COVID-19 Planning and Workforce Survival: Women Leaders in Critical Care, Ep. 1

This podcast series aims to highlight the women leaders in critical care medicine. Moderator Jaspal Singh, MD, MHA, MHS, interviews prominent women making waves in their field and breaking the glass ceiling. Listen in to gain insight on the leadership lessons learned.

Episode 1: Moderator Jaspal Singh, MD, MHA, MHS, interviews Asha Devereaux, MD, MPH, and Mangala Narasimhan, DO, about how they planned for the initial COVID-19 wave, the lessons they learned that helped them pivot during the new wave, and the personal and professional challenges each of them face as critical care specialists. 

Jaspal Singh, MD, MHA, MHS, is medical director of pulmonary oncology and critical care education, as well as a professor of medicine, at Atrium Health in Charlotte, North Carolina.

Asha Devereaux, MD, MPH, is a critical care medicine specialist in Coronado, California.

Mangala Narasimhan, DO, is senior vice president and director of Critical Care Services at Northwell Health in New York, New York. 

TRANSCRIPT:

Amanda Balbi: Welcome to women leaders in critical care —a special podcast series led by our Section Editor on Pulmonary and Critical Care Medicine, Dr Jaspal Singh. The views of the speakers are their own and do not reflect the views of their respective institutions.

Jaspal Singh: Welcome, everybody. I'm Jaspal Singh. I'm a pulmonary critical care physician at Atrium Health in Charlotte, North Carolina. I’m the medical director of critical care education, and I'm involved in several societies within critical care, including CHEST, ATS, and the Society of Critical Care Medicine.

With me today is this first episode in a series of women leaders in critical care with Consultant360. We have a couple of great leaders as featured in our first episode here. First with me is Dr Asha Devereaux from San Diego, California. Asha, good morning.

Asha Devereaux: Good morning.

Jaspal Singh: Good morning. Asha, can you give us a brief description of your background and tell us about yourself a little bit?

Asha Devereaux: Well, Jaspal, I don't know where to begin. I am an adult pulmonary physician practicing in Coronado, California. I feel very fortunate.

My background is in pulmonary critical care. I'm a former Navy-trained pulmonary critical care physician. I served 11 years active-duty service. I always say that the Navy issued me a husband and 2 kids, and they became my priority. That's why I transitioned into the civilian world.

Since that time, I've been in private practice for the last 18 years. I’m the past president of the California Thoracic Society and have a whole slew of other extracurricular activities.

Jaspal Singh: Well, that's great. Thanks for joining us today. I also have with me Dr Mangala Narasimhan. Mangala, do you want to introduce yourself?

Mangala Narasimhan: Yes, thank you, Jaspal. I’m Mangala Narasimhan. I work in New York for Northwell Health, which is a large health care system with 23 hospitals in it. I'm the director for Critical Care Services for that system.

I also run the acute lung injury and V-V [veno-venous] ECMO center that we have, where we take care of 40 to 50 acute lung injury patients on V-V ECMO every year that we bring in from other parts of the city.

And I have a very active role in CHEST. I'm the chair of the live learning subcommittee, I'm on the Education Committee, and for the last 20 years I've been teaching point-of-care ultrasound to CHEST all over the world and helping to bring point of care to the bedside for critical care doctors everywhere. So that's what I do.

Jaspal Singh: Well, that's a fantastic segue from both of you. Thank you so much. I know both of you have been very involved in not just at your local areas, but also sort of on the national level, helping us with pandemic planning.

We're going to go quickly into COVID-19. Obviously, there's been a massive change of how we all work, in critical care especially. I'm going to ask you both about your role in early pandemic planning and operations and what things you've been experiencing, doing, and learning about, including some of your biggest challenges and contributions.

So, Asha, I’ll start with you, if you don't mind talking to us about all that you're doing.

Asha Devereaux: Thanks for that question, and the answer goes back to 9/11, at which time my platform was the chem-bio isolation unit of the hospital ship MERCY.

At that time, there were only 2 of us who knew what to do with biological, chemical, radiological injuries in the mass critical care setting, landing in the ICU, which we always maintain readiness and training, which is what the military does.

