Commack resident Theodore Wawryk, above, recently received shockwave intravenous lithotripsy at Huntington Hospital. Photo from Wawryk
Theodore Wawryk, a resident of Commack who performs maintenance work at the Bronx Gardens nursing home, had six stents placed in his heart in 2005.
One of the doctors performing the procedure was Dr. Gaurav Rao. Photo from Rao
This past February, Wawryk, 52, had a buildup of calcium behind some stents at their edges, which could lead to restenosis, or a narrowing of the arteries again.
The patient came to Huntington Hospital, where his cardiologist, Dr. Raj Patcha, director of the Cardiac Catheterization Laboratory, couldn’t initially get through the blockage.
Patcha reached out to Dr. Gaurav Rao, director of Interventional Cardiology at Huntington Hospital, to see if Wawryk might be a candidate to become the first Huntington Hospital patient to receive shockwave intravascular lithotripsy, also known as IVL.
Rao had used the shockwave treatment, which uses pressure waves to create fractures in the calcium, for over a year at other hospitals and was prepared to introduce the procedure at Huntington Hospital.
Other options for breaking through the calcium, such as orbital or rotational atherectomies, which act more like miniature jackhammers breaking up the calcium in the arteries, are off label when a stent is nearby because it can shave off the metal in the stent, leading to other complications, Rao said.
Additionally, placing another stent in the area without modifying the calcium leads to stent failure.
Rao and Patcha performed the procedure in early February.
“This is a much safer” approach, Rao said. “It’s revolutionary in the way we deliver classic cardiac care.”
Shockwave IVL enables the placement of stents by creating fractures in the calcium that allow doctors to put in functional and durable stents, Rao explained.
Other area hospitals have used shockwave IVL for circulatory issues as well. Stony Brook Hospital, for example, uses shockwaves for peripheral arteries. Huntington Hospital also uses shockwaves to treat peripheral vascular disease.
While every surgical procedure includes risks, Rao cited studies that indicate that the possibility of a dissection, or a tear in the wall of the aorta, for heart-focused IVL is 0.3% for shockwave IVL, which is substantially lower than the 3.4% rate for orbital atherectomy and 3% for rotational atherectomy.
Rao said about 70% of patients who are coming in for stents are eligible for IVL, while the remainder are still candidates for atherectomy.
Extremely long lesions or lesions where the entry point is small so that doctors can’t deliver an IVL balloon make atherectomies, with their front cutting abilities, the preferred approach, he said.
So far at Huntington Hospital, the growing number of patients eligible for shockwave IVL have chosen to have this approach.
“No one has shied away from shockwave therapy,” Rao said.
Patient experience
As for the patient experience, Wawryk recalled how the operation, felt “a little weird.”
Wawryk described how the doctors told him he’d feel a “little zap” inside his body.
Indeed, Rao said the procedure uses an electrical pulse that can cause the heart rate, particularly for someone with a resting pulse below 60 per minute, to accelerate for about 10 seconds.
Intravenous lithotripsy, which uses a low energy pressure wave of about 8 to 10 nanojoules and involves inserting a tube through the arm or leg, is generally “well-tolerated” Rao said. Many patients don’t feel the effect of the procedure.
Even with the slight shockwave, Wawryk said he would recommend the procedure to other patients considering it.
Wawryk, whose father died of a heart attack at the age of 46, is grateful for the cardiac care he received. He appreciates the time he gets to spend with his wife Nydia and his 19-year-old son Michael.
The Commack resident spent a day at the hospital, as the procedure started at 7 a.m. and he was heading home by 7 p.m. that night. He said he felt like the staff treated him as if he were at a “five-star resort.”
Rao is pleased to offer this interventional cardiac approach at Huntington Hospital, which makes it possible for residents nearby to receive the treatment and head home, without a longer ride back from a hospital further away.
Dr. Adam Bitterman. Photo from Huntington Hospital
Huntington Hospital has appointed Adam Bitterman, DO, chair of orthopedic surgery. Dr. Bitterman is a board-certified orthopedic surgeon and an assistant professor of orthopedic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is a foot and ankle specialist and has a focus in treating conditions of the lower leg.
“Dr. Bitterman has the experience, demeanor and dedication needed to lead Huntington Hospital through its growth as a premier destination for orthopedics,” said Nick Fitterman, MD, executive director of Huntington Hospital. “I am confident he will set a vision and strategy well suited to support the orthopedic needs of residents in Huntington and Suffolk County.”
A native of Commack, Dr. Bitterman’s clinical interests include arthritis of the foot and ankle, deformity correction, Achilles’ tendon disorders, and sports-related injuries to the ankle and foot. He is highly skilled in arthroscopic, minimally invasive, and open approaches for various conditions surrounding the lower foot and ankle.
“The Department of Orthopedics at Huntington Hospital has enjoyed a rich history, and now with Dr. Bitterman as chair, we look forward to continuing to advance the highest quality patient-centric musculoskeletal care in our region,” said Nicholas Sgaglione, MD, senior vice president and executive director of Northwell Health Orthopedics. “I look forward to watching the department continue to grow under Dr. Bitterman’s leadership.”
