Front-line doctor in NYC: What we all need to consider
Cape Cod Hospital Obstetrician/Gynecologist Richard Heywood, III, DO FACOG is seeing the tragedy of the COVID-19 pandemic unfold on a daily basis. A 23-year Navy Reserve veteran, he was called up in early April to help with the onslaught of patients arriving at one of the safety net hospitals in New York City, NYC Health + Hospitals/Woodhull in Brooklyn. The military deployed health and medical reserves to many of the hospitals in New York to relieve overwhelmed and exhausted staff.
“When we arrived, they were clearly overrun with patients,” Dr. Heywood said. “There was a line of ambulances down the street. Every room in the ER had four patients and everyone had similar complaints – cough, fever, shortness of breath. Every other complaint had completely dried up. No traumas, no car accidents. It was creepy.”
Dr. Heywood, who is also credentialed in general medicine (and has federal emergency disaster credentials to work in the NYC hospital), was assigned to a Navy team of doctors and nurses who were asked to completely staff a 12-bed intensive care unit. Many at the hospital had been working for days on end before the Navy team arrived, he said.
“We at least felt like we were giving them a little respite,” he said.
A Powerful Lesson
Dr. Heywood saw what he was up against on the very first night he was on duty. He was covering three patients suffering from COVID-19, all of whom were on ventilators. “Within a few hours, two of the three had coded and died,” he said.
Some intubated patients, however, have lingered for days and even weeks, and Dr. Heywood’s experience with these patients has reinforced a powerful lesson – the need for all of us to make our end of life wishes known before we are unable to.
“I recently worked with a few patients in their 70s and 80s with multiple co-morbidities, who were intubated for two weeks and they were starting to have neurological issues, and, in some cases, they were diagnosed with brain death,” he said.
Because family members could not enter the hospital, he and the other medical staff had to set up family meetings via FaceTime or over the phone to discuss a plan. And often, they found the family had no idea what their loved one’s end of life wishes were.
In many cases, patients did not have pre-determined orders and doctors had difficulty finding someone who could tell them what the patient would want them to do. Dr. Heywood was often referred from family member to family member, or even to a friend of the patient’s, and no one could say what the patient’s wishes were.
When no one can or will decide, the case is sent to the hospital ethics committee to make the best medical decision, Dr. Heywood said.
“As I was having these end of life issues, it dawned on me that in an ideal world, if everyone felt comfortable having these conversations with their families, and they had laid out their advanced directives ahead of time, many of these scenarios could be avoided,” he said.
“We need to have those difficult conversations with our family now – whether you’re young or old and whether you have some type of illness or whether you’re healthy. You need to let your family and (designated healthcare) proxies know; if your heart stops beating, what you want them to do. If you can’t breathe on your own, do you want them to put a tube down your windpipe and have it breathe for you?”
If you are undecided, it is important to designate who you would like to decide for you, if or when the time should arise, he said.
“When push comes to shove, someone else will have to make that decision for you. Who do we, as healthcare providers, go to? That’s a powerful thing to bring up, (telling your undecided loved one) ‘If you don’t make that decision, then I’m going to have to live with my decision.””
A “Giant Medical Experiment”
Doctors and researchers are learning as the pandemic progresses how best to treat COVID-19 patients, including whether to put the sickest patients on ventilators, Dr. Heywood said. But, in the day-to-day fight against the disease, “we don’t always have the luxury of figuring it out.”
Having covered a few maternity shifts at Woodhull Hospital, 50 percent of the mothers were COVID-19-positive when he arrived, he said. Most did not seem to have significant illness, however, which is something researchers are finding with infected maternity patients, in general, he said.
But drawing too many conclusions about how the virus behaves and affects different segments of the population is often impossible when you’re in the middle of the crisis, he said.
“It’s going to be a year or two before people have a chance to digest all this data and figure out what it means,” he said. “We are essentially living in the middle of a giant medical experiment.”
While in New York, Dr. Heywood and the other Navy reserves live in hotel rooms in Manhattan, a few blocks from the Jacob K. Javits Convention Center, where the Army established a 2,500-bed field hospital. Working around the necessary precautions has been a challenge for trained military personnel, Dr. Heywood said.
“The military has been known for having a lot of people packed into dense areas. That’s a behavior change, so to have a large meeting or pass information to a large group can be hard,” he said. When military staff checks in, the Army issues each of them an iPhone with various programs to enable them to communicate with each other and to meet virtually, he said.
Dr. Heywood is working in the Woodhull ICU with a team of Navy medical personnel, including an internal medicine doctor, a trauma surgeon and a half-dozen Navy ICU critical care nurses, who do “much of the heavy lifting,” he said. “They are the true heroes in all of this mess.”
Taking Day to Day
Dr. Heywood, whose wife, Laura, and three teenage children are home on Cape Cod, said they are accustomed to the military life. “When I told my wife (he was called to NYC), I know her heart sank, but she just kind of sucked it up and said, ‘all right, let’s start making plans on how we can make this work.’
This is not the first time Dr. Heywood has been called up for active duty, having served from 2004-2011 during Operation Enduring Freedom. Afterwards, the family returned to Cape Cod, which is where Dr. Heywood grew up, and he opened his practice. He was also attached to a Marine Corps battalion from 2014-2019, which required him to serve one weekend a month, and two to three weeks of active duty each year.
Laura Heywood continues to manage Cape practice, Falmouth Women’s Health in Mashpee, while Dr. Heywood’s partner, Obstetrician/Gynecologist Elizabeth Speed, MD, is doing “the heavy lifting” of taking care of all of the practice’s patients, Dr. Heywood said.
“Thank God I have such an amazing colleague to take care of all of our patients while I’m pulled away,” he said.
Dr. Heywood has orders to be activated until Sept. 30 but hopes to be home sooner.
“We take it day by day and try to keep the faith,” he said.
For now, he is working 12-hour shifts, three days on and three days off. During his time off, he said he reads or does something else to help distract him from what he is seeing in the hospital and from the very real possibility he will contract the disease.
“It’s constantly on your mind,” he said.
He is heartened by the evening ritual that has been adopted in New York since the pandemic arrived.
“Every night at 7, all of a sudden you start hearing all this noise of people yelling and clapping for five minutes, to say thank you to healthcare workers,” he said. “You hear it throughout the city and it’s incredible.”