By: Hannah Lin (CC '23)
Can you talk about your background in medicine and research and how you got into cardiology?
My path to cardiology was interesting. I really enjoyed cardiology as a resident, and at the time, there were only four cardiology fellows per year. You had to apply during your second year of residency as opposed to your third year, so you had to apply a year in advance of finishing residency. I wanted to start a family and felt like cardiology seemed very male-oriented and required frequent overnight calls. It didn’t seem like a lifestyle that was very appealing to me, so I actually initially matched in pulmonary critical care.
I was in my gap year working in a clinic, and I ran into Donna Mancini, who was head of the heart failure transplant group at the time, in a garage elevator. She had been one of my attendings on the ward service when I was an intern and she asked me what I was doing. I explained to her what I had wanted to do and what I was doing, and she asked, “Well, why don’t you just drop pulmonary and come do a heart failure fellowship with me and work for me?”
I thought about it and said I would do it. I did that for a year, and then I worked as a hospitalist for her for two years, and then she came to me and said, “I really think you should do a cardiology fellowship.” They were expanding the fellowship, so I was able to start as a general fellow the next year and then I went back to work in heart failure transplant after that.
That definitely is a very interesting path. Fast forwarding to now, could you talk about the COVID-19 research that you’re involved in?
I was involved with a group of cardiologists at the hospital led by Dr. Sahil Parikh which published an article in JACC about the cardiac manifestations of COVID early on, trying to draw attention to the fact that it wasn’t only ARDS that we were seeing but also plenty of cardiac manifestations like myocarditis, heart failure syndrome, stress cardiomyopathy, and arrhythmias.
We are also awaiting acceptance on a paper about women and COVID, looking at why women seem to get COVID less, what some of the reasons are for that, what some of the socioeconomic impacts are for women getting COVID and the types of jobs they do, whether they really get COVID less or are just not getting diagnosed as much because they are less likely to come to the hospital. We were trying to tease some of that out.
Finally, I do cardiac obstetrics, which is the care of pregnant women with heart disease, and the obstetrics group published a paper with guidelines on how to do telemedicine visits with pregnant women with different medical problems. I participated in the section on cardiac problems during pregnancy, how to manage during COVID, and what the recommendations would be for how to integrate televisits with in-person visits.
I was just about to ask you about your work in obstetrics. How are you seeing pregnant women being uniquely affected by this pandemic?
I think that the division has done a really good job of trying to stay very connected with their pregnant patients and trying to do outpatient visits on pregnant women. There was a very interesting paper published in the NEJM about the COVID positivity rate in all women admitted for delivery, and they reported a pretty high incidence of asymptomatic COVID positivity in the community of women who were coming in, some of whom became symptomatic during their pregnancy, some of whom may have thought they were asymptomatic but were having symptoms of labor which may really have been symptoms of COVID. The positivity rate was 13.7%, which was high, and not expected, at the time, and provided insight to us about how much undiagnosed COVID was in the community.
I think women have had a hard time in the labor and delivery world, especially initially, because the hospitals put restrictions on visitors, and I think there was about one week there when women who were pregnant were not allowed to have any visitors with them during delivery, which was incredibly difficult and emotionally taxing on these women. That actually ended up getting reversed, and they were allowed to have one visitor with them during the delivery. I think it’s been very stressful for pregnant women, since they’re having this beautiful thing happen to them, and they’re wearing a mask, their partner’s wearing a mask, everyone in the room is wearing masks and gowns, and it’s not exactly the warm and fuzzy delivery that people may have imagined for themselves.
In terms of illness, we haven’t had any deaths in pregnant women from COVID. We’ve had women get sick after delivery and need medical care for COVID, and I actually couldn’t tell you right now what the transmission to the fetus is in our institution, I believe it’s either zero or very low.
Going back to the televisits, you wrote an op-ed in The Wall Street Journal titled, “House Calls are Back—Virtually.” Unfortunately, I don’t have a subscription, but I could read the first paragraph, where you talked about how virtual visits give you surprising insights into your patients’ health. What do you think the future of telemedicine looks like specifically for your specialty, cardiology?