“I am excited about continuing to raise the bar at Huntington Hospital, from clinical growth to the enhancement of efficiency and safety,” said Dr. Bitterman. “I’ve been fortunate to work at Huntington Hospital for six years and I look forward to continuing to build on the achievements we’ve made and I’m excited for what we will create in the future.”
Daniel Tuttle received the therapeutic treatment Intracept for back pain. Photo from Tuttle
Over 30 years as a plumber took its toll on Daniel Tuttle.
Daniel Tuttle, who received the therapeutic treatment Intracept for back pain, enjoys a boat ride. Photo from Tuttle
The 79-year old Northport resident felt daily pain in his lower back, which limited his ability to walk for any length of time.
“I always lifted up [stuff] you shouldn’t lift,” Tuttle said. “It was too heavy. Over the years, I got more and more pain.”
Tuttle visited several specialists. His cardiologist recommended he see Dr. Frank Ocasio, director of Acute Pain Management and chair of Pain Management at Huntington Hospital and the director of North Shore Head and Spine in Huntington.
Ocasio recently started performing a therapeutic treatment called Intracept, which involves cutting a small incision in the back, inserting a tube and providing enough heat to deactivate the nerve that causes chronic lower back pain.
About a month after the procedure, Tuttle is pleased to report that his pain has declined from “an 11” to closer to a three on a daily basis.
Several doctors around Long Island have provided the Intracept procedure, which was developed by Relievant Medsystems, over the last few years, including at Stony Brook University and Port Jefferson’s St. Charles Hospital.
Dr. Jonathan Raanan, assistant professor of Neurosurgery, Physical Medicine & Rehabilitation in the Department of Neurosurgery at the Renaissance School of Medicine at Stony Brook University, has performed about 10 such surgeries over the last few years.
Raanan described such lower back pain that lasts more than six months or a year as being something of a “big black hole” in terms of treatment.
In a magnetic resonance image, the disc becomes darker, indicating it doesn’t have good hydration and that it isn’t an effective shock absorber.
Intracept can help reduce the pain.
“It’s very satisfying when someone comes in who has tried everything but the kitchen sink to treat this” who then says “I do feel better,” Raanan said.
Tuttle’s wife Susan, who has been married to him for over three decades, said the procedure has improved his quality of life.
Susan Tuttle said her husband has been able to “do everything he wanted to do.”
Ocasio found the idea of Intracept appealing, particularly because it was a one-time effort that didn’t require ongoing follow up visits.
“There’s not much out there in the pain management space that’s a non medication, a non-opioid strategy that’s a one and done,” Ocasio said.
The surgery is an outpatient procedure and can take anywhere from 45 minutes to two hours, depending on the area over which the nerve is sending a repeated pain signal.
Patients either receive mild sedation or are under general anesthesia.
“People see results within weeks,” Ocasio said. In some cases, they can get relief within 24 hours.
Dr. Frank Ocasio recently began to perform the therapeutic treatment. Photo from Ocasio
To be sure, the procedure, as with any, involves some level of risk and isn’t appropriate for everyone.
Raanan advised potential patients to discuss the risks and benefits with any provider.
Starting in January, Intracept will have a Current Procedural Terminology, or CPT, code, which will give health care providers a standard way to describe the procedure and insurance companies a way of determining patient eligibility.
Until then, patients need to appeal to indicate to insurance companies what other treatments they’ve had for back pain.
In Raanan’s experience, patients sometimes have flare-ups of other pain that is similar to sciatic discomfort after the treatment for days or even weeks after Intracept.
“That might be a reasonable trade-off in the eyes of the patient,” Raanan added.
Deadening the nerve doesn’t cause any loss of control of motor function, Ocasio said, as the nerve provides a sensory benefit while others provide necessary muscle control.
“You still have multiple nerves around that area,” Ocasio added.
Candidates for this procedure typically have lower back pain associated with activities that require bending forward, like loading a dishwasher or flexing at the waist, Ocasio described.
Ocasio said doctors who perform Intracept receive training under guidance from the company.
Patients interested in this approach are anywhere from their 30s through their late 70s, local doctors said.
For Daniel Tuttle, the procedure provided relief.
“He’s outside, puttering around, doing the things that make him happy,” Susan
Tuttle said.
“It gave me my lifestyle back,” Daniel Tuttle said.
The Tuttles are planning a trip to Italy next summer.
Raanan cautioned that, for at least one patient, the relief led to another problem.
A female patient returned to working out in the gym, where she exercised so vigorously that she created a different spine injury that he treated.
“When patients feel better, they have to remember they are still vulnerable,” Raanan said. “Poor mechanics, postures, flexibility or excessive and prolonged activity come with some risk.”
Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at the Renaissance School of Medicine at Stony Brook University. Photo from Stony Brook Medicine
Dr. Sunil Dhuper’s actions speak as loudly as his words.
