Raise the Line Podcast Featuring ER Attending Physician Dr. Poonam Desai
Published on Apr 16, 2020. Updated on Sep 15, 2020.
Imagine being a pregnant ER doctor in the middle of the coronavirus crisis and then finding out you’re COVID-positive. That’s the compelling story Dr. Poonam Desai shares with our Chief Medical Officer (and her cousin!) Dr. Rishi Desai, host of our new podcast series Raise the Line, which explores solutions for increasing healthcare capacity during the COVID-19 crisis and beyond.
Listen to the podcast and watch the video/read along with the transcript below:
DR. RISHI DESAI: Hello, I'm Dr. Rishi Desai, I'm the Chief Medical Officer at Osmosis, and today I'm here with Dr. Poonam Desai. She's an Attending Physician in Emergency Medicine in New York City. Poonam is also my cousin!
Thanks for being with us here today, Poonam. I wanted to say that I got some bad news from you. I want to share what that news is and understand a little bit more about that. You were working in a busy ER in New York City up until you found out you tested positive for COVID-19 on the evening of March 24. I wanted to discuss that with you and just jump right in!
Can you tell me a little bit, just for background: what do you do, and what it's been like the past few weeks working in New York City?
DR. POONAM DESAI: Thank you for having me! So, I'm an Emergency Medicine physician in New York City. I work between two hospitals: one on the Upper East Side, and one located in Queens, which is one of the hardest hit boroughs when it comes to COVID-19.
It's been pretty busy. We've seen a surge of patients presenting with the typical COVID symptoms, ranging from fever, chills, shortness of breath, coughs, and we also see many patients who have the milder versions of the symptoms—sore throat, a minimal cough. Both types of patients are presenting: those who are very sick, and need to be taken care of, and those who are mildly ill because they're worried, and want to be reassured that everything's going to be okay.
DR. POONAM DESAI: Yes. I'm very, very fortunate to work at hospitals where I have been given an N95. We have the goggles, we have the surgical masks, the gloves, and when needed, we have the gowns to see these patients. So yes, I've been fortunate enough—though I know that the supply is decreasing. I know we don't have an unlimited amount of supply, so we will be faced eventually with a time where we may not have the supplies that we need.
DR. RISHI DESAI: So, with yourself and your own story, what were your first symptoms of COVID-19?
DR. POONAM DESAI: As an ER doctor in this situation, with any mild symptom I immediately start thinking, "Oh gosh, do I have COVID-19? Did I end up getting COVID-19?" So I've been a lot more cognizant of myself, my body, in the last few weeks.
I started noticing a sore throat, which I normally would not have thought twice about. A day before (I think it was maybe Monday, March 23) and the morning of March 24, I woke up and I started having this headache, which is abnormal for me—I don't normally get headaches, so that kind of caught me off guard. When I got up and went to the bathroom, I had sputum and phlegm, and that's also very abnormal for me. When I spit it out, I noticed—it was very mild, but it was present—blood-tinged sputum. And so at that point I was like, "Oh gosh, I have three of these symptoms... Let me call my hospital and talk to my chairman and see if I should get tested."
I had a surge of shifts that were coming up in the next week or two. The chairman was very kind. He said, "Come right over. Let's get you tested, because you are 26 weeks pregnant." And he was rightfully worried.
DR. RISHI DESAI: And how are you feeling right now? How has it been since then?
DR. POONAM DESAI: When I got the positive test, I felt two things... Number one, I was scared, frightened. My feeling was, "Oh gosh, how's it going to impact me and the baby? And also my husband who lives with me. Did I possibly give it to him?" The second feeling, ironically, was, "Oh gosh, now that I have it, does it mean if I can get through it, I'm immune, and I don't have to worry about this for all the shifts I'm going to be working in the near future?"
DR. RISHI DESAI: What are your thoughts now that you've had some time to reflect about the pregnancy?
DR. POONAM DESAI: Being sick before pregnancy was like, "Okay, I can get through this, I can fight through it," but being pregnant and sick is much different. Medically, I know that being pregnant puts me in the immunocompromised category. My body may not be able to fight infections as well as if I was not pregnant. So, with that, I was very, very scared.
Something that I think I have to mention is that during the weeks prior to getting the COVID diagnosis... I'm part of many chat groups with other physicians, healthcare workers, where we talk about COVID-19, where we share our experiences. A huge topic recently amongst my colleagues and in these groups has been, how do we not get COVID-19, and how do we not take it home to our family? Decontaminating ourselves was a huge topic amongst all of us.
When we get to work, we put on our scrubs, we are given the N95s, and we have our own goggles in our bags that we disinfect and put on. At the end of the shift we have this long process of how we're going to decontaminate ourselves. I normally used to just walk out of work and not think twice about, you know, even probably washing my hands! I would just put hand sanitizer on and walk out.
Now what I end up doing is, I literally take everything off, put it in a corner that I've wiped down clean with disinfectant wipes. I take the wipes, and from top to bottom I wipe my entire scrub— my entire outfit—with whatever disinfectant wipe that I got ahold of, including my bag, every water bottle, the lunchbox that I had, I decontaminate the entire thing, and carefully place it in a bag that I've also decontaminated. And when I get into the car, I bring a wipe with me and I wipe everything down.
