It’s a well-known fact that the COVID-19 crisis has thrust many healthcare workers into roles they neither envisioned nor trained for pre-pandemic. Among these “accidental” heroes are residents and fellows in the Montefiore Einstein Department of Pathology who train at Montefiore Health System’s Montefiore Medical Center and its affiliate hospitals in the Bronx—which quickly became the epicenter of the epicenter.

Our trainees chose to pursue the next phase of their medical education here for a variety of reasons. For some, the Bronx community -- a crazy-quilt of diverse cultures and underserved populations -- offered unique educational opportunities and real-world healthcare challenges. For others, the exceptional faculty, collegial work environment and strong tradition of mentorship at Montefiore Einstein was appealing. For still others, idealism drew them to this institution’s storied commitment to social justice. Or a combination of all three.

Much like young people in preceding generations who were suddenly called upon to transcend their individual circumstances to serve their country or community during wartime or periods of social upheaval, their professional and personal development has been accelerated by unforeseen external forces in ways that will impact their lives and careers for years to come.

Three of our Pathology chief residents, Kevin Kuan, MD (PGY-2); Roger Fecher, MD, PhD (PGY-2;) and Ridin Balakrishnan, MD, (PGY-3) recently shared their reflections, in their own words.

Brave New World

Dr. Kevin Kuan, Chief Resident, PGY-2:

Typically, residents do not have a large role in the operational side of Clinical Pathology. But redeployment during the COVID-19 emergency gave me the opportunity to learn about laboratory management and hospital operations at a much higher level.

Due to the drastic changes in hospital services and the huge influx of patient admissions the laboratory was  overwhelmed by a tsunami of specimens coming in on a daily basis. So, like most of the Pathology residents, I was reassigned to various duties within the laboratory— specifically, handling the samples sent for diagnostic COVID-19 testing. This included testing for the virus using PCR platforms and sending the various specimens to outside labs if necessary.

I took on other responsibilities as well. These included organizing the schedules and assignments of all our residents within the different labs and being the liaison between the residents and the lab staff, medical student helpers, lab directors and house staff.

Dr. Roger Fecher, Chief Resident, PGY-2:

Although initially scheduled for a Neuropathology rotation, I was reassigned due to the lack of neurosurgical specimens and the huge increase in specimens for COVID-19 Cepheid testing for SARS-CoV-2 and respiratory cultures. I helped Dr. Wendy Szymczak [director of the Pathology Department’s emergency COVID-19 Command Center on the Moses campus] look into interesting cases, triage specimens, and run some SARS-CoV-2 testing. We also looked into potential additional ways to test patients for SARS-CoV-2 when there is a strong clinical picture and negative nasopharyngeal swabs.

I worked on implementation of new testing, when and how to open testing within the hospital network, and determining new avenues for testing. I also spent lots of time learning about the specific tests we were offering to determine exactly how they work and what conclusions we can draw from the results.

Dr. Ridin Balakrishnan, Chief Resident, PGY-3:

I was scheduled for spring rotations in Cytology and Hematopathology but then the COVID-19 crisis happened. As chief residents, Roger, Kevin and I came up with scheduling to assign residents to various positions throughout this crisis. The schedules had to be changed daily, given how quickly things were moving.

I volunteered to work in the COVID-19 Command Center and at Weiler [Montefiore’s Einstein- Weiler Hospital] helping run testing of SARS-CoV-2 on patient samples, and at Wakefield [Montefiore’s Wakefield campus] helping with accessioning specimens and running SARS-CoV-2 testing on patient samples.

Dr. Fecher:

From the get-go, the chief residents were keen on identifying areas in which our residents and fellows could play a critical role in response to the crisis. We helped identify new projects and initiatives that would require additional help and sought out interested residents to fill those vacancies.  We also deployed residents and fellows to the Pathology COVID Command Center on Montefiore’s Moses campus and helped initiate the formation of command centers at other campuses to help with specimen processing and, eventually, running the SARS-CoV-2 testing.

Above and Beyond

Dr. Kuan:

In times like these, the selflessness and commitment of the entire Pathology Department in the service of patient care became evident. The residents, attendings, PAs and technicians alike were more than happy and go out of their way to take on new responsibilities in response to the COVID crisis. The biggest challenge was meeting the demands of increased testing.

All of the residents were more than willing to join and fight, along with the hospital, against this public health crisis. In light of the big surge in specimen volume and lab staff calling out sick, the residents chipped in and worked around-the-clock to help out.

