By Pete Mazzaccaro

In mid-April, as the COVID-19 pandemic hit its peak in the city of Philadelphia, Chestnut Hill Hospital experienced a real strain on its infrastructure.

“Proportionally we were hit pretty hard,” said hospital CEO Dr. John Cacciamani. “We saw a tremendous increase in very sick patients, so our ICUs were taxed. We built capacity to manage more ICU patients on the fifth floor.”

It was an expansion of intensive care units never needed before. Cacciamani said that the hospital would experience waves of cases, particularly as nearby nursing homes in both Philadelphia and Montgomery County were hit with outbreaks.

COVID-19 has been just that sort of disease – a once-in-a-century pandemic that has, as of this writing, killed more than 80,000 people in the United States. Philadelphia did not experience the dire circumstances of New York City, but the region was hit much harder than most of the rest of the country. As of May 10, Philadelphia has recorded 857 deaths from nearly 15,000 positive cases and Montgomery County has recorded 525 deaths from more than 5,000 cases.

According to data published online by Tower Health, Chestnut Hill Hospital’s parent company, Chestnut Hill Hospital has treated a total of 323 COVID-19 patients as of May 11, and 88 of those patients have died.

Cacciamani said that stress to his staff was extraordinary, not only for the duress it put on his workers who were rightly concerned about getting infected, but also due to the need to care for patients who died without the support of loved ones.

“It's a uniquely traumatic experience for our nurses,” Cacciamani said. “Death and dying is hard as it is. But death and dying alone without your family is different. … When somebody's dying, usually there's a family member in the room holding their hand, which is as it should be. This is uniquely troubling.”

So it was more than a relief to hospital staff when, this month, the U.S. Army Reserve offered to deploy personnel to city hospitals, not to take care of patients, but to take care of the hundreds of doctors, nurses and their support staff who have been on the front lines of what has been a health crisis without precedent in more than 100 years. Even though Cacciamani said he believed the worst was behind the hospital, his staff was still dealing with the remarkable stresses of treating COVID-19.

“Health care workers are trained to take care of people who may be facing death and dying, but I think the scope and the magnitude of this pandemic has overwhelmed the capacity for individuals to keep up with this,” said Dr. Robert Daroff, a colonel in the U.S. Army Reserves who is one of three soldiers making rounds at the hospital.

“Nurses in particular are being asked to do things that they would normally not have to do. And that's been a huge weight for many health care workers to carry. At the same time, they're trying to hold hands and be emotional support and be essentially surrogate family members. They've got an ICU that's overflowing and other patients that need medical care. Now, there's no time to hold hands, and I think it's put a lot of strain on the on the staff.”

And yet, Daroff said he thought the prognosis for the hospital was positive.

“The good news, from my perspective, is that most of the staff here are doing fine."

Daroff, a psychiatrist and faculty member of the University of California San Francisco, was assigned to an 85-soldier unit that came together in California, trained for two weeks and was than deployed to Philadelphia’s Liacouras Center, which had been converted into a temporary hospital to handle a possible surge in COVID-19 patients.

Fortunately for the city and city residents, that surge never happened. The Liacouras center never had more than six patients in it at any one time and it was decommissioned in late April. The unit that remained in Philadelphia was made available to city hospitals. Daroff, Dr Ryan Graham and Dr. Dean Acheson (who was not available for an interview when the Local visited the hospital) were sent to Chestnut Hill. The group was among seven in the original unit who were behavioral health practitioners.

Graham, an Army major and a psychologist who works for the Las Vegas VA, said he was until recently a full-time soldier who worked with active duty soldiers in combat situations. He said there was much that combating COVID-19 and actual combat had in common.

“What the workers here and in other area hospitals are going through it is very similar to what soldiers go through in a deployed environment in combat in that they have a persistent threat to their health and well-being and the well-being of those that they care about,” Graham said.

“They have a significant disruption of their normal support system and in their normal coping mechanisms. They have a significant disruption of their sleep cycles, usually because of the shift work. And then on top of all of that, these experiences are persisting over a certain amount of time that's beyond what they can have an expectation of. In combat, it's very rare for soldiers to say issue is because of this one thing that happened on this one day. It's usually an accumulation of events that happened over a course of time where they don't know when they're going home. And that's the same thing that these healthcare workers are facing. They don't know when this is going to stop.”

Cacciamani said the feedback he’s received from staff who have taken advantage of the reservists at the hospital has been all positive. For many, he said, even if they didn’t feel like they needed to talk to someone, just knowing that there was support was a much-needed morale boost. Too often, he said, health care workers feel like they’re the lone backstop in a crisis. This is particularly true for this pandemic.

“You feel so isolated,” Cacciamani said. “You're stuck on the same floor with the same dying patients in the same story with no family. There's nothing more out there. I'm here alone. I'm all by myself. There's nothing bigger behind me. Just walking around in fatigues… It made people cry. Cry pleasantly.”

They were the tears, he said, of people relieved to feel like, even if they had been losing a battle, the reinforcements had arrived

Pete Mazzaccaro can be reached at pete@chestnuthilllocal.com