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“This pandemic presents a unique opportunity for senior anesthesiologists to see the benefit of accommodating the health care needs of our workforce. Just as I tried to avoid the teratogenic effects of certain cases when pregnant, we should consider the most effective ways to protect senior anesthesiologists from a life-threatening infection. When the pandemic has passed, anesthesiologists of all ages can take into account times when each of us is more susceptible than others. I hope that we will work to accommodate the age dynamics of our profession and protect each other. For now, while we still have a full roster of healthy anesthesiologists, an effort should be made to spare older colleagues who are at higher risk. After all, this is at the heart of what we do as physicians: care for and protect those who are in need.”
Becky Wong is an anesthesiologist and can be reached on Twitter @BeckyWongMD.
She shares her story and discusses her KevinMD article, “Spare older anesthesiologists COVID-19 coronavirus risk.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Becky Wong. She’s an anesthesiologist, and she wrote the KevinMD article “Spare older anesthesiologists COVID-19 coronavirus risk.” Becky, welcome to the show.
Becky Wong: Thank you for having me.
Kevin Pho: So we’ll get into your article in a bit, but first off, can you share your story and your journey to where you are today?
Becky Wong: All right, thank you. Well, like you said, I am an anesthesiologist. I’m a Chinese American, first-generation. I’m the first in my family to earn an MD degree, and I’m very thankful for all of their support and their love throughout this long journey to get where I am.
I initially thought that I would be a PhD researcher. I really loved biology, and I loved asking questions and finding answers. But when I discovered medicine, I really fell in love with the human condition, with caring for people with diseases and helping people when they need health care. So that’s why I decided to go into medicine.
I then pursued anesthesiology because of the excitement of the operating room, the compelling medical stories, and being able to save a life and make a huge difference in just a matter of a few hours. Most operating room cases, surgeries, and procedures are only a few hours, so our interaction with patients is brief but can be very intense.
Kevin Pho: So how has the pandemic affected you and your practice?
Becky Wong: The pandemic has affected us in a few ways. Now, there are a few different types of anesthesiologists. In terms of pain management, specialists can maybe move their practice to more of the telemedicine side of things. They don’t necessarily have to be just always interacting in person with patients.
For the anesthesiologists in the intensive care unit, that has taken on, not a completely different role, but a much more intense role of having these patients. I mean, that’s where the most critical patients go.
For the anesthesiologists in the operating room, where I mostly am, it has been fluctuating. Initially, there was a great decrease in the amount of surgeries and elective procedures that we were doing, and many of us were thinking that we might be redeployed to the intensive care unit or to other areas. And now, with the elective surgeries starting again, we find that we’re right back to the volume that we used to have, although there’s much more complexity now with the COVID patients, having to test for them, and knowing the proper procedures of how to keep the patient and all the medical staff safe.
Kevin Pho: So we are speaking in the third week of June, and the pandemic has been going on for almost six months now. Is there something that you know now that you wish you knew back before the pandemic started?
Becky Wong: Just that very thing that you were saying, that the pandemic is a marathon, not a sprint. We have to pace ourselves. We have to pace our resources, our PPE. Just because we have been battling and knowing about this disease for six months, it doesn’t mean that we necessarily have a vaccine. We don’t have a cure. We are learning more about the virus every day, about the best practices for treating the patients, and what might be working and what might not be. But there are still a lot of unknowns, and we really have to manage our expectations.
In terms of society, we have to be careful about reopening. I understand that there are a lot of pressures for that, and this is a very multifaceted problem. It’s just that we still don’t have a cure. And if everyone wants to rush out and have a great summer and congregate and have parties, I understand how much desire there is for that, and the closeness of physical touch, and being near family members and loved ones, but we still have to be very careful.
Kevin Pho: So you wrote your KevinMD article, “Spare older anesthesiologists COVID-19 coronavirus risk.” You wrote this back in mid-March, but tell me the story behind that article and why you decided to write it.
Becky Wong: I wrote this back in the very early times of the pandemic, before we had testing, before we knew to what extent this would really affect our lives.
So anesthesiologists, we go right into the lion’s den of the coronavirus. One of the most critical procedures that we perform is airway intubation. Now, if it’s not done properly, the patient may be coughing. If the intubation is particularly difficult, we might need to use higher-flow oxygenation, we might have to do bag-mask ventilation, and all these procedures can aerosolize the virus. Now, the anesthesiologist is the closest person to the patient and to the source of the virus, but aerosolization of the virus puts everyone in the room at risk: medical staff, nurses, respiratory therapists, and anyone else who might be there to help the patient. Now, this risk is drastically reduced with the PPE, but there’s always the concern and always the danger looming.