I put on a mask that I have in the car and I put on gloves after I've washed my hands. The reason for this is because my husband will get back into that car and I want to make sure that he doesn't get COVID-19. In New York City, you know, we're limited with space, so we park our car in a garage. The worker who works in our valet, he's going to get in my car, and I want to make sure that he's also protected and safe. So, it's a long process.
The minute I enter our apartment—and this is probably across the board amongst all healthcare workers who are currently working at the hospital—is that the minute I walk in, I strip down my entire outfit, put it in a bag that I know I'm going to wash that night, or in the next day or two, and go straight to the shower and wash everything top to bottom again.This is because I don't want to get it, and this is because I don't want to give it to my loved ones.
It's been a huge concern where we (my network of health professionals) all talk about our entire process and we all discuss how to do this. Being pregnant and getting this was almost like... It was going to be my fault if I got it. Did I not do this entire decontamination properly? Was there something I could have done differently? And I think that's what initially bothered me. I kept thinking back: was there a time that I had a contact with a patient where I didn't wear the mask? Did I lift up my mask too many times to drink water, to eat lunch, to take a breath?
DR. RISHI DESAI: Wow. That's a pretty extensive process. Given that you've been thinking so hard about this whole thing, was there a specific moment that you recall where you had an exposure that you can point to, or does it feel like there wasn't any one moment like that?
DR. POONAM DESAI: There's not a particular exposure that I vividly recall. However, I do remember thinking on almost every single shift that, when I looked around and I saw my coworkers and colleagues so worried about taking this home or getting it, I kept thinking, "Oh my gosh, I'm actually bringing my baby to work," you know? And every time I talked to someone, every time I'm exposed to a viral load, I'm actually also potentially giving it to my baby; if I get sick, that's going to affect the baby. So that thought was always in the back of my head.
In regards to any particular incident, I think the patient encounters that have really stuck with me the longest are the young patients, the ones who, you know, remind me of my friends, that remind me of my brother, or my loved ones, or could have easily been my husband. I think when I see a younger patient who is severely affected by COVID-19, from a lung disease, to needing to be intubated... I think those patients stick with me longer because it makes me think, "That could be me. That could be somebody I know. And somebody I love."
DR. RISHI DESAI: I wonder for yourself, again, Poonam, are you taking anything, medication-wise, or are you on any treatment as you go through your own process?
DR. POONAM DESAI: I definitely did everything I could to research all the treatments that are out there and try to find strong, evidence-based research or any kind of direction on whether I should take medicine or not. And no, at this time because my symptoms are mild—I'm not in severe respiratory distress requiring an admission or ICU or to be on a ventilator—I'm not taking any other medications. I do frequently monitor my temperature and if I do have a fever, then I plan on taking Tylenol.
DR. RISHI DESAI: Got it. Do you plan—you know, once you recover from all this, once you feel well—do you plan to go back to work?
DR. POONAM DESAI: Absolutely. That wasn't even a thought that crossed my mind, not going to work. Actually, this is what I signed up to do, and this is when I'm probably needed the most in my entire career. And maybe—maybe, and hopefully!—this is the time when I'll be needed the most and this will never happen again. So, I think during this time I feel like I have to go to work, I have to be there for my patients. This is what I signed up for and this is absolutely not a time where I would step back and not go to work.
DR. RISHI DESAI: Do you have any advice for other healthcare workers?
DR. POONAM DESAI: My advice to everybody is to make sure that you 1) wear your PPE and 2) practice safe donning on and off of the PPE. I think that's what we could all use more education on: how do we properly put on our protective gear and then how do we take off all that protective gear so we don't contaminate ourselves? I think there were many studies that were done where they showed infection didn't really stem from contact with the patient. It showed that a lot of healthcare workers got infected when they were trying to take off all their equipment. I think that's number one: if you're going to be working in that environment, then please do everything you can to make sure you're following the proper procedures to keep yourself safe.
DR. RISHI DESAI: Another audience, of course, is pregnant people out there. What advice do you have for them?
DR. POONAM DESAI: I think the most important advice that I would give a pregnant person—and probably anybody else—is to practice physical distancing. I think we used to say social distancing, but you should continue to be social through FaceTime, phone calls, and things like that. You need that emotional and mental support. But definitely practice physical distancing. Try to stay six feet away from everyone and anyone and try to stay home as often as you can. It's a time where we're very vulnerable to getting an infection. And more importantly, there's so little known about pregnancy and COVID and and infants that I think it's better to be safe, rather than spend the rest of your pregnancy worrying or stressed or anxious about what this could mean for future.
DR. RISHI DESAI: Poonam, what can the general public do to keep our healthcare workers on the front lines as safe as possible?
DR. POONAM DESAI: Physical distancing, frequent hand washing—so practicing good hygiene—and seeking out the right resources when you are sick. If you have mild symptoms that don't require an ER visit, it's best not to be flooding the ERs right now. Reach out to a tele doctor or your primary care doctor with a phone call and see whether you really do need to come to the ER or not. I think those are ways that the general public can really, really help flatten the curve and raise the line.
DR. RISHI DESAI: Thank you so much, Poonam. I think it's safe to say that I speak for everyone when we want to wish you a really speedy recovery. Make sure that your baby's safe, your husband's safe, and I hope everyone out there who may be in a similar situation to you is safe as well.[Editor's note: Dr. Poonam Desai has since recovered from COVID-19.]