Walking into the unknown: An important perspective from a Tampa General clinical leader

In my last column, I shared with you my reflections on my personal and professional experience so far during the COVID-19 pandemic. Fortunately, I am surrounded by a team of amazing people that are open to sharing their experiences as well.

Candace Amato is a career-long nurse and director of medicine for the Tampa General Hospital unit that has cared for most of our COVID-19 patients. I am incredibly proud of Candace, her team and our entire TGH family. In the scariest of times, they have risen to meet every challenge, stayed positive and, most importantly, were there for our patients and each other. I am amazed every day by both their compassion and grit, and I'm so grateful for them.

Two things stand out in Candace's remarkable story and perspective, in my opinion. One is her wealth of compassion and vulnerability. She is able to show her sense of fear and, at the same time, lead with great skill and determination. The second is her and her team's ability to improvise strategically. They have tackled every obstacle, coming up with solutions or workarounds. They have let nothing stop them from providing the best possible care. 

With extreme admiration, here is Candace's reflection on COVID-19.

I was mentally prepared—at least I thought I was. As a nurse with more than two decades of experience and a recent promotion to Director of the Medical Division at Tampa General Hospital, I had seen almost everything you could imagine — the sickest possible patients, remarkable recoveries and devastating losses. I had cared for or run scenarios for all kinds of medical disasters and emergencies — hurricanes, mass casualty, swine flu (H1N1), Ebola — all of it. 

In December 2019, we started hearing rumblings of a virus coming out of China. I felt confident we could handle what came our way. I read up on the Spanish Flu and reviewed pandemic protocols. We spent the next two months discussing potential scenarios and getting ready in case the virus made its way to our community. I knew, should TGH get "hit," it would significantly impact my patient population.

And then March rolled in. That's when everything changed, and things got "real" very quickly. I had planned to take my son, a high school student and history buff, to New Orleans to see the WW2 museum for spring break. Suddenly, he and I both knew that we would not be hitting the Big Easy. COVID-19 was at our doorstep.

Slowly, patients began to trickle in. Specific units were challenged with the care of these patients. One of our first teams to take on the COVID-19 care challenge was our complex medicine units. They did this with grace, expertise, and compassion. I am so very proud of them! Specialized training was provided to keep them safe while following the strict isolation procedures required for these patients' care. 

As cases continued to mount, we quickly outgrew the negative pressure rooms we had on these units, and the patients became much sicker. On March 26th, we turned our 18-bed MICU into a negative pressure COVID-19 unit overnight, doing our best to protect the team and the patients. Seven months later, our MICU unit continues to provide world-class care to our COVID-19 patients.

I have been a nurse at TGH for 23 years. I came here in 1998 as a travel nurse, and TGH has given me an amazing career and become my extended family. I knew I could count on my colleagues. I knew in good times and in bad, we were there for each other. But those early COVID-19 days would remind me of that in spades.

Of course, like everyone, I was scared. Not so much for myself but for my team and our families. I had been in my current director position for less than a year when we began treating COVID-19 patients. While I had managed the MICU for years, and I knew the new manager and had a deep connection with the team, being the person responsible for all these teams took things to a different level.

I also knew that some of my team members had immune-compromised family members. Many were scared to hug their kids when they got home from a shift, afraid that they might make someone sick. We all cried together, and those early days were hard. I felt the weight of caring for my team — sending them into the unknown was a terrifying feeling at first.

And while worry was always in the back of my mind, everyone's fear was immediately channeled into taking care of patients. How could we keep everyone safe while providing the best care we possibly could — that became our constant focus — and this required continuous innovation and out-of-the-box thinking. 

For example, when we realized it was hard to hear each other, someone jumped up and went immediately and bought walkie-talkies. And when we realized the IV tubing was not long enough to reach across the room and outside the door, a team member secured longer tubing to dispense meds from the hallway. There were dozens of small, collaborative things like this that made a tremendous difference. 

Multiple units within the hospital and my division were impacted. We converted entire units. We relocated entire teams and brought in crisis staff to assist with the surge. The ICU and Complex Medicine units worked hard and remained flexible as we navigated this rapidly evolving crisis. Everyone pulled together daily to find solutions and move forward. It was knowing that we could make it work that made things less scary and more manageable.

While the last seven months have been incredibly difficult, I have learned so much. I honestly believe that COVID-19 was on-the-job training like no other. I gained more experience and training from this than I could have over a decade. More importantly, I developed a new level of appreciation for these teams and the entire division.  

Looking back, it is a testament to the strength and determination of this organization. Everyone came together and circled the wagons to fight this crisis. No one batted an eye when we had to open units or reallocate staff.  It was such a fantastic show of support from everyone. They all went above and beyond. In the end, I realized that if I must walk into the unknown again, these are the people I want by my side.

John Couris is president and CEO of Tampa General Hospital. Candace Amato is the Director of the Medicine Division at Tampa General.

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