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Dr. Phillip Cuculich, Cardiologist at Barnes-Jewish Hospital. Photo courtesy of Cuculich.

The heart of healthcare

Dr. Greg Flaker, cardiologist at University of Missouri Health Care, University Hospital

On the deeper meaning of the COVID-19 pandemic

Dr. Greg Flaker has lived in Columbia since 1968, when he came to the University of Missouri⁠—Columbia to pursue his undergraduate degree while on a basketball scholarship and later complete medical school. After finishing specialized training at the Ohio State University, Dr. Flaker returned to Columbia to work at the University Hospital where he resides today as an adjunct professor of medicine, all culminating in a 40-year long career as a cardiologist. 

Dr. Flaker said the magnitude of his experience gives him a unique perspective on the advances in medicine and cardiology, as he’s seen how they have evolved. 

“The mortality rates of heart disease in our country have markedly reduced in the 40 years since I’ve been practicing. I have in my career witnessed some fascinating developments in heart disease therapy,” Dr. Flaker said. “When I was growing up [during] high school, if a person had a heart attack, gosh, that was the kiss of death. They didn’t have much longer to live. Now, people have a heart attack, they go back to work, they’re active, they’re vigorous. And so while we have a long way to go, we have made great progress in the field of heart disease.”

Scientists are finding out the COVID-19 disease is one that predominantly attacks the lungs, Dr. Flaker said. But the disease can also weaken the heart in a variety of ways, such as making the blood vessels clog  more easily and causing a variety of cardiac arrhythmias.

At Dr. Flaker’s office on the third floor of the University Hospital, he often encounters the infectious disease specialists who work across the hall. From them, he’s learned a few other new things about COVID-19, though through a wider lens than its effects on the heart. 

“90% of your cells in your body are microbial. They’re germs. They’re in your skin, they’re in your mouth, they’re in your gastrointestinal tract, all over your body,” Dr. Flaker said. “So … 10% of your DNA, the building block of your cell machinery, is human, and actually 90% are microbial in origin.     

“Humans are the most highly evolved species on Earth, right? We’re the smartest ones, we can think, we can come up with putting people on the moon and things like that. But the microbes are all over the place. They really run the earth, even though they’re dumb, and they don’t live very long.

“I think [pandemics] reflect a life cycle in human existence. I think that life cycle is coming about because we were doing something wrong with our environment.”

Dr. Greg Flaker, Cardiologist at University of Missouri

“But people think that the microbes have sensed something wrong with Mother Earth, something’s happening. They’ve made an adjustment. COVID[-19] has come up … a way for the earth to protect itself.”

Some scientists think it would be wrong for humans to eradicate the disease with vaccines without first examining and improving its underlying meaning, which probably has to do with climate control and fossil fuel emissions, Dr. Flaker said. 

“When I heard that, I thought that was a very interesting concept, and it pretty much sums up my idea about COVID[-19],” Dr. Flaker said. “I think it’s telling us something about the global environment. Since COVID[-19]’s been around, global pollution is down 30%. So yeah, I think that’s kind of my philosophy of COVID[-19]. It’s not just me getting the vaccine and socially distancing and protecting myself, but it’s really trying to figure out how we could better preserve our Earth.”

Dr. Flaker also brings up the idea that epidemics and pandemics reflect a life cycle. The 1918 Spanish Flu pandemic, for example, infected about a third of the world’s population and killed an estimated 20 million to 50 million victims, according to history.com. There were no drugs or vaccines at that time to treat this flu strain, so the only tools people had were masks, social distancing and shutting down public places.

“Pandemics have been with us for as long as we can remember. Even in biblical times when Moses changed the Nile River into blood, apparently, or he had the locusts and destroyed the Egyptian crops, even back then people thought those were really pandemics that were starting,” Dr. Flaker said. “So they’ve been around with us for a long time. They seem to be getting more serious, but I think they reflect a life cycle in human existence. I think that life cycle is coming about because we were doing something wrong with our environment.”

Earth isn’t just a planet for humans, Dr. Flaker said; it’s one for the germs that inhabit our bodies, too. Humans need germs to digest food and fight infection, but germs need humans for a place to call home. It’s a symbiotic relationship.

