On March 17, 2020, David I. Lee, MD, chief of Urology at Penn Presbyterian Medical Center and an associate professor of Urology in Surgery at the Perelman School of Medicine, embarked on something new.
Few things are new for a physician with the experience of Lee, a urologic surgeon with expertise in minimally invasive robotic surgery. But that day, when Lee arrived right outside the hospital to a big white tent, he was tasked with tackling something not only entirely novel to him but new to the rest of the world: COVID-19.
“As surgeons, we’re problem solvers,” Lee said. “And the situation we were all in, especially this spring, was a problem with unclear solutions.”
Lee was tapped by Penn Medicine to co-manage the Influenza-Like Illness (ILI) tent, at Penn Presbyterian. The tent was designed to efficiently triage patients with coronavirus symptoms or other life-threatening conditions, quickly test the patients, and take some of the load off of the Emergency Department. Lee had time to take on this new challenge because, in order to protect patients and allow them to socially distance at home, all elective surgeries were postponed.
Lee’s day job is primarily doing prostate cancer surgery and serving as a leader and expert. His “pandemic” job put him under the tent on 38th Street in the role of learner and supporter. The new duty and environment led to unique lessons on problem solving, lessons learned not by treating Penn’s sickest COVID patients but by assisting those who did.
Diving into the Known
“What I do with prostate cancer is predictable,” Lee said. “My urologic surgeon peers and I understand the disease, its progression, and the most successful ways to treat it. Many aspects of the coronavirus were the exact opposite: a mystery.”
Instead of being bogged down in the unknown, Lee and his colleagues focused on what they did know. From an organizational perspective, that meant dedicating their time to patients who they could help without immense emergency medicine expertise and sending the sickest to their peers in Emergency Medicine. They also worked on registering patients more quickly, employing the most-effective PPE, structuring the tent so that patients would be appropriately spread out and away from others who could potentially be carrying the virus, quickly processing swabs, and helping patients schedule and plan for proper follow-up.
“Largely, it was a mix of employing general medical skills and administrative tactics that we know work,” Lee said. “It was a good reminder that when you’re out of your element or dealing with something new, there’s always a foundation to build on or action steps that you can take to make things better.”
Being on the Ground
The best part of being in the tent was having an opportunity to work with clinicians and staff outside of Urology — interactions that will have lasting benefits now that he is returning to his regular work, Lee said.
“Building relationships with people outside of my department was enjoyable, but there’s a real practical benefit, too. If one of my urology patients has a secondary issue or concern, I now have personal relationships with colleagues, staff, and administrators who I know can help advise on the right course of action or help a patient be seen easier by the appropriate clinician.”
While working in the ILI tent, the diverse pool of on-the-ground experts made it possible to offer patients efficient care. Lee was able to care for a few patients who had come in with urologic symptoms like blood in the urine and discuss best options with ED staff. Lee recalls other specialists, like Kristopher Fayock, MD, an assistant professor of Clinical Family Medicine and Community Health and a Sports Medicine specialist, who also worked in the tent, treated patients with physical injuries without needing support from the ED.
“In March and April, people were increasingly taking the virus very seriously,” Lee said. The patients who showed up at the emergency department were often not sure how to keep themselves safe from the virus, if they would pass something off to a loved one, or even if they were sick enough to warrant a trip to the hospital in the first place.
“There was a lot of anxiety around the virus. The levels of fear were often very similar to those my cancer patients have.”
While other clinicians in the tent evaluated patients who had severe COVID-19 symptoms, Lee was able to help counsel patients with more minor symptoms or those who had come in for other urgent health issues. He shared best practices to use at home to stay healthy and heal, and he could explain some of the latest information he and his colleagues had learned about the pandemic.
Lee said he hoped the chance to educate patients relieved their anxiety and led to better healing at home. “For me, focusing on the things that patients can do rather than all the unknowns about the virus is the most productive for both of us. And taking time to thoroughly counsel patients is something I am committed to continuing with my urology patients. It’s even easy to do with telemedicine which is becoming a greater part of all health care.”
Lee also has “inside information” on all the thought and care that has gone into protecting patients who are now increasingly returning for their regular appointments and procedures at Penn.
“I can confidently tell patients who need to come in for surgery that they can come to our campus and feel safe as everyone at Penn Medicine is committed to the very best safety precautions. It’s certainly safer than any other public place like the grocery store.”
And, back in the OR, Lee now carries with him increased confidence in what he and his colleagues can do along with a fresh perspective.
“I think it’s going to be a long time until things are fully the way they were before,” Lee said. “We’re ready either way.”