Voices from the Front Lines

By Jeannie Evers

Exhaustion. Fear. Uncertainty. Hope. Eight alumnae in the medical field share their stories from the fight against COVID-19.

Nurse Jinny Kim ’12 doesn’t usually get to speak with her patients. By the time they arrive in the intensive care unit at Nassau University Medical Center in Long Island, New York, it’s too late for any meaningful conversation. Their respiration is too compromised from COVID-19 or their mental state is too altered or they had already been intubated in the emergency room.

This day was different. A man in his early 40s who had been admitted to the hospital was sent to the ICU because his condition was declining and he would need to be intubated. While they waited for the anesthesiologist to get into a protective suit, Jinny walked the patient through what was about to happen. They would put him to sleep, insert a breathing tube so his lungs could rest, do everything they could to make his lungs better, and wake him up again. She asked if he wanted to call his wife—he already had—and then with his permission took off his wedding band to store in a safe place. When the anesthesiologist arrived, she could tell her patient was worried. She did her best to reassure him that everything was going to be OK, that it was better to take this step sooner rather than later. “Then he smiled at me and said, ‘Just don’t let me die,’” she recalls.

When she returned to work two days later, he was dead.

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To say that the COVID-19 pandemic has upended our lives feels like an understatement. Economies and workers are struggling. Schools have shifted to online instruction. Everyone feels the loss of basic human contact. As of this publication, more than 62 million people have been infected worldwide, and about 1.5 million have died. Throughout it all, our nurses, doctors, and other health care workers have been heroically serving on the front lines to treat the sick and to keep the rest of us safe.

The Bulletin talked with eight Santa Catalina alumnae in the medical field about their experiences. They all spoke of physical and emotional exhaustion, of fear and uncertainty, but also of the community that rose up around them. “There have been so many days when I’m exhausted and fried, but then a Catalina classmate might post something wonderful or funny on our group chat and then I’m good for many more days,” says Amy Pine ’85, a public health official in the San Francisco Bay Area. “The friends I made at Catalina are truly the best.”

Amy Pine ’85 is the immunization section director at the Alameda County Public Health Department who is currently organizing vaccineimplementation for the State of California. “I talk about public healthas being the immune system outside of the body—the quiet workforce andthe systems behind the scenes that are trying to minimize disease andkeep people safe and healthy.”

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Most of the United States wouldn’t experience the full effects of COVID-19 until March, but Amy was already responding to it in January. The virus emerged in Wuhan, China, in late 2019 and was slowly making its way into other countries. Concerns about the virus’s spread prompted the Centers for Disease Control and Prevention (CDC) to begin screenings at airports that receive passengers from Wuhan, including San Francisco International Airport. That meant Amy and her team at the Alameda County Public Health Department needed to call all county residents on these flights to ensure they quarantined in their homes for 14 days. Amy, the department’s immunization section director, had officially taken on a new responsibility that gets activated during emergencies: disease containment.

“It was quite different than anything we’d had to do in the past and I knew then this was not going to be a typical disease response,” Amy says, citing previous responses to measles and meningococcal outbreaks. “The scale was, right off the bat, much bigger than anything prior. I remember a feeling of hope that we were being extra cautious and we would be able to contain this new virus, but I also had a sinking feeling that, since it was novel, there was no telling where this was really headed.”

Elsewhere in the Bay Area, Kiren Rizvi Jafry ’01 was also preparing to respond to the disease. Kiren works for Sutter Health, a not-for-profit network of clinics and hospitals throughout California. She is the area operations executive for San Francisco and Marin counties, overseeing about 40 outpatient clinics. When the first confirmed case of COVID-19 in the Bay Area was announced on January 31, health system officials sprang into action. Kiren assembled a local incident command team to try to figure out how to properly equip health care workers, track patient data, expand testing, and coordinate with other areas of the Sutter system. “There was so much unknown about how to respond in the safest way,” she recalls. “What kind of PPE would we need to treat patients? Can we treat indoors? Do we have enough ER rooms?”

Kiren Rizvi Jafry ’01 oversees about 40 health clinics as the area operations executive for Sutter Health in San Francisco and Marincounties. She is working to instill a sense of safety and security inthe clinics— for patients and personnel.

Across the country, Jinny Kim was keeping a close eye on COVID-19 developments. In mid- to late-February, cases were spiking in South Korea, where her family still lives. She knew it was only a matter of time before the virus came to New York. Still, she thought, treating the disease wouldn’t be that different from treating other acute respiratory illnesses she regularly encounters in the ICU. “I was like, it can’t be that bad,” she says. “But of course it hit and it was that bad.”