“We have to be in harmony with the environment. I saw some statistics that our human population has doubled since we put a man on the moon in 1969. But there are many, many animal populations in the wild that have gone down by 50%,” Dr. Flaker said. “So, maybe humans are starting to exert a little bit too much influence, consuming more resources than we should compared to animals. And I don’t know, that environmentalist part of me wants to protect us, but also protect other animals and endangered species.”

 

Leissa Beckman, registered nurse at University of Missouri Health Care, University Hospital

On the COVID-19 vaccine and precautions

Leissa Beckman has been a registered nurse at the University of Missouri Hospital for 24 years. She specializes in cardiology and works in cardiac catheterization labs during heart catheterizations, devices implants, vascular procedures and ablations. 

“I have always been interested in cardiology,” Beckman said. “[The heart] is the most important organ in the body. It’s both simple and complex at the same time.”

Beckman said she has had to take additional precautions because of the COVID-19 pandemic, such as minimizing spending time at the head of a patient’s bed during procedures. Every day when she comes in, she has to get her temperature checked and go through a checklist of possible signs and symptoms. 

“If we don’t know [a patient is] COVID [-19]-negative, which we don’t with the emergency patients, then we have to wear the whole PPE gear with an N95 mask on, and then we put a regular mask over that. Then there’s a headpiece that has a splash guard, as well as plastic gowns and booties,” Beckman said. “There are more precautions. It’s more fearful.”

Receiving the COVID-19 vaccine is another new experience for Beckman. According to the Centers for Disease Control and Protection (CDC), one dose starts building protection and a second, administered a few weeks later, is needed to get the most protection the vaccine has to offer. After Beckman’s first shot, her only symptom was a mild headache for a couple days, and she described the pain level as “better than the flu shot.” She did have a reaction to the second shot, however.

“After I received it, about 24 hours later, I was so, so, so tired, like I ended up having to leave work, because I was just so tired,” Beckman said. “And it was a different type of tired, it was like, I couldn’t even think, and I felt like my speech was even slow. I was very dizzy and lightheaded, and then I came home and I slept for about 18 hours.”

Side effects of the vaccine may feel like the flu and affect one’s ability to do daily activities, according to the CDC, but they should go away in a few days. Additionally, COVID-19 vaccines that require two shots may not be protective until a week or two after the second shot, as it takes time for the body to build immunity after any vaccination.

Although Beckman’s role as a health care worker includes tasks such as getting the COVID-19 vaccine, this doesn’t eclipse her life-saving duties as a nurse. Beckman said the most rewarding part of her job is when someone comes in with a heart attack, scared and hurting, and the cardiology team helps them. They open the artery that, left untreated, would result in death.

“I became a nurse because I wanted to help people,” Beckman said. “I wanted to make a difference when they needed it the most.”

 

Dr. Phillip Cuculich, cardiologist at Washington University at St. Louis, Barnes-Jewish Hospital

On the emotional burden of COVID-19 on health care workers, patients and visitors

Dr. Phillip Cuculich is a cardiologist at the Barnes-Jewish Hospital at Washington University in St. Louis (WashU) where he specializes in heart rhythm disorders. He spends most of his time doing procedures, trying to correct slow, fast or irregular heartbeats. Additionally, he spends time seeing outpatients in the clinic and more critically ill inpatients in the intensive care unit. Lastly, Dr. Cuculich has the freedom to do research and invent tools to help solve problems because of his university job.

Dr. Cuculich has seen the hospital face problems and make adjustments since the COVID-19 pandemic. For example, there were shortages of ventilators as patients with the COVID-19 disease required them.

“When we saw what was happening in other cities, like what was happening in Wuhan, like what was happening in Milan, Italy, New York, we saw the healthcare resources, especially hospitalization resources, really stretched,” Dr. Cuculich said. “In parts of 2020, we simply stopped doing a lot of elective procedures.”

With a fixed number of ventilators available, many patients went months without getting elective procedures done, including surgeries or ablations. Additionally, the Barnes-Jewish Hospital had to increase the capacity of intensive care units (ICUs) “pretty dramatically.” The staffing of the ICUs that have tripled and quadrupled in size has become a “major issue” to this day, and the cardiac ICU space had to move several times to make way for more COVID-19 units. The staff taking care of these critically ill patients have had to be flexible in new situations and locations with different resources, Dr. Cuculich said.

