A Year Later, Remembering When COVID Came to Einstein
It was just over a year ago that a 43-year-old father of four was brought to the emergency room at Einstein Medical Center Montgomery, with a ferocious cough, a fever and difficulty breathing.
It was three days after the World Health Organization had declared COVID-19 a global pandemic. The chatter about it at the hospital had ranged from expressions of inevitability to skepticism.
No one yet knew that it had crossed Einstein’s threshold on March 14, 2020, when a very sick Mike DeWan was brought in by his wife.
“It was a pivotal moment,” says Davis Samuel, DO, an intensive care unit doc who took care of DeWan. “Once I heard about Mike that day, it was – finally, it’s arrived here and it’s in my hospital.”
DeWan had recently celebrated the end of his daughter’s basketball season at a restaurant with a few other fathers. He got sick the following Monday and got worse as the week wore on.
“It was really weird,” he remembers. “I couldn’t even get enough breath to go to the bathroom. I’d never experienced anything like that.” His wife, Kelly, a home care physical therapist at Einstein, took him to the hospital.
The Day the Pandemic Arrived
DeWan was too sick to remember much of what happened to him for the next few weeks. But the medical staff will never forget the day the pandemic hit home.
Elizabeth Wembacher was a new nurse, eight months out of nursing school, when DeWan was brought into the Emergency Department. “I thought it was just another respiratory infection or the flu,” she says – though he did seem to be struggling unusually hard to breathe for a young man with no underlying conditions.
The flu test came back negative. But the chest studies were alarming. “The physician took me aside and told me the patient had ground glass opacities in his lungs. He’d done his homework and knew what it meant,” Wembacher says. “He says ‘Put your mask on. This is it.’ I felt like, OK, here we go.”
Wembacher was home the next day when she got a call from the hospital confirming that DeWan had tested positive for COVID. “I was anxious,” she says. “But I thought, I’m young, I’m healthy and I live alone. My parents live out of state, I don’t have young children, I can’t infect anyone. I’ll be OK.”
From Emergency to ICU
DeWan was transferred from the emergency department to the fourth floor telemetry unit just as nurse Colleen Price was ending her shift. She’d been a nurse for 31 years and her instincts were well-honed.
“I went right into the room, did his vitals and did the initial assessment,” she says. “The swab test was pending, but I could tell just by the way he was breathing that he was positive. I can’t explain it. It was a gut thing.”
The next day, throughout her shift, Price watched DeWan decline. His respirations were getting faster, his oxygen blood level was dropping, and the “horrible” coughing was unrelenting.
Over the next few hours, Price increased his oxygen from two to four liters, then to six, and, when that didn’t help, notified the doctor that DeWan might need to be transferred to ICU. And she prayed for him. “I’m kind of old school,” she says. “I pray in my head for my patients.”
At 3 a.m. on the day after DeWan was admitted, Josh Malenbaum, MD, an anesthesiologist, was finishing a case in the operating room when he got the call from the fourth floor: DeWan’s respiratory status was declining and he needed to be intubated.
It’s something that Dr. Malenbaum has done every day for a dozen years. But this was his first COVID patient. He was “beyond anxious.”
‘So Much We Didn’t Know’
“There was so much we didn’t know,” he says. “We’d been very well prepared. We’d discussed the protective equipment we’d need and how to intubate a COVID patient. But that didn’t make it any easier.”
When he arrived at the fourth floor, Dr. Malenbaum and his nurse anesthetist prepared for the intubation procedure outside DeWan’s room, instead of at bedside, as usual.
“We were both very nervous going into the room,” he says. “Mike was very frightened and I remember feeling bad for him. Someone told me his whole family was sick.”
Indeed, DeWan’s wife, four daughters, parents and in-laws had COVID. They’d all had dinner together the weekend before DeWan got sick.
An hour after DeWan was intubated and transferred to ICU, nurse Emily Petipren arrived for her 7 a.m. shift.
“We were novices about it and there was a lot of fear,” she says. Since nurses with non-COVID patients weren’t allowed in a COVID room, Petipren was often in the room alone with DeWan. “Nobody was coming in. They’d run and get stuff for me, but I was in the room by myself.”
Treatment and safety protocols were changing constantly, as Einstein’s Incident Command Center of network leaders and practitioners had virtual meetings twice a day to process and communicate new information. “As soon as we got that first patient, emails started coming with protocols,” Petipren says. “New information came out all the time.”
Maximum Oxygen, Then a Transfer
As Dr. Samuel made his way to DeWan’s ICU bed, he remembers being, not fearful, but curious: he wanted to see how the new disease manifested itself in the heart and lungs.
But curiosity changed to compassion as soon as he walked into the room and saw how sick DeWan was. “You know you’re taking care of a young guy and giving him the maximum amount of therapy. I was worried about his breathing and wondering if we were going to be able to give him enough oxygen. He was on pretty high settings.”
There was only one more treatment that could save DeWan’s life: to put him on ECMO, a heart-lung machine that would oxygenate his blood. Einstein Montgomery didn’t have ECMO. Arrangements were made to transfer DeWan to a hospital in Philadelphia that could take over his care.
A few days later, when Dr. Samuel had a day off, he reached out to Kelly DeWan.
“Dr. Samuel texted me and said he was checking on me,” Kelly says. “He asked if I needed groceries or if there was anything he could do. He was great.”
Surviving Crisis, Caring Deeper
Two days after he arrived, DeWan was transferred. He’d be the first of nearly 16,000 COVID patients to be treated at Einstein Healthcare Network in the last year. It has been life-changing.
“I think how I am as a person and as a nurse will forever be affected by this event that I lived through,” says emergency nurse Wembecher. “The relationships I’ve established with my colleagues – nurses, techs, physicians – I’ve grown so much closer with them, and I don’t think that bond would be as deep as it is now if we weren’t thrown onto the front lines together.”
And then there’s the confidence born of crucible.”For the rest of my career, in the back of my head, I know I survived the COVID pandemic,” Wembecher says.“If I survived that, I can survive anything.”
“It’s been such a learning experience for me,” says Chief Medical Officer Angie Nicholas of what she called “the crisis that never ended.”
“It was gratifying to be part of a team that delivers excellent patient care and know that we can call on each other no matter what,” she says of the leadership team who were “attached at the hip” throughout the early days of the crisis: COO Beth Duffy, Chief Nursing Officer AnnMarie Papa and Vice President of Healthcare Services Pat Modafferi.
ICU nurse Petipren has sought counseling to deal with the anguish she witnessed as the virus ramped up and she held patients’ hands as they died alone. But with the pain has come a renewed appreciation of life.
“You love deeper,” Petipren says. “You care deeper. When you see that kind of stuff, you want to care for your patients the best you can. You put yourself in their shoes and their families’ shoes. You appreciate your own family more. Every moment you spend is so much more meaningful. I’m just so much more grateful to God for everything I have.”
On April 4, 2020, after three weeks as an inpatient, including 17 days on a ventilator, Mike Dewan made it back home. He’d lost nearly 40 pounds and was too weak to walk.
He still hasn’t fully recovered his stamina and he has ongoing bouts of joint pain and shortness of breath. “It’s always there,” he says, but he is hopeful for a full recovery.