As many unknowns as Amy and Kiren encountered in their pandemic planning, they were able to turn to places like Washington and New York for guidance. Those states in many ways were flying blind. "New York got hit the hardest, the fastest," Jinny says, "so literally whatever policies the hospitals were coming up with, those were the best guesses we were making. We had to survive through it without having any good examples of what works and what doesn’t.”

Jinny (Yoojin) Kim ’12 is an ICU nurse who transitioned from Nassau University Medical Center to NYU Langone’s Tisch Hospital in the spring. She says her patient load has more than doubled at various times throughout the pandemic. She has had up to six critical patients at a time, when two is the standard.

In March, the World Health Organization officially declared a pandemic and California became the first state to issue stay-at-home orders. Amy and her team in Alameda County were by now focused on isolation and quarantine measures. They went from calling individuals to issuing blanket orders for the county. “Our average caseload was, at that point [in early March], maybe 10 to 15 cases per day. But then, in late March, it just blew up to 50 cases per day, then continued up up up,” she says.

At Denver Health in Colorado, pediatric emergency room nurse Alex Pollack ’12, ’08 LS had her first encounter with the virus. A family that had been living in China returned home through San Francisco, and they were experiencing symptoms. “We were well aware that they definitely could be positive. I remember they came in and everyone was really scared,” says Alex, adding that the family had to be brought in through a separate entrance. “It was like they had this green haze around them and no one wanted to get close to them. That was when I really felt that this was scary, because it’s such an isolating disease.”

The feeling of isolation was especially acute for Meghan Barrett Mancha ’04, a registered nurse at Carmel Hills Care Center, a skilled nursing facility in Monterey. The facility, which has seen only one positive case of COVID-19, implemented strict protocols to protect its vulnerable population. That means no visitors, except in end-of-life situations, and a 14-day quarantine for new arrivals from hospitals or homes. It’s been especially hard on patients with dementia. “They know something bad is going on, but they don’t know the extent of it, they don’t know why they can’t visit their families or why their families can’t visit them,” Meghan says. To try to make up for it, families are encouraged to make an appointment to see their loved ones through the front windows, and residents are encouraged to go about their usual routines, such as visiting the activity room or getting on-site manicures (masks on, of course). “That sense of community is really important, especially for the population I work with,” Meghan says. “We’re trying to keep everything as normal as possible, trying to keep everything positive. At Catalina, everything was always so positive.”

Meghan Barrett Mancha '04, a registered nurse at Carmel Hills Care Center in Monterey, says “we’re washing people’s hands like it’s going out of style.”

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Along with the physical toll of 12-hour shifts, higher caseloads, and hypervigilance comes an emotional intensity. Some amount of anxiety results from the unknown. “The evolution of our understanding of how this virus spreads, how contagious it is, what the health symptoms are—that kept changing and continues to change,” says Kiren. Adds Amy: “I talk about practicing the ‘F’ word, which is flexibility. As more is learned about COVID-19 disease, guidance changes from CDC about how best to tackle different situations. There were times when it seemed like guidance changed every five minutes, and the ripple effect of that can seem crippling. There have been so many moments when I’ve had to think ‘F-word, F-word, F-word!’” Asymptomatic patients add another level of uncertainty. “Nerve-wracking” is the term used by Kelsey Green ’13, ’09 LS, an emergency room nurse at California Pacific Medical Center Van Ness Campus, a Sutter Health hospital in San Francisco. “Someone could come in with toe pain, and they could end up being positive,” she says.

Then there are the mask shortages. N95 masks filter at least 95 percent of airborne particles, a crucial function when dealing with COVID-19, an airborne disease. The standard of care is for nurses to change their mask every time they interact with a patient. Now, they reuse the masks until the band breaks or the mask becomes visibly soiled. Kelsey and Alex both credit their hospitals with continually finding new sources of masks and other personal protective equipment (PPE), but it’s still not enough. Alex, describing the masks as “precious,” recalls having to store them in paper bags between use. Kelsey says her hospital allots one mask per shift; she wears a simple surgical mask over her N95 to help extend the life of the latter.

The availability of testing has also gone through ebbs and flows. Testing is important not only for tracking and treating the disease, but also for helping nurses determine which mask to wear. In theory, if you know your patient tests negative, you can get away with wearing a simple mask. But without the certainty of a test, you take a risk when interacting with patients, especially those who present without symptoms. So, despite hospital guidelines and health department recommendations, “it’s still up to our own judgment on when we’re going to use an N95 and when we’re going to use just a simple face mask,” says Kelsey, adding that she always errs on the side of caution. “It does make me feel nervous.”

