Date Published: June 19, 2020
Emergency physician Erik Blutinger, MD, was in his first year out of residency when the pandemic hit. As COVID-19 patients flooded Mount Sinai Queens, Dr. Blutinger strained to apply his training in an unprecedented situation, where split-second decisions had to be made on an evolving understanding of the virus. Two months after the virus peaked in New York City, and with the number of patients with COVID-19 at Mount Sinai Queens near zero, he reflects on what getting back to “normal” means for him and his patients. “Seriously, right now, people should not be afraid to see a medical doctor,” he says.
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about overcoming adversity. I'm Jon Earle.
Dr. Erik Blutinger: 00:11
I'm about ready to walk into the ED. We'll see what the situation is like. I heard that our volume is just exploding, and we have so many people in the hallways that are all COVID-19 positive.
About two months ago, when the pandemic was hitting its peak here in New York City, Dr. Erik Blutinger shot a video diary. In it, he takes us through the halls of Mount Sinai Queens Hospital, halls crowded with COVID-19 patients. And even though he's completely calm, you can feel the tension.
Dr. Erik Blutinger: 00:44
It is just totally crazy right now. Everyone is COVID-19 positive in these hallways. All you hear is oxygen. I'm seeing young patients, old patients, people of all age ranges who are just incredibly sick.
But the most effecting part of the video to me isn't the scene itself, it's the look in his eyes after he finishes his shift. He's just so completely drained. Dr. Blutinger says he can't even bring himself to watch the video. It gives him goosebumps. Besides, things at the hospital are very different now. There are virtually zero COVID-19 positive patients. Elective surgeries are back. It's almost like normal. As the city's hospitals reopen for business, we've been wondering about this word on the podcast, "normal." It's one thing to see the light at the end of the tunnel, it's a very different thing to step into the light, and in that moment of disorientation, try to understand where you've been and where you go from here. On this episode, Dr. Blutinger joins us to talk about exactly that. He shares what reopening feels like for a front-line physician, what it means for patients, and what the past three months have taught him about resilience.
So let's just start out by having you describe your role during the pandemic. What were you doing on a day-to-day basis?
Dr. Erik Blutinger: 02:06
On a day-to-day basis, I was evaluating and treating patients of all walks of life. I worked 10 hour shifts, often days on end. Throughout the crisis, I purely worked clinically in the department, but in my time off, I worked on a various number of projects.
So you were in your first year out of residency. What was it like to go from residency to the epicenter of the pandemic?
Dr. Erik Blutinger: 02:37
It blew my mind. I mean, I had always been told, getting out of residency, you're going to have a steep learning curve. And when COVID-19 hit, I found myself to the nth degree, struggling to understand the world around me. I had no idea what COVID-19 was when I first heard about it in the fall. And like everything else I had been trained on leading up to this point, I thought there is a solution to this. But I find myself still trying to grasp, what are we facing right now? What is this new world that we're in?
There's a video that you shot of yourself in the hospital--I think it was in early April--at Mount Sinai Queens, and it was at a time when the patient population, the COVID-19 population was exploding. It all kind of comes to a head at the end of the day when you take your mask off and the viewer sees your face, and it's just the face of pure exhaustion. Have you watched that video since then?
Dr. Erik Blutinger: 03:37
I'll be honest, the videos I took, I have never watched from start to finish because when I think about them, I get a cold chill up my spine and I get goosebumps re-imagining those days and those fragile moments. The stress and the unbearable reality of seeing so many people struggle to just breathe without family close by, not having a viable treatment option, except getting them through the disease process and not knowing where they would end up—it was unbearable and there was no end in sight at that time. And so those videos, I just, I can't bring myself to watch them, even though, ironically, I shot them, and I know they're accurate and I know they portray a very real world at the time.
I read a statistic recently that up to 40 percent of front-line workers can expect to experience some kind of PTSD. If you're comfortable talking about it, could you talk about how the stress manifests itself in your life and some of the measures that have been helpful for you to fight back against that?
Dr. Erik Blutinger: 04:58
There are moments where I feel like my level of patience is a bit less than normal. There are moments where I feel as though, mentally, I just feel drained doing some of the basic things that I used to be able to do without thinking twice. And I still wake up to nightmares thinking about suddenly losing my breath and not having a ventilator machine available, even though right now our capacity is great, hospitals are open, and I don't have to worry about that.
Do you talk to your colleagues about it?
Dr. Erik Blutinger: 05:36
I have found it's really difficult talking to colleagues about it because everyone is struggling to grapple how to just rationalize it and how to think about it and how to even discuss it. Even something as simple as, "How are you doing?" or, "How are you feeling?" can go in so many different directions.
That's so interesting. I would have thought that talking to others who could relate would be the easiest thing to do.
