‘One Minute At A Time’

Michael Somekh on the day of his discharge with his daughters, Skylar and Sloane. He received a long, loud “clap out” from dozens of SBMC doctors, nurses and staff.

 

With teamwork and tenacity, critical care specialists at Saint Barnabas Medical Center saved a COVID-19 patient’s life.

On March 18, Livingston resident Michael Somekh, 52, went to the Emergency Department at Saint Barnabas Medical Center (SBMC). He had what he thought was a very bad cold or the flu.

As it turned out, Michael was one of the first COVID-19 patients at SBMC, and he had one of the most severe cases doctors there saw.

As a result of the intensive eff orts of the multidiscplinary critical care team at SBMC, however, he made it through. On May 22, he was released from SBMC to rehabilitation.

“Neither Michael nor any of the survivors, and there were many, could have done as well as they did were it not for everyone on our healthcare team working together,” says critical care physician Paul Yodice, MD, Chairman of Medicine and Director of Clinical Excellence and Effectiveness at SBMC.

“We were focused on one goal, and that was getting people back home with their families where they belonged.”

A MOVING TARGET

In mid-March, doctors around the world were reaching out to each other to try to figure out treatments for this new viral threat.

As a first step, Michael was given antibiotics in case he had a bacterial infection. He was tested for COVID-19, and while test results were pending, he was given hydroxychloroquine, the only management for COVID-19 doctors had at the time.

But Michael’s condition deteriorated rapidly. Within two days, he was on life support.

“His blood pressure was falling so fast that he was in shock,” Dr. Yodice recalls. “He needed a special kind of ventilator reserved only for the most hypoxic [oxygendeficient] patients. We had to put him in a medication-induced coma.”

Michael got bacterial pneumonia. His kidneys were barely functional. He developed what’s known as a “cytokine storm” in which the body begins to attack its own cells and tissues as it attempts to fight off a virus. “It’s like a fire in a fireplace that rages out of control,” explains Dr. Yodice. “It stops doing what you need it to do and burns down the house.”

To fight that battle, doctors tried tocilizumab, an immunosuppressant. “It may have helped prevent him from getting worse, but we can’t really know,” says Dr. Yodice.

Members of the critical care team in the lobby of the Cooperman Pavilion

 

ALL HANDS ON DECK

SBMC was seeing many cases like Michael’s during that period. “We had to convert the entire OR and recovery room space, as well as several additional floors, into intensive care units to accommodate people as sick as Michael was,” says Dr. Yodice.

For weeks, no one working in critical care was able to leave the hospital for more than a few hours. Reinforcements were pulled in from throughout the medical center: residents from all specialties, anesthesiologists, nurse anesthetists, physician assistants, physical therapists. Engineering and environmental services teams put themselves at personal risk to do what was needed to make the rooms safe.

“Every single person went well above what anyone would ask or expect, and did so every day without complaint,” says Dr. Yodice. “We were all determined to succeed.”

In dealing with COVID-19, there are no quick fixes. Patience, perseverance and endurance are necessary because patients often have multi-organ system failures, Dr. Yodice explains.

“We have to take it one minute at a time,” he says. “As I tell families, minutes become hours, hours become days and days are what you need to get you home.”

TURNING THE CORNER

At one point, Michael’s condition was so dire that, despite the no-visitors rule, his older sister, Barbara Julich, was allowed in to see him for a couple of hours. “There must have been six people standing over him the entire time,” she recalls. “Doctors, nurses, respiratory therapists.”

Barb held up her phone so that his daughters, Skylar, 18 and Sloane, 22, and other family members could talk to the unconscious Michael, hoping that he could somehow hear them.

It was the low point. Soon thereafter, however, Michael’s condition stabilized.

In early May, doctors were allowed to try convalescent plasma therapy for people with severe cases of COVID-19. In this treatment, patients get blood from people who’ve recovered from COVID-19 and have developed antibodies to it.

No one knows for sure if the treatment is why Michael turned the corner, but turn it he did. He was moved from the ICU to the respiratory floor. He was slowly weaned off the powerful anesthesia he’d been on. Nurses showed him pictures of his daughters and asked if he recognized them, and he blinked “yes.” Soon, he was able to talk on his own.

“Why isn’t anyone coming to see me?” he asked Barb via FaceTime. She explained about the no-visitor policy. As he talked with Barb and his sister Carole Baron—who’d served as the main conveyor of information between the family and medical professionals—Michael began to realize that the world had changed. He understood why the nurses had full plastic suits on when they entered his room, and why they took them off when they left.

“Those nurses were so great,” Michael recalls. “Anything you needed, anything you asked, they were there for you.”

NEXT STEPS

On May 22, Michael became SBMC’s 750th COVID-19 discharge. On June 3, he was released from rehab to home. He has begun to regain some of the 50 pounds he lost and to get muscle strength back.

“His recovery is just one example of how dedication and perseverance can make a difference to the life of a person and an entire community,” says Dr. Yodice.

Given the nature of viruses, the world can expect another outbreak at some point, Dr. Yodice says. “But I’m hopeful that we won’t see anything approaching what we saw in the COVID-19 pandemic, because people and healthcare providers are now more aware and if they see anything developing, will take rapid steps to prevent its spread.

“The analogy of fire is an important one,” he says. “Constant vigilance is the only way a fire doesn’t escape and burn everything around it.”

For information about physicians, programs or services at Saint Barnabas Medical Center, visit www.rwjbh.org/saintbarnabas.