The chief medical officer at Port Jefferson’s St. Charles Hospital is planning to get a booster for the COVID-19 vaccine this Thursday, after the Centers for Disease Control and Prevention authorized Friday, Sept. 24, the additional shot for a range of adults, including those in jobs that put them at an increased risk of exposure and transmission, such as frontline health care workers.
Earlier, the U.S. Food & Drug Administration announced Sept. 22 that “a single booster dose” was allowed “for certain populations” under the emergency use authorization, although the EUA “applies only to the Pfizer-BioNTech COVID-19 vaccine.”
Dhuper received his first vaccination in January and would like to raise his immunity.
“I am very eager to get the booster dose,” he said in an interview. “I reviewed scientific data from all over the world — from the United States, Israel, the United Kingdom — and I had reflected that, after six months after the second dose, it’s time to get a third dose.”
While St. Charles and other hospitals haven’t required a booster, Dhuper believes that state and national guidance will likely recommend it before too long.
“Over time, I do anticipate people may begin to get severe infections or get hospitalized” if they haven’t enhanced their immunity with a booster, he said. “It would be prudent to get the booster dose in the arms of those who are fully vaccinated.”
Stony Brook University Hospital is providing boosters to employees and to eligible members of the public.
Meanwhile, Northwell Health and Huntington Hospital are deliberating how to proceed and will announce a decision soon, according to Dr. Adrian Popp, chair of infection control at Huntington Hospital.
While boosters are available for education staff, agriculture and food workers, manufacturing workers, corrections workers, U.S. Postal Service employees, grocery store workers, public transit employees and a host of others, the overall infection rate in Suffolk County has stabilized over the past few weeks.
Decline in infections
As of Sept. 25, the seven-day average rate of positive tests in the county fell below 4% for the first time since Aug. 15, dropping to 3.9%, according to data from the New York State Department of Health.
“We think the numbers might have plateaued,” Dhuper said. That decline coincides with the increasing number of people who are vaccinated. In Suffolk as at Sept. 29, 1,043,478 people (70.7%) have received at least one dose and 950,058 (64.3%) are fully vaccinated, according to Covid Act Now. Anybody who is at least 12 years old is eligible to be vaccinated.
The number of COVID Patients from Huntington Hospital has fallen in the last month, dropping to 20 from about 30, according to Popp. Five patients are in the intensive care unit at the hospital with COVID.
Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Children’s Hospital, described the downward trend in the seven-day average as “great news,” but added that such an infection rate is “not close to where we need to be to say we have turned a corner.”
The current infected population includes children, as “more kids are getting infected,” she said, with children currently representing 25.7 percent of all new COVID cases nationwide.
With the FDA and CDC considering approving the emergency use authorization that provides one-third of the dosage of the adult shot for children ages 5 to 11, Nachman urged residents to vaccinate their children whenever the shot is available to them.
“There is no advantage to picking the right age or dose for a child,” she explained in an email. “If they are 12 now, get that dose. If they are 11 and 8 months [and the CDC approves the vaccine for younger children], don’t wait until they are 12 to get a different dose. Get the dose now that is available for that age.”
When younger children are eligible for the lower amount of the vaccine, Dhuper also urged them to get that lower dose, which he feels “offers a good level of protection for the foreseeable future.”
Nachman said she sees the issue of weight or age bands regularly in pediatrics.
“The take-home message is to not play any games and treat the child at the age or weight that they are now and not wait for them to be older or heavier,” she suggested.
As for the next month, Dhuper cautioned that the county may show another peak, particularly with the increase of indoor activities where the spread of the more transmissible Delta variant is more likely. At this point, concerns about the Mu variant, which originated in South America and was much more prevalent in the United States and in Suffolk County in June, has decreased.
“We were seeing 5% of the cases in New York state were Mu variants and the remaining were Delta,” Dhuper said.
Popp estimated that the Mu variant constitutes between 0.1% and 0.3% of cases.
The World Health Organization has urged wealthier nations like the United States not to administer boosters to their populations widely before the rest of the world has an opportunity to vaccinate their residents.
Dhuper said the United States has contributed 500 million doses to the rest of the world this year and plans to donate about 1.1 billion doses to the rest of the world in 2022.
“I hope that other upper and middle income nations can do the same, so we can get [the shots] in the arms of those who need them,” he said.
Popp urged people to recognize that COVID is a global disease.
“We in the U.S. will not be safe until the epidemic is cleared in other parts of the world as well,” he explained in an email. “I believe it is in our national interest to help other countries fight the COVID epidemic.”
Popp said the United States has plenty of vaccine, with enough for boosters and to vaccinate those who haven’t gotten a shot.
Huntington Hospital scored a five-star rating from the U.S. Centers for Medicare & Medicaid Services in its annual 2021 hospital rankings.
The hospital, which is the only one in Suffolk County to achieve a five-star rating this year, has climbed the rankings over the last year, with three stars in 2019 and four stars in 2020.
“This is a reflection of the dedication of all the staff here,” said Huntington Hospital Executive Director Nick Fitterman. “What it means for the community is that they can get great care in their backyard.”
The top 13.56 percent of hospitals nationwide received five stars in 2021, according to the CMS website.