And so, following 9/11 and my transition to the civilian world, I realized that that level of readiness was not present in our hospital systems or really our country in that thought process.

I was fortunate to have been absorbed by the leadership of the ACCP. At the same time the ATS and SCCM were also forming similar committees. Interestingly, there were probably only about 10 of us interested in that topic. And so, we all became members of the same committee for each organization.

I think we all can agree, because we are all members of all those 3 organizations, we all tend to be sharing knowledge that way similarly. So, that led to 2 sets of consensus documents on pandemic preparedness and mass critical care for disasters.

The subsequent one in 2014 involved more than 180 participants from all over the world. And that led to some foundational preparedness documents that aren't perfect, as we are now learning in our current environment. But they did serve to help with surge preparedness for ICUs and getting everybody's mindset on a topic that people don't commonly think about.

It was great to be able to have something that had gotten buried by the wayside, because so many other things are keeping everybody occupied on a day-to-day basis. But now everybody is speaking the surge terminology literature. All the acronyms that we had come up with. So, it's nice to have that language now reflect back on us. So that was part of our early role.

Jaspal Singh: That's fantastic. Such great contributions right there, getting some of the fundamental multi-society collaboration and teams together. That's phenomenal leadership. Thank you for really spearheading that.

The other thing is, can you talk a little bit about your work with this weekly or biweekly call that you arrange with multiple societies? I think a lot of people have benefited from that, if you don't mind talking to us about where that came from, how that generated, and how that's going?

Asha Devereaux: I am former chair and co-chair of the Task Force for Mass Critical Care. That generated following a meeting at the CDC and the history of that is:

We were in a room. I was invited on the Faces of Flu and how you prepare for mass influenza for pandemic preparedness. Dr. Michael Osterholme was in the audience—and so many other people were—but only about one-fifth of the audience, or even a tenth, were practicing clinicians. Suddenly, we all had raised our hands as it was a CDC meeting. We were the only ones who were clinicians, and we found ourselves in a corner all talking to each other, saying “This is a big deal.” And right then and there, we all generated this idea that we all needed to get together, the American College of Emergency Physicians and the American Association of Trauma Surgeons. Whenever something happens in a mass casualty or mass pandemic, we need multi-societal collaboration as well. And so that led me to bring that idea back to ACCP, who helped with getting the minds together. We formed this task force for mass critical care.

In many ways it's independent now of one organization, because we want it to be multi-societal. It’s also that group that had been early thinkers on this and trying to realize that we can't do things differently in a pandemic. Otherwise, it will be chaos and that was the purpose of how we had formed initially, and to wrap our heads around surge, how to do it uniformly so that it's fair so that people can't fly across state lines to get, so to speak, a ventilator, and how people can be treated fairly in allocation decisions.

Jaspal Singh: That's fantastic. Important concepts that we've all benefited from and are learning about and learning collectively. It’s a fantastic series. I enjoy being on those calls whenever I can, and when I'm not busy in the trenches.

And speaking of which, let’s hear from our second guest, Dr Mangala Narasimhan. You are in New York City, thrust at the center of this pandemic early on from the United States side. I can’t imagine the chaos that you went through. Talk to us about—I know it's a big blur, I imagine—what started, what you learned, and how things are progressing?

Mangala Narasimhan: Sure, unlike Asha who has been planning for years and well prepared, I was definitely thrown in the deep end.

It's March, and we're hearing all of these things that are happening in Italy. Our health system is having multiple meetings, trying to prepare for what's coming. We're having conversations with the Italian doctors and had a group call with the Chinese doctors, just trying to understand what they were seeing so that we could be ready for it.

And in my hospital system, everyone is talking, but no one really understands the magnitude of what's coming. We're starting to prepare, but nobody's thinking about the ICU and I'm jumping up and down, saying, “Where are we going to put patients? What isolation rooms are we going to use?” Thinking that we would have some patients, but no idea what was coming.

Being part of that planning committee, I finally convinced them that the ICU needs to be part of it. We had an EOC [emergency operations center] structure, and it was very military-like in structure. Each hospital had a command center, and then we had a central command for the entire health system.

