A COVID Doctor’s Journey: Aulick Looks Back at a Year of the Pandemic
GLEN DALE — Sometime in late February, Dr. Neal Aulick walked through the emergency room without gloves — for the first time since March 2020.
And, lately — on the still-rare occasions in which a parent is willing to brave COVID-19 in order to get emergency care for a very sick child — he does something that would have been unthinkable just a few weeks ago. He briefly lowers his mask so the young patient can see a real human being.
“They get scared,” said Aulick, a Wheeling physician who staffs the emergency rooms at both Reynolds Memorial Hospital in Glen Dale and Wetzel County Hospital in New Martinsville. “This way, they can see I have a real face instead of vampire teeth or something like that.”
Aulick shared such details with the Sunday News-Register, reflecting on a year of COVID. Here is a sampling of what he has seen on the front lines of the local battle:
“I just heard from cable news there was this virus going around, but we really didn’t see any of it,” Aulick said of learning of COVID in early 2020 the same way most Americans did.
The local healthcare system began to prepare, he said. Workers were sobered by watching the horror of a New York outbreak that left patients dying in hospital hallways because rooms were filled and hospitals storing the dead in refrigerator trucks while funeral directors struggled to keep pace.
“We were ready (but) we probably still didn’t have the resources if we had gotten hit,” he said of what could have been. “In West Virginia, there just was not a lot of (physical space) capacity.”
But, that kind of surge did not materialize here.
“We overreacted at the beginning. We were looking at New York,” said Aulick, who previously served as the director of the former Ohio Valley Medical Center’s EMSTAR. “What we did then, we should not have done. In September is when we should have (been on lockdown).”
There was some local COVID in March and April, however, he noted. Ironically, the first case he diagnosed was outside the hospital and happened to be his best friend.
“He was just sick as a dog,” Aulick said. They met – at a distance – suspecting already that it was COVID. “I kind of tossed it (a pulse oximeter that measures blood oxygen) through the car window to him and he was wheezing.”
The friend’s oxygenation rate was 90 percent, suggesting lung issues unusual given his ordinarily good health, but he went on to recover without hospitalization. As did the friend’s entire household, who also became infected.
Aulick additionally diagnosed the first case in Wetzel County. That man had pre-existing lung disease, which made diagnosis tougher at first.
Two down. But, how many would there be to go? Aulick and his colleagues had no idea.
COVID cases continued to be rare in the first half of 2020, but Aulick said something new was afoot as the pandemic lockdown continued into May. His hospitals, like others around the nation, began to feel the pinch of weeks of extreme limits on medical services.
“In March, we were told ‘two weeks to flatten the curve’ and then we’d be back to normal…but then it just never opened back up.”
Administrators took a 10 percent pay reduction. The West Virginia University healthcare system that operates both of Aulick’s hospitals and Wheeling Hospital among others stopped making matching payments into employees’ retirement accounts. It was a cutback that would last six months.
His job was safe because ERs have to be staffed regardless of patient load, he said. He added that nurses – who are always in high demand – were also free from hour reductions. But, others weren’t as sure.
“Volume is still not back to normal,” Aulick said as of the second week of March. “(But), I’m pretty confident the next three months we’ll get back to where we were.”
By late October, such financial considerations were put on a back burner. COVID’s big strike on the Ohio Valley finally hit, in a way far worse than most residents who don’t work in healthcare probably realized, Aulick said.
There were times when there were literally no open hospital beds in the entire state of West Virginia. Overload patients were being housed in examining areas inside emergency rooms and patients were shuffled from hospital to hospital as space became available.
Aulick began limiting the time spent with patients and did some consultations standing in doorways, trying to keep himself healthy so that he could continue to work. He also began learning some of COVID’s nasty tricks – particularly the formation of unusual lung blood clots that appeared suddenly rather than moving there from a leg or pelvis as is more common.
It didn’t stop there. “Sometimes people looked really sick but their chest X-rays looked OK. Only a CAT scan showed COVID pneumonia.”