The rating measures five qualities, including mortality, safety, readmission, patient experience and timely and effective care. The first four categories receive a 22 percent weighting, while timely and effective care receives 12 percent.
The star rating encompasses over 100 measures CMS publicly reports, including the death rate for heart attack patients, surgical site infections for colon surgery, percentage of health care workers given influenza vaccinations, and the percentage of patients receiving appropriate recommendations for follow-up screening colonoscopy, among other measures.
“The five-star quality rating system is ultimately grounded in helping patients and their families make informed care decisions,” a CMS spokesman said in a statement. The ratings provide a general indication or what to expect in the future based on how a facility performed in the past.
Fitterman suggested that the rating reflects the hospital’s dedication to its mission, rather than focusing on achieving a specific rating.
Delivering excellence in clinical care is “the best and only strategy,” Fitterman said. “We don’t perseverate on what the rating agencies are looking for: we perseverate on what we think we’re doing for our patient.”
The improvements over the last few years have been incremental in numerous areas, including in neurosurgery and stroke care, cardiovascular care, and orthopedic care, which is ranked in the top 50 in the country, Fitterman said.
Fitterman praised the nursing staff, which he described as “first class,” and suggested that their culture is “contagious.”
While Huntington Hospital, which is part of Northwell Health System, doesn’t negotiate independently as a hospital, he said companies and payers “want to align themselves with high quality institutions and providers in their networks, because good [care] equates to less expensive care.”
After Fitterman received the news last week about the five stars, he walked through the hospital, high-fiving and fist pumping everyone from valets to engineers, to the food and nutrition workers and the doctors and the nurses.
“There was such excitement and jubilation and everyone realizes the hard work, the blood, sweat and tears, that go into the job,” the executive director said. “They put their heart into what they do. To get that public recognition was outstanding.”
Fitterman said he walks the halls each day, thanking staff for what they do and reminding them that they don’t just do their own task. They are all “helping relieve the suffering of others.”
In response to an easing of state regulations and their approach to patient care, area hospitals are relaxing restrictions about patient visitors.
Cheryl Miranda, director of Patient Experience at Huntington Hospital, has been planning the new visitation policy since the beginning of the month. Photo from Huntington Hospital
Starting this past Monday, Huntington Hospital will allow patients who do not have COVID-19 to have one visitor per day, between 2 p.m. and 6 p.m. St. Charles and St. Catherine of Siena hospitals also allow one COVID-19 negative visitor per day during those same hours.
Huntington Hospital is responding to the medical, emotional and personal need its patients have for the support of family and friends during whatever health challenges they face.
“There is nothing like having your loved one at your bedside, holding your hand,” said Cheryl Miranda, director of Patient Experience at Huntington Hospital, which is a part of Northwell Health.
Family also provides helpful information, helping medical professionals know whether a patient’s behavior is different from normal
“As a nurse, I’ve always felt that family is part of the caregiving circle,” Miranda said. “The family knows their loved one better than anyone. They will help us provide better care.”
St. Charles Hospital and St. Catherine of Siena started allowing one hospital visitor per COVID-negative patient per day starting about four weeks ago.
Stony Brook is making several changes to its visitation policy.
As of April 1, the hospital is allowing two visitors for patients in labor and delivery, for pediatric patients and for patients in end-of-life situations. This will increase from one to two.
Patients receiving same day surgical procedures will also be allowed a patient visitor until a procedure begins. The visitor is required to wait outside during the procedure and then can return during the patient’s release from the hospital.
Inpatient child psychiatry will also allow a visitor, as will cancer center and outpatient offices.
Approved visitors to Stony Brook must wear a mask that covers their nose and mouth the entire time, will have symptom checks, including thermal scanning, will not be allowed outside the patient’s room, must maintain six feet of distance and must wash their hands on entering and leaving the room.
Hospitals had generally restricted most or all patient visitors over various periods in the last year amid the pandemic to limit the spread of COVID-19. Nurses throughout Long Island and the world have used tablets, phones and other technology to help their patients connect with family members, enabling them to see spouses, siblings, children, grandchildren and friends from hospital beds that often had them feeling isolated during their health battles.
Allowing visitors, who are still required to wear masks, will help hospitalized patients feel more normal and receive the kind of support that can brighten their day while shortening their hospital visit.
A hospital employee will screen patients on their way into the hospital, asking them questions about any possible symptoms and taking their temperature.
Visitors who are COVID-19 positive can’t enter. Additionally, visitors who come in from out of the state or whom they believe necessitates a screening will have a rapid swab.
“We are not asking everyone to be tested,” Miranda said.
The hospital is spreading the word about its new patient visitor policy by changing its on-hold messages, is sharing information on TV sets and is telling families directly during virtual visits that one person at a time can come to the hospital.
Patients can determine who visits, which includes family members and friends.
“There is nothing like having your loved one at your bedside, holding your hand.”
— Cheryl Miranda
Miranda said the medical staff is well-prepared for an increase in visitors through the hospital.
“I don’t have to tell anybody in this building to follow precautions,” Miranda said. “We’ve all been through this for 13 months now and there isn’t anyone” who needs reminding about personal protective equipment, hand washing or social distancing.
