handwashing, Doctor Mukkamala also has his patients wait for their appointments in their cars and come straight to the exam room when it’s time for their appointment.  

“In the interest of everyone’s safety, we’re really doing everything we can to eliminate all unnecessary interaction,” he said.

And just because the curve is flattening doesn’t mean the work is done. With new COVID-19 cases declining across the state, Doctor Mukkamala is ready to start looking to the future. 

“I think the big takeaway in all of this is we must take action to be prepared for the next public health crisis,” says Doctor Mukkamala. “And while there will always be illness and diseases that kill people, we must do our best to minimize the deaths due to lack of preparation and management of those diseases. It will be critical that we all thoroughly review how this pandemic was handled, learn, adjust, and continue to try to heal better.”

Stephanie Duggan, MD, FACEP, CPE (Saginaw County)

As a practicing emergency department physician for more than 20 years who now serves as the regional president of Ascension Michigan Northern Ministries, consisting of Ascension St. Mary’s, Ascension Standish and Ascension St. Joseph hospitals,  Stephanie Duggan, MD, FACEP, CPE, thought she had “seen it all” in her career.

And then a global pandemic hit.

For Doctor Duggan, as a critical administrative leader in a large health care organization, working to develop, implement and manage the various hierarchies and processes necessary to effectively and efficiently respond to the COVID-19 pandemic has been a massive undertaking.

“When COVID-19 hit, Ascension set up national, state, and local incident command (IC) teams, which changed how hospital and ambulatory operations were handled for us,” said Doctor Duggan. “Those are large, complex teams, and meetings were held twice a day with a specific reporting structure to facilitate better communication both up and down the command chain.”

Complicating logistical matters even further was the 500-year flood that ravaged much of the region served by Ascension Michigan Northern Ministries during the middle of the COVID-19 pandemic. 

“On day 72 of our COVID-19 incident command when those two dams broke in our service area, that was certainly a new and unanticipated additional challenge we had to manage,” she said. “Those floods left so many displaced. We had to set up an additional IC structure just to manage the details associated with the flooding disaster, so that was another wrinkle.”

Despite the challenges, Doctor Duggan’s staff rose to the occasion.

“I’m so proud of all the health care workers on our team here at Ascension Michigan Northern Ministries—in my eyes, they truly are heroes,” she said. “We learned something new about COVID-19 every single day. And invariably, that new information had to be shared up and down the chain, and processes were changed as a result—sometimes several times a day. That’s a taxing thing for any sort of team. However, despite the challenges, our health care worker’s collective resilience and commitment to delivering quality patient care was unwavering. Watching that was very humbling, and it reminded many of us of why we went into health care in the first place—to make a difference to those whom we serve.”

Delicia Pruitt, MD (Saginaw County)

Serving as a medical director for a major county during a public health crisis is stressful enough on its own. However, starting that position at the onset of a global pandemic adds a whole new degree of difficulty to the role.

That’s the position Delicia Pruitt, MD, found herself in when she became the medical director of the Saginaw county Public Health Department in January 2020.

“I don’t know public health without COVID-19,” says Doctor Pruitt.

Unsurprisingly, the transition has been laden with challenges.

“I essentially had to become an expert in COVID-19 overnight to effectively perform the duties of my position, which includes providing critical public health guidance to community organizations, health care providers and allied health organizations throughout the county,” said Doctor Pruitt. “And with COVID-19 being a novel virus, I had to quickly learn how to be comfortable with the unknown, which was certainly a challenge.”  

In addition to providing county-wide oversight, Doctor Pruitt directs Saginaw County’s COVID-19 testing efforts, regularly co-leads educational Facebook Live events, and oversees the county’s Medical Command and Control group, while also still managing to see patients on a daily basis—something she now does more and more of through telemedicine.

“In my opinion, utilizing telehealth visits when possible is absolutely the best precaution physicians can take regarding COVID-19, both for their health and safety and the health and safety of their patients,” she said. “The way we practice medicine is going to be forever changed coming out of this pandemic, and I think one of the good ways is that telehealth is going to become more robust and more heavily utilized. Currently, half of my patient visits are through telehealth, and it’ been a really good experience for both me and my patients.”

