Ready, Set, Go: How One Physician Led Through a Crisis

Transcription:

Prakash Chandran (Host): In September 2020, in the middle of a COVID pandemic, Jackson County also suffered another emergency when a fire swept through, forcing people to evacuate at a moment's notice. When the fire approached Asante Regional Medical Center, a physician had to think fast about how to provide care and leadership during a crisis.

We're going to talk about it today with Dr. Joy Anderson, an OB GYN, Hospitalist and Site Director at Asante Rogue Regional Medical Center in Medford. This is the Obstetrics Podcast from OB Hospitalist Group. My name is Prakash Chandran. So Dr. Anderson, quite an experience that you went through. I'd love to get started by asking you, you know, just as a physician with also a family at home, what ran through your mind when you first heard about this approaching fire?

Joy Anderson, MD (Guest): Well, of course I was terrified. My husband is a stay at home dad and he's always been a stay at home dad, and we've been married almost 20, 20 years at that time. And he's always got the homefront. And so he tells me that, whenever I leave for work, he's like, don't worry, we've got everything here for the kids.

And so I knew he had it. He's always had it. We've had tornadoes and stuff in other places we've lived. And so he's got that at the home, but that being said, I was more worried about my partners at work. One of my partners survived the Paradise Fire. His name was Ron Ainsworth and he was really worried about his house in Bend because there was another fire in Bend too. And so he and I were working together making a plan for what we do with our patients. So, I was more concerned about the hospital front than the homefront. My husband had it all taken care of on the home. Thank goodness.

Host: Yeah. That definitely sounds reassuring. You knew you had that support at home. So, it was really around worrying about your partners and patients. So, talk to me a little bit about that timeline. Like, what is the moment that you found out to the moment you started putting together a plan with your friend Ron?

Dr. Anderson: Well, Ron had retired. Dr. Ainsworth had retired at the time when he was in the Paradise fire and he actually moved away from it, but he had gone through all of that, personally. And so I called him for advice about what to do, and he was super helpful with that. He's kind of a man of few words.

And so he's like, well, we'll just take care of stuff as it needs to happen. So, that was our master plan. We're going to take care of stuff as it needs to happen. I'm a little bit more of a planner myself. And so, I worked with the nursing staff to kind of figure out which patients needed to evacuate, which patients we could send safely home.

And remember the patients were terrified too, they had homes that were at danger also. And so we were discharging patients bordering on, I mean, you know, as appropriate as we could, to be honest with you. I've always been a little bit fascinated with catastrophic events from a physician standpoint. So, I was familiar with like Anna Pou who worked through the Katrina hurricane and I'm a big fan of what she did during that.

It was really crisis intervention at that time. And so I was thinking, well, how can I do similar sort of stuff, taking good care of the patients and triaging things appropriately. And so, we made a plan with the nursing staff that I would take the patients in the most active labor, we would turn their epidurals off. And we'd take one of the nurses with me in my car if we had to, because of course ambulances and things like that are going to go for the ICU patients. I mean, these are patients that are having a relatively, almost, always normal birth process. And so, we had a couple of high risk patients on our service, and so I would take the highest risk.

Then there was a couple of nurses that were training to be midwives. And so I was going to let them take the lower risk patients. Then I was going to take one of the younger nurses with me if there was an emergency, along with a set of forceps. So, you do what you gotta do. We had contingency plans. It was an interesting process. And the nurses were super helpful throughout all of that.

Host: Yeah. I mean, there's so much to unpack there, but I guess let's just talk about your mental state while all this was going on. You know, I guess my question is how do you even try to stay calm, especially for the sake of your patients and your team members, because you can't really promise anything because things are happening so fast.

Dr. Anderson: I knew we could always do it, somehow, some way and we just have to be creative. And I think a lot of that is how surgery runs. You know, you have a plan that you set out with, and then there are times where things zig a little bit and you've got to zag with it. So, that's just obstetrics, a lot of times, and it's in emergency obstetrics for sure.

And so you just figure out that you're going to do the next best thing, and you hope that you're doing the right thing at the moment. There's not really a magic answer for that. I think we all kind of live day to day, like that.