Then the surge starts, and we start hearing patients coming in, we're watching it. In the first week of the surge, we start to get a ton of patients. We’re filled up in the ICU. We have to open another ICU in all of our tertiaries. We're hearing overhead that there is a rapid response and an anesthesia call about every 20 or 25 minutes that they're intubating somebody.

We were very nervous about noninvasive at that time. We didn't really know if our PPE was going to work. If patients failed non-rebreather facemasks or failed large amounts of oxygen, the next step was to go to intubation. So, there were intubations left and right. We were filling up ICUs on a 24-hour basis with 20 patients in each unit.

And within 2 weeks, we were up to 150 intubated patients in our tertiary sites—at each site—and trying to find people power to cover those units. So, you can imagine that we had the PACUs [post-anesthesia care units] had any open space that we could converted into ICU rooms. We were trying to take stable Med-Surg patients and put them in tents, put them in auditoriums, put them in any open space—the cafeteria was turned into a med surge space.

We had big open units with 40 or 50 patients in a row, and we would run vent rounds, where there would be a hospitalist running the show and the ICU docs would come through 2 or 3 times a day, round on the vents, and move on to the next patient just to make sure that the vent management was done properly.

But we all know that that is not standard of care for an ICU patient, and an ICU patient is so much more than vent management. I mean, these were sick, sick patients who had renal failure, multi-organ failure, were coding and crashing left and right.

It was quite the endeavor. At our max, we were up to 900 critical care patients in our health system. Normally, we run a max around 350. So, you could imagine what this was doing to our community hospitals.

We had hospitals in Queens that were epicenters, where people were waiting to get into the emergency room and dying waiting to get in. We were taking those patients right from the ER and transferring them to our less-busy hospitals and other regions of New York. So that really made a big difference.

I was trying to keep my head above water just trying to get staffing together for all of these places that needed it, trying to move patients to less busy places, and just trying to keep abreast of what was happening next.

We took care of about 3000 critical care patients through March and April and about 8000 in the health system in general. So, you can imagine the chaos that that created. It was like a tidal wave of patients. It is a big blur, as you said.

At the same time, I was worried that this was going to happen everywhere. And we were just the beginning of it, trying to get the word out as to what was going on, so that my colleagues through CHEST and other places could get a head start to get ready for their preparation.

I tried to get on as many webinars as I could, saying, “Hey, you need to be prepared. You need supplies you need ventilators.” I mean, we were running out of ventilators, and every day at 4:00 would have a phone call saying, “Okay. This hospital is a hotspot today, and we're likely going to need more ventilators. Let's move them from a less-hotspot area to here,” just trying to get them in a truck every night and move them to where they needed to go, because we were down to about 20 to 30 ventilators at the height of it for the whole health system of thousands of patients. So just trying to keep on track with that.

We ran out of paralytics, we ran out of antibiotics, we ran out of a lot of sedatives that we were using. And these patients were long stays. They were staying in the ICU for 14, 15, 16 days on average. So, once they were in, you had a bed that was gone for 2 weeks, and you had to keep making space.

So, it was crazy. I was on a New York City group of medical directors, where we would speak every day and, definitely, we saw this about a week before every other hospital in New York saw it. I kept saying “It's coming, guys. It's coming guys.” And everybody was like, “Yeah, yeah. Northwell is crazy. Why are they so busy?” And suddenly the rest of New York City got hit as well.

It was an interesting time. I think it taught me to make plans on my feet, to keep things moving, to make quick decisions even if they are not always well informed, because we didn't have any information at that time. And we really did our best to keep our doctors safe, to keep the staff safe, and to do the best we could to take care of our patients.

I still think that had we had those patients one-on-one, the way that we do today, in regular units were critical care doctors were taking care of every one of those patients, I think the mortality rates would have been very different. I think that looking back, that's what haunts me thinking about it, because we did have so many patients who would have gotten different care had it been today that they were coming into the hospital.

That overwhelming of the system really does change outcomes and made a big difference in how people did. I think that is what we have to look to prevent, and I know that's what's happening in other parts of the country now.

I really feel that we had the advantage and New York that no one else was surging, and we could ask for help. We got help from Utah and from South Dakota, all these people came to help us weeks into it, but they did come. We can offer that help back right now, because we're going right back into a surge as we speak.

