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“COVID was ominously not only drowning people in their own spit but struck in different shades to alter human personality that kept helplessly getting lost in the maze of their own minds. It made the young maniacal, hearing voices and talking to walls in a schizophrenic frenzy. It made the elderly become muted in silence.
The face of helpless madness. Every now and then, the balm of soothing whispers would lull them to slowly break free from this trance.
This strange malady kept fogging up brains behind the faces. Faces of disintegrating seizures. Faces staring into oblivion. My penlight shining down dark pupillary tunnels, in vain, felt futile.
And then there were other faces. Of hospital caregivers, faithfully grooming seemingly lifeless bodies. I would feel enriched when they shared on my rounds, updates from up close, and personal patient care moments.”
Ayushi Chugh is a neurologist.
She shares her story and discusses her KevinMD article, “Unmasking the faces of COVID: pages from a neurologist’s diary” and “The science of compassion.”
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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. Here on the show, we have Ayushi. She is a neurologist, and she wrote a pair of KevinMD articles: first, “The science of compassion,” and second, “Unmasking the faces of COVID: pages from a neurologist’s diary.” Ayushi, welcome to the show.
Ayushi Chugh: Thank you for having me. It’s a pleasure to be here, and kudos to you on this platform for having us, giving a voice to health care professionals.
Kevin Pho: Well, thank you so much for writing and sharing your story, and we’ll get into your articles in a little bit. But first off, can you share your story and journey to where you are today?
Ayushi Chugh: I am currently a neurologist with specialty training in neuromuscular medicine, working in the role of a neurohospitalist in a community hospital in the Phoenix metropolitan area.
How I got here: I was born and raised in New Delhi, India. I did my medical school training in India, followed by a pulmonary medicine specialization, and worked in an ICU for about a year. That’s where I developed some interest in neurology cases. And as destiny would have it, after I moved to the U.S., I pursued neurology residency at New York Medical College in Valhalla, New York, followed by a neuromuscular medicine fellowship at Hospital for Special Surgery at NewYork-Presbyterian Hospital Weill Cornell Medical Center. And from there is where I am here, in my job as a neurologist.
Kevin Pho: Tell me what you think right now are some of the biggest challenges facing neurology today.
Ayushi Chugh: I think the biggest challenges that we as neurologists faced were more in the outpatient world. With my peers, when I discussed with them in our teams, it was tough to do the neurological exam over Zoom. So that was a lot of hurdles we faced, but we came together and found some tricks of the trade that we shared with each other.
In my role as a neurohospitalist, it was hard. I couldn’t be on a screen with a patient who is on a ventilator or a BiPAP or even a non-rebreather, really trying to get a story. So just having to be up close and personal was how we had to kind of go with the flow and figure out how we would, maintaining social distance, do the neuro exam or a stroke code, where we didn’t have to go through the documented NIH Stroke Scale, but we had to come out through, no, tricks of the trade for how to get around getting our information. And with the masking, we were trying to get all our points in from a distance. We would make this curved diagram in which we would stand on different sides and ends of the bed and try to gather our data as a detective, as much as we could.
So I think in the outpatient world as well as the inpatient world, getting our neuro exam, which was the essence, was a learning curve for all of us. For getting our patients in who had transportation issues, I think Zoom and the virtual world helped a lot there. So there were silver linings too, as well as some difficulties. But all in all, I think we’ve come a long way from where we began.
Kevin Pho: And you share some of those experiences in the KevinMD articles that you wrote. The first is “The science of compassion,” and the second is “Unmasking the faces of COVID: pages from a neurologist’s diary.” Now, for those who didn’t get a chance to read those articles, just walk my audience through, I guess, the first one, “The science of compassion,” and share the story of why you decided to write it.
Ayushi Chugh: So “The science of compassion” was the title I wanted to give to the essence of the practice of medicine. In my role as a frontline neurologist, I was able to eyewitness firsthand all the havoc that COVID was causing, and at the same time see my colleagues, my peers, nurses, etc., be so resilient in this time of tragedy. And I wanted to come back home and, for self-care abuses to begin with, journalize it down. And then I felt I needed to resonate this with the community: what lessons we were learning on the pandemic front, out outside the hospital walls.
