Countless South Carolina Honors College graduates work in health care, facing down a pandemic that’s raged worldwide for almost three years. What have they seen? Were they prepared? How are they different now? Explore alumni reflections from an internist/hospitalist, pharmacist, advanced practice registered nurse, and pediatric critical care physician – all of whom are teaching future generations of medical professionals.
“Personal protective equipment was in short supply so many of us worried constantly that we would get sick or transmit the virus to our families.”
For Keith Barron, COVID-19 hit fast and hard. An internal medicine physician and hospitalist at Prisma Health Richland Hospital in Columbia, South Carolina, Barron has treated more COVID patients than he can count. As the virus spread, patients filled all floors of the hospital, and Barron working on all of them.
“What I remember most about the first few months of the pandemic was the fear that so many patients and healthcare workers had,” said Barron, ’06 biological sciences, ’11 medicine. “Even many of my colleagues experienced this fear, mainly because none of us knew how to best treat COVID or who would have the worst complications and die.”
Worried he’d contract and spread it to older members of his family, Barron stayed home while his wife and children moved in with his in-laws. “The only way I saw my three kids for several weeks was on walks outside.”
Fortunately for him and his patients, Barron had trained extensively in Point of Care Ultrasound. Because POCUS integrates ultrasound at the patient’s bedside in real time – often replacing other diagnostic imaging – the risk of viral spread is lessened.
“Clinicians had to modify how they provided high-value care, with many routine imaging studies, like chest X-rays, discouraged due to elevated transmission risk,” he said. “POCUS proved very valuable to manage patients, particularly patients in the ICU.”
Barron, a Columbia native who teaches residents and medical students at the University of South Carolina School of Medicine, includes POCUS in his teaching. In November 2020, he and three other physicians published “The Use of POCUS to Manage ICU Patients With COVID-19 in Journal of Ultrasound in Medicine (http://onlinelibrary.wiley.com/doi/10.1002/jum.15566)
Three things kept him going. “My Catholic faith, duty to patients, and support from colleagues and family.”
“I think I am now even more passionate about making sure I combat misinformation and communicate evidence-based information to my patients in addition to my friends and family. I want to make sure they are appropriately educated to make informed decisions about their medical care.”
When COVID patients don’t improve with traditional therapies and advance to end-stage lung disease and fibrosis, lung transplantation becomes their last option. That was the situation Dr. Rickey Evans, PharmD, BCPS, faced about a year into the pandemic.
A clinical pharmacy specialist in lung transplantation at University of Kentucky Healthcare and assistant professor at UK College of Pharmacy, Evans was a member of the multi-disciplinary team caring for their first patient requiring a lung transplant for COVID. The patient was 43, with few previous health problems.
“Our medical team had to have an honest conversation with her that receiving two new lungs was the only way she would survive,” Evans said. “As expected, this was a difficult and challenging situation and decision for the patient to grasp. Our entire team worked extremely hard to find innovative treatments and medical therapies to make her a good candidate to receive a lung transplant in addition to finding a great set of donor lungs for transplantation.”
The surgery was successful, and the patient was discharged after a total hospital stay of three months. “It has been the most memorable patient encounter I have had during the COVID pandemic,” said Evans, SCHC ’09 political science, ’13 pharmacy. “It was a massive undertaking for all health care professionals involved, including physicians, pharmacists, nurses, respiratory therapists, dieticians and so many others.”
A native of Cades, in Williamsburg County, South Carolina, Evans said work slowed almost to a standstill when the pandemic first hit. Transplants and elective surgeries were put on hold while the virus took precedent. Now things are back to normal speed, with Evans staying extra-busy keeping up with the medical literature about optimal treatments, preventive medications and vaccination recommendations for COVID.
“Because I work with patients who are immunocompromised, COVID has made a large impact on how we adjust and manage their standard medications used to maintain the function of their newly transplanted organ,” he said. “There are so many pieces to think about regarding their medical care.”
Evans says his “excellent education” at the South Carolina Honors College and University of South Carolina College of Pharmacy “absolutely” prepared him for his profession and the pandemic, as did his post-graduate residency training at UK Healthcare.
“Having an excellent foundation in pharmacotherapy and immunology has been key in navigating through the COVID-19 medical literature to recommend appropriate prevention and treatment strategies for my patients in addition to communicating this information to my patients, family, and friends in a language they can understand.”
These days, given how difficult the pandemic has been on health care workers, one of his goals is self-care. For him, that’s spending time with family and friends, as well as attending sporting events, traveling and going to the gym. He knows a good work/life balance is critical to ensure he’s providing his patients with the best care.
And what keeps him going? The question should be who keeps him going. For Evans, it’s his patients.
“We develop very close and meaningful relationships with our patients during the transplantation process and take over every aspect of their medical care,” he said. “They are highly dependent on us to maintain their health and provide them reliable and trustworthy information.”