It is a different time right now with lots of different places surging. But I think the interaction with CHEST kept my head above water, because I kept thinking, “Okay, everyone else out there is, OK. We can still get help from people.”

I was able to give information out, which was very important to me to say, “Guys, I'm worried this is coming.” And I think the interaction with the other medical directors in New York City kept me sane, because everyone was dealing with the same shortages and the same PPE worries and things like that.

We could at least speak to each other openly and honestly and get advice from each other as to what people were doing and change our medical guidelines based upon a group-think instead of what one person thinks. All of these activities and thoughts really did help, but it was a very overwhelming time of just rounding on 30 and 40 patients a day, which is what we were all doing at that time.

Jaspal Singh: Wow, that's quite a story. I can't imagine what that's like. And it's a nice segue into the next part. I want to thank both of you. To review, Asha, thanks for all the background work and all of your military background and preparation of the pandemic and then refining these materials for a broader audience, multi-society collaboration. Then, Mangala, for your leadership in helping us not, just in your local institution, but also spreading the word. I'm a big fan of your publications. I’ve been reading your stories and learning from those lessons, and that helped us prepare as well. So, thanks for taking the time to contribute to those both in webinars, but also writing the thoughts down.

Mangala, you did a nice job introducing the next part of this topic, which is we're entering a whole new unknown phase this pandemic. I know people think it's the same thing going through. I think all of us think we're on the front lines or saying this is different.

Things are a little bit different now, as this next wave comes through. I was just kind of curious as to lessons you've learned, things you're doing this time around that you want the audience to know about. I think will be very helpful is what you're doing this time around. Let’s start with Mangala first.

Mangala Narasimhan: I think the advantages that we have this time is that we have a lot less patients so we can handle them in a different way. We have critical care doctors that know how to work ventilators, taking care of every one of these patients, and meticulously following ARDSNet guidelines and all of that.

I think there was a lot in the beginning that we did not know in March and April. We didn't know what treatments would work. Everybody was guessing. There was a lot of stuff out on the internet as to the magic cure and this is a different ARDS, all this stuff that would come back to us.

Every hospital, every ICU, wanted to do things a little bit differently and thought they had the right answer. Some were giving tocilizumab, and some were giving steroids, and some were giving remdesivir, etc. Like there was no uniformity of anything.

We have some randomized controlled trials. We know that dexamethasone in this patient population works. We know what doesn't work, and we're not hurting people with those things anymore. We saw a lot of secondary bacterial infections that people died from as a result of all the immunosuppression that we were giving them in March and April, so we know what NOT to do.

We're approaching patients in a much more standard, uniform way that “This is what we're doing.” We're using a lot more noninvasive now. We're using high flow, using CPAP bilevel, and we are using AVAPS [average volume-assured pressure support] in some patients. So, we're not afraid to do that.

We know that our N95s are working. Remarkably, our doctors did not get sick in March and April. That's very reassuring the second time around that we can use noninvasive ventilation safely. We've been keeping people out of the ICU by doing that, and we found that that makes a big difference. The people who are intubated, we're now following classic ARDS guidelines, and we're really trying to do great ventilator management.

There is no magic to this. This is just daily meticulous care of patients. I think all of those things put together—a uniform approach, noninvasive, using steroids, not using a lot of these other drugs that we were using—has changed things dramatically. We're keeping people out of units. We have space for patients to take care of them.

Patients are being discharged from the hospital after a week on high flow, rather than 3 weeks of intubation, pneumatosis, barotrauma, and fibrotic lung. We have learned a lot. I think that this will help the rest of the country going through this, and we have the benefit of time and quite a few good randomized controlled trials.

Jaspal Singh: That's very helpful. So, just to recap: better treatments, better capacity management, better science, more familiarity, and I think you brought up—I wanted to mention—better understanding of the PPE or the personal protective equipment and the stories related to that. I think there was a lot of madness early on, and obviously there’s still some madness in some parts of the country.

But I'm going to switch gears a little bit. What I'm a little bit nervous about it, you alluded to it, Mangala, earlier, and I'm going to switch to Asha here. Asha, you have a lot of interest in the workforce issues and wellness and burnout. I know we've talked about this many times in the past.