Initially, Huntington Hospital workers will escort visitors to patient rooms, reminding them about safety policies.
During visits, patients and visitors are expected to wear masks. If a family member comes during mealtime or brings food, the patient can eat, but should do so at a safe distance.
Miranda, who has been at Huntington Hospital for 20 years, realizes the suffering patients and their families have endured during the pandemic.
“To tell someone they can’t be here is an awful, awful thing,” Miranda said. “My heart goes out to the families that haven’t been allowed to be here” and to the patients who “haven’t been able to have their loved ones at their side.”
Miranda has been planning this new visitation policy since the beginning of the month.
The hospital has learned numerous lessons about health care, including by providing virtual support for patients.
In addition to bereavement support groups, which have been particularly busy as families mark the one-year anniversary of the loss of a loved one, the hospital is adding a long-haul support group.
Starting on Thursday, April 8 at 2 p.m., Huntington Hospital will offer support to people who have a lingering cough, ongoing debilitating fatigue, body aches, joint pain, shortness of breath, loss of taste and smell, difficulty sleeping, headaches and brain fog.
People interested in joining that group can email Kacey Farber at [email protected].
Dr. Jean Cacciabaudo, associate medical director at Huntington Hospital and a cardiologist, will sit on the long haulers support meeting. Cacciabaudo, who had COVID-19 and has some long haulers symptoms, will attend not just for herself, but to provide the physician’s perspective.
Miranda said the bereavement support groups have helped family members amid a loss.
“It’s the beauty of humanity, when we reach out and help each other,” Miranda said. “There’s no magic solution for grief and loss. For some people, it’s just about remembering all the wonderful things they had when they had that person and sharing that with other people. It’s about not being isolated. That’s a big key.”
Adrian Popp, chair of Infection Control at Huntington Hospital/ Northwell Health and associate professor of Medicine at Hofstra School of Medicine, spoke with TBR News Media newspapers to discuss vaccinations and COVID-19. Please find below an abridged and edited version of the discussion.
TBR: Why do some people have a stronger reaction to a second shot?
POPP: These two vaccines are very well tolerated. Yes, there are some side effects after getting the shots. Indeed, even in the trials, it has been shown that the second shot is sometimes more prone to have side effects. There is pain, tenderness at the site of the shot. Sometimes people can get fatigue, fever and even a chill. It is rare to have something more severe than that … From my experience, most people tolerate them well, including the second shot.
TBR: Should people try to take at least a day off, if they can, after the second shot?
POPP: That is not necessarily unreasonable. A lot of my colleagues did take the shot later in the afternoon and then go home and rest for the evening. If you can afford to have a day off the next day, that’s probably not unreasonable.
TBR: Does having the vaccine free people up to interact with others?
POPP: What we know from the Moderna and Pfizer trials is that the effectiveness of the vaccination is 95 percent to prevent symptomatic disease … Can a vaccinated person develop a light form [of the disease]? In theory, yes. There are not completely safe in [not] transmitting the disease to someone else.
TBR: Have the Black and brown communities, which have been somewhat resistant to taking the vaccine, been included in the clinical studies?
POPP: Those studies with Pfizer and Moderna included these populations. They are well represented in these studies. There’s no significant difference in the side effects in African Americans, or less efficacy in the Black and brown communities …. [The Black and brown communities] should feel comfortable that it’s as safe or as efficacious as it is in a Caucasian person.
TBR: Have people from the Huntington Hospital or Northwell community asked you about the safety of taking the vaccine?
POPP: I do have conversations like this every day with different members of Huntington Hospital [as well as] the community at large … I bring up one very recent study that will probably help in kind of showing a few things. I’m going to bring in Israel, a smaller country with a centralized health care system that has been very good in vaccinating people …. More than 50 percent of their population has received the COVID vaccination. Specifically, the senior population, 65 and above, has received the vaccine in percentages even higher … In a study in the New England Journal of Medicine of more than 600,000 people who received the vaccine, [they] compared the incidence of COVID without the vaccine. They found the protection is more than 90 percent … That tells us the vaccine is very effective.
TBR: What do you hear about the Johnson & Johnson vaccine?
POPP: The best thing about the [J&J] vaccine is that it’s only one shot and the second thing is that it can be stored at normal temperature compared to the other vaccinations [which require deep freezing] … That allows it to be distributed more easily … It will probably be a good vaccine as well.
TBR: After the shots, what is the immunity?
POPP: After the first shot, approximately a week or two weeks after the first shot, you develop quite a significant level of antibodies. There is a certain amount of protection. With the second shot, the level of antibodies shoots up probably 10 times higher than after the initial shot … Full immunity is one week after you receive the second shot.
TBR: Some reports suggest that people who have COVID and develop antibodies may only need one shot. Is that true?
POPP: There are infectious disease experts looking into this. We do know that after getting COVID, you do develop a certain level of antibodies … That varies widely from person to person … The jury is still out on this one. Truly, we have to look at it in a more scientific way. We’ll find out if this will be an option down the road. At this point, as the recommendation stands, you do have to get both shots, even if you had COVID disease before.
