BULLHEAD CITY — Most physicians choose their field so that they can help people, so it should come as no surprise that when the coronavirus hit and Dr. Joel Paulino was forced to close his clinic on Highway 95 in Bullhead City, he realized quickly what he had to do.
“I closed the practice down in late March and for a week was staying home,” said Paulino. “I would see the news everyday and how bad it was getting in New York. I’ve always felt that you’ve got to help if you have a chance.”
Paulino added that he regretted not going to help for hurricanes Katrina and Sandy and thought he would regret it if he didn’t help this time.
“People were dying,” said Paulino. “Not just patients, but doctors and nurses are dying. At that point it was a 20% infection rate among health care workers. So I was scared, but I thought if I don’t go, I will hate myself.”
Paulino joined colleague Dr. Irfan Mirza at Brookdale Hospital in Brooklyn, New York, just a few days later, but first he needed to prepare. For him that was very difficult.
“It’s not like you jump into the river to save someone, that’s instinctual and instant,” said Paulino. “With this, I had a few days to think about jumping into that river. My girlfriend was begging me not to go. My brother said I was stupid for going. It was just the idea that I couldn’t look at myself when there are people crying for help and I just let it go.”
The hardest part was saying goodbye to his youngest son.
“My youngest son is 11 and we are so close,” added Paulino. “To look him in the eyes and tell him I’m going to New York and then to go over my last will with my girlfriend, it was very emotional. I think the scariest part was thinking that you might die alone.”
Paulino, an Air Force veteran who has been practicing internal medicine since 1994, arrived at the hospital on April 8. He was teamed with a resident and an intern. Typically, Brookdale is a teaching hospital, but with the massive influx of patients, that changed.
“The wards were overflowing,” said Paulino. “I told them when we first sat down that all the teaching is out the window. We are not teaching, we’re getting patients treated and out of the hospital to make room for the next patients. So that’s all we did.”
Paulino said he was working in sort of a triage area that was set up as kind of an extension of the emergency room. He would meet with his team at 7:30 a.m., spend a couple hours learning about their new patients, then gear up to get to work.
“We went over all the labs, X-rays, studies, medicines, histories, everything on 25-30 patients,” said Paulino. “Once we geared up, we didn’t want to come back and sit at the nurses’ station with all of our stuff on. Then we’d start out our rounds with patients not infected, then to people under investigation and then to the confirmed coronavirus people last.”
The team would go non-stop, bypassing lunch and coffee breaks to avoid having to regown. They did suffer a shortage of personal protective equipment, so it turned into a barter type situation where staff would trade gowns for masks, gloves and other items.
“The masks and hoods were easy,” added Paulino. “Finding a gown was always a problem. I would hide my stuff behind things to have them for the next day. Those white biohazard suits — I had that one day. The rest of the time were the very cheap medical gowns. I was paranoid the entire time I was up there.”
At that time, Bullhead City had hardly been touched by the virus, so Paulino had to learn about how it presents and is treated. Luckily, he found a treatment guide on the Harvard website.
“I followed it and what’s interesting is that in the beginning it said to intubate,” said Paulino. “It said to ‘think intubation early.’ Now, that’s shifted to avoiding intubation. Before it was avoid steroids. Three weeks ago that changed to give steroids. It’s just constantly changing.”
Upon his arrival, Paulino noticed that the hospital room doors were being left open. He was sure that it allowed the virus to circulate around the hallways, including the nurses’ station. He asked that to be closed down and it was.
But despite all the precautions, the virus had been spreading quickly. That resulted in not only the wards overflowing, but the death rate rising. That was an eye-opener, he said. While Paulino was seeing the patients early, he still would hear whenever there was a code called over the intercom.
“I was sitting there one day and I heard this ‘Code 99’ on the intercom,” said Paulino. “I heard it four times in about 30 minutes. I asked the intern ‘what’s a Code 99?’ He said that’s a code blue where someone is actively dying. I was stunned. At (Western Arizona Regional Medical Center) or any other hospital that I’ve been in, you might get one in six months. In that morning that was four. They said they were averaging 10-15 a night.
“I can’t imagine what they went through.”
It had gotten so bad, that the hospital adjusted the way it did things, not to protect the medical professionals, but to protect the patients. Typically, an intern, an attending physician and a nurse would see the patient. The intern would do all the interaction with the patient.
The hospital, to protect the staff, changed it so that only the attending physician would go in. Then, due to so many doctors catching the virus, that would leave nobody knowing the condition of the patients, so it changed it so that the entire group was allowed to see the patients in case the intern or attending contracted the virus, someone would know the history of the patient and care wouldn’t suffer.