“I saw a patient who walked in with a little difficulty and complained of extreme fatigue. I remember speaking to him, having a normal conversation, while conducting my examination. I was shocked and horrified to see this man having a full conversation with me had a blood oxygen saturation reading of 34%. His chest x-ray was remarkable and I immediately phoned an internist for his admission to the intensive care unit. His only positive COVID-19 criterion was fatigue. He did not even complain of shortness of breath, fever, or have any of the other typical symptoms. That evening, as I did my admission follow-up calls, I was told that he had been placed on a ventilator within two hours of arriving in ICU. I had never seen such a quick deterioration. Luckily, this patient improved quite miraculously and he is one of my favorite recovery stories.”
This type of rapid patient deterioration became a common occurrence at the beginning of the pandemic in the Johannesburg, South Africa hospitals where Executive MBA Student, Dr. Teneel Noble, works as an ER physician. “A patient would come in speaking and by the end of your hospital shift, they would be requiring some sort of ventilatory support. By the time you came in for your next shift, they had passed away. It was scary to witness,” says Noble.
During the beginning of the pandemic, many of the hospitals had to rapidly convert their resuscitation rooms and non-emergency consultation rooms into COVID-19 red zones. This is where positive patients were cared for, as well as anyone exposed to the disease. “While hospitals, clinics and medical practices all have certain baselines and infectious control standards that need to be adhered to at all times, COVID-19 caused many complications to arise during implementation of these. This is mainly because massive infrastructure reallocation and subdivisions had to be achieved because the disease is so easily transmitted from person to person.”
Moving between the red zone and normal zone became a mission and a constant cycle of changing gowns and personal protective equipment (PPE). “Coming into the red zone requires putting on new personal protective equipment and new gowns each and every time. Coming out of the red zone requires removing all the gowns and personal protective equipment again. This cycle continues for each movement between zones. In an average shift, one could change in excess of 80 times.”
Beyond facility logistics, staffing shortages, due to people contracting the disease, and lack of PPE began to become a reality. “Massive restructuring of schedules had to be undertaken to accommodate staffing of the ER. Due to the sheer amount of PPE that we were using, we needed to find a way that was cost effective and yet still efficient. I ended up having to buy a large number of refuse bags, as they were essentially what was needed. I cut out space for my hands and arms and used that. I was also able to recycle it in a sense, I would take it off, wash it in soap and water, dry it out and then dip it again in 70% alcohol.”
Adapting to situations and finding quick solutions became a goal of Dr. Noble. Beyond working in the ER, the company she works for, MedAire, provides telemedicine for aviation and yacht medical support. Her startup, Medica Alliance International, now has an entire MDConnect wing dedicated to providing medical support for COVID-19. “My own personal practice endeavors have evolved since the start of COVID-19. What I love most about my job is the ability to make a tangible difference in the lives of others, and at the same time to learn and relearn on a daily basis. Medicine is not an exact science. It is science that draws upon the facts and also draws upon intuition when the facts do not make sense.”
Dr. Noble’s personal practice is what inspired her to pursue an MBA. Quantic’s flexible platform was the perfect fit. “After practicing clinical medicine for a few years, eventually settling in Emergency Medicine, I noticed there were many things that could change on the business side. Quantic has revolutionized how an MBA program should be run. Being in this profession, having a career with timely demands, and not being in a constant location, made it refreshing to find a program that took all of that into consideration. Quantic enables one to complete the coursework and requirements without burning out and trying to fit all spheres into a rigid schedule.”
After witnessing these pandemic hospital experiences first-hand, Dr. Noble has advice for a potential second wave. Her main takeaway is to stay vigilant and stay active. “One of the most important things to get through to the general public is that relaxation of lockdown does not mean that the pandemic is over. In fact, it means that despite greater freedoms, there should be greater awareness of preventative strategies. Mental health is also a major issue. This time may produce frustration, anger, depression, as well as anxiety. Physical exercise is very important. It will relieve stress and release those needed endorphins.”