I'm a little bit nervous about the human capacity, and, I don't know, what are you seeing? What are you sensing? What are your thoughts on the human capacity of the pandemic this time around?

Asha Devereaux: Thank you for that question. It's very important, but I want to also thank Mangala for her candor in sharing everything and ringing the bells for all of us, because those experiences did inform the rest of us. And so, I think it can't be understated, being honest about what went right and what went wrong.

In that same vein, we do have a similar issue with staffing across the country, as Mangala mentioned. In California, we have an organization called the CAL-MAT [California Medical Assistance Team], which I'm one of the Southern California senior medical officers for.

We are health care providers responding to disasters throughout our state, similar to the NDMS [National Disaster Medical System] state system for DMAT [Disaster Medical Assistance Team], which has been modeled after. We're one of the only states that have our own workforce, maybe one other.

For us in terms of staffing, this has been a marathon, because we thought we got a little reprieve in the spring following our first surge here. And we did have significant hotspots where we had to set up alternate care sites to support overwhelmed hospitals, hospitals that had a 12-bed ICU and suddenly they're transferring out upwards of 100 patients a week.

We did support them with staff, and then we had all our fires. Our disasters were compounded. Thousands of firefighters came in, and they all needed our support, of course, in the setting of COVID precautions.

Then right from the fires, we're now into COVID surge. Actually, I'm heading out to one of our hotspots tomorrow to provide support. But in the meantime, we also have to shore up our hospital systems, our offices, and our practices.

We, I think, are needed, and most of us have not had a break. I think that's the sad part. To take a break means that another physician or provider is working 24 hours, and we just don't do that to each other. So, I think it's a real issue. We don't have resiliency in our system at all for pulmonary critical care when we're short staffed as it is.

One thing I'm trying to do—which I wish I would have thought of to do earlier, but we're just putting out fires left and right, pardon the pun on that—is trying to make our ancillary providers that aren't critically care trained who are responding in alternate care sites with some kind of knowledge of critical care.

I'm using the Fundamentals of Critical Care course [from the Society of Critical Care Medicine], and also the Fundamentals of Disaster Management. But for this particular effort, as Mangala mentioned, it's doing the small things in critical care correctly early on, which prevents morbidity and mortality. So, we have started teaching our CAL-MAT providers.

Dermatologists have signed up. People who are responding to these sites are oral surgeons, interventional radiologists, dermatologists. They're coming out to our shelters or alternate care sites to help people. Those sites are like a med-surg unit with everybody on oxygen up to 5 L plus. They're extending their capacity, and they're coming out to help. So, what can we do to give them that knowledge base to make them feel secure so that they these patients don't overwhelm ICUs and hospitals.

That's what we're doing here, and it's been well received. I wish I would have pulled it out sooner so that we could start talking about it earlier.

Jaspal Singh: That’s fantastic. Mangala, do you have any other thoughts on this topic? I think this whole idea of the pandemic and the marathon, and what you're facing your next phase is particularly interesting and how you're approaching it this time around.

Mangala Narasimhan: I'm very worried about our staff. I think everyone has been pushed to their limit. No one's had a real vacation now since February. People are exhausted. People are mentally frustrated that we're back in this situation in New York that we thought we were past.

I'm trying to rally the troops as best I can, but I am definitely concerned that this time around we know what we're getting into. There isn't that same enthusiasm of “We can do this. This is a battle we can win.” It's much more like, “We're exhausted, and we're frustrated.”

I'm trying to do what I can. We have a bunch of wellness initiatives. We had a suicide recently in our health system, so really trying to reach out to people, check in on them. We've created a buddy system of just checking in on each other. A lot of critical care doctors are tough people, and they don't like to talk about their feelings. So, I’m trying to break those barriers, a little bit and just find people to open up to other people individually, rather than in group settings.

Doing what we can. It's like the things that we would normally do to decompress—go out for a drink or have dinner together or go to a conference and vent—we can't do any of those things. It's a different time, and we have to make adjustments for it. But that's my top concern.

I have the CEO of our health system addressing the critical group tomorrow to just remind everyone that we're out there for them and that they have people to turn to. But we've been going nonstop since February, the end of February. It's a long time, and it's a lot of sick patients, and we're really seeing a real surge again here.

