Four Westchester Health pediatricians have been nominated for the Westfair Communications “Doctors of Distinction” Award/Team Category for the work they performed on the Proning Team at Phelps Hospital, a Northwell Health member hospital. The four physicians — Lauren Adler, MD, FAAP; Erin Kelleher, MD, FAAP, IBCLE; Hildred Machuca, DO, FAAP; and Deborah Tesler, MD — were nominated by Robbins Gottlock, MD, MBA, Vice President and Associate Medical Director, Phelps Hospital, and Medical Director, Northwell Health Physician Partners.
The team award recognizes a team of doctors who are able to work together to find solutions in difficult and unique medical situations. Referencing the four nominees, Dr. Gottlock states, “Thanks again for everything you did and the impact you made. Whether we win this award or not, you’re incredible heroes in my book.”
Dr. Gottlock’s nominating essay is reproduced below.
It’s the ultimate fish-out-of-water scenario. Imagine four outpatient pediatricians (doctors specializing in children) suddenly providing care to adult patients only, in a hospitalized setting, all of said patients are COVID positive, and using a new treatment modality called proning. It sounds like a potential recipe for disaster. Instead, the Proning Team became a critical team that may have saved the most lives, and provided the most comfort, of any physician team anywhere during the COVID surge.
The Proning Team formed in April 2020 at Phelps Hospital during the COVID surge. At the time, hospitals in the New York area were inundated with COVID patients struggling to survive. The outpatient physician offices had huge decreases in volume as non-acute patients chose to stay home and forego routine medical care.
At that moment, four outpatient pediatricians recognized that the patients who needed the help were in the adult hospitals. The four pediatricians who stepped up to the plate to make a difference were:
- Lauren Adler, MD, FAAP
- Erin Kelleher, MD, FAAP, IBCLE
- Hildred Machuca, DO, FAAP
- Deborah Tesler, MD
They volunteered to leave their outpatient pediatric sites to start working at Phelps Hospital to support COVID patients in any way they could. It was the metaphorical equivalent of running into a fire to save the victims. And they did save lives.
On their first day at the hospital, the doctors were informed they would be the core group of the Proning Team. What is a proning team? Proning is the act of placing a person chest down in bed. Normally, hospitalized patients lie on their backs (supine) in hospital beds during their stay. But brief experience with COVID showed that when patients laid all day on their backs, the posterior lung tissue got squished and didn’t aerate during breathing movements. That compressed tissue was unable to bring oxygen into the body. The last thing a patient with a COVID infection in their lungs needs is to remove additional lung tissue from service. So, by turning the patient on their chest for a few hours a day, the lungs repositioned, the posterior lung tissue expanded, and the person was able to draw more much-needed oxygen into their body.
Medically, the change from proning was stunning and immediate. Whereas a normal oxygen saturation level is in the high 90s, many COVID patients had baseline levels constantly in the 80s (or below). Almost miraculously, when the patient was proned by the Proning Team pediatricians, the oxygen saturation readings instantaneously climbed five, ten, or even more points. For many patients, the act of proning put them in normal oxygen saturation levels. It gave their lungs a rest, provided proper levels of oxygen to all the tissues of their body, and bought them time to naturally kill off the infection.
Recall that this Proning Team was working at a time where other treatment options were uncertain. Hospitals around the world were trying different medications, convalescent plasma, antibiotics, and other drugs to fight COVID. We’re still unsure which, if any, of those treatments actually worked. But we do know that data shows that proning patients is effective and might have been the most impactful treatment a COVID patient could receive in the hospital.
What is the protocol for a proning team that never treated COVID before? The doctors had some sparse medical literature to follow but otherwise used their medical knowledge and their astute observations to create workflows for their services. The four pediatricians chose to provide this proning service seven days a week. They divided into two alternating teams and, coupled with amazing outpatient nurses (LPNs) and medical assistants (MAs), they provided care to all the COVID positive patients in the hospital. It’s important to note that the four pediatricians were the core team. However, ten other physicians rounded out the team, helping to staff an evening proning session. Although the pediatricians performed many more shifts and hours than these other doctors, it would be important to recognize the others’ selfless efforts as well:
- Brian Gair, MD (family medicine)
- Robbins Gottlock, MD (family medicine)
- Janice Teixeira, MD (OBGYN)
- Lisa Spiryda, MD (OBGYN)
- Lilly Singh, MD (OBGYN)
- Sarina DiStefano, MD (OBGYN)
- Nikki Dinall, MD (OBGYN)
- Franklin Zimmerman, MD (cardiology)
- Yili Huang, MD (Pain management)
- Stephen Thorp, MD (Pain management)
Likewise, it is extremely important to emphasize that the Proning Team was a team in the best sense of the word, with nurses, MA, administrators, and other support staff playing irreplaceable roles helping the team to fulfill the mission.
Each day, the Proning Team pediatricians visited all the patients at least twice — once in the morning and once in the afternoon — to physically help assist them from a supine to prone position in their beds. Picture patients who are completely winded, weak, and debilitated from their rapid breathing. The pediatricians would physically help the patients turn, avoiding IV lines and oxygen tubes, and perfectly place pillows and blankets for maximum comfort.
The Proning Team pediatricians could have just proned the patients and left the room. But the most remarkable part was how they went above and beyond. The pediatricians realized that the nurses on the floor were understandably strained by the increased tasks of providing care to these high acuity COVID patients. So, the proning team pediatricians took on any extra task they could. If the patient was thirsty, they refilled the water pitcher. If the patient couldn’t eat, they spoon fed them their nourishing meals. If the patient hadn’t spoken with family (recall that no visitors were allowed), the pediatricians would dial up their loved ones and help facilitate the call. And it didn’t end there. The pediatricians emptied bedpans and removed garbage. And, if the patients had recently soiled their beds, the pediatricians removed the sheets and clothes, cleaned up the patients, and brought in fresh linens and gowns. The pediatricians weren’t there simply to give medical care. They provided human connection and emotional support. They were a team of heroes.
It was no wonder that the patients started looking forward to the pediatricians’ visits. The patients came to recognize the Proning Team pediatricians and would start turning themselves in their beds the moment the doctors entered. They Proning Team lingered in the rooms and the patients and pediatricians spent time each day catching up and sharing updates.
It would be nice to think all proned patients did well. That was not always the case. Despite the patients’ determined efforts to fight the infection and the Proning Team’s courageous and thoughtful care, many patients ended up worsening, moving to the ICU, and sometimes even expiring. The pediatricians, being the thoughtful people they are, mourned greatly each patient loss and felt the deep emotional toll of their work. Conversely, when one of their patients improved and was able to be discharged from the hospital, the Proning Team was there to salute and applaud as the patient triumphantly left to go home to complete their recovery.
Over time, the COVID surge gratefully waned. As the census of COVID patients decreased, the Proning Team eventually was no longer needed. By mid-May the team was disbanded. The pediatricians returned to their outpatient practices where their patients were finally coming back for routine care.
And what were the parting words of the Proning Team pediatricians as they left the hospital for the last time? “We’re ready to come back if there’s another surge!”
The Proning Team at Phelps Hospital, managed and staffed mainly by Drs. Adler, Kelleher, Machuca, and Tesler, deserves to be recognized by the Doctors of Distinction team award. By creating and staffing the Proning Team at Phelps Hospital, the doctors found a successful solution in the midst of a unique situation and undoubtedly saved dozens of lives and in the process brought humanity and dignified care to the patients most in need.
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