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We sit down with Marissa Lombardo, a cardiologist, to delve into her deeply moving experiences on the frontlines of the COVID-19 pandemic in New York City. Join us as Marissa shares her journey, from delivering heart-wrenching news to families over the phone to coping with the isolation and fear that gripped health care workers during this challenging time.

Marissa Lombardo is a cardiologist.

She discusses the KevinMD article, “Saying goodbye: the tragic impact of COVID-19 on families.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Marissa Lombardo. She’s a cardiologist, and today’s KevinMD article is “Saying goodbye: the tragic impact of COVID-19 on families.” Marissa, welcome to the show.

Marissa Lombardo: Thank you, thank you for having me. It’s a really special article to me, so I’m excited to discuss it.

Kevin Pho: So let’s start by just briefly sharing your story and journey to where you are today.

Marissa Lombardo: Sure. I was born and raised in Queens. I went to school in a New York City outer borough all my life, Queens and Brooklyn. Grandparents lived right by the hospital where this article takes place. I went to Hunter College for undergrad, Einstein for med school, Cornell for residency, and NYU for fellowship. So I was kind of always in the same kind of outer borough setting. I’m currently a cardiologist in North Carolina with plans to go back to New York City soon. So it’s been an interesting ride, training all over New York City.

Kevin Pho: All right, so what is it about New York City that makes training there different from anywhere else in the country?

Marissa Lombardo: I think kind of the tale of two cities, where I was in Bellevue and I was in Langone kind of at the same time. An incredible kind of community setting. For me, it’s home, so working with patients and talking to people. It’s funny, now I understand, practicing in North Carolina, how different it is to be with your own community. And so working at Cornell too was interesting, and then Einstein in the Bronx. I mean, you see everything from all walks of life in the middle of a city that has it all. So for me it was a really special experience and close to my heart.

Kevin Pho: So let’s talk about your KevinMD article, and you share a story there. It’s titled “Saying goodbye: the tragic impact of COVID-19 on families.” So tell us how this article came together.

Marissa Lombardo: So I was deployed to the Brooklyn satellite site of NYU in Sunset Park, and I wanted to go there. It’s kind of a smaller community setting in the outer boroughs, and outer to Manhattan at least. And I really wanted to be again in my community. Manhattan is kind of a major metropolis and I had had the opportunity to train there, but I really wanted to be on the ground. And so working there, there was definitely a need, and it was incredible.

I met so many young men and women who reminded me of myself. And then the two characters I discuss are a young woman who I saw a lot of myself in, and it was very hard to watch her pass away, and the interaction with her mother was difficult. And then the father, who, Sicilian Italian American, I kind of saw my own father in him.

And being deployed during COVID-19 was just insanely traumatic, I would say. It was extremely difficult, it was like something I’d never experienced before. I think as a cardiologist I went into a field where I wanted to help people and save lives in a very immediate, acute type of way. And what we saw here, we couldn’t save, I mean, April 10th was Good Friday and we had the most deaths. I remember it was a code like every 30 minutes, so it was a 12 hour shift, about 24 codes.

And it was hard. The hardest was to call the family members, aside from witnessing what had happened, and tell them what had gone on. And I really had a hard time with that, it was very hard. I think when you have difficult experiences it’s important to document them and to share them with others, because people experience that, and I think our experiences are a means of just helping others. And so when I sat down to write this it just flowed. I think I wrote it in 30 minutes and shared it with friends and family, and they said submit it to KevinMD. And I was so excited that really there were no edits coming back. It was really gratifying and it helped me a lot.

Kevin Pho: So we’re speaking at the end of November 2023, and the height of COVID, that’s kind of faded from a lot of people’s memories. So I want you to take my listeners back to that. Maybe you could share those stories about that woman who reminded you of yourself, as well as the father. Tell us their stories and go into more detail about what it was like to care for them during that time.

Marissa Lombardo: Yeah. So essentially we were in the STEMI lab and we were told, there’s this worldwide pandemic and we have to shut everything down and you have to go out to Brooklyn, we need help there. And I was happy to go.

And basically from the moment I landed, it was one tragic situation after the other. And Diana was one of the earlier patients, in fact it was probably about the first week I was there. And just the setting was, I got from Astoria, Queens to Sunset Park in Brooklyn in 15 minutes. There was no one on the streets. I was actually extremely scared that if something had happened to me on the highway, on the way to or back from work, that there would be just no assistance. I mean, EMS was not available, there were trucks full of cadavers essentially surrounding the hospital. EMS and other personnel were just not available at all, and it was terrifying.