I totally agree, and I don't know how else to deal with it. If these resources that we have are not traditional things that doctors go to for help. So, trying to find ways to reach out to people is really what I'm struggling with.

But I agree. We're trying to train other providers. We're doing the FCCS course as well for large numbers of people just around the New York City area so that we have backup reserves of people who can step in if people get sick or if people just need some time away from the hospital.

Doing what we can to get people out of work and doing other things is all I can really do to help people get through this.

Jaspal Singh: That's great. And you guys are both really been working really hard to help all of us in every phase of this. Asha, I know you're also helping a lot with the transition to the pulmonary world, which a lot of us are seeing the effects of the delays in outpatient care that happened in the earlier part of the pandemic. I don't know if you want to talk a little bit about that as well, like what you've learned in that piece and any particular lessons there?

Asha Devereaux: Yes, and I think we're still learning those lessons. Outpatient pulmonologists—and outpatient providers period—do not receive the attention they needed. And just like Mangala’s been waving, I’ve have been waving, saying, “You guys can't forget this front, because if we don't shore up the outpatients, because 80% of the people affected by COVID are our outpatients.”

But their offices are being shuttered. We have no access to ordering PPE, because those have been diverted to hospitals. I think that there's still a huge gap in our outpatient world.

Many providers are using telemedicine. A lot of primary care offices are still not fully functional or at 100%. Now with vaccines coming out, and even the monoclonal antibody treatment, those messages have not reached outpatients and the outpatient community, and how will they accept that will they infuse, how will they distribute. And so, I think that's the workforce that has been forgotten in this pandemic a little bit.

It would be great to harness that energy and also understand the chronic COVID care. But we can't keep our outpatient workforce operational if they don't have the supplies they need. I think that's still a huge issue. I mean, my staff go into Home Depot to buy gloves. So, we're still in the surge.

Jaspal Singh: That's important. I mean, I think it's a part of this pandemic. I think, as Mangala said, it's a marathon. It's not just the critical care, but it's moving beyond that. I think you both have done a great job giving us a lot of important lessons throughout this thing.

One of the things that I wanted to ask is you both have contributed so much and helped us all around the country deal with this and save lives.

First, I want to thank you for that. But I want to ask you how are you managing it? I mean, it must be hard for you both at home and professionally to manage all this, to lead, and under such intense circumstances.

You’re both looked at as role models for many women—leaders especially, but also critical care leaders, men and women—across the country and around the world. Are there particular aspects of this story, and women leadership in particular, that you want to share?

Asha Devereaux: Mangala, you've had to rise quickly, and so I'm sure that your experiences are going to be the same on this one. I think mine is more of a marathon of leadership. Little bursts.

I probably am guilty of seeing everything as a tremendous opportunity. So, I have a hard time saying no, because I just always see the opportunity to make things better. I've identified myself, in terms of as a leader, I'm a connector. That's the role I feel I'm best suited in, and I like to build everybody up as much as possible.

But by doing so, I may not be as effective as I'd like to be in messaging. I think that’s a challenge for women. When we say something, it's viewed as a suggestion instead of a directive or as anything said with authority. Then, if you're in a zoom meeting or a boardroom or whatever it is, the statement settles in, gets repeated by somebody else—usually male—and then it seems like, “Yeah. What a great idea!” And we're like, “Okay.” The astute members in the meeting will know where it originated from.

I think that's still a problem even in this environment and the pandemic. I think it's okay. I think we just now know how to identify our messaging and how to get the point across. And we're learning how to refine that and how to relay that effectively so that we can get the job done.

I think that's my leadership lesson on this one. And I have to thank my colleagues in the military, outside, everywhere. We all support each other. None of us can have done anything alone. There are many, many people we've worked with, and I feel guilty that I don't get to always acknowledge everyone as much as I'd like to. And so that's my leadership lesson.

Jaspal Singh: That's beautiful. Thank you for that. Mangala?

Mangala Narasimhan: I have to say that I think there are advantages and disadvantages to being a woman leader. I think it's hard because you have, I have 2 teenage kids. I have 2 elderly parents that live with me that I take care of, so balancing that plus a very busy job is difficult. But I also think of it as a gift.