There was a lot going on, so much to learn on the fly. “That’s when … we started to get overwhelmed.”
But, it’s also when the long calm before the storm paid off. If the hospitals hadn’t learned from what had happened in New York – realizing the unprecedented need for extra ventilators and other equipment like specialty nasal tubes that can supply extra oxygen — before the local COVID wave hit, there wouldn’t have been enough.
Even with the preparation, the storm was furious. “I’ve probably had at least four or five (COVID patients) die on me in the ER.” And, since ER doctors also respond to patients in extreme distress in other parts of the hospital, he has pretty much seen every patient who ultimately died at one point of another.
The dying was only part of it.
“Once patients got COVID, half the ER nurses got it.” A fellow doctor did, as well. A doctor friend of a doctor friend became so sick he needed a lung transplant. “I tend to be kind of an adolescent when it comes to mortality. I don’t think I’m ever going to die. But, I get twinges now and then.”
Ultimately, Aulick did not get sick. But, he felt the staffing difficulties and a war-like form of decision making he had not experienced in his 26 years of emergency medicine.
“The ER was filled with lots of COVID (and) lots of very sick people who didn’t have COVID and were scared to death to be there … It got to the point if you weren’t really sick, we shouldn’t put you in the hospital.”
Some COVID patients were sent home with pulse oximeters so they would know if they were suddenly worsening. Ones who were admitted were cut off from contact with family and friends, a “heartbreaking decision.”
“It’s like apples and oranges,” Aulick said, comparing COVID’s deadly winter to previous experiences that have included a bus crash and chemical spills that had intense but limited impact on the ER. “The longer it went on, we were thinking, ‘Is this ever going to end … how long is it going to take?'”
Fallout vs. recovery
It took until January of this year, as it turned out.
A wave of vaccines first targeted at healthcare workers and the region’s most COVID-vulnerable residents began to be felt by then. And, the first glimpses of recovery began to literally appear. Patients with sore throats and other minor ailments still aren’t showing up in Aulick’s realm, but those who actually need emergency care finally came.
It’s a mixed back of recovery and fallout from a year of postponed care, however.
“I’ve been diagnosing a lot more primary cancers because people haven’t been getting care,” Aulick said. “I’ve been seeing patients who’ve been off their medications because they haven’t been able to see their doctors for a while – kind of Band-aiding some stuff.”
He’s also spotted two cases of sudden-onset Type 1 diabetes among 20-somethings that he believes were sparked by the virus.
While that part of COVID sorts itself out, Aulick is just hoping the normalcy trend that vaccines are enabling will continue.
“Then, it’s over. My hope is by summer. I don’t care about people getting COVID. I don’t want the wrong people to get COVID,” he said of balancing the need to protect the vulnerable with national controversies involving fair distribution or anti-vaxxers motivated by various sentiments or fears.
“There shouldn’t be any controversy about this whatsoever … I don’t care (about the distribution details or the politics) as long as you’re getting needles in arms. Even if you don’t get it, if enough people get it you’re going to get herd immunity.”
“Every virus is different,” Aulick cautioned of the idea that COVID can provide a template for any future pandemics. “I think we’ve learned things that will help (especially that) we have to be able to adapt and adapt quickly. Science is not law. It’s not set. You can’t dig in your heels.”
He recalled the changes of policy that happened during this single pandemic. “Last spring, we were spraying down Amazon boxes. That turned out to be unnecessary. We probably shouldn’t have closed down schools, but it’s hard to know. We did what we thought was best.”
On that note, he thinks mask wearing should continue for a time. He has stopped wearing one in private interactions, but continues to do so at work and in public even though he is fully vaccinated.
“I’m not a sheeple. I wear it to be courteous and I’m going to still wear a mask if people are concerned about it. People just need to be nice.”
“The last week or two, I quit wearing gloves. When you’re fully gloved and gowned and shielded, you lose something,” Aulick said of interacting with patients who are already stressed to be in the ER. “I don’t feel scared to touch a patient and I think that makes the patient feel a little better.”