ENT Residents Launch First ENT COVID-19 ICU at Elmhurst Hospital

We were all in this together

The COVID-19 anxiety level had already begun steadily rising at Elmhurst Hospital in Queens when Dr. Arvind Badhey began his first day as Chief Resident of Otolaryngology on March 15, 2020. The Department of Otolaryngology – Head and Neck Surgery had halted all non-urgent and elective cases and transferred the majority of appointments to telehealth. Because of this, administrators asked for volunteers to assist the COVID-19 effort in the Emergency Room and Intensive Care Unit. Knowing family members and friends working with COVID-19 patients in ICU’s across New York City hospitals, Dr. Badhey was eager to volunteer on the front lines. A surgical recovery room transformed into an ICU would become the first ENT/Otolaryngology-run COVID-19 ICU in the nation - and his professional post for the next 40 days.

Initiating and Operating the Elmhurst Hospital ENT COVID-19 ICU

Dr. Badhey asked his fellow residents to volunteer in the newly formed ENT-operated COVID-19 ICU. Shortly after, he relayed to Elmhurst Hospital administrators that he had eight enthusiastic residents who volunteered. This team grew to 11 and three additional substitutes, thanks to the encouragement of Dr. Marita Teng, Residency Program Director, and Dr. Eric Genden, Chair of Otolaryngology – Head and Neck Surgery at the Mount Sinai Health System. Members included Drs. Arvind Badhey PGY 5, Benny Laitman PGY 2, Usmaan Basharat PGY 1, Jaclyn Klimczak PGY 4, Eli Kinberg PGY 3, Kevin Wong PGY 2, Peter Filip PGY 3, Caleb Fan PGY 3, Doug Worral PGY 5, Noel Phan PGY 2, Christine Barron PGY 1 and substitutes Josh Zeiger PGY 2, Shirley Hu PGY 4 and Andrey Filimonov PGY 3.

The ICU unit was covered 24/7 by four teams of three residents rotating around the clock, guided by attending physicians in critical care and anesthesia who were overseeing multiple units. The resident team became primary caregivers for the 7-bed unit of critically ill COVID patients, and as momentum built, more ENT attending physicians also joined the unit. “The naturally existing trust amongst our ENT team is a huge part of what made this work,” recalls Dr. Badhey.

Most of these patients presented to the Emergency Room and required critical care management. The hospital needed more providers who understood clinical differences of a patient who was stable and a patient who would worsen. For otolaryngologists who address respiratory distress on a regular basis, this was a natural role. Grateful for the dedicated team, Elmhurst Hospital demonstrated superior support, enlisting other disciplines to assist. In addition to the anesthesiologists and critical care physicians, other experts who collaborated with Mount Sinai’s otolaryngologists included pulmonologists, general surgeons, nephrologists, ER physicians, infectious disease specialists, general medicine residents, nurses and nurse practitioners. “We were much respected due to our highly functioning and dynamic team,” Dr. Badhey added. “And all of us made clinical decisions together.” 

Challenges of Managing the New York City ICU

Elmhurst Hospital in Queens, NY, often referred to as “the epicenter of the epicenter” during the COVID pandemic, is located in the hardest hit state, city and borough in the United States. Located in an ethnically rich and diverse neighborhood, a significant challenge for the team was the large majority of non-English speaking patients. Taking a medical history and communicating with the families became quite difficult; some patients even passed away without having the opportunity to see their families in person. The team compensated as much as possible, coordinating video conferences with family members while being at patients’ bedsides and holding their hands.

The countless unknowns of COVID-19 disease also proposed various challenges, such as mental fatigue and gaps in knowledge about the virus. During rounds, the team would ask, ‘What have you learned that is new today?’ The learning curve was steep, but sharing as a group helped them absorb and apply the takeaways efficiently.

Band of Brothers and Sisters Anchored by Strong Support System

Fear was the emotion that initially overwhelmed Dr. Badhey, as he initiated the unit with only a few team members focused on learning about an unfamiliar disease process and cautious about burnout. This evolved into rejuvenation when his full ‘all-star’ team was assembled and he knew the work would get done. Knowing they went through this traumatic event together bound them as a band of brothers and sisters, carrying unique badges of courage.

Dr. Teng regularly checked in with Dr. Badhey as a mentor and colleague. She and Dr. Diana Kirke, Laryngologist and Head and Neck Surgeon at The Mount Sinai Hospital, kept abreast of details, including when days became extra tough. In an effort to build resilience among them, Dr. Kirke hosted a mental health seminar with the residents, which evolved into a daily huddle. “After we told her some of our stories, Dr. Kirke got emotional, and that opened the door for the rest of us to express ourselves,” recalls Dr. Badhey. “She is so respected in the field, so for her to say, ‘It’s OK - this is really awful,’ was very refreshing. She was so open and willing to listen to us; her empathy broke down the hierarchy and gave us a communication channel that was much needed.”

How the ICU Prepared Residents for the Future

I know more now about intensive care than ever before,” Dr. Badhey remarks. “And as a soon-to-be fellow of head and neck surgery, I know how to better manage these critically ill patients.” He and his colleagues have “more intelligent conversations with anesthesiologists about patients” and now possess a level of experience that only approximately 1 percent of ENT/Otolaryngology residents have. “We are better intensive care physicians, swift critical decision makers and more prepared for our future as physicians than we could have ever imagined.”