TBR: Do we know more about why one person gets very sick and another has only mild symptoms?
POPP: Up to 50 percent of people who get COVID are either asymptomatic or have really minor symptoms. There are risk factors for developing a serious disease. We know that obesity, hypertension, diabetes and specifically certain immunocompromised conditions are risk factors for more serious disease. I have seen older people in their 90s who do have a mild form of the disease, then I’ve seen somebody in his 40s who has very severe disease … There is no real good way of saying who will develop a more severe disease versus somebody else who will have a milder form.
TBR: What about the aftereffects of COVID?
POPP: I have seen quite a few cases of people who … develop quite severe symptoms. On the milder end, people have a loss of taste and smell. This can last for some time … From my experience, most people will recover from this. On the other hand, people with more severe illness, people who get hospitalized, I have to say that the virus can take a significant toll on that person. I have seen patients who have lost 20 to 40 pounds over a period of a month or a month and a half … Recovering from such a hit of being sick for such a prolonged period of time takes a toll on people. Some patients also develop some degree of cognitive impairment.
TBR: What keeps you up at night?
POPP: Even though [the infection rate] is coming down in New York, it is still not insignificant. It’s still an issue. Until we get … a significant number of our population vaccinated, we’re still going to be in trouble … The only way we can stop the whole thing is by vaccinating as many people as we can.
St. Catherine Chief Nursing Officer Mary Jane Finnegan gives a flu shot during a free mobile clinic at the end of September. Photo from St. Catherine hospital
They lost patients, sleep and time with their families and yet, through some of the most difficult conditions in over a century, they persevered, brought together by the shared goal of saving lives threatened by the pandemic.
The Times Beacon Record Newspapers is pleased to honor the health care workers who put themselves in harm’s way to offer comfort, cures and solutions for COVID-19.
State Sen. Jim Gaughran (D-Northport) described health care workers as “heroes beyond belief.” He added, “There are folks who have gotten sick and died, simply because they were just doing their jobs.”
Unusual Requests
Indeed, in some cases, these health care workers took on tasks that aren’t typically a part of their job description or training.
Tricia Coffey on the phone at Huntington Hospital. Photo from Coffey
Take Kristen Thomas, a registered nurse at Mather Hospital in Port Jefferson. A priest came up to her in the halls of the hospital to ask for an unusual favor. A person had died and the family, who couldn’t be by his side, asked for last rites. The priest knew he couldn’t enter the room.
He asked, “Would you mind taking holy water and anointing the patient?”
She approached the patient, made the sign of the cross and prayed, as the priest stood outside the door.
“A moment like that, you never really plan to do that,” Thomas said. “We tried to give the family a little bit of closure. They didn’t get to attend the normal [rituals].”
For the community and health care workers, normal took on new meaning, especially in the first few months of the pandemic, when Suffolk County became an epicenter of the virus.
With family unable to sit by the bedside, nurses often stepped up, holding up iPad and phones so the family could spend time together virtually.
Marilin Dilone, Emergency Department nurse at Stony Brook University Hospital, called the young family of one of her patients.
Marilin Dilone, emergency department nurse at SBUH decked in full PPE gear. Photo from SBUH
His wife “put the baby on the phone — the baby looked like he was maybe 10 months old. The baby was making noises. I swear [the patient] opened his eyes. The wife is crying. Such a moment, we take for granted. He could hear her say, ‘I love you.’ To be able to provide that was very humbling for me.”
Like Dilone and so many other nurses, Robert Collins, a nurse at Mather Hospital ,shared how he held an iPad up to patients whose conditions were deteriorating so they could say goodbye to their families.
He had to stay in the room because some of the patients couldn’t hold the iPad.
“You do that once or twice, it kind of sticks with you,” Collins said.
Deep Connections
The connections the medical staff made to the families of patients extended well beyond the typical interactions.
“We had patients for an extended period of time,” said Patricia Coffey, nurse manager of the Critical Care Unit at Huntington Hospital.
Coffey, who spent 11 weeks actively caring for patients as her managerial duties “went to the wayside,” said the staff talked to families for extended periods of time. She spoke with some families daily, spending as much as two-and-a-half hours each day on the phone.
The nurses felt like members of the family because the normal support system couldn’t provide bedside support.
“You were channeling the family to the patient,” Coffey said. The nurses were “rooting so hard” for the patients.
When one of those patients who was in the hospital died after a long battle, she said it was “unbelievably heartbreaking — you felt like one of your own family members had died.”
She still keeps in touch with family members.
Mather Nurse Robert Collins. Photo from Mather
Coffey said one of her neighbors was admitted to the hospital with COVID and was on her floor. Coffey’s children and her neighbor’s children grew up together and their daughters were friends.
She not only spoke with his wife every day during her 60-hour weeks, but she also called her coworkers over the weekend to ask how he was doing.
The conversations with the neighbor’s wife were “a little hard. I wanted to be honest with her. He was very critical. At the same time, I was trying to be hopeful. It was a hard balance.”