So driving really carefully and going to work, it was about the first week I was there, and with the holiday weekend looming, it was a really hard time. And I will never forget, Diana was sick and she had a cough and she was a law student, and she called her mother and said, I’m going to the ER, maybe I have COVID.

And she was on our wards not even 12 hours and she just acutely decompensated, hypoxic respiratory failure, as so did many others. And because she was young, we really dedicated a lot of energy and attention to her and brought her over to one of the real ICUs, as opposed to the other makeshift units we had had. And we really tried to take as best care of her as we could.

But I will never forget looking in her eyes and telling her that she needed to be intubated. It was very hard to watch these patients and how kind of powerless they were, and how powerless we were. And really, barely able to get a breath in, she said, OK.

And we were so busy. Her mother had asked to FaceTime with her prior to her really getting too sick, and I just didn’t have a chance, I really was just totally inundated. And when she was intubated, at that point we just kind of had to call over for ECMO, the main NYU, get things moving quickly. And the way this virus was, it just created multisystem organ failure in a way that was so rapid, and young healthy patients, these were young healthy men and women that got very sick and died right in front of us over and over.

And so when she was there, Easter Sunday I was off, and I texted my friend to see if we were able to shift her over to get her to be resuscitated at NYU. And he said, I’m sorry, overnight she passed away.

And I actually, I try not to get too connected to patients, but I had Googled her and looked at her life and her Facebook and her Instagram and all these things, and I just wanted to connect more because I felt so kind of disconnected and overwhelmed. Which for me is not what I do. I’m an outpatient cardiologist generally, and I love taking care of patients and seeing them every 30 days if I need to, and this to me was such a strange and unfamiliar experience. So that was terrible.

And then essentially the gentleman I discuss afterwards, who goes by Goo, he had a very Italian name. And really it’s that call that they made before they walked into the ER, telling their family, I don’t feel well, I’m going to go to the ER, by the time you get home from work maybe I’ll be back, they’ll give me some inhalers or steroids.

And he got very sick very rapidly. He was really suffering, he had a very painful pneumothorax and he was in a lot of pain. We had to essentially sedate him and intubate him, and he just coded almost immediately. It was horrible.

And the worst part was calling his wife and telling her. I’m not sure anyone had kind of updated her yet. I mean, the phones were just ringing off the hook, there was no personnel, there was no one to answer. By the time I finally reached her and notified her, she was just out of her mind. And I didn’t realize I was on speaker, and when her three daughters just started screaming and wailing in the background, and realizing I just told all of them at the same time. Having no connection, no relationship with them whatsoever, I kind of wanted to say, I am so sorry, my dad is the same age and I understand, but I didn’t have the time.

And so the fact that they all were just begging me, please let me see them, please, just let me sneak in or something, and to have to tell them that they were not allowed to come anywhere near the hospital, and the last time they saw their family member would be the last time. I felt awful. I actually felt like I had kind of committed a crime, almost like I was a criminal, like inflicting so much pain on someone without any ability to offer any relief. It’s kind of a horrible experience.

Kevin Pho: Now this was Easter, was it 2020?

Marissa Lombardo: 2020, Easter 2020, was about two or three weeks into the pandemic. It was hard. And it’s a big Italian-American holiday, it’s my favorite, it’s the biggest one I think we have. And I also found that very ironic, and also the Jewish high holidays. I mean, it’s a massive time of kind of reflection and faith and connection with God across all walks of life, and to me it struck me as such a poignant time, such a landmark experience, and it was really terrible.

I wanted to go to my community. I think none of us understood that we weren’t going to be able to help, we were going to do much less helping than we thought we would do. So for me, I had to take a day off at one point. I mean, the 12-hour shifts were hard enough, and it was just continuous ICU level care, continuous codes. It was difficult. And I think really it struck me too as further horrifying in that just that piece, that people cannot come in and say goodbye. That was really hard.

Kevin Pho: And just to be clear, you couldn’t reflect, you couldn’t spend time with the family, because all around you I’m sure there were dozens of codes as you mentioned, and you had to quickly move on to the next crisis?

Marissa Lombardo: Yeah. And as a cardiologist, me and my friend who’s a cardiothoracic surgeon, Dr. Travis Geraci, he and I trained together and we were just tag teaming. We were kind of in high demand, it was us and pulmonology and ICU attendings.

And it was incredible, three weeks in, again, we had so much ignorance in regards to the kind of fluid, rapid progression of this virus, that we just kind of kept doing all we could for every single patient. And there was one morning where we rounded and it was just corpses, actually. And that was, I mean, it’s just traumatizing.