Dr. Erik Blutinger: 06:09
Right. I know. I thought the same thing, and there are a few who I've felt comfortable talking to, and we've had a very nice dialogue and a fair number of conversations. But the difficulty of discussing it with colleagues just points to the fact of how challenging and complex of a problem we're facing.
So it's not a question of stigma. It's not as though it's not welcome. It's just that the conversation is so complicated.
Dr. Erik Blutinger: 06:43
Exactly. It's not a question of stigma. It's more a question of how complex and delicate the conversation can be. And many people are scared to tap into the inner psyche and the emotions attributable to what they've been through. Just like I'm scared of imagining that box of unanswered questions that I have tucked away in the back of my brain, because I'm worried to open it and really get engrossed by it.
Yeah. Where do you even begin?
Dr. Erik Blutinger: 07:24
Yeah. I'm at a loss for words, truthfully.
Yeah. All that being said, the situation in New York and at your hospital is very different today than it was when you shot that video in early April. When was the moment when you saw the light at the end of the tunnel, when you realized that things were going to get better?
Dr. Erik Blutinger: 07:49
I can't think of an exact moment in time, but there was a shift about a month ago where I was able to take off my mask outside of the Emergency Department itself, drink my coffee and think, huh, I think I can breathe for 10 minutes and just look on my phone, on YouTube, or waste time doing something as part of my break, because I can take this break. And if I can take this break, it means that there's something heading in the right direction.
Thinking back to where you were two months ago, how would you describe the situation right now at Mount Sinai Queens?
Dr. Erik Blutinger: 08:33
Night and day. Night and day. And it's nice to see us get on the other side of the curve or at least close to it, because if we have another curve, hopefully we have the confidence in our minds to be able to deal with it.
You shot a video recently, and in that video, you mentioned that there were empty beds in the ED [Emergency Department] and that was concerning because it meant that there were people out there who were having heart attacks, who were having other conditions, and weren't coming in to the ED. Is that still the case?
Dr. Erik Blutinger: 09:07
It's a little bit better than having completely empty beds, but we still have a fair share of our department empty. And that really concerns me because—on two fronts. On one front, there were so many people who still had strokes, heart attacks, bowel obstructions, appendicitis, and life went on during coronavirus in other areas. So with so much time that lapsed without receiving medical attention, they should be reevaluated. They should be seeing their doctors, they should be getting checkups.
So what would you say to somebody who might fall into that category? Who's like, "I don't know. I saw a lot of press coverage about Mount Sinai Queens, I'd rather risk it."
Dr. Erik Blutinger: 10:01
I would say to them right now, coronavirus is extremely few and far between across New York City hospital systems. And we have been doing this for months now on the front-lines of dealing with coronavirus and reducing the risk of contamination and exposure, in many ways much better than businesses and other parts of our surrounding communities. So if there's anyone you're going to trust to protect you from acquiring coronavirus or spreading it to someone else, it's us. Seriously, right now people should not be afraid to see a medical doctor.
So as we come to a close, I want to ask you a question that I like to ask a lot of our guests, which is: What does resilience mean to you?
Dr. Erik Blutinger: 10:49
Resilience is all about toughness, grit, and strength. And what I've learned over months of being in the Emergency Department and being thrust into this crisis is anybody with enough dedication, heart, discipline, and determination can get to a level of resilience that we could never imagine. And so we are all capable of being resilient. We are all capable of reaching a level of toughness, no matter what gets thrown in our direction, if we have the desire and the passion to get there.
What have you learned about yourself?
Dr. Erik Blutinger: 11:30
I've never been the smartest person in the room. I've never been a person who knew all the answers. I've never been the person who can fix any problem that comes through the doors, but I've learned that it's okay to not know all the answers. It's okay to feel scared and anxious, but what's most important is using that fear and anxiety to become a better person and to love the ones you're with, to take care of things that are most important in life. I'm blessed to be here and I'm blessed to be able to talk to you and I'm blessed to be on the front lines, but at the end of the day, I'm just blessed being a part of this world because seeing and hearing things that I never thought would be possible, it's just been, it's been eye-opening and it's been touching and I feel blessed.
Well, thank you so much for being on the podcast and sharing some of them with us. We're really lucky to have had you.
Dr. Erik Blutinger: 12:44
I'm really lucky to have been here, and I appreciate you taking the time to meet me and so, really, thank you.
Dr. Erik Blutinger is an emergency physician at Mount Sinai Queens. Road to Resilience is a production of the Mount Sinai Health System in New York City. It's made by Katie Ullman, Nicci Hudson, and me, Jon Earle. Lucia Lee is our executive producer. From all of us here, thanks for listening, and we'll see you next time.