Prakash Chandran (Host): Yeah, absolutely. And, you know, I imagine that being in a pandemic, there are certain procedures and maybe even emergency procedures that COVID-19 might have helped affect during this time of crisis. Can you maybe speak to those?

Dr. Anderson: I was enrolled at the time in the Moderna trial. So, I had hoped that my vaccine was a real vaccine. Unfortunately, I was not actually in the active vaccine arm, so no go on that front. So, I had a placebo and didn't realize it at the time, but I had been hoping that my vaccine would work for us there.

Kind of unreliably, universally testing as many people as we could, because there were also limitations on the number of tests that we had. And honestly, I figured, well, it is what it is. And, you know, practicing medicine during a pandemic is not for the weak of heart. And I think we've unfortunately selected some of the people that are not ready for that sort of thing out of medicine.

Plus minus on that one, you know, it's not fair to practice medicine in a global pandemic. To be honest. Don't you think you'd watch your doctor ready for something like that is my thought.

Host: Sure. Yeah. Yeah. You know, I kind of wanted to get a sense of timing around the whole thing. You know, you kind of mentioned that you found out you, you spoke with your friend, Ron. How much time did you think that you had to put all of these plans together and then start executing on them?

Dr. Anderson: Well, not much time at all. It was a little bit worse than that. There was actually, I was supposed to be off during that week. And so I went home and was coming back to the hospital to orient a new hospitalist and we have a really high-risk practice. And so the new hospitalist came on and his first words out of his mouth were, I want to be like a midwife and do all normal stuff. And I'm like, this isn't going to work. You know.

We had like vasa previas on our service, which is a really high risk situation. We had some pretty horrific things going on at the time. And yeah, so he didn't work out. And so I took his shifts and so I actually did, I think one of those shifts was like 48 hours straight.

I can't remember exactly because I was in the haze of being exhausted. So, there wasn't really time to plan. I didn't plan to be at work. He kind of fell through, and so I had told Ron to go home to his family in Bend because there was a fire there too. And I was going to take Ron's shifts since I was here in town.

And so, I called Ainsworth back and like, hey, look, I need your help. And so he, of course being the great doc that he was came back and was super helpful and made plans to come the next morning. And we all just kind of circled around and did what we needed to do. There wasn't time to plan. They were changing things every minute, every single day.

And so, you'd get a notice that you need to evacuate. And we were all just kinda sitting on pins and needles. There was also a time for the nursing staff. I was post-call that day. I think Dr. Ainsworth was on where they wouldn't let the nurses leave. And so they felt like it wasn't a safe situation for the nurses to leave at the moment.

And so they wanted to clear the nursing staff to be safe, to go. And so there was all that too, you know, the nurses were working extra hours. They were staying to help evacuate patients if we needed to. And thankfully, so thankful it didn't actually have to happen. And we were just going to make it work. I mean, this is emergency catastrophic care. You know, you just do what you need to do at the time and you have to be open-minded about what you got to do.

Host: Yeah. And, I kind of want to talk a little bit more around how you took the lead during this crisis. You know, there's obviously a lot of different team members that you work with. And I imagine also a lot of different personalities. And so when you got the call and started putting this plan together, how did you make sure that everyone was on the same page in the midst of this frenzy?

Dr. Anderson: I think we were all planning together and we have such a great team at this hospital that I've been other hospitals. I mean, this is going to be the reason that I'm going to stay at this hospital for a super long time because the team there is just so wonderful. For example, the nursing staff, the nights I was post-call during that whole thing, they were watching my house for evacuation alerts because the evacuation alerts were not consistent.

And so there was the charge nurse who also doubled as a midwife. And she would like refresh every five minutes to check, to see if we were being evacuated. And she had a list of all the docs that were on, all the nurses that were on and she would call them at home and say, hey look, your area's getting evaced.

And so I felt like having that team behind me was just the most important thing. And I would even say, I was behind them. And so they're just fantastic in every single way that they work. And they were all super liberal about it. Like we had some of the nurses that were like, well, I've got a Subaru. We can pull the backseat out.

I mean, literally this is how we were talking and, you know, we can turn off her epidural and she seems like she's a multip, she can probably push, we'll be good. You know, it was just, what you do in the catastrophe and everything happily worked out great. We didn't have to evacuate. It really had a happy ending.