And in that, I felt that we were dealing with a lot of skepticism, a lot of cynicism initially, in the early periods, with scientific reasoning. By day, we would be taking care of patients, seeing them at their worst, and by night, every breathing, every waking moment, our main goal would be to come back and gather information as much as we could in a very fast-changing scenario, and yet try to dispel misinformation and create awareness, so that we could keep as many people out of the ICU as possible. And we kind of felt that our profession is very different. It’s not just our skill, not just our art, but we have ethics and empathy as an added commodity, which is the science of compassion to it all.
During this time, when the first article came out in the fall, our end of the planet was going through a lot of social and political upheavals as well, if you remember. So it wasn’t just on the medical front that COVID was causing havoc; there were these political upheavals. And one felt that COVID as a virus does not discriminate. No one is immune to it based on, say, color or your bank balance or your religion. It affects you, it affects you equally, and no one is immune from it.
We as physicians, though we as humans get caught in these rhetorics of politics and divisiveness and social dilemmas, we do not discriminate who comes in through the door. At the end of the day, our treatment remains as per the Hippocratic oath, of course within the resources that we have in a particular community. We treat every patient regardless of their polarizations, regardless of their viewpoints or opinions. So we have to lead by example, that if we do not discriminate, standing steadfast in the face of this virus that does not discriminate. The doctor-patient relationship is a lost value, is losing value.
And as you know, every relationship is two-sided. So the patients also, we must remember, have a duty: that if they are lucky enough to get past this tragedy, they do not minimize or undermine the whole scenario, and they do come out in the community and encourage compliance. And that is how we will perpetuate the common good.
Interestingly, there were a few cases of patients that, even after coming off the ventilator or getting extubated, would ask, “Doc, are you sure this was COVID and not just a bad flu?” And it would be an eye-opener as to how deep-rooted this lack of understanding of this phenomenon is, and how much we are trying our level best to explain. So that is what I wanted to go through with “The science of compassion,” using the three-pronged approach of the virus, the people, and the doctors, and the doctors in this situation to lead by example as the dossier, as the teacher.
Kevin Pho: You mentioned the lost value of that doctor-patient relationship and how COVID puts stress on that relationship. Now, as we move forward, what are some ways that we in medicine can help preserve that relationship?
Ayushi Chugh: Absolutely. I think, first and foremost, where it all began: our bedside manner. As soon as the patient enters the room, or we enter the patient’s room, the connection starts right there. So how we, even in our fast, busy lives, and we are expected to churn out a certain number of cases in a certain time span, even just a look in your eye with masking. I kind of felt that, you know, with the second article, and I’m jumping here a little bit, but even with masking, it was just the sound of your voice and the empathy, and, you know, cut to the chase, get to where they’re really hurting, and try to engage them with eye contact.
I think those are very simple skills we all learned in medical school, and we tend to get caught in the speed of our profession and how much we have to perform, so sometimes this gets left behind. And I think that that is the essence: the human touch, the human connection. That is the best way we can do this, no matter how many patients we see in a day.
And I would say that to help one’s own self, because you cannot just keep pouring from an empty cup. You have to step back, take a moment, see what you want to reinvent yourself as, as mid-career or later career or even early on, and what’s something that you can come home and get self-care abuses from. You know, the old adage, “Doc, heal thyself.” That is very, very true. We cannot go on if we do not have something to rejuvenate ourselves with every day, and then pour it out, and then come and fill ourselves up again.
Kevin Pho: Now, you talk about that juxtaposition where in the day you were a frontline clinician, and at night sometimes you have to dispel misinformation and talk to people who may not believe that COVID was real. What are some of the techniques that you use to talk to patients who disbelieve the severity of COVID, or who do not want to get vaccinated because of conspiracy theories? What’s your approach to patients who don’t believe in the science?
Ayushi Chugh: Yes, absolutely. We always come across such patients. At the very beginning, when this was all happening in the spring, we tried to do it a little indirectly, by approaching public health officials. So, joining on the bandwagon with physician friends, we all went together. We wrote emails to mayors, to public health officials, to help encourage mask mandates or just public preventive health care measures, so that it would be put on a larger scale, which would indirectly help us get people to be more compliant. So we kind of went out on a limb, outside the hospital walls, and went out into the community to do this in a very indirect way. And so then, when we started seeing people masking in grocery stores and the like, it was a sigh of relief.