Perhaps worse is knowing that they may not be able to comfort their patients. “When you go into the rooms and you’re covered from head to toe in PPE, you forget that your emotional connection with the patient just goes away,” says Alex. “They can’t see you smiling, they can’t see your facial expressions other than your eyes. . . . Not having that emotional connection with a patient when they are in such an intense situation was and is still probably the hardest part about it.”

Alex Pollack ’12, ’08 LS is studying to be a physician’s assistant at Rocky Vista University in Colorado. She still picks up shifts as a pediatric ER nurse at Denver Health.

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While New York was dealing with high case numbers in March and April, California was preparing for a surge that wouldn’t arrive until July, when the state’s stay-at-home orders were gradually lifting and people were heading back out to restaurants, salons, and malls. At Monterey County Jail, where Jessica Price ’03, ’99 LS works as a nurse practitioner, more than a quarter of the roughly 700 inmates tested positive in July. “We’re dealing with a population that’s living on top of each other in close quarters, so pretty much when one person got it, it spread very quickly,” Jessica says. Until then, the jail had done a good job of keeping the virus in check. Staff and inmates wore masks and had their temperatures checked every day. The jail had instituted a no-bail policy, so those accused of nonviolent crimes were released, thus reducing the inmate population. When the outbreak occurred, most of the inmates who tested positive were asymptomatic, Jessica says. Of the few who had to be hospitalized, none stayed in the hospital for long.

Practices certainly changed, though. Jessica explains: “The inmates have access to tablets, and they can send messages to the medical staff. Typically an RN would intercept those messages and then triage the patient and decide if I needed to see them. But because the RNs were inundated with all this monitoring they had to do, myself and the physician’s assistant started going through all of these messages. So in a way we were doing telemedicine, even though we were on site.”

Jessica Price '03, '99 LS, the nurse practitioner at Monterey County Jail, says she enjoys the excitement of the job: “You never know what’s going to happen when you walk in for the day.”

Just as working from home has become the norm, telemedicine is an interesting side effect that some medical professionals expect will continue. Kiren says, “There were a lot of program closures in the early days and we had to convert as much as we could to virtual care and virtual medicine, which actually has turned into one of the most exciting aspects. How does an entire industry pivot so quickly to safely treat patients but also add more accessibility? I anticipate that virtual care video visits are here to stay. We see that not only from the workforce that’s delivering the care, but also from patients who are demanding it and found it to be extremely valuable. . . . Virtual care has opened up an appreciation and awareness of what’s possible.”

Another side effect, at least for San Francisco nurse Kelsey, is a greater understanding of the societal side of health care. She recalls helping another nurse with a patient who ticked all of the boxes for COVID-19 risk factors, including race and socio-economic status. “I just remember feeling upset with how unfair it was,” Kelsey says. “It was unfortunate because they were pretty young, and if they did have proper access to care, they probably would have had a lower risk of (1) getting COVID and (2) suffering from it so much compared to other patient populations from different demographics. . . . It just showed me the whole picture.”

For most people, that might have been the end of it. But Kelsey went to Santa Catalina, which she says taught her not to be afraid to do more. The patient, along with the Black Lives Matter movement, inspired her to create a three-part series of posters for hospital workers highlighting the medical, societal, and economic issues that put some people at higher risk of COVID-19. Her first poster focused on the Black population: how they are typically diagnosed with common illnesses that increase risk, and how their lack of trust in health care professionals means their health issues often go untreated for a longer time. She also plans to create a poster on the Latino population and another focusing on children, the elderly, and people who are abused. “[The posters will] remind people it’s more than just the patients we treat at work. It’s a bigger problem,” Kelsey says. “COVID-19 has opened my eyes to all the different issues in health care, so I want to make others aware. There’s something we can do in our own lives to help other people out, not just the patients who come in.”

Kelsey Green ’13, ’09 LS is an emergency room nurse at California Pacific Medical Center Van Ness Campus in San Francisco. She says that while her hospital planned for possible surges in the spring and summer, it was never overwhelmed by patients.

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So what’s next? Now, as cases in the United States are again on the rise, everyone is also focused on flu season and how to prepare for what Amy calls “twindemics.”