We had great outcomes. Even the patients that we had to discharge a little bit urgently to go to their own houses were in close contact with us. They would call my cell if they had any issues. But I think all of them were in the same situation we were in, which is, touch and go, moment by moment.

And there's no keeping people calm during all of that. But I think it actually worked really well. We just had a super calm group of people by luck.

Host: Right. And when you say that it didn't come to fruition, like you didn't have to evacuate, what was I guess the turning point that you would have had to start loading someone in the back of someone's Subaru? Like how did you know that you were, you know, out of danger's way.

Dr. Anderson: I don't think there's ever such thing when you're in the middle of that kind of thing. But in the Pacific Northwest, they have a ready, set, go system for forest fires. And so, we were at the set level, which means you need to have all your bags packed and have a plan with your route out. The street, across from us was at the go level, which means they'd already evacuated.

And so, typically police or some community service worker would come by and bang on doors and say, you need to evac. So, the street across from us had evaced. And so we were just at the set level, which, we had delivery kits ready. We had emergency hemorrhage kits ready. We had all the equipment that we have ready anyway, for every delivery. We just had it, you know, in the fridge ready to grab.

Host: Well, it definitely sounds like this ready, set, go, framework that was present in the state of Oregon was useful because you were able to easily map your plans and your strategy to each one of the different stages. Isn't that correct?

Dr. Anderson: Yes, it is, it was really helpful for home too, because my husband was in the set level as well as the hospital. And so, he knew where that would be. You know, what that meant, when we hit go. And we had multiple routes out for both the house and the hospital. So it's, it was a very helpful system. The only thing that was a little bit of a fall through is that we had heard from people whose houses had already burned down. One of our her house burned down. She said that they didn't contact her. And so her family contacted her while she's at work saying yeah that the house is, we think is burning. And we lost a couple of nurses over all of this too. So, one of them was so traumatized because literally the street across from her got burned down, that she moved away to Colorado. Not that there's no forest fires there, but I think she just needed a change of scenery and to not drive by that area every day.

Host: Yeah, that's tough. And you know, I was just going to ask you, given this experience, what do you think was the hardest thing for you?

Dr. Anderson: My kids being terrified. And I'm just really thankful that my husband was at home taking care of that. And the kids they're, they're actually pretty chill kids. My husband's a super chill person. And so between the four of us, we were able to kind of keep everybody calm and say, you know, this is no different than a hurricane or a tornado.

It's just a little bit, going to look different. And so we have to be ready to go at any time. And of course, counseling my then 11 year old. No, you can't bring, you know, your electronics, you can't bring, we don't have room in the car for your PlayStation, you know, that sort of thing. It kind of lightened the mood a little bit and kept me in John, my husband a little bit chill about what the reality was.

Host: You know, there's going to be a lot of hospital leaders and physicians that are listening to this kind of looking for maybe lessons learned, or maybe even things that you might've done differently. So, just kind of, I guess, with some hindsight, what do you think those are for you?

Dr. Anderson: I would have liked an every six hour checkin from hospital administration, which I know in the feed of all this stuff, that's way asking too much. I know that they had so much on their plate. And so I'm more of a you know, I need a daily conversation every day about how things are going. And so that's why I'm in an administrative position myself. And I know that when they have an ICU that's overrun with COVID, when we have an ED that's bordering on divert because of the fire, the last thing they need to be do is checking in with me, but it would have been helpful. And so maybe some sort of global email, you know, like to the entire hospital staff, like, hey, things are good guys for the next six hours.

We'll check in in six hours. And so I checked in with my team, with the nursing staff and was much more physically present. I mean, I'm always kind of physically present anyway. But that's what comforts me. And so I felt like I needed to kind of touch base with everybody and kind of be out there and make patient rounds because patients were delivering during all of this hot mess.

So, some of our high-risk patients like the patients with vasa previa, which is where the blood vessel is in front of the baby. And so if they go into labor, it's not good. Those patients were freaking out too, and they were coming from different areas that were also under stress from the fire sort of things.

And I'm like, you know, we've got this. I'll take you in my car if you're high risk enough. And we will figure out what we need to do. There's always things that we can do. And we actually behind the scenes plans for some kind of C-sections under local anesthetic. I mean, not cool plans ever. But things that you need to do, if you've got it. I would've liked to a more frequent S bar, but I think that's probably asking too much, in that sort of scenario. So, I exercised what I would have wanted with my team.