I think telemedicine is an incredibly useful tool, and I know that there’s been a lot of pushback, especially from community physicians who see a large volume of outpatients. I think that billing is obviously an issue for people trying to run a business in medicine. But there were a lot of rapid changes made that allowed for telemedicine to take off that I don’t think could have happened without COVID in terms of regulatory requirements and crossing state lines, having the ability to see people in different states where you’re not licensed but still allowed to do televisits with them.
I think telemedicine is amazing. I know that there is always going to be resistance to new things, but I think it really fills a void especially for people of lower socioeconomic status, assuming that they have access to some kind of a smart device, people who are very disabled and for whom it’s very hard to get to the hospital, people who aren’t feeling great that day and can still be seen, people during COVID who were nervous to come to the hospital or who needed to minimize their exposure.
I also hope, in the future, that people will be able to consult with specialists that aren’t near their home and get ideas and recommendations that don’t require a huge cost to the patient to travel and see that specialist. I like to give the example that someone has a rare brain tumor, lives in a rural part of the country, and doesn’t have the resources to just take a trip to Chicago, New York, or some major medical center. They can have a visit with a neurosurgeon that specializes in that kind of tumor and a specialty board, and those specialists can review the images with the family and make a recommendation that can help them decide what they want to do. I think that telemedicine is going to make it much easier for people to get those kinds of consultations. I think that it’s going to be here to stay.
I think that people are going to fill in the gaps in between regular visits in order to keep better tabs on people’s health, especially heart failure. For me, it’s great, because we can have a video visit where you can tell me what your weight is, you can show me if your legs look more swollen, I can see if you look short of breath, I can adjust medications, or I can say you need to come into the hospital.
Obviously, procedure-based professions are going to be a little more challenging. You have to be here to get a procedure, but you could have all the workup done when the proceduralist does a televisit with you and then you can schedule the procedure right after. So it’s not totally useless for proceduralists, but there are specialties where it would be a bit more difficult. Dermatology might be hard; sometimes, you really can’t see as well on these video visits as in other types of things. Obstetrics, you need to examine the patient and see how far along the baby is, what’s going on, and they need to get ultrasounds. So there are areas where it’s more challenging, but for my group, it’s great.
Shifting away a bit, it’s been about three months since the peak of the pandemic in NYC. You dedicated yourself to patients on the frontlines along with other healthcare providers, away from your family, and a lot of providers have spoken out about the huge physical and mental burden they felt and still feel. If you’re comfortable talking about it, I thought I could give you some space to talk about how you felt then and how you feel now, a few months after.
I think at the beginning, it was really very stressful. I have two children who are 12 and 15. We’re lucky enough that we have a family country house upstate, so my husband took them there, but then that meant that we were apart for chunks of time, which was hard. I think, especially for my younger child, there was a lot of anxiety around my health and wellbeing, whether it was safe to come home and see them, and whether I could reenter the home safely.
The beginning was really hard. I think it took a big emotional toll on many of us and I think there was a huge amount of fear because we hadn’t dealt with it before. What we were seeing was really at the level of chaos and war. It felt like a situation that no one had ever seen. Practically the whole hospital was COVID, every ICU bed was COVID except for one unit, popup ICUs were all over the hospitals, some had to have two patients to a room, some operating rooms had four patients to a room.
I was actually incredibly overwhelmed in a positive way by my colleagues and how hard everybody worked, how devoted everyone was, how much they looked out for one another, took care of each other, making sure that they were okay, they were safe. Pretty much every surgeon in the whole hospital wasn’t doing surgery, and they formed a group to go out and put in lines in all the patients so that people didn’t have to fumble around with putting in lines in someone with overwhelming COVID. That was amazing. I felt the hospital handled it incredibly well from an organizational perspective, being very transparent, providing a lot of information. Dr. Craig Smith wrote these daily missives about the experience which were very uplifting.