Of course, the big beacon of hope is a vaccine. In September, Amy became the team lead for COVID-19 vaccine implementation for the State of California. As you might imagine, there’s a lot involved with planning on this scale. Amy notes: “Medical providers will have to know how to store [the vaccine], receive it, and administer it. The general public will have to know it is safe. It will have to be made abundantly clear who qualifies to be vaccinated if it’s an environment of scarcity. . . . There are multiple questions about equity, transparency, communication, and access.” And Amy is not just preparing for one vaccine, but several that are in development. The vaccines vary in the number of doses required, the time needed between doses, and the temperature at which they need to be stored. “Keeping track of all of these complicating factors and differences makes for logistical and informational challenges at every step of the way,” she says. “Many county health departments are also using flu vaccine now as a means of collecting best practices on how to conduct socially distanced vaccination clinics—a concept that was never necessary until this pandemic.”

Amy expects the vaccine to be rolled out slowly, starting with the highest priority populations such as health care personnel, first responders, and people with underlying conditions. Those priorities will likely stay in place even when the vaccine becomes more widely available in the following months. She says it could be summer 2021 before there is enough of a supply for everyone to receive it.

For the vast majority of us, masks and physical distancing remain the best means of stopping the spread of the disease. In Ireland, Kahlil Thompson Coyle ’93 has been working to spread that message, among others, on behalf of the Irish health service, known as the Health Service Executive (HSE). In early March, she was chosen to lead a team in the HSE’s communications division to help outside organizations share COVID-19 public health information. Later that spring, the HSE launched the “Hold Firm” campaign, inspired by a poem written by the Irish president. The campaign was created to “acknowledge and encourage the enormous effort being made by everyone in Ireland in the face of the COVID-19 pandemic and to encourage people to ‘hold firm’ for the people we love, the things we miss, and the future we hope for,” Kahlil says. “It was an incredibly moving and inspirational call to action that brought us together and inspired us to follow the public health advice. I don’t ever think I will forget the feeling that it sparked in me—of solidarity, compassion, and hope.”

With cases spiking worldwide and with the prospect of several more months of lockdowns, “hold firm” will be a message worth repeating.

Kahlil Thompson Coyle '93, who is part of the Irish health service's COVID-19 communications team, says her biggest challenge has been the scale and speed of the work.

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Despite all the long days, uncertainty, and heartbreak, alumnae felt enormous gratitude for the support they’ve received throughout the pandemic: support from their co-workers who stepped in when others needed a break or offered reassurance that they were doing the best they could; support from those in the community who donated masks and meals; and, of course, support from their Catalina classmates. “We’re everybody’s cheerleaders,” says Kiren. “I think that network of sisterhood is so, so, so important, especially this year when there is so much unrest, so much uncertainty, so much crisis.”

In normal times, Khalil is the deputy head of the Irish health service’s culture unit, where she spearheads Values in Action, a behavior-based approach to shaping the internal culture of the HSE. Appropriately, she is guided by personal values that she developed at Catalina. “I have been finding myself leaning firmly into my values while I navigate life through the COVID-19 pandemic,” she says. “Our Catalina promise of ‘Do well. Do good.’ is a belief that I carry with me and is at the cornerstone of my approach to life and work—and for which I will be forever grateful to Santa Catalina.”

For many of these alumnae, Catalina played a role in where they are today. Their very approach to medicine is laced with lessons they carried with them after graduation. Compassion and empathy are high on the list. Says Jessica: “I might not have too much in common with my patients, but I can empathize with them and always want to give them the care that I would want for my own family.”

For Jinny, it’s about looking at the whole person. “I somehow went from a Catholic high school to a Jesuit university, and the first hospital that I worked at was Adventist. So I kind of worked and studied in a religious setting for a very long time,” she says. “Even though I’m not really religious myself, I think a lot of the values carried through, and it’s been easier for me to communicate with my patients whether they’re religious or not. . . . You treat them as another human being, not always as a patient.”

Kelsey says Catalina taught her to remember that she, too, is human. “Nursing is more than just skills and objective evidence. It’s also taking five minutes to be a person with your patients,” she says. “I’m not just here to poke you and give you medicine, I’m also here to support you. I think those are qualities that I definitely learned from Catalina: How to be a good person, but how to be a hard-working person too.”

On her path, Kiren has embraced Catalina’s culture, spirit, and mission of raising and developing young women to serve. She says she’s humbled by all of the health care workers who risk their lives in this fight against COVID-19, this “long endurance marathon,” as she puts it. “What surprises me is the level of engagement, the willingness to take care of these patients even as you’re putting yourself in harm’s way,” she says. “I’m just so proud of working in an industry that has so much purpose.”