The patients are in uncharted territory, too.

“I would say lately in the last three to four months, patients have been rather reluctant to come into hospitals,” Dr. Cuculich said. “We’ve definitely seen a resistance to the idea of having to come to the hospital for any sort of treatment, or condition. We had to get very creative for how to administer some of these treatments in a safe way but not do it inside. Where there’s fear for spread of COVID[-19], it’s been very unique from a clinical care standpoint.”

According to Healthcare IT News, 79% of U.S. specialists said their use of telemedicine technology had increased during the COVID-19 pandemic, and telemedicine is projected to continue to be used even past it. Although it’s a helpful tool for some consults, Dr. Cuculich said others need to be done face-to-face.

“Trying to understand the acuity of somebody’s disease, it’d be certainly difficult to do just on a phone call or on a Zoom telehealth meeting, because it becomes really important to be able to assess a patient and really understand how they’re doing with their conditions, look them in the eye, examine them, really try to get a sense of how severe their condition is,” Dr. Cuculich said. “So sometimes we know that some conditions may be more of a nuisance than a life threatening issue, but it’s really trying to understand which of those conditions is life-threatening or life-altering that would require a more urgent evaluation in the hospital, even in riskier situations.

“In the spring, when we had our first wave come through St. Louis, when we stopped our elective procedures, there were tens, if not hundreds, of people with heart rhythm conditions who had to wait for their procedures. During that time, we would certainly reach out to those patients on an every week or every other week basis.

“I think it’s really hard to be a patient right now. I feel for patients more than ever.”

Dr. Phillip Cuculich, Cardiologist at Barnes-Jewish Hospital

“Once those resources became available again that summer and we were able to do our elective procedures again and start treating some of these patients, our staff and our doctors did a really terrific job, I would say, accelerating their ability. That is, our typical capacity might be to do two procedures in a day in one room ⁠— we found a way to do three procedures in that day in that room in order to really try to move through that waiting list. And it was not easy. It was asking a lot of sacrifice for the staff and for the doctors to work harder and work deeper into the day, but it certainly was the right thing to do, whatever we could to try to make it so that patients didn’t have to wait extended periods of time for those procedures.”

Dr. Cuculich commended hospital leadership for making the “difficult decision” of limiting visiting hours as well as the number of visitors for patients to minimize the spread of COVID-19. Although it can be hard for them, he said, it’s well worth it to protect patients and the staff.

“I think it’s really hard to be a patient right now,” Dr. Cuculich said. “I feel for patients more than ever. Being a doctor now, in the hospital, requires being able to connect with families every single day. When you’re taking care of patients in the hospital, your day gets longer because not only are you caring for patients in a more challenging environment, but you are absolutely making sure that you call their family members every single day and give updates if they can’t be in the hospital.”

Dr. Cuculich said it’s especially important to communicate with family members of patients who are critically ill and might be in a COVID-19 unit and cannot have visitors. He said many nurses in the ICU went above and beyond in making sure family members were connected to the patients, whether it be by music, video call or phone.

Another precaution WashU implemented was offering health care workers at the hospital the COVID-19 vaccine, and almost all of them took it. Dr. Cuculich has received both of his doses, but he also volunteered to administer the vaccine. He said everyone thinks about what it’s like to get the vaccine, but it’s equally challenging for health care systems to find people to deliver the vaccines, keep track of patients and reschedule them for their next doses.

“It was really a remarkable experience, I have to say,” Dr. Cuculich said. “When people receive vaccines, some people are very tough, and it’s no big deal and it’s just another day in the office. But so many people seem to really have emotional reactions to finally receiving the vaccine. There were a handful of individuals … when they received the vaccine, many of them really broke down into tears and were almost overwhelmed by the seriousness of it all. We as doctors and nurses have really, I think, stored away a lot of our anxieties and really packed them away so that we can treat other people and not really worry about ourselves, but when you receive the vaccine, it’s a very self reflective moment. There were a lot of doctors and nurses who were really overwhelmed at that moment and really shed tears, of joy, of happiness, of a release of that anxiety that they’ve been hacking away for months in and months out. It was really a unique experience, and I’m really happy that I have to do that.”

How do you think health care workers have been impacted by the COVID-19 pandemic and its affect on patients? Let us know in the comments below.

 

 

 

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