Watch: A local anesthesiologist reveals her ‘eye-opening moment’ amid the pandemic

Coronavirus is affecting everyday life — even for those who have not been infected. We are sharing stories of its impact on local people. To share your own, please submit this form or email us at [email protected]. This story was told by Julie Tammaro, an anesthesiologist at Lowell General Hospital, and has been transcribed and edited from a conversation with Kristi Palma.

My name is Julie Tammaro. I’m an anesthesiologist with extra training in critical care and I currently work at Lowell General Hospital.

Personal protective equipment (PPE) has been on the front and center of everyone’s minds in health care. For me, specifically, I had a real eye-opening moment a handful of weeks ago. I had gone to our intensive care unit (ICU) to kind of orient in case they needed extra, extra hands. They were looking for other physicians that aren’t currently practicing in critical care at the hospital, but that have training in critical care to get credentialed for it in case it was necessary. So I was in the ICU and I saw two patients that were my age with COVID-19. And I saw another patient who had pretty much my profession. She was a nurse anesthetist. They were both in the ICU. And so, if I walked into that ICU with any sort of feeling that I was invincible in any way at all, I certainly walked out not feeling that way and feeling that, of course, me — just like anyone else or, actually, more than anyone else because of my job — was at quite a significant risk.

In the meantime, there were regular, daily conversations about the shortage of PPE — whether it be masks or face shields — that were going to be in unlimited supply. It’s hard to hear because you hear, ‘OK, well we only have enough for the next two weeks’ and maybe somewhere, somebody, knows, ‘OK, well we’re expecting a shipment in a week and a half.’ But you have to make a plan because you can’t wait for that. I had already spent a significant amount of money on trying to get my hands on other forms of PPE. I actually bought three respirator masks — construction-approved ones — and had bought face shields of my own and also Tyvek jump suits. So, I think, kind of getting my hands on what I could was a huge priority for me. And so that was all kind of happening and I saw a picture being shared through Facebook that showed an anesthesiologist in Taiwan using a clear box around patients for intubation. And that seemed like a great idea. And I wanted to figure out how to get my hands on it.

So there was directions for a prototype that was available online. I was kind of communicating with a friend of mine from residency who lives in California, and she was actually the one who sent me the exact description of how to make it. So I was on my way to Home Depot to try and make it myself with acrylic cement and as that was all going on my husband was isolated in our basement, because he had a fever, so I couldn’t rely on him for any extra help.

I turned to my brother-in-law, who I had been speaking with that day. He kind of had the foresight to say, ‘Maybe let’s put the brakes on and reach out to a manufacturer, because that way we can change it or make more if we if we need to.’ So he took the lead on contacting a manufacturer out in Chicago who was super responsive because it kind of showed to us that there’s a lot of interest out there where people want to help and want to get involved. They’re feeling really sidelined and want to be able to get involved. And so we were able to get one made the next day and shipped within 24 hours so that I could try it.

From there, he suggested, ‘Well, why don’t we see if there’s enough interest? If we get 100, let’s have our priority be getting them to people as quick as we can and we will kind of sort out how we want to finance this after, if we have enough interest.’ And the interest was way more than I was expecting. I had just made a simple post, really, on Facebook, assuming that it would spread within my local community. And, of course, it spread way beyond that. So we made a website to make it easier to organize and get the requests that we had. There are requests from Maine to Florida to California. I’ve been in touch with even an anesthesiologist out in Hawaii who wasn’t asking to have one shipped to him but wanted to know what we thought and had seen the video and wanted to get ideas for how to make it there. And when we realized how extensive the response was, we set up a GoFundMe page to help with it.

This all happened in less than a month. We are shipping out the last ones at the end of this week. I say the last ones because we feel like our funding supplied enough to do this first wave and we’re at a juncture of trying to decide whether we should continue to get funding and do this as donations as we were doing, or whether or not we feel like we’ve created this message that has spread really well and whether or not there are enough pockets of manufacturers in each region to take this on.

We’re using donations and we realize that everyone who donated want [the money] to go to good use. So we’re trying to cut as much costs out of shipping as we can. So the ones in New England, we hand delivered. We had a series of volunteers that were able to deliver 75 of them throughout New England. The total being about 330, actually, that we’ll have delivered by the end of this week are kind of extended across the US.

So for patients that have COVID-19, or really any respiratory virus, there is a high risk of [health care workers] getting exposure to the illness when doing procedures in the airway. Procedures in the airway we are talking about are intubations when patients are having breathing tubes put in. And when the breathing tubes come out, extubation. Other times people are in the airways, physicians are doing procedures in the airways, would be bronchoscopies. Other procedures would be when there are upper endoscopies — tubes going into, kind of, the mouth and into the stomach —  also end up producing a lot of coughing. So those types of procedures are high risk because the patients will generate a cough that will allow a lot of the virus to become aerosolized, meeting suspended up in the air. Besides it being, you know, a high chance of getting exposure in that moment, there’s also what’s become clear over the last several weeks to months of data, is that healthcare workers are at high risk of getting severe disease because they are having such an exposure to such a high viral load. So what this does is it creates a kind of a reverse PPE, if you will, as opposed to the healthcare worker wearing protective gear. It creates a barrier over the patients that allows us to be able to do the task at hand but creates an extra shield.

I think that all of the health care workers out there have to constantly be on their toes and thinking of how they can advance their own protection because the hospital administrators or the leaders in their field that are making the recommendations and rules can only make recommendations within their available resources. For example, they can’t say ‘Everybody should wear an N95 mask every day, throughout work,’ if they don’t have enough. That would be a useless policy. They have to have their policies match their resources. But if you, as an individual, feel strongly about an issue, you kind of have to keep pushing and find other funding so that you can make it happen for you. Because one really bad exposure can truly be life threatening. There’s not a lot of second chances with it.

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