But even despite that, we would still come across people that would not be so convinced. And in those moments, we could only really share with them, of course with privacy restrictions, how much we are seeing, not only in the ICU settings. I would tell them, “I’m seeing families lose their loved ones. It’s so much easier to wear a mask than to be on a ventilator or to be suffocating, and you don’t want to be that way.”
Or we would just kind of guide them that this not only has effects on the respiratory system, but it’s affecting the brain, you know, so many other multi-organ systems, and there’s so much more out there that we have seen as experiences from patients that did not do well, that we just had to bring it out to them. Just like with smokers, when we kind of show them pictures of disfigured faces or lungs, we just had to kind of sometimes really lay it out to them. The truth always helps.
And there were patients I had to tell, you know, “This ICU room that you see now, we had two patients plugged into this.” And they would be, “Really?” And we said, “Yes.” So that’s how bad it was, and it would really make them kind of think that, “Yes, I guess, doc, you are interested in getting me better.”
And I did have patients on discharge, stroke patients, that asked, “Did you get vaccinated?” And they said, “No, I think I already got it, so I don’t need to.” And I had to kind of tell them that, “I’m seeing the worst, so I’m talking in your best interest, and this is how bad it was.” And they kind of turned around.
Kevin Pho: We’re talking to Ayushi. She is a neurologist, and she wrote a pair of KevinMD articles, “The science of compassion” and “Unmasking the faces of COVID: pages from a neurologist’s diary.” Ayushi, can you talk about that second article briefly, “Unmasking the faces of COVID: pages from a neurologist’s diary”? Tell me some of the experiences that you had as a neurologist.
Ayushi Chugh: This was this role, as a frontline neurologist, that I wanted to journalize. I was seeing, everywhere, of course, we were masking in this whole pandemic, so now I wanted to take a step back and use the metaphor of unmasking the human within. I was seeing patients with stroke, with delirium, with encephalopathies of various degrees, with the lung involvements, and how it had affected them. So I wanted to write down their stories.
People would ask me, “What is a neurologist? What are you doing on the front lines? Aren’t you?” Because, you know, they tend not to really associate neurologists with being there. And I wanted to bring forth the impact on the brain that COVID was wreaking havoc upon. I wanted to just bring forth, even to other neurologists, what was going on on the inpatient side.
And not only that, I was trying to, in a way, unmask the emotional masking that all of the community had undergone in this crisis, and put a face on those masks: that they were not just numbers in the TV statistics that we saw, but these were real humans. These were families taking care of them. I would not forget the teams, the ICU teams, respiratory therapists, the nurses. They were going through tons of PTSD. They were getting sick. We were all getting, you know, sick and coming back to work after the protocol number of days.
So I knew that, you know, just like every storm, this pandemic too is going to, hopefully, yes, come to an end, and I wanted to journalize and set in stone what all these people had undergone, so that they feel validated and it boosts their morale, that what they did helped the community overall. I even actually put a printout of the KevinMD article, once it was published, in my ICU and wrote a heading, “This is dedicated to you all.” And they took copies, took it home, took it to their families, to their exes, to their kids, and they came back with tears, saying, “We felt so validated. We didn’t even know what we were going through until we read it all.” And they would be in tears.
So I felt, if I had a talent to write, I had a moral responsibility as well to use it the right way, so as to get some healing in any form out into the community. So that was the role of the unmasking article that I wanted to bring forth: bring out the face that we had hidden for so long.
Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?
Ayushi Chugh: My take-home message is, I will quote my favorite, Dr. William Osler, the father of modern medicine, in which, again, redeeming the doctor-patient relationship, I want to bring forth to society that medicine is not just the glamour that you see on TV. A lot more goes, sweat, blood, and tears, underneath it. And like William Osler, I quote, “The practice of medicine is an art, it is not a trade. It is a calling, it is not a business. It is where your heart will be exercised equally with your head.”
And to that, I add my two cents: that between the heart and the head, there lies the face, which has these intangible connections of silent struggles. So that is my message: that as we move along, let the patients realize what we are doing for them, so that they have faith in us, and may we continue on our journey, relentless and steadfast, and continue to come out more compassionate than probably how we started.
Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.
Ayushi Chugh: Thank you for having me.
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