Krista Udd (’15 MPAP) has a passion for being a physician assistant and is in the thick of the COVID-19 outbreak in New York City. Below is her story (in her own words) along with a note to the Campbell University PA class of 2020. The Campbell community thanks and prays for all of its hard working, dedicated alumni who are battling this pandemic.
My name is Krista Udd, and I graduated as a part of the third Campbell PA class in December 2015. Four years have flown by, and it seems like only a short while ago I was sitting in the third row trying to cram in PANCE practice questions and review lecture notes.
After I graduated, I went on to do a critical care fellowship at CMC in Charlotte (definitely a do if you’re interested). Since that time, I have been working in the cardiothoracic ICU at a hospital in Manhattan.
I remember my first six months in the ICU as a blur of studying physiology, re-learning EKGs …and the EMR. Most days I felt like I was in over my head, and I came home exhausted both mentally and physically. But with each day I spent in the unit my confidence grew, and now three years into my career I am one of the more senior providers on my team.
Normally, I help run a 24-bed ICU with post-op cardiothoracic surgery patients along with another PA and an attending. We have eight surgeons and do an average of five to 10 surgeries a day. However our busy OR came to a crashing halt on March 19, and since that time I have been working in the COVID ICUs in New York City.
This experience has been, in a word, surreal. I remember the day our unit was opened for COVID; I will never forget that day. We rushed all the remaining cardiac ICU patients to a makeshift ICU on a step-down floor so that negative pressure filters could be added to the rooms to prevent the virus from aerosolizing into the common areas, making our rooms safer treating COVID-positive patients. Over the remaining 10 hours of my shift, the admissions began pouring in. Most of them needed immediate intubation, some were acutely hemodynamically crashing and needed immediate central access, while others were struggling to breathe on one form of respiratory support or another.
Almost immediately my head was spinning. Suddenly I was in way over my head as if it were my first day back in the ICU. My team was overwhelmed, too. I wish I could tell you that we were able to immediately pull it together and revert to trauma triage mode like they do in the movies, safely treating every patient systematically with an air of sophistication and poise, but that was not our reality that day.
The truth is, that day our ICU fell into absolute chaos. We ran out of IV tubing, central line kits, ICU ventilators and masks with shields. Patients were arriving so quickly, there was no time to adequately evaluate them, admit them properly or call their families. It felt like a war war zone, with doctors, PAs and nurses running from room to room, treating emergencies only to be interrupted by a seemingly more pressing matter. There was a lot of yelling, confusion, frustration and fear. Fear that our patients weren’t being adequately treated, fear that we were not adequately protected and anxiety that this endless stream of patients would never end.
When the dust settled at the end of that shift, orders were not completed, consults were left outstanding, some lines still needed to be done, but every patient was still breathing. I have never been more proud of the medical team, MY team, than I was on that day. We had done our best, and though it didn’t feel like it that day, looking back a month later I can honestly say it was enough.
I walked the eerily quiet streets to work the next morning with a nauseous unease in my stomach. Could it possibly be worse? Would I know what to do? Had all the patients even survived the night? There were so many uncertainties, but when I finally arrived on the unit the nurses were signing out at the bedside, the overnight PA was printing sign-out and even Mike the x-ray tech was gowned up in a room shooting a film. My team was back, eager and ready to fight, and I was ready to join them.
The initial first few weeks that followed were unsettling and chaotic. We faced new challenges every day, our protocols changed rapidly, so much so that the morning’s plans were thrown out by the afternoon. There were mixed signals from the administration and even the government about how to protect yourself and what PPE was available to staff. One day we were only allotted masks to wear in the COVID positive rooms, the next we wore them everywhere because it was considered unsafe to be without a cover on your face.
As the patient load increased, we converted new units to ICUs and doubled the number of patients allowed in one room overnight. We borrowed ventilators from the OR, transport units and even used donated vents from long term care facilities. Supplies became scarce, we ran out of sedation, pressors and insulin. Our daily discussions shifted from identifying a patient’s medical needs to what medical treatments we could provide based on the availability of medications and supplies. It seemed unreal that in our privileged world of modern medicine we were facing similar challenges to the medical systems in developing countries.
This was never how we expected to practice medicine; COVID-19 humbled us all. However, if this experience has taught me anything about medicine, it is that as a community we are determined, creative and capable of taking on whatever challenge is put in front of us. We believe in our cause and we believe in the oaths that we took as medical providers to ease our patient’s suffering and above all else, do no harm.
My coworkers and I have shown up everyday to work to fight alongside our patients. We have stood at the bedside and watched as they succumbed to this deadly disease and shared in their families grief when we called to give them the news. We have watched as our own families, friends and colleagues have become ill but have continued to dutifully show up to work everyday to continue this fight. We have felt broken and beaten down and even hopeless at times but we have NEVER given up.
As the weeks have gone on things have started to improve. We have learned a great deal about the disease process that COVID causes and we are beginning to see more and more patients improve. We’ve created new protocols and enlisted more help in our units. I am honored to tell you that PA-Cs have stepped up from all different areas of the hospital to help the ICU teams. They have shown tremendous courage and resilience as they work long hours, nights and weekends alongside us in the units. Many of them have been put out of their comfort zones, but have thrived in this demanding and stressful environment, a true testament to their skills and training as PA-Cs.
I am grateful for every one of them who has volunteered to join us.
To the PA class of 2020:
I want you to know that you are entering a work force of colleagues who believe in you and welcome the arrival of your help to their cause. Know that the challenges you face may be overwhelming at times, remember you are stronger than you know and you will get through them. Be flexible. Change will be inevitable throughout your career.
Many things will be out of your control, learn how to achieve your goals within the system that is already in place and be creative in your solutions. When you are stressed or falling behind, adjust the expectations that you have set for yourself and for your colleagues. Simply do the best that you can each and every day, it will be enough.
Remember that you are a part of a team, no task that ultimately helps your patient is out of your job description or beneath you, whether it be helping nurses turn a patient or even taking out the trash. Support your team, empathize with them, I can promise you there will be a time when you rely on their support in return. Remember that caring for patients is an honor and that the oath you took is meaningful, at the end of the day we are all here to help our patients in whatever way we can. Believe in yourself and what you have sworn to do.
Remember that showing up willing to learn is far more important than having all the answers. Remember to ask for help when you need it. No one is in this fight alone. And finally, remember that you have a strong foundation of knowledge and a supportive PA family as an alumni of the Campbell PA program.
Best of luck! (Though I know you won’t even need it)
Krista Udd, PA-C