I think for me personally, it was pretty hard in the beginning, having to travel to see my family, the unknown, the anxiety. I did feel like I had a lot of insomnia. It’s funny you asked because just, I would say, the last week or two, I’ve been starting to feel much more back to myself. I feel safe in the hospital. Obviously, the numbers of patients have dramatically reduced, we have a lot of data to show that PPE works really well and there was very low transmission to healthcare providers once we started using PPE, and I’ve been starting to see patients in the clinic again, so even today felt like a normal day. I’m not wearing scrubs anymore, I’m wearing normal clothes, and I don’t have to wear Crocs! That’s been a lot better. I can sleep again.
But it was a good three months that were very challenging. We saw some of our colleagues become very sick and thought some of them would die, we know some people who died, and I think that was emotional for everybody.
Thank you so much for sharing that. For students interested in going into medicine and specifically cardiology, do you have any advice or life lessons that you would like to impart?
I would say that medicine is a great profession, no matter what everybody else says. One thing I didn’t mention earlier was the toll that it took, seeing all these patients in the hospital who didn’t have their family members with them when they were dying or were very sick. The emotional support having to come from nurses and doctors there to try to help them communicate with family was very distressing but also showed how important our job is and really reminds everybody that medicine is a calling and that when things get crazy, your job is still really important. You don’t sit home and conduct business as usual over the internet, you really are in the trenches taking care of sick people.
I think that cardiology is a great field. I wish more women would go into cardiology. You don’t have to do any procedures to be in cardiology, like me. If you want to do procedures, there’s plenty of them. The thing about medicine now is that there are so many different ways to practice it. You can be a cardiologist who only does echo, you can be an interventionist, you can be a general cardiologist, you can be an EP specialist. The same goes for all specialties. You can get as specialized or as general as you want, you can carve out the lifestyle you want in terms of how much you work.
I’ve always thought medicine is a great career for women. The one area that is not as great is that we need to see more women being promoted and in positions of power. That goes for the entire country.
I think people should know that it’s normal to doubt whether medicine was the right choice when you’re in medical school and residency. I think a lot of people ask what they’re doing there, why they did this, they feel tired, they feel useless, they feel stupid, they feel like they made the wrong choice and wasted all this time and money. But I think that if you can just keep going and find some people to talk to, you’ll realize that when you get to the other side, you’ll feel really lucky to have this job. I feel really lucky to have made this choice.
Lastly, to end with some optimism: what gives you hope for the future of cardiology, medicine, and society as shaped by everything that has happened this year (the pandemic, the fight for anti-racism)?
From a medicine perspective, I feel very hopeful because I think we’re really on the cutting edge of a whole new way of practicing medicine in terms of drug design and targeted therapies. For diseases that were very hard to treat, I think in the next 10-20 years we’re going to see a huge change in how cancer’s treated, how heart disease is treated, how for so many illnesses, even neurologic diseases, genetic therapies and targeted therapies are going to make a huge difference for the treatment of people and hopefully become less and less invasive, which we can see in cardiology with the advent of TAVR. There are very few reasons to have a surgical aortic valve replacement at this time, and eventually, that’s going to be true for so many other surgeries. That’s one.
From a societal perspective, I feel like despite how stressful and chaotic everything in the world is right now and sometimes people feel hopeless, I’ve seen so much goodness in people during this outbreak in the hospital, whether it’s nurses, doctors, travel nurses from the South who came up to work with the sickest of the sick COVID patients with a smile on their face and FaceTimed the families. I just always remind myself that there are so many people that are inherently good and that we’re bombarded with all this social media showing how terrible people can be. If you try to push through all that and focus on what you see around you, you’ll see that so many people deep down are incredibly kind, brave, and inspiring. That’s the second.
The third, in terms of social justice, I think that in medicine, this has become an incredibly important thing to focus on, not only in providing equitable healthcare to all different kinds of minorities, which is a big focus for me in terms of cardiac obstetrics, knowing that the maternal mortality rate in this country is incredibly high, particularly among Black women, but across all areas of medicine. I think, at Columbia, they are making every effort, as they should, to make all minorities feel like they have no barriers, that they are not being discriminated against, that we are all equal and the same, and are taking note of past decisions that were not acceptable and trying to make changes as a result of that.