Led by Dr. Wendy Szymczak and Dr. Sean Campbell on the Moses campus, several residents -- Drs. Mojisola Popoola (PGY-1), Linlin Yang (PGY-1), Kenji Ikemura (PGY-2), Carlos Castrodad-Rodriguez (PGY-2) and Angela Baldwin (PGY-3) -- spent numerous hours at Pathology’s emergency COVID-19 Command Center on the Moses campus receiving and processing COVID-19 specimens for testing.

Others, including Stacia Semple (PGY-4), Sophie Cameron (PGY-4), Sebastian Jofre (PGY-4), Gregory Dickinson (PGY-4) and Jui Choudhuri (PGY-2), worked at the Weiler, Hutchinson and Wakefield campuses, setting up and validating new instrumentation for SARS-CoV-2 and COVID-19 antibody testing.

Drs Mohammad Barouqa (PGY-3) and Kenji Ikemura along with faculty member Dr. Morayma Reyes Gil, director, Montefiore Einstein Hematology and Coagulation Laboratories, collected and analyzed data regarding abnormal D-dimer values and coagulopathy observed in COVID-positive patients. They collaborated on a paper that has been submitted for poublication.

Dr. Raquel Yokoda (PGY-1), whose focus is GI/Liver Pathology, used her valuable past experience in medicine to take care of COVID-19 patients along with the Montefiore Einstein Department of Medicine and other allied health forces.

Our Pathology fellows also actively participated in helping out in the laboratories. Dr. Michael Dewall, our Dermatopathology fellow, volunteered to work at the Wakefield Laboratory in addition to his dermatology consults and other regular house-staff duties and educational responsibilities. Dr. Saeed Asiry, one of our Cytopathology fellows, volunteered at the Pathology Department’s COVID-19 Command Center on a weekly basis.

A Humbling Experience

Dr. Kuan:

The opportunity to be involved in an environment where I had to troubleshoot and come up with solutions to problems in real time has been invaluable. Working with all the different volunteers was a humbling and true learning experience.

Dr. Balakrishnan:

The chance to work so closely with the laboratory staff and clinicians and be in the thick of testing implementation and research while keeping up with the demands of increasing volume has been a unique experience. Above all, the thing that has humbled me the most is the dedication and selflessness of my fellow residents. They have risen to the occasion yet again and I’m proud to call them my colleagues!

Rising to the Emotional Challenge

Dr. Fecher:

It’s been amazing seeing all that the laboratories and, in turn, our clinical colleagues have been able to deal with during this crisis.

Although physicians want to help their patients, people have been really scared about what could happen to themselves and their families. It’s been critical to understand what drives that fear in order to help dispel it or help them find a way to deal with it.

Winding Down, Looking Ahead

Dr. Fecher:

As of mid-May, the Pathology residents and fellows are slowly transitioning back to our normal service. We are getting busier in the surgical department, and our autopsy service just reopened. We still have a few people helping out on the evening and overnight shifts; the plan is to gradually transition the residents and fellows back so as to prevent a possible "workforce vacuum" in the clinical labs.

Through this experience I’ve been able to see different approaches physicians take to understanding a problem and implementing a solution – and how those approaches can sometimes be at odds with each other, even when the ultimate goals are to deliver the best care for patients. I got to “see behind the curtain” to better understand why a measured roll-out of a test is beneficial and in some ways problematic, and how different ways of ordering can impact testing.

Dr. Balakrishnan:

While this has been a challenging and unprecedented experience, it has taught us a lot about ourselves and the field of Pathology/Laboratory Medicine.

Managing a crisis like this from a laboratory perspective is extremely difficult and we have been able to watch, learn and assist various Attendings in navigating through it. The team  efforts during the crisis have improved our interpersonal and communication skills and have given us a fresh new perspective on leadership.

The central role of laboratory testing and diagnosis in delivering appropriate and timely care for patients has been highlighted over these past few months. The labs were able to handle the massive volumes of cases while maintaining extremely high-quality standards—a fact that has gone under-recognized. The ocean of research data generated by laboratory medicine during the crisis will drive the treatment for this virus in the future.

Given that I plan to specialize in Women’s Health Pathology in a community/academic setting, the opportunity to have been part of a real-world clinical laboratory operational crisis scenario is something unique to have in my repertoire as I venture into my career.

All three of us agree that the selfless dedication of our colleagues has been inspirational and has strongly validated our decision to choose Pathology as our career path in medicine.