Physician ministers during peak of pandemic
Dr. Nicole Williams
After excelling in three sports at Seton LaSalle High School, Dr. Nicole Williams played basketball at Hofstra University, where she also earned her medical degree. She is an emergency room physician at two Northwell Health hospitals in New York City.
Niki Williams
Northwell Health hospital workers, including Upper St. Clair native Dr. Nicole Williams, celebrate the discharge of their 1,000th COVID-19 patient. The New York City facilities have been at the epicenter of the pandemic.
Dr. Niki Williams suited up for emergency room encounters with COVID-19 patients. The Upper St. Clair native was recently acknowledged by her college alma mater for her efforts.
By Eleanor Bailey
Dr. Nicole Williams was a three-sport athlete, excelling in basketball, soccer and softball at Seton LaSalle High School. She was The Almanac’s female Athlete of the Year in 2005 and went on to play basketball at Hofstra University. She is now an emergency room physician treating COVID-19 patients at two hospitals in New York City.
Niki Williams
Eleanor Bailey/ The Almanac
Niki Williams drives around an opponent during her high school basketball playing days at Seton LaSalle High School.
After a 12-hour shift in the emergency room at North Shore University Hospital on Long Island, where she has seen more death than survival, Dr. Nicole Williams empties her emotions. She strenuously tortures the TRX band hanging suspended from the ceiling and wrapped around the door of her 500-square foot apartment in Queens. The workout thwarts the sobbing.
“Sweating is my way of coping,” said the Upper St. Clair native.
“Yes. 100%,” she admitted to weeping, “but there’s no crying in baseball, right?
“I feel if I do this,” she added of her exercise routine, “then I will be OK.”
After a good night’s sleep, too, Williams is more than all right. The former Hofstra University basketball guard is revitalized.
She downs a glass of homemade juice, then grabs the cup of coffee from her French press as she heads out the door. On her short drive, this day to Long Island Jewish Medical Center, she listens to “Underdog,” by Alicia Keys, “pumped” to do battle again with a hideous opponent: COVID-19.
“In high school,” she laughed thinking back to her glory days as an athletic standout at Seton LaSalle. “It was water and Gatorade that I drank and ‘Eye of the Tiger’ that we warmed up to or that I played before a big test.”
Never in her athletic career did Williams expect such an exam. As a third-year resident, she is learning on the fly about all things COVID-19.
“I have played teams sports all my live so I am accustomed to the rigorous physical demands placed on an athlete. I’m used to that vigorous activity,” she said of the hectic pace inside an emergency room. “Nothing, though, could have prepared me for this emotionally.”
An emergency medical physician treats everything that comes through the door – broken bones, strokes, heart attacks, COPD issues, accidents, gun shot wounds.
“That’s our bread and butter,” said Williams. However, at least 85% of what ERs are seeing is COVID, she added.
Williams operates out of two Level 1 and 2 trauma centers, which she described as a hot spot in the coronavirus crisis.
“The epicenter of the epicenter,” she said. “We are in the thick of it.”
New York leads the world in confirmed COVID-19 cases. With more than 10,000 succumbing to the disease, the state accounts for half of the deaths in the United States. The city alone exceeds 7,900 deaths.
“My heart is broken,” said Williams, who admits to seeing more death than she wants to witness. “This is a tragedy. The worst pandemic in generations,” she added.
While she has read books about the Spanish Flu epidemic and Ebola, Williams never anticipated when she entered the medical field that a pandemic would be her reality.
“Definitely not,” she said emphatically.
Yet, she noted now that she dresses up like Halloween every day. She dons personal protection equipment to shield her from getting the virus. Williams said she has never performed a procedure without the coverage of an N95 respirator, face guard and reusable scrubs.
“We are used to running into a fire, but we know we need to slow down and take that extra three minutes to put the gear on to protect ourselves and team. It’s the new normal. Wearing six layers with sweat dripping under our clothing in order to treat people without family,” she said. “Never once, though, did I feel that I haven’t been protected.”
Enough equipment
Williams added that while her hospital system has sufficient PPE, there is always going to be a need because no hospital can keep up with the rate required. She noted that COVID-19 has “overwhelmed” the health system. To date, however, her hospitals have managed to provide ventilators to those in need.
“We are not at the point but lack of PPE is real and it’s reassuring that we have had enough ventilators. We have not had to decide does a 50-year-old deserve one and an 80-year-old doesn’t.”
Williams said that in an emergency room, physicians confront life-and-death decisions every day. However they are not accustomed to making decisions of “such magnitude” during the pandemic. She noted that it’s happening on such a large scale now and often without families. “It’s new territory,” she said.
Noting that there are a lot of ill people and a lot of patients on ventilators, Williams adds that she is “fortunate” not to be in the position to decide end-of-life care, as an ethics committee is in charge of those choices.
“I do what’s best for the patient. Sometimes it’s just provide comfort because sometimes it’s not the right thing to do to intubate a patient. Our first duty is not to do harm. There’s discussion with the team and family members as end-of-life care is tricky. Sometimes it’s not the right thing to do. It’s never an enjoyable decision ever,” she stressed. “We are physicians. We try to do the right thing for the family member. It’s all you can do.”
Her job is care. Williams finds the work both “interesting” and “humbling.” Especially rewarding are the COVID-19 recoveries.
Every time a patient is discharged from the hospital a bell rings. Williams celebrates these victories.
