In the second year of his psychiatry residence, Ridgefield resident Ryan Flanagan was temporarily moved to a medical floor to help treat COVID-19 patients at Montefiore Medical Center in the Bronx.
Contributed photo /Until late April, Ryan Flanagan’s work shifts followed a traditional pattern for a doctor serving the second year of a psychiatry residence at Montefiore Medical Center in the Bronx.
“Second year is spent rotating through different psychiatric sub-specialties,” said Flanagan, a 31-year-old Ridgefielder. “I was on my child-and-adolescent rotation, treating patients as a psychiatrist. I was working as a consulting psychiatrist at the Children’s Hospital at Montefiore, spending the day seeing medically hospitalized patients who previously had or developed psychiatric complaints.
“In addition, I would work overnight — as part of my ‘on-call’ duties — covering the Montefiore adult and pediatric emergency departments [and] seeing psychiatric emergencies.”
Like a plane landing on a shortened runway, Flanagan’s regular routine came to an abrupt stop last month. As part of Montefiore’s efforts to treat an overwhelming surge of COVID-19 patients, Flanagan was among the residents who had their roles reassigned.
“I was re-deployed to the medical floors at the end of April,” he said. “My initial thoughts were filled with a mix of emotions ... anxiety, fear and relief. I had been watching the curve [of positive COVID-19 cases] in New York increase over weeks and had seen that my colleagues had been re-deployed, so I knew it was only a matter of time before I was called.
“At the time of my re-deployment, all of the inpatient units in the hospital were comprised almost entirely of COVID-positive patients,” added Flanagan, a 2006 Ridgefield High grad who subsequently graduated from Gettysburg College (2010) and the Georgetown University School of Medicine (2018). “Montefiore also had converted lecture halls and outpatient buildings to inpatient beds to help manage the influx of COVID patients they were seeing.
“I felt that, at the very least, I would be able to help ease the work load that my internal medical colleagues had taken on and maybe use my skill set as a psychiatrist to help with the emotional toll that my patients and their families encountered.”
Assigned to a general medical floor, Flanagan became a first-hand witness to the wide range of severity and symptoms among COVID-19 patients.
“What stands out most from my deployment was how quickly patients decompensated,” he said. “People that you thought would be well enough to be discharged at the end of the week would get very sick very fast and often die. There were oxygen levels and lab values that were so abnormal it was shocking. On the other hand, very sick people who had many things going against them got better and went home.
“The majority of the patients I was treating had respiratory illness from COVID, so my time was spent monitoring their oxygen levels and managing their breathing status,” Flanagan added. “COVID causes many different types of complications, though. People develop significant kidney injuries, blood clots, and a whole host of metabolic problems that require close monitoring. On top of that, many of these patients had chronic medical issues (in addition to their COVID infection), which still need to be managed while they are hospitalized.”
Flanagan characterized the experience as “emotionally draining” for himself and his colleagues.
“At a very basic level you are dealing with people dying, which is hard,” he said. “Having difficult conversations with patients’ family members over the phone was also hard. There is no way to prepare for a situation like this, so being adaptable was key and adjusting to this ‘new normal’ took some time.
“It seemed like each day I cycled through a whole host of emotion — fear, hope, anxiety, doubt — that changed based on what I was hearing that day on the news or what was going on with my patients or my family,” Flanagan continued. “There is always a worry that you will transmit the virus to somebody you love.
“But ultimately, I felt proud that the psychiatry residents who were re-deployed with me were able to provide the best care possible to these people.”
Around the same time Flanagan was moved to the medical floor, a union representing nurses at Montefiore filed a lawsuit claiming that the hospital was not providing adequate PPE (personal protective equipment), including daily N95 respirator masks. A U.S. district judge in Manhattan granted Montefiore’s motion to dismiss the case last Friday, saying he lacked authority to address the nurses’ concerns.
Flanagan didn’t have a similar experience. “There was always adequate PPE, which was always changed to prevent contamination between patients,” he said.
As Connecticut and other states take steps to reduce stay-at-home policies and reopen businesses, Flanagan is concerned about the medical consequences.
“I think the most important thing to understand is that social distancing is working. It is the reason the COVID numbers have been on the decline in our hospital for weeks and the reason that the other medical specialties can go back to treating their own patients,” he said. “Although it is true that that those who are older and with multiple medical problems are at higher risk, people from all different age groups with varying amounts of medical issues have gotten very sick and died.
“Unfortunately, there is no ‘quick-fix’ for any of this,” added Flanagan, who has returned to his psychiatry residency now that Montefiore is treating fewer COVID-19 patients. “I worry that as the weather improves the urge to gather will increase.
“The hospital systems were very close to being overwhelmed — to the point where doctors from orthopedics, ophthalmology, dermatology, psychiatry, radiology, anesthesiology, neurology, radiation oncology, and urology needed to be taken off their service to treat COVID. This can happen again if we are not diligent. We are living in an extraordinary moment in our history where our actions directly impact the outcome.”