Paul Bozyk, MD (Oakland County)

The COVID-19 pandemic has been a strange and scary time for everyone. However, for most, the ill-effects have been ancillary—disrupted work life, cramped home life, canceled trips, canceled appointments. The list goes on. 

Thankfully, most have been lucky enough to avoid the true horrors of COVID-19, and the dangerous effects of the infection itself. Most health care systems weren’t overrun and overburdened. Most hospitals weren’t battered by a steady and seemingly ceaseless wave of sick and dying patients.

Too many communities and hospitals, though, weathered that experience, and without fail, there were physicians in those places leading charge.

Paul Bozyk, MD, is one them. As a pulmonary critical care doctor in southeast Michigan, Doctor Bozyk has truly been on the front lines in the fight against COVID-19.

“Since the pandemic hit southeast Michigan, I hadn’t seen a patient without COVID up until the last week of May,” he said.

The number of patients with COVID-19 has been alarming. During the pandemics peak, Bozyk would provide care to at least 20 COVID patients, sometimes overseeing a unit of over 50 COVID patients.

“The volume of critically ill patients was like nothing we’ve ever seen before, so it was just physically and emotionally exhausting.”

For Doctor Bozyk—and many other physicians in his position—one of the hardest parts was the challenge of communicating with patients and their loved ones.

“It’s a whole new level of emotional burden having to do all the communication with the patient’s family over the phone,” he said. “It’s so hard to explain what we’re seeing at the bedside when families can’t see it for themselves. We used things like tablets and facetime calls to demonstrate to families the care that’s being provided, or to give the family an opportunity to try to communicate with the loved one in the hospital, but that was often times the best we could do and that alone was very hard.”

“Despite the challenges, I was so grateful for the way that the entire health care team pulled together to provide the best care possible.  I really do love my work family.”

Thankfully, things have started to settle. And should a second wave hit, Doctor Bozyk is confident his health care system would be prepared for it from an operational standpoint, though no one is ready for the emotional toll it might take.

“This was an education that I wouldn’t wish on anyone, but I learned so much through the process—supply chain process, allocation and distribution of resources across the System, dealing with a new pathogen, there’s just so many things,” he said. “So operationally, we’re ready and prepared. But It would be incredibly taxing for physicians and other members of the health care team to have to go through what we just went through all over again.”

Sandro Cinti, MD

One of the things that makes COVID-19 so difficult to treat, contain and model is the fact that it’s brand new to everyone. COVID-19 is a novel coronavirus—everyone on earth is experiencing this particular infection for the very first time.

Thankfully, there are physicians who are uniquely poised to battle the virus, and Doctor Sandro Cinti, MD, is one of them.

As an infectious disease specialist at the University of Michigan who is well-versed in pandemic preparedness, Cinti is one of the physicians others are looking to for help and guidance through this global pandemic.

“I’ve done this all of my adult life,” says Cinti. “I was involved in the response to the anthrax attacks in 2001, the SARS outbreak in 2003, the pandemic flu of 2009 and the Ebola outbreak from just a few years ago, so it’s only natural that people come to me and my colleagues with question about COVID-19. And I’m more than happy to serve as that resource. I work hard to stay up to date on the latest quality research and reliable information, and I feel a sense of responsibility to pass that information along and to make myself available as resource for everyone as much as I can.”

Identifying that right information is no small task. With medical professionals and researchers around the globe desperate to develop effective treatments and vaccines, new research is being published every day, and unfortunately, not all of it is always up to snuff.

“It definitely takes a lot of work to stay up-to-date on the latest, and critically, most reliable information,” says Doctor Cinti. “The amount of new literature and research being produced related to COVID-19 is just enormous, and unfortunately, the immediacy of this pandemic means a lot of that literature hasn’t been fully peer-reviewed.”

Cinti’s advice for his colleagues: remain vigilant and continue to do the work.

“We all need to continue doing our due diligence to get the right information,” he said. “That’s the message that we need to continue pushing out to physicians, residents, and medical students everywhere. There’s an overwhelming amount of research out there, but the obligation is on us to keep tabs on it, and ultimately get our heads around the best, and ultimately, right information. That’s what we all need to be doing to deliver on our promise to provide the best possible quality care to our patients.”