Coffey said he was “one of the lucky ones who survived.”
Dilone of SBUH described how the work was more physically demanding.
She would “try not to ask for people” as she didn’t want to expose others if it wasn’t necessary. “You are taking care of patients more by yourself, turning them and doing chest PT [physiotherapy] — it was physically more demanding,” Dilone said.
Dark Moments
Watching patients who died took its toll, even on people who have been in the medical profession for decades.
MaryJane Finnegan, chief nursing officer at St. Catherine of Siena Medical Center in Smithtown, described the unusually high number of people dying from the virus. The hospital was running out of space for the dead. The morgue was filled and an additional refrigeration truck outside also filled quickly.
Mather Nurse Kristen Thomas. Photo from Mather
“One day, eight people died — usually in a week, you can have eight people die, but not eight in a day,” Finnegan said.
Nikki Fiore-Lopez, chief nursing officer at St. Charles Hospital in Port Jefferson said a nurse was present for the death of her mentor. Watching her die was “one of the darkest moments” for the nurse, Fiore-Lopez said.
Many medical professionals encouraged their patients to fight through the worst of the virus.
Stony Brook’s Dilone stayed with a patient whose blood oxygen level kept dropping. She wouldn’t let him fall asleep because she was worried he’d get intubated. She reminded him of his family and that he needed to help himself.
“I felt like Nurse Ratched,” Dilone said, referring to the dreaded nurse from the movie “One Flew Over the Cuckoo’s Nest.”
Dilone spent hours with this patient. Later, a doctor told her keeping the man awake prevented him from getting intubated.
Unexpected Challenges
With a virus no one had battled before, health care workers had to be flexible, learning about everything from new protocols for admitting patients to the latest and best treatments.
Chief Nursing Officer at St. Charles hospital Nikki Fiore-Lopez delivers flowers to patients at Christmas with Foundation Board Chair member Doug Casimir in 2019. Photo from St. Charles
The staff had to confront the “speed with which everything changed,” said Dr. Eric Morley, associate professor and clinical director in the Department of Emergency Medicine at Stony Brook University’s Renaissance School of Medicine. “Every day, there were new protocols, new ways to deal with things.”
Hospitals had to create a forward triage system to deal with the flood of COVID patients amid all the other potential emergencies hospitals routinely have.
These efforts required hundreds of employees to “get on the same people to sort people out,” Morley said. Training staff to manage the flow of patients required constant communication.
Even some of the smaller elements of managing the crisis took Morley’s time, such as getting new traffic signs to direct people to an alternate site.
Hospital managers were continually confronted with numerous unexpected challenges.
Ken Roberts, president of Mather Hospital, said the hospital had to ensure the PPE was hospital grade and not counterfeit.
“There were a lot of suspicious and unscrupulous suppliers when supply and demand was unbalanced, and everyone was in crisis,” he explained in an email.
Health care workers tapped into their personal skills to connect with patients.
Angel Figueroa, a registered respiratory therapist at SBUH who grew up in New York City and learned Spanish thanks to his Puerto Rican heritage, walked into some rooms and spoke Spanish to patients.
When he greeted patients in Spanish, “I would see their eyes open up [and think], ‘Somebody understands me.’”
They would ask him numerous questions, particularly because the medical information came at them so quickly.
Mather’s Collins described how the routine changed so dramatically the moment he arrived at work.
Mather President Ken Roberts holds a sign thanking health care workers. Photo from Mather
“Rapid response bells were going off as soon as you walked in,” he said. “You didn’t take your coat off” before patients needed attention. “People were not doing well. That was happening more frequently than before. That was an adjustment.”
On the other side of the struggle, health care workers felt a tremendous sense of relief when patients continued their recoveries at home.
“When people were discharged, the staff was thrilled,” St. Catherine’s Finnegan said. “We’d play the [Beatles] song, ‘Here Comes the Sun.’ A lot of hospitals did that. People would gather as many as possible to wish the person well as they were wheeled out.”
Teamwork
Through the difficulties, though, Morley appreciated the support from the community and the families, along with the teamwork and camaraderie from so many departments and staff that all pulled together.
Roberts expressed similar sentiments.
“I was extremely pleased at the teamwork displayed by all hospital staff during the height of the pandemic,” he said.
The Mather president was also grateful for the letters, cards, donated meals, handmade masks and donated PPE.
“The local communities we serve gave us and continue to give us tremendous support and encouragement,” Roberts said. “That has meant so much to the staff to know that the community was supporting them and recognizing their efforts.”
Stony Brook Respiratory Therapist Angel Figueroa wearing mask and shield. Photo from SBUH
Coffey, from Huntington Hospital, was impressed with how, even amid such extraordinary and challenging times, numerous groups collaborated.
“In many ways there were positive things — the community, the team, everyone working together,” she said. “Parts of it were so uplifting. As hard and as difficult and sad and heart wrenching [as it was], so many other parts, you just saw such humanity. It was amazing.”
Lasting Thoughts
Finnegan said the staff was incredibly appreciative of all the food local restaurants donated.