I get to have all of these aspects of my life and enjoy all of them and do all of them to the fullest that other people don't get, who aren't dealing with all of those things. So, I think it makes me a richer person.

I think each of those aspects of my life play into the other. And I think that, although is very stressful and busy and exhausting, I'm living life to the fullest. So, I find that to be a gift, rather than a burden.

I always feel that leading by example is my downfall. I never would ask people to do things that I wouldn't be willing to do myself, so I spent a lot of time taking care of critically ill patients during March, April, May and June, because I really felt that my folks needed to know that I was out there with them. Critical care doctors respect other critical care doctors.

To me, that was a very important thing that I wasn't hiding from the pandemic at home and putting them out there. So, I was out there. I learned a lot from doing that. I learned what these patients were like, and I learned how to take care of them. I did a lot of ECMO during that time. And I learned what had different ECMO was for the COVID patients. So, a lot of lessons learned. I think it made me a better doctor, a better leader.

I learned to deal with scared people who really had no idea what was coming. Difficult people— I think being a woman leader, you have to deal with rooms full of nonwomen leaders that really have been leading forever and don't have any interest in hearing from a new, young woman leader—or not so young anymore, but you know what I mean.

So, I think dealing with that aspect of it was difficult for me going into it. It's intimidating, but I think when you know the medicine and you know the bedside and you know the critical care people, it brings a lot of respect that no one can take away from you no matter what, who you are, what race you are, or what gender you are.

I had that advantage that I had bedside experience that none of the people in those executive meetings had. Don't ever underplay that is what I would say. I think that brings a lot of value to what you're saying always. Those were my lessons learned.

Jaspal Singh: I think you both given us a lot to reflect on and to be hopeful for. I think you both said it, like a richer life, a more interesting human experience, not just male or female gender experience, but actually a much richer connection to humanity and all the things that you both do, contribute to. and also absorb.

I'm very hopeful for all the things that we talked about, including the better planning, the better science, the better treatments, now the vaccines. We even have a woman leader in the White House as Vice President during a very critical piece of the pandemic.

So, I have a lot to be hopeful for. Are there things that you're hopeful for that you want to share and that how you look forward to this phase and how to get through this?

Mangala Narasimhan: I think that we have elevated critical care to a new place. I think that everyone in the country now knows what an ICU is and what an ICU doctor does. I think the value of critical care will never be questioned again after this.

After it's over, this will, I think, do a lot for the world of critical care and elevate us to a different place. I think lots of research will be put in and energy and time. I think we'll learn a lot about ventilators and COVID and other diseases.

This will escalate and propel critical care is what I'm hoping for the future. So, I'm very hopeful that once this has passed us, we’ll be in a very good place in our field of medicine.

Jaspal Singh: Thanks, Mangala. Asha?

Asha Devereaux: I agree with Mangala on that one. I think ever since March I have been telling every colleague I can that they are worth their weight in gold in terms of their critical care and pulmonary knowledge. I hope society continues to value these hard-working physicians.

Everyone is hard working, but I think now they understand the stresses in the ICU, and I really hope that energy will be spent in not stressing those providers further. That's my hope is that when this is said and done, we don't go back to business as usual and just pile on more things for folks to do. Because my fear is that there will be so many people who are exhausted that they're just going to walk away from medicine.

So, I'm hopeful, but there is that slight caveat that we won’t lose some valuable senior providers who still have a lot of mentoring that can be done.

Jaspal Singh: I think you both have given us a lot to think about and a lot to consider. I want to thank you both so much for your time on this podcast for Consultant360. Again, I'm Jaspal Singh from Atrium Health in Charlotte, North Carolina, with Mangala Narasimhan and Asha Devereaux.

I just wanted to say that both these women leaders are phenomenal, and it's great to have them on our first episode of women leaders in critical care. I think both of them have shown us why they are such fantastic leaders and why there's a lot of hope for the whole field of critical care moving forward with all the collaboration, all the leadership, and all the different things that we are offering.

So, with that, thank you Asha, thank you Mangala.

Mangala Narasimhan: Thank you, Jaspal, for doing this. Appreciate it.

Asha Devereaux: Yes, thank you very much.