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CHI Health pulmonologist says sticking to the fundamentals of ICU medicine saved lives of COVID patients

September Online

Sept. 23, 2020

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Jagan

Dr. Nikhil Jagan, a critical care and pulmonology physician at CHI Health St. Francis hospital in Grand Island, Nebraska, is among the team of clinicians that has treated COVID-19 patients at the 159-bed, community hospital, part of the CommonSpirit Health system. According to the Grand Island Independent, at one point in April the mid-sized city and its Hall County environs carried the dubious distinction of having the highest number of coronavirus cases in the state. The newspaper reported clusters of disease at food packaging plants, in a nursing home and a health clinic.

Jagan spoke to Catholic Health World Associate Editor Lisa Eisenhauer in early September about his experience in caring for patients battling a life-threatening infection about which little is known. The rate of new infection hit a peak in Nebraska in late April and early May and then dropped, but the number of cases has been on an uptick in September. Jagan's comments have been lightly edited.

What really helped us in Grand Island was when we started seeing the first waves of the COVID-19 pandemic in New York City and New Jersey and the East Coast, we were already planning. We had command meetings, where everything was planned out. I think we were ready to just deploy these plans as soon as it hit, which we did.

We did have a COVID-19 surge in Grand Island. I think it was in March and April and a little bit into May, then it gradually plateaued off. What changed in a rapid fashion after the pandemic hit us was the number of people I saw with respiratory failure or lung issues, both in the ICU and up on the floor.

The surge was challenging from the standpoint that COVID-19 is new and some of the patients, unfortunately were very, very sick.

Some of the other challenges were the rapidity with which they got ill and the number of people who got ill pretty much at the same time, who were coming in to the ICU and needed advanced care like ventilators and to be on them for a fair amount of time. We had to make sure that we got them stabilized and made room for newer people coming in.

I think what I did learn through this that was the fundamentals of medicine — good supportive care, good ventilator management, good electrolyte management, which you're taught through training — must always remain strong. And that's kind of what guided all of us through.

I think what came about with COVID-19 was to make sure that we kind of galvanized and amalgamated all the research, which was being actively done. There was nothing we could rely on which had already been tried and tested or repeated at the time, given that the disease state was new. It was a challenge to keep up with that and to try and keep up with what's working well, what's not. It was a lot of reading on a daily basis, a lot of discussion with my partners as to what is in the evidence today. It was challenging just keeping up with the rapidly changing guidelines and recommendations.

We were fortunate that we had a good supply of personal protective equipment at all times. At no point did I ever feel that I did not have adequate protective equipment to go in and provide the best care for my patients. We had ventilators, medications, pretty much everything we needed. It was all available, which helped me focus on my job and do my best.

When the ICU hit capacity, we utilized the CHI Health transfer center, which helped us immensely. The benefit of being part of a big organization and the network is the folks who were in the ICU who were relatively stable but still needing ventilators, we moved them to different hospitals — maybe sometimes to Lincoln, sometimes to Omaha using the transfer center. That way we had room for people coming in, who were getting sick on the floors or people who are sick in the emergency department who needed a bed. We worked with the transfer center pretty much around the clock and it just worked in a very smooth way. It was a very efficient process.

Every single member of the team with every single patient played a role — from getting the rooms turned over, to having every single nurse getting ready to meet the sick patients' needs, the respiratory therapists, dieticians, the emergency department physicians, emergency department personnel. I think we coordinated as a team and we did this on every patient day in and day out. I think it was just the effortlessness with which we did it and how everybody chipped in almost immediately with ease, which we built in the team through this, is something which will stand out.

We were motivated to help everybody who came through and, honestly, not at one point did we feel tired or fatigued. Throughout everything we did, there were people encouraging us, helping us out. I think it was from top down, the level of appreciation (for) everybody. And just the simple, thank you for all that you do, thank you for helping us, for doing this, things like that, I think that really, really kept us going. I don't think I heard a single person at any point in time through this, and even now, say that they were tired, fatigued or did not want to do this.

The gratitude was everywhere. It was within the organization. It was from the community. It was from people who I knew.

I absolutely think the whole CHI Health mission of being compassionate and delivering the best possible health care we can, to every single patient, every single minute, every single day, was met. And I'm really, really proud and still proud to be part of this whole unit.

I don't know if the nation has seen the worst of the pandemic. It's kind of a dynamic and evolving situation. I certainly hope so, but time will tell.

What we need to do to get through this crisis, I think, is continuing to do the basics — stay safe, wear a mask, make sure you wash your hands, don't go out if you feel sick. I think it just comes down to the basics and then keep yourself informed at all times.

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