Ob/Gyn Dispatches During COVID-19: Dena Goffman, MD
Each day during the COVID-19 pandemic, we'll share an update from a member of our team in the Department of Obstetrics and Gynecology at Columbia University Irving Medical Center. Today's note is from Dena Goffman, MD, Chief of Obstetrics and Associate Chief Quality Officer for Obstetrics at NYP/CUIMC.
As I look back on the last 12 weeks it feels surreal.
In retrospect, I realize that I was learning about COVID-19 before it was officially on our radar, as I managed my healthy, 43-year-old brother Devon, my only sibling, with an illness that behaved like nothing I had ever seen. I did this over Facetime multiple times each day and night for two weeks in late February after urgent care sent him home repeatedly without even mentioning coronavirus. If testing had been available then, he might have been the first case in the borough of Queens. He is okay now, with some residual shortness of breath and lots of antibodies. It was scary, and I’m not entirely sure that I did the right thing by keeping him at home. I can’t even bear to think about what could have happened.
On Friday, March 6, I sent an email to staff sharing some minor planned changes. We were cancelling patient tours and childbirth classes, recommended watching a donning/doffing video, and I closed with a promise to keep everyone posted as this situation “continues to evolve quickly.” I had no idea where this was headed. I felt uncertain and afraid - afraid for my own family, afraid for all of us, and afraid for our patients.
While it wasn’t a conscious decision, instead of allowing my fear to get the better of me, I realize now that I went into action mode. Those of you who know me well know that this is what I do. The more chaotic things around me get, the more focused I become. I began the process of learning anything that I could to understand this new and terrifying disease, trying to understand what might be next, and thinking critically through how to best keep everyone safe. Because safety is what I do - right?
On March 11, I began to send daily emails in an effort to share our developing plans for obstetric care during a pandemic. We quickly met as multidisciplinary teams and did drills to try to prepare. On March 13, we had our first COVID-19 positive pregnant patient, and we learned together how to care for her as her illness progressed. On March 15, I moved into the basement at home, self-isolating in an attempt to keep my family safe as the potential gravity of the situation became more real to me. The next week, we had two of our previously asymptomatic OB patients become critically ill with COVID-19. We took outstanding care of them, but had many team members exposed in the process. I was devastated. Learning from these cases, we advocated for many changes that weekend, all of which were quickly operationalized, including universal SARS-CoV2 testing, dramatically increased PPE use, and previously unfathomable visitor restrictions.
What ensued over the next six weeks was nothing short of amazing. I watched our department come together in a way I could not have even imagined. Many, many people were redeployed and worked outside of their comfort zone willingly, always asking what more they could do to help. People working in their usual areas were asked to go above and beyond their typical duties and did it with excellence. Our department provided invaluable information to others throughout the country and beyond, through manuscripts, webinars, and personal communications, to help them prepare for what to expect and how to care for pregnant women during the COVID-19 pandemic, while also advocating for pregnant women in our own state of New York. We accomplished all of this while continuing to provide outstanding, safe, high-quality care to all of our OB patients. We indirectly supported multiple other NYP services by consolidating two obstetric services within one location and opening our own OB-ICU, while we watched the pandemic peak with our institution at the epicenter.
As I reflect now on this experience, I am so grateful for my health, my family’s health, my colleagues' health, and for this incredible women’s health family. I am so proud to be a part of this huge, collaborative team and of all that we have accomplished. I am hopeful as we look towards the next phase, a renewal phase. I look forward to a time when we can be together again. I miss seeing all of your faces in person. I will anxiously await the time when we can be together to celebrate the lives lost during this challenging time, and also celebrate the incredible successes that we have achieved together.
Dena Goffman, MD