An Interview with Dr. Nadia Zaman
Unmasking Rehab Medicine During COVID - Narratives & Portraits
Dr. Zaman is a PM&R physician and recently finished her fellowship in sports medicine at Mount Sinai. In medical school she was initially interested in neurology and one of the neurologists told her about the similarities between neurology and PM&R, but that PM&R focused more on the rehabilitative side. She then did an audition rotation at a PM&R program in NY, and she really enjoyed the combination of outpatient and inpatient rehabilitation. During her PM&R residency, she realized she really liked the hands-on aspects like doing procedures such as botox for spasticity or spinal injections for pain. As an athlete growing up, Dr. Zaman found that sports medicine was a good fit for her, and her interest was solidified after working with a sports physiatrist during residency. “When you’re an athlete yourself, you know what it’s like to love something and then get injured and not be able to do that thing you want to do so badly. So it’s nice to be on the other side where you can progress the patient athletes through getting back to sports,” said Dr. Zaman.
In terms of the pandemic, Dr. Zaman said that, “When it was really surging here in New York, it was scary to be outside. Even as a professional in medicine, it’s not like you’re immune somehow to getting infected.” She would see the statistics of the number of younger people getting infected which she said was very concerning. In general, she also said it took an emotional toll being physically distanced from friends and family. And then there was her largely outpatient sports medicine fellowship which had to close at the start of the pandemic. Dr. Zaman recalled that, “It wasn’t just the PM&R or the sports people that got shut down, it was essentially anything that was elective. So pretty much all physicians were put on hold.” She did virtual didactics and appointments for the first week and a half, and then she and her colleagues were suddenly deployed to COVID units, where they spent the next 5-6 weeks. Dr. Zaman said that, “Fortunately from our department we were deployed as a team together, so we had our own attendings, our residents, our fellows, and we were also on the unit that used to be the rehab unit.” Dr. Zaman was glad to be with familiar faces, but she said it was also interesting and challenging to transition from being a sport medicine fellow to essentially being a critical care internist. “I did a lot of [internal] medicine during my intern year but that was almost five years ago now. In rehab there is a lot of medicine involved in terms of taking care of post-stroke patients, post-brain injury patients, but the more specialized you get, the less you remember the nitty-gritty of a lot of that. So we were finding ourselves reading books on the pulmonary system and cardiac system, what to do in acute respiratory failure.” Luckily, a hospitalist team was assigned to the opposite wing of their same floor, and Dr. Zaman said that they were great resources.
During this transition period, Dr. Zaman said, “You almost had to wear another hat on top of your PM&R hat, because it’s not like we took the PM&R hat off.” Dr. Zaman noted that the other hospitalist team on their floor would come to them for advice on mobilizing patients. “PM&R was still playing a very big role in getting people moving better so that when we were sending them home, that they were at least able to walk. We were still utilizing our PM&R knowledge.” She also worked alongside other specialists such as dermatology residents, orthopedic attendings, and physician assistants from other fields, who were all deployed to COVID floors like her. “It was actually nice in a way to have this multi-disciplinary environment around so you could run things by each other.” Dr. Zaman said that it was refreshing to build relationships with other departments because normally she said, “As we get more specialized in medicine, we start living in our own silos of what we’re specialists in.” As a physiatrist and sports physician, Dr. Zaman said that, “From a functional aspect, a lot of sports [medicine] is similar to PM&R, a lot of it is to improve the quality of life and function, it’s just directed towards a more athletic type of population.” Using her sports medicine and PM&R specific training, she said that, “Ultimately, our biggest goal was that as [COVID patients] trended down in their need for oxygen, we tried to see if we could get them up and moving,” which Dr. Zaman said is basically the same goal as sports medicine.
On the COVID team, Dr. Zaman said, “The other scary thing was that you’re going from potential exposure from riding the subway to definite exposure because you’re [working with] known COVID-positive patients.” Dr. Zaman said in the days leading up to starting on the COVID floors, her team was nervous, but they tried to calm each other down and support one another. Once she started working on the COVID unit, she was reassured when she saw the precautions put into place like the extensive PPE. “Being on our own teams, being with our own people was great because you’re working kind of with your family. All of that helped,” said Dr. Zaman. She also reflected that, “Your fears get put aside when you deal with the fears of patients. It’s like being a doctor in any other setting. Your first day of intern year is nerve-racking, your first day of residency is nerve-racking, your first day of fellowship is nerve racking, but when you sit down with the patient, their fears always trump yours.” Dr. Zaman said, “For these patients, they can’t see their families either, they can’t see their friends, they’re essentially in this room isolated. When you go in they all have this sense of anxiety because they don’t know what’s happening, and they don’t have anyone to hold their hand.” Though they had to limit their physical interaction with patients, the team would call their patients throughout the day to stay connected and check-in. In addition, for more stable patients, they gave them their own pulse oximeters, which the patients used to check their oxygen levels and report back, allowing patients to be involved in their own care. Regarding her own health, Dr. Zaman said that after she finished working on the COVID unit, “I got antibody-tested and I came back negative. So clearly the PPE either was great or I followed the precautions, and ultimately what that proved to me was if you take care of yourself and do the right things, then even though we were put in that situation to do our jobs, it doesn’t mean you’re going to get infected.”