Host: Yeah. And just to expand on the patient side of things, you know, I had a question around what their disposition was like, because in some cases they may have been told that there is an approaching fire, or maybe they're even looking out the window and seeing smoke. So, how did you manage in that type of environment to keep the patients calm?

Dr. Anderson: The hospital was undergoing construction all of this time. Okay. We're building a new tower. And for some reason they decided to move a diesel tank to right outside one of the labor and delivery rooms, visible by the patient's window. So, we had to, you know, kind of move that patient to a different room, but the reality of it is it was in our parking lot right there.

And so we all, and it was on the side of the street that had the evacuate orders. And so, you know, we were all kind of joking around about that and using humor as a mature defense mechanism, but there's nothing you can do about that. That diesel tank had been there for six months before. It was an appropriate place because it was actually the safest place before the fire.

So, a lot of it was kind of palliating patients and moving them to a different room so that they didn't have to see the diesel tank, things like that. Thankfully, we, you know, the high risk patients, like the vasa previa patients that we had, were relatively chill. And God, I couldn't have asked for better patients during all of that.

And I think we leaned on each other because they were under the same stress we were, you know, and it was a daily check-in and everybody checking the hospital internet to see what was going on with the fire and listening to families evacuate as this is all happening. It was a little scary, but we all just kind of leaned on each other and it worked out.

Host: Yeah. You know, we already talked about things that maybe you wish might've been done a little bit differently with some hindsight. What are the things that you feel went really well?

Dr. Anderson: I'm thrilled that I had Ron Ainsworth as my partner. That man has, I hate to say he retired. I'm heartbroken that he retired just a few months after that, but that man has saved some lives for real. He's done some vaginal breech deliveries, which is an art and a skill that's lost on the newer docs. And I've watched him save babies lives in front of my eyes, and I was glad to have him there. So, he's just a man of few words and very common, doesn't freak out. And so he was great to have on the team at that moment. There are other hospitalists that I've worked with who were a little anxiety inducing for the team.

And so that would have been a bad move at that moment, but I was just so thankful to have him. It couldn't have worked out better with the two of us. Unfortunately, both of our houses were a little bit like in danger. So, it was probably the worst team from a mental sanity standpoint for us, but for the rest of the team, it worked out great.

I'm really thankful to have him. I think it worked great with the nursing staff that was on just because we're friends too. And so we were all making plans and I was lucky enough to have a charge nurse that happened to be in school for being midwifery. So, I was thankful to have that also, and this is a really super safe hospital.

I've been other places where hospital admin doesn't communicate well. And so I think my expectations were probably unreasonable, in retrospect, but I was glad for the communication that I did have from them. It was very stellar. And again, I think I have really incredibly high expectations of more communication, but you can't really have too much in my mind.

Host: Well, Dr. Anderson, I really appreciate your time and sharing all of this information today. Is there anything else that you think is important for hospital leaders or physicians to know, just given all of your experience with the situation?

Dr. Anderson: You know, I was joking with a friend of mine about this earlier, and they asked what is it that you do when you're the most frightened and you and I had kind of spoken about this earlier, but I really do, when the moments come that I'm super scared of, it helps to pretend, it helps to pretend that you're really calm.

And I jokingly say I channel RuPaul, the drag queen, because it helps me. She's a little bit tough and she's a stoic person and she just says things how they are, which is how I want to be spoken to when there's an emergency. And so I find that really strangely helpful and humor is a mature defense mechanism too. So we use a lot of that in emergencies. And I think that combination kind of got me through that alive.

Host: Well, I think that is the perfect place to end. Thank you so much for that little anecdote. And thank you so much for your time again today, Dr. Anderson.

Dr. Anderson: I appreciate you.

Host: That's Dr. Joy Anderson an OB GYN, Hospitalist and Site Director at Asante Rogue Regional Medical Center in Medford, Oregon. To learn more about how OBHG physicians lead teams visit OBhg.com. Thank you so much for listening to this episode of the OB Hospitalist Group Podcast series. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest. My name is Prakash Chandran and we'll talk next time.