One of the pieces that we did know about the virus at that time was that it seems to affect the older population and the chronically ill worse than the generally healthy younger population. So there started to be some concern arising from more senior anesthesiologists, and within our department, about whether it was appropriate to have the older anesthesiologists be caring for the COVID patients if there were other people around who would otherwise be able to help. And my first thought was, of course, we need to protect those who are most at risk. As doctors, we care for people with compassion and with special care, focusing on their needs all the time, and it should be no different with each other, with our colleagues.
I think that I was particularly feeling that vulnerability and that need for special accommodations because I had just had a few pregnancies. I had a few babies, and I went through the pumping and the breastfeeding. And so during those times, I had to find the courage to speak up for myself and to ask for special accommodations, whether it would be avoiding certain teratogenic exposures or having extra breaks to pump. And so I felt at that time we needed to have that compassion and understanding for each of our colleagues, that there are certain times when each of us is more vulnerable than others, and when we are able, we should be able to step up.
Kevin Pho: So after writing that opinion piece, what was the reaction of both the older anesthesiologists and the younger ones?
Becky Wong: You know, no one has, well, actually, some people have come up and mentioned it to me. I think that as a department, I was very proud of our stance that we definitely did not force anyone to be on the special COVID airway team. And we had, in our area, the luxury of having enough staff, so we weren’t necessarily deployed to other areas. So I was very proud of our department, of our hospital, for protecting people when they needed the protection.
Kevin Pho: So as you mentioned before, we are reopening, for better or worse. So from an anesthesiology standpoint, can you predict what the next three to six months will look like?
Becky Wong: I think that predictions are difficult. In the beginning, our area seemed like it was going to be pretty hard hit, and for whatever reason, we were able to socially distance well. Maybe it’s just because we’re very high into technology here where I am, and we were able to get right onto telemedicine and telecommuting, to just tele-everything or virtual everything, and I think that that helped our area.
I think that for each of the locations, it’ll be different based on what kind of gatherings there had been recently, how much people are kind of packed in together, whether it be very urban or very spread out. For anesthesiologists, I think that we will continue to be at the front lines along with other specialties, but we will be the ones to be called on for intubations. We are in the intensive care unit, and so we will be intimately involved with caring for COVID patients.
Kevin Pho: So let’s take a step back. I was wondering if you could share with my audience something that you’ve been curious about or something that you’ve been passionate about recently.
Becky Wong: I have been thinking about how we will view the pandemic in 20 or 30 years. Is it going to be like how we view polio now? Will turning patients prone for better ventilation of their lungs be like the iron lung of polio? I wonder about what the treatment will eventually be, and what the cures are, and what kind of new knowledge we’ll gain about this virus and about pandemics in general.
I think about what our children will think of the pandemic. Will they look back on it? And I think about the teenagers looking back on it. Will they be resentful of the times that they’ve missed, the graduations, the proms, the college parties, and what the pandemic took from them? Or will they see it as kind of a mixed blessing of being able to reconnect with family members and having that time to be at home?
And finally, I think about the families of patients that we lost from the virus, and how they’re able to grieve when they can’t even visit them in their final hours, and how they will be able to move forward when there’s still so much isolation from having to socially distance.
Kevin Pho: Well, thank you so much for sharing your insight. We are talking to Becky Wong. She’s an anesthesiologist, and she wrote the KevinMD article “Spare older anesthesiologists COVID-19 coronavirus risk.” What’s your take-home message for the KevinMD audience?
Becky Wong: I think really the spirit of the piece that I wrote is that we need to be kind and compassionate to our fellow people, our colleagues, anyone we meet. We don’t know how this virus is affecting each person. What we think we know about someone is really just a snapshot of their life. And this idea of showing more compassion to everyone can be applied everywhere, in anything, whether it be the pandemic or standing in solidarity with our fellow races and people from all backgrounds.
Kevin Pho: Well said. Becky, thank you so much for joining me on the show.
Becky Wong: Thank you very much for having me, Kevin, and thank you for all the great work that you’ve been doing.
Kevin Pho: All right, thank you.
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