During the peak week of cases in New York City in April, Dr. Zaman had a patient who she remembered vividly. Dr. Zaman said, “She spoke a little English, enough to understand most of what was going on, but her native language was actually the same as my native language of Bengali.” Dr. Zaman said how the patient’s oxygenation started to decline, even though her labs kept coming back normal and she was relatively young. The attending went in and talked to the patient about proning to help her breath better, but she felt that the patient didn’t fully understand her and that’s when the attending mentioned that the patient’s native language was Bengali. After gowning up, Dr. Zaman went into the patient’s room and started speaking to the patient in Bengali and told her that if she had any questions she’d try to help. Dr. Zaman said, “She had this huge smile that spread across her face. She literally said something like ‘Oh my gosh, it’s so good to hear my own language’ and I speak a language that a lot of people speak, but I don’t get to use it in the hospital that much. It made me feel good that I was able to make such a difference for her... she had a ton of questions, she relayed to me that she understood everything the doctor had said to her, but there were so many questions she didn’t know how to verbalize in the proper words in English.” For the remainder of that week, Dr. Zaman would call the patient and go into her room with the attending. The patient continued to improve and she was eventually discharged. “That story stands out to me because I feel like it was one of those times where something unique can make such a difference for a patient. It worked out so serendipitously,” said Dr. Zaman.
In response to the stresses of the pandemic, the hospital set up wellness rooms, which Dr. Zaman said were amazing. A group called Frontline Strong, which consisted of medical researchers, artists, musicians, and many others, came together and converted the research center into a wellness space. In addition to healthy snacks and drinks, there was a meditation room in the back that Dr. Zaman described as having beautiful landscape videos and nature sounds, in addition to relaxing incenses. “You could take a few moments for yourself or a small group, and just sit there and breathe or talk about something other than your work. We made it a point to go every day even for a couple minutes,” said Dr. Zaman. They later expanded the wellness rooms to a couple different locations as the space became more popular.
At the end of May, their sports medicine clinics opened back up and Dr. Zaman said, “It all happened just as fast as things closed down.” When they first reopened, the waiting room was closed and so they were only seeing one patient every hour, and they scheduled far fewer procedures. In between physical appointments, they would have telemedicine appointments as well. “We don’t want to infect ourselves, and we don’t want to infect our patients, and so we’re taking every possible measure that we can.” Dr. Zaman said, “We’re trying to see how safe we can be without also just shutting patients out altogether. For those two months, everything was closed so for these poor patients who have been suffering, who haven’t been able to see any doctor, they’ve just been waiting and sticking it out as long as they can.” Even though her fellowship was slightly truncated due to the pandemic, Dr. Zaman said that when she returned to the sports medicine clinic, she was glad to see how much she remembered and how second nature her skills had become. “You really don’t realize how far you’ve come until you have a break and then you come back. This will seem crazy, but it’s kind of like riding a bike. It was the moment where I realized that in those 9 months that we did get the training we were supposed to get, we learned a lot and we are prepared.”
This Fall Dr. Zaman is starting a new job as an attending sports medicine physician at Tufts and she says, “It’s so exciting to be at this stage finally, because you’ve worked so hard to get to this point, but it’s also a little scary.” She will be working with orthopedists and PM&R doctors to build a new non-surgical sports program and Dr. Zaman said, “I’m super excited because I love working from the ground up, and I think it’s going to be a great opportunity.” As she prepares for this next stage, she also reflects on her COVID deployment. Dr. Zaman said, “You’ll always remember the time where you stopped everything you were doing to be a part of something that was so much bigger than you. There were people who could choose not to [be deployed] and I’m glad that I didn’t do that despite being scared because I think in the end, having been a part of this was so important. Because I had a set of skills that I chose to develop because I chose to go into medicine, and if I didn’t utilize them now, then why did I really do it in the first place?”
R. Mayeda is a second year MD candidate at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.