In fact, some of them joke that they gained the “COVID-19,” referring to the weight they put on while they were working numerous shifts and benefiting from all the donated food.
Morley “rediscovered” Twinkies during COVID in the break room. He has since been able to lose the weight the snack cakes added.
While gyms were closed, Collins relieved stress by buying a 400-pound tractor-trailer tire that he flipped up and down along his driveway. He also took a sledgehammer and “beat on it.”
The exertion would make him tired enough that the stress would dissipate for the day.
Dr. Eric Morley from SBU participates in COVID testing. Photo from SBU
Ultimately, what made an ever-expanding job — that affected so many aspects of health care workers’ personal and professional lives — manageable was the shared sense of purpose and the inspiration people drew from each other.
“The fact that the staff was out there doing it” helped give her energy, St. Charles’ Fiore-Lopez said. “We had patients to care for, we had shifts. We had days and weeks and months to get through. They put one foot in front of the other and I needed to do the same.”
Morley appreciated the way the Stony Brook staff pulled together during an intense and challenging time.
“Although it was grueling, it was a special thing to go through with that group of people,” he said.
Huntington Hospital has been recognized with American Heart Association’s Mission: Lifeline gold plus award for its high-quality care of people with severe heart attacks. The hospital earned this distinction by providing life-saving, time-sensitive patients who experience ST Elevation Myocardial Infarction (STEMI), the most serious type of heart attack caused by a blockage of blood flow to the heart. National guidelines recommend that balloon angioplasty be performed within 90 minutes or less of arrival to the hospital.
This is the first time the hospital has achieved the gold designation; Huntington Hospital received the silver award last year.
“This achievement was made possible through Huntington Hospital’s partnership between its emergency department and cardiac catheterization laboratory teams, as well as our strong relationship with our community first responders,” said Lawrence Ong, MD, vice president of cardiology for Northwell Health’s Eastern region and chairman of cardiology at Huntington Hospital. The hospital has two cardiac catheterization laboratories as well as two electrophysiology areas
Treatment done this quickly has been made possible in part through the hospital’s use of the LifeNet system, which allows first responders to securely send important health information Electrocardiograms (ECG) to Huntington Hospital’s emergency cardiac team so they can mobilize to help the incoming patient.
For more information about Huntington Hospital’s cardiac services, call 631-351-2000.
Mather Hospital changed its visitation policies Nov. 23. File photo by Alex Petroski
This story was updated Wednesday to include Stony Brook University Hospital.
Amid increases in the percentage of positive tests for coronavirus, Northwell hospitals including Huntington Hospital and Mather Hospital have changed their visitor policies.
Effective on Tuesday, Nov. 24, Mather Hospital has suspended patient visitation, including the Emergency Department and Transition Care Unit.
The exceptions for visitors include patients for whom a support person is considered medically necessary, including people who have intellectual or developmental disabilities and patients with cognitive impairments, including dementia.
Additionally, patients in imminent end-of-life situations may be allowed a family member or legal representative as a support at the bedside. The Department of Health defines imminent end-of-life as a patient who may die within 24 hours.
Pediatric visits in Emergency Departments are limited to one parent or guardian. Adolescent psychiatry, meanwhile, is limited to one parent or guardian between 3:30 and 4:30 p.m. and 6:30 and 7:30 p.m.
Visitors must meet several criteria at Mather. They have to be 18 years old or older, have not been exposed to COVID-19 and be screened for symptoms. Visitors also have to wear appropriate personal protective equipment. Those who don’t wear such PPE won’t be permitted in the hospital.
Visitors will have to stay in the patient room during the visit. When they leave the room, visitors will remove their PPE, wash their hands and leave the hospital. Visitors should not be in the room during aerosol-generating procedures.
Patients can choose who can and can’t visit and may select priority support people.
A view of the front entrance to Huntington Hospital on Park Avenue in Huntington. File photo
Huntington Hospital
Meanwhile, at Huntington Hospital, all visitation, except for extraordinary circumstances, is suspended, effective Nov. 30.
The hospital has experience an increase in cases, although the total numbers remain low, with fewer than 20 people hospitalized with COVID-19 as of Tuesday.
“Social Distance and mask wearing by the community is critical,” Nick Fitterman, Executive Director at Huntington Hospital, said through an email.
One support person for patients in the Center for Mothers and Babies may remain throughout the hospital stay.
Outpatient Radiology services are canceled, effective Nov. 30.
Huntington Hospital’s surgical services are fully operation. The staff will take COVID-negative surgical patients through the hospital’s safe pathways.
The hospital strictly enforces universal masking, protective eyewear, hand hygiene and social distancing.
“We remain confident in these practices, and that they will protect our patients from COVID-19 while in the hospital,” Fitterman said.
File photo
Stony Brook Hospital
Starting on Friday, Nov. 27, all visitation is suspended except for patient support persons or family members and/or legal representatives of patients in imminent end-of-life situations.
Hospitals will permit a patient support person at the bedside for patients in labor and delivery, pediatric patients patients with intellectual and/or developmental disabilities or patients with cognitive impairments including dementia.
Prev