“I was dismayed that in our community, in the beginning of the pandemic, the work of giving the vaccines fell to the hospital nurses. They were already burdened with taking care of the influx of critically ill COVID patients in the hospitals.”
COVID unleashed a stream of emotions in Marty McGirt Hucks, an advanced practice registered nurse and certified nurse educator in Florence, South Carolina.
It started with worry about her elderly parents, patients and colleagues working in hospitals. Then came the “awe and hope” when administering the vaccine in its early days, followed by the “fatigue and monotony” that followed as the vaccine clinics wore on. “Annoyance” describes her reaction to one patient in particular, a nurse who didn’t get the vaccine, contracted COVID and then kept calling and asking for “the most outrageous cures.”
And Hucks couldn’t shake the heartbreak of loss – consoling the woman who survived the virus but had given it to her husband, who died.
Then there was the 90-year-old woman who arrived at the federally qualified healthcare center in respiratory distress. She had been misdiagnosed with another condition at a different health center and was waiting the 10 days for her COVID test to be returned from the health department.
“I will never forget her face as she was wheeled out on the stretcher to be transported to the hospital,” Hucks said. “She said, ‘I knew you would help me.’
“I didn’t feel I had been helpful at all, that I had merely been the bearer of bad news, that we had all failed her in ways I couldn’t express. She left the keys to her Cadillac with me. Her car had to be left in our parking lot. The least I could do was keep an eye on the car during her extensive hospital stay.”
That patient survived. She gave up driving and lives at home, using oxygen when necessary. Hucks knows that without driving, that patient is isolated. It’s just one of many problems COVID survivors face.
“We are still learning what the effects of COVID are,” said Hucks, ’90 nursing, ’94 master’s. “I have several patients who had fatigue for months but seem to be better now. I have one who has developed heart failure. Many have depression and anxiety.”
At Francis Marion University, where Hucks has taught since 2000, “lecturing with fogged glasses and muffled voice to anxious, disengaged students spread out at least six feet apart” was challenging. Moving class online during spring break also was hard.
“We were not prepared for this,” Hucks said. “For years, those who work in public health have known that we were ill-prepared for a pandemic, given our shrinking public health workforce.”
Still, her education at the University of South Carolina has helped. She remembers how her nursing class responded to Hurricane Hugo’s devastation in 1989. They traveled to McClellanville, on the state’s coast, to work in disaster relief. Her work with the state Department of Health and Environmental Control’s Medical Reserve Corps also gave her experience in extreme situations.
And there have been moments of joy. At a National League of Nursing summit in Washington, D.C. last September, she and a colleague visited the National Mall, where 681,253 small white flags were fluttering, representing Americans who’d died of COVID.
“It was breathtaking, surreal,” she said. “They went on as far as the eye could see. Some had notes written on them. When the wind stirred and they shimmered, their movement gave me a sense of peace and hope. A volunteer approached us, and when she learned we were nurses, she dropped everything and rushed to embrace us, thank us.”
Hucks, a Columbia, South Carolina, native, recognizes she has experience on her side. “I have a long career to draw on for wisdom and solace, but what has helped me most through these trying days has been my faith,” she said. “I am so very grateful that my family has been spared serious financial or health consequences.
“And I have never been prouder to be a nurse.”
“It is a privilege to care for families’ most precious gifts, and it is heart-wrenching to share with families that their child has died. This happens not uncommonly in my field but is harder on everyone when the death is a result of a potentially preventable illness or injury.”
Elizabeth Mack, ’99 biology, ’03 medicine, has lost count of how many times she delivered the tragic news to parents that their child had died of COVID-19.
Mack, a pediatric critical care physician and professor at the Medical University of South Carolina in Charleston, and her colleagues cared for 366 children from March 2020 through January 2022 with COVID requiring hospitalization, according to data from the Children’s Hospital Association and American Academy of Pediatricians. Of those, 25 percent were in January 2022 – proving, Mack says, that “the Omicron surge was significant for children.”
The Columbia, South Carolina, native found herself fairly well prepared to respond to the virus. During her fellowship at Cincinnati Children’s Hospital Medical Center, she earned a master’s degree in biostatistics and epidemiology.
“We studied public health and pandemics,” she said. “Who knew I’d use that (knowledge) so soon?”
Even with preparation, the pandemic brought surprises. “I would never have thought we would have pregnant women and folks older than me in a pediatric ICU, but that’s what happens when resources like ICU beds and personnel are scarce,” Mack explained.
The pandemic has taught her the importance of preventive medicine and scarce resource allocation. What keeps her going, she says, are “friends, family, and hope for a better future!”
Mack herself contracted COVID in June 2020, prior to the availability of vaccines. She isolated for two weeks and feels fortunate that she recovered, albeit with a known side effect.
“It appears my sense of smell will never be the same; that may work out for the best since we have pets!”