“It’s a moral boost when patients go home because so many are so sick. It’s a mini success amid the devastation. You feel at least we got one to go home.”
Williams adds it’s often hard to predict who will survive. Some patients appear to be doing well and die. Others make remarkable comebacks.
All are grateful for the care they received. Williams recalled a 98-year-old woman who was able to celebrate Seder with her family. Another was an appreciative daughter. Knowing how ill those patients were, their thank-you notes have brought Williams to her knees.
“Those keep you going,” she said. “Just to be able to facilitate someone going home means everything. It’s hard to see the death, and in the emergency room you do see it every day. It doesn’t get easier when there is more of it. Any loss of life is a tragedy.”
Family influence
While every day is fraught with emotion, Williams feels fortunate her own family back home in Upper St. Clair is relatively safe.
The daughter of Francine and Stuart has six siblings, ranging in ages from 15 to 32. Younger brother, Louis, is a sounding board for Williams. He specializes in internal medicine at Bellevue Hospital in New York City. While his normal day-to-day encounters concern patients with hematology and oncology issues, currently the fellow is assigned to a floor with all COVID admissions. As a result, he is living in a hotel room to protect his wife and two children who reside in New Jersey.
While the two sibling physicians have never worked a shift together, they put in the same schedules. This affords them the opportunity to “bounce” ideas off one another during daily phone calls.
“We are able to have conversations that I know we don’t want to have with Mom and Dad because it would raise their fears and anxieties. Because I can find peace with knowing we have each other’s back, I think we’ll all be OK.”
In the loop
Williams also makes a conscious effort to get to know and her staff. She acknowledges the behind-the-scenes people, the nurses, technicians, janitors, housekeepers. Not only does she routinely check on them too, she makes sure they have the protective gear they need to do their jobs.
“So many people are getting up and going to work and doing heroic things that go unnoticed,” she said.
New York City has not allowed emergency responders during this pandemic to go unnoticed. Each evening at 7 p.m. for the duration, the city erupts in applause from home-bound residents leaning out of apartment windows as sirens wail in the background from local fire houses.
Williams finds this curious and “odd” because the last time this occurred she was on a basketball court.
“I like being clapped for,” admitted Williams. “The cheering was the best thing, next to winning, that I experienced in sports, but now, we want it to stop.
“Speaking for the community as a whole, we want to go back to normal. We want it to be healthy. We want to treat the every day things,” she said.
Williams would give anything if family members could be more involved in their loved ones’ care. Her heart aches with each admission.
“Family members can’t be with the patients. So imagine dropping your loved one off at the door and having to leave them there alone?” she said sadly. “These people deserve to be in the loop.”
Williams has found a way to make that happen. She keeps patients in contact with their families by using cellphones and iPads to FaceTime and to involve them in treatment discussions.
“To me it’s about building relationships amid a crisis. It takes extra time and extra effort, but I think it’s worth it. It helps me, too, because I believe I am making a difference, especially when there are terrible outcomes.”
To her relief, Williams has seen a decline in negative outcomes. While she continues to work 7 a.m. to 7 p.m. five days a week, she has seen volume going down in the ER. She is doing less than she did two weeks ago.
“Our results have improved. I was nervous if it had continued at the pace we were on, but things seem to be stabilizing. That’s good news. Things are getting better. The lockdowns are working, but we can’t loosen up. We have to stay on it and work harder. As long as people are fighting for their lives every day, I can’t say I see a silver lining.”
Williams, however, does hold out hope. She said she will always see light at the end of the tunnel.
“You have to. I don’t know how you do what you do and not focus on the glimmers of hope. Whether it’s warranted or not, we all need hope or it becomes awfully hard to get up and go to work.”
Dr. Niki Williams applauds the efforts of Southwestern Pennsylvanians. The region has altered its bleak COVID-19 forecast because of social distancing, limiting outdoor activities to essential shopping and washing hands.
“412 people are the best,” enthused Dr. Williams of her hometown. “We listen to rules well and we are diligent about following them.”
Dr. Williams who grew up in Upper St. Clair and excelled at three sports at Seton LaSalle High School, is an emergency room physician at two Northwell Health hospitals in New York City.
Dr. Williams noted that Pittsburgh is not “in shambles” because it has taken on a big team approach to battling the coronavirus crisis.
While the numbers in Allegheny and Washington counties appear to be leveling off, Dr. Williams cautions the region needs to continue doing the things that have contributed to lower numbers of positive cases, hospitalizations and deaths compared to the opposite end of the state.
Dr. Williams offered advice that the region already follows religiously. Care for neighbors and those most vulnerable members in our society.
“We need to take not only take responsibility for our loved ones but others. Check on others and get groceries for the people who shouldn’t be exposed,” Dr. Williams encouraged.
“For me,” she continued, “making sure people are okay, especially those with emotional health issues or underlying conditions, is so vital.”
Vital to seeing the decline in COVID19 cases has been physical distancing. Williams believes it has helped flatten the curve “100 percent” and adds that it is not a “novel” thought to her.
“That’s science,” she said emphatically. “We know how the disease spreads through respiratory droplets being launched in the air. That’s what a virus is. So it helps and it’s necessary. It’s our social obligation.
”But as a society, it’s not a natural thing to isolate because we depend so much on each other. It’s so important though because we all can’t get sick at the same time.”