I think the only community that can really identify with that much trauma is like the combat veteran community. And I actually did a departmental presentation on that too, and that medical training, if you look at it for what it is, there were something like 20 features including cognitive dissonance and detachment, isolation, loneliness, and inability to make friends and family and see them and watch people grow. These things are all very similar.

And I think that there is, and absolutely appropriately so, there are so many things in place for men and women who experience these things, and I think that there’s less awareness and willingness to discuss it among physicians. Which is very difficult, because coming from a cultural anthropology background, which I studied at Hunter College, and kind of having so much of a pull towards narrative medicine and the lived experience of being a doctor, I was always really interested in that.

I think it’s not easier, but it’s more important for me to discuss these things in a way that allows others to process it hopefully. I myself am kind of sick of hearing or talking about COVID, I had COVID last week for instance, so, the blessing of Paxlovid and able to recover. It’s not lost on me that this is a virus that has taken many lives, and this is a serious thing, and it’s very, very serious for physicians who aren’t allowed to process it and have actually walked away from clinical medicine because of it.

Kevin Pho: Sometimes I think that some of us forget about how much of a crisis that was, especially a month or two after March 2020. And you telling that story in such vivid detail, I think it’s so important just to remind everyone what it was like back then. And you could only imagine that scenario that you describe was happening in hundreds if not thousands of other hospitals across the country.

Marissa Lombardo: Right. And further kind of powerful, I guess, and I would say emotionally overwhelming, were the fire trucks at the end of the day that would come and applaud us. I mean, New York City firefighters, police force, first responders would come and just applaud outside of the hospital, and I felt like a fraud. I felt like an impostor, who was here to do a different job, and calling families at the end of the day, being applauded after essentially kind of firing a bullet at this family, these three young women and their mom, and all this. I felt like it was very much undeserved.

I also really wanted to kind of emphasize that the first responders who do go to the homes and see that tragedy even today deserve that applause, whereas we were just, it was one of the, as a physician it was one of the most difficult experiences, further because we were just so powerless. And that’s not familiar territory for either of us.

Kevin Pho: Now that you’ve had some time to reflect on this, how has that experience, and all your experiences during the depths of COVID, how has that changed you?

Marissa Lombardo: Gratitude. That’s one word. I have so much gratitude. I’m so grateful to be a doctor who can help people every day, who can educate the community, patients, my fellow colleagues. I get that opportunity, I get to write things and express how I feel, but I get these incredible life experiences, and that’s my job, I get paid for that.

I am not sick, I don’t have family members who are sick, and that’s a blessing. So many people do not have that luxury. I always say health is wealth. As long as we’re healthy, my friends and loved ones are OK.

I further feel that it’s made me, I hate to use this because it’s not necessary to sustain trauma to be strong, but I feel like I am a stronger individual, in that I am able to have these experiences and process them and discuss them. And I think people who don’t have these experiences tend to, in a way they’re kind of cheated from that. It really forces you to look inside, and that’s scary, but it’s how we grow.

Kevin Pho: We’re talking to Marissa Lombardo. She’s a cardiologist, and today’s KevinMD article is “Saying goodbye: the tragic impact of COVID-19 on families.” Marissa, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Marissa Lombardo: Yeah. So for me, I read an article this week that almost a third of clinicians are thinking about a non-clinical career, and for me that makes me really sad, because I really wish us as physicians can come together and understand that it’s not a failure of your professional prowess. There’s a lot that cannot be solved and done, but don’t let that pull you away from taking care of people and helping people, which is kind of why we all decided to do this. Don’t let that discourage you and get you down.

I continue to help a lot of people today, and sometimes I’m tired, but if it weren’t for me being there, I know a lot of things wouldn’t maybe have happened that get to save the next life. I think that’s important.

Furthermore, to process what you’re going through and not to shove it down, because it does inevitably manifest as burnout, and when you’re burned out you really can’t help anyone. So you really have to look within and take care of yourself. It sounds rote and it sounds basic and it’s annoying to hear it almost, but it’s so important.

So I hope people that are thinking about leaving do choose to stay, and do whatever you need to do to kind of shape that career to be a little bit more to make you happy, to be more along the lines of what you want and you need in your life. But I can’t imagine not helping people. And sometimes it’s not helping them, it’s helping them get through the reality that I can’t help, and that’s OK too.

Kevin Pho: Marissa, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Marissa Lombardo: Thank you.