As both a neurologist who sees patients at Massachusetts General Hospital and a clinical postdoc conducting Alzheimer’s disease clinical studies at MIT’s Picower Institute, Diane Chan already has two demanding jobs. But as eastern New England’s need for Covid-19 care surged in late March, she volunteered to take on a third by joining the first wave of non-internal medicine doctors to be trained to evaluate patients in MGH’s respiratory illness clinics. The Covid-19 pandemic has called upon doctors and other health care workers, regardless of their usual specialty, to provide pulmonary care.
On a recent afternoon Chan’s newfound duties meant venturing through drenching, wind-whipped downpours to begin a shift at a new respiratory clinic MGH opened in Chelsea, Massachusetts, a densely populated town next to Boston’s Logan airport. Chelsea has emerged as an especially intense hotspot of Covid-19 infection. The venue was new, but Chan had already been seeing respiratory illness patients at the hospital for about two weeks after receiving the training. She’s learned to identify upper and lower respiratory infections, to evaluate whether someone has the virus, and to determine whether those patients need to go to the emergency department, or can go home. She has also been trained in how to carefully doff and don personal protective equipment including masks, gloves, face shields, and gowns. Not too long ago, Chan’s residency included a full year of internal medicine, so with this new training and the constant presence of her internal-medicine colleagues, she says she feels well-prepared and protected for this urgent new work.
“I’m grateful that I have skills to contribute during this time when the hospital needs our help and patients need our help,” Chan says. “I’m glad to have some capabilities I can use to try to help people. I’m really grateful to my internal medicine colleagues for training us to be able to do this in the respiratory clinic.”
Of course, she has already been helping people in her two regular jobs. Typically twice a week at MGH, but more recently via videoconferencing, she sees neurology patients with conditions such as dementia. Even as they grapple with the unexpected need to use a new technology for remote care, she says, many patients are still happy to remain in touch with their doctor.
At MIT's Picower Insitute for Learning and Memory her work in the lab of Picower Professor Li-Huei Tsai consists of running a program of studies testing whether light and sound stimulation at the 40-hertz frequency of gamma brain rhythms can improve memory and cognition in patients with mild Alzheimer’s disease and reduce the condition’s progression. If so, the experimental method, called GENUS, could potentially help millions of people. Patients participate in the randomized, controlled, and blinded study from home, but because the pandemic has delayed in-person visits, key evaluations are being delayed and so the study is being extended. Although she acknowledges feeling stress, for instance about the possibility of bringing the virus home to her family, what rises above for Chan is again a feeling of gratitude.
“I feel grateful to the people in our study,” she says. “They have been working with us for a very long time. People were looking forward to their appointment that have had to be canceled. We are at the time when people in the control group would be switched to active stimulation. I’m very grateful to the whole group, everybody, that they would delay this time point and continue doing the stimulation at home until we reopen.”
That will happen when the virus subsides. But for now, because it hasn’t, she is on the front lines of the battle against it. She is not alone. Another physician-scientist in the Picower Institute, Ravikiran Raju, is similarly helping out in the emergency department of a different Boston hospital.
At MGH, Chan has seen respiratory patients from as far away as New Hampshire and Rhode Island. Most are referred by their primary care physician after a virtual meeting where they describe symptoms worrying enough to merit the in-person care that MGH still provides. At the clinics, doctors like Chan can listen to their lungs, check blood oxygen levels, take chest X-rays, and administer the nasalpharyngeal swabs needed for Covid-19 testing. Results come back the next day.
The most critical decision, though, is whether patients require hospitalization right away. Most do not, but Chan has so far referred three patients for such emergency care. One was a man in his 30s who had already tested positive for the virus, but when he came to the clinic he struggled to speak in full sentences and his blood oxygen level was down. His X-ray showed a lot of pneumonia — Covid-19 infection tends to produce a distinct pattern in chest X-rays. Another was a woman who walked in, but just in the time she was at the clinic her blood oxygen reading dropped by more than 10 points.
Some patients, however, do not have the virus. One, for instance, had a scary-sounding rattle in her voice and labored breathing, but clinical examination revealed that her lungs sounded and looked clear. Moreover, her blood oxygen saturation was at a healthy reading and her vital signs looked strong. Chan and her colleagues sent the woman home with some inhalers to help her breathing. The next day her Covid test came back negative, confirming their decision.
Some patients turn out to be more nervous than sick. A man who came in hoping for a test turned out to have symptoms that were mild, at most. As they talked, Chan reassured him that he was doing well and doing the right things but that he didn’t need care at the clinic.
The skill set of counseling patients, attending to their state of mind as well as their physical health, is a big part of neurology.
“I think that I’m using some of those reassurance skills for some of these patients,” she says.
Even in normal times, many patients need Chan’s reassurance. Now she is extending her care to many more that she never would have expected to see.