We Are Better Together

A Crash Course in Everything

For years before March 2020, Englewood Health put considerable time and work into preparing for emergencies, everything from storms and power outages to active shooter situations and mass casualty events. Pandemics were no exception—the hospital had a plan in place for these as well. “A few years back, when we were preparing for H1N1 flu, we redefined our emergency preparedness policies, based on CDC and Department of Health guidelines,” says Harvey Weber, vice president for facilities management and emergency preparedness.

That policy was wide-ranging, covering support services as well as clinicians, Weber says. “We wanted to make sure our environmental services people were trained in donning and doffing PPE appropriately and understood what cleaning measures were needed to protect us from the virus,” he says.

COVID-19’s spread appeared to be unprecedented in our lifetime. Hospitals in the epicenter soon halted outpatient services and elective procedures. At Englewood Health, people from those areas were redeployed in areas that needed them. “Everyone who was going to come into contact with patients — in food and nutrition, facilities, environmental services, security — had to adapt to the quickly changing safety protocols,” Weber says.

As infection prevention manager, Diana Torres, RN, was central to much of that training. One big task was translating CDC guidance that “would change in the blink of an eye,” she says. “We collaborated with our communications team to get the word out, but we also had to go up to the clinical units and educate the people who were in direct contact with patients about changes in protocol in real time.”

Ideas about treatment also evolved quickly and constantly, says Kathleen Kaminsky, RN, senior vice president of patient care services and chief nursing officer. “We started seeing themes emerge about what worked and what didn’t,” Kaminsky says. When “proning” — turning ventilated ICU patients on their stomachs to improve oxygenation — turned out to be helpful, the Englewood team added it to their treatment protocols. But that, too, required a new initiative: to recruit and train a proning team that knew how to perform that delicate process.

Torres and most others at Englewood also had to face another issue — how to keep family members safe from a disease about which so little was known. In many cases, families had to live apart from one another to minimize any potential exposure. “That was really difficult, but it was the safest thing to do,” says Torres. She and many others tell of elaborate routines of showering and changing clothes at the end of the day before seeing their loved ones. Rick Sposa, director of EMS, notes that before the pandemic, his young daughters had loved running across the lawn to meet him when he got home and having him spin them around. “Now I couldn’t let them come near me, and they didn’t really understand,” he says.

Transforming a Hospital

Another immediate change was to reconfigure large sections of the hospital to accommodate the influx of COVID-19 patients. Before the crisis, the hospital had 12 intensive care beds. Space for 50 additional ICU beds came in part by reconfiguring another 22-bed unit. Overnight, construction crews were drilling holes through walls and bringing in equipment, and within 72 hours the new rooms were ready.

In addition, the hospital’s engineering and construction teams had to create negative pressure rooms, designed to keep the airborne virus from reaching other parts of the hospital. That change was made all the more crucial by an evolving understanding not only of how the virus was passed along but also of what was clinically effective, Weber says.

“It was amazing to see the grit, resilience, and sheer will and determination of the team to care for our patients. Not only did our nurses care for our patients with extraordinary sensitivity, but they also cared for each other,” Kaminsky says.

Learning from Peers

Another common theme cited by those who were involved in gearing up for this monumental challenge is that they couldn’t have gotten it done without collaboration from their peers at other institutions. “Early on, I started getting calls from my colleagues in other hospitals in our area,” says Weber. “We talked about what we were experiencing, what we needed, where resources were coming from.” They shared what they had, doing whatever they could to help meet immediate needs in one place with the assurance that in a few days or weeks or months, PPE, IV pumps, ventilators, and other supplies could be shifted somewhere else.

That kind of cooperation was happening among hospital systems that normally worked independently. Now they freely shared clinical knowledge. Dr. Stephen Brunnquell describes an informal consortium of clinicians from seven area hospitals and health systems who had daily calls to talk about what they were learning. “Every day, seven days a week, we would describe patients to each other and talk about what medicines we were using and what worked,” says Dr. Brunnquell.

One major result was the realization, noted by many of those on the daily calls, that blood clots in COVID-19 patients were resulting in many heart attacks and strokes. So experts across the country devised protocols in order to prevent people from clotting.

During all this, as people at the hospital looked for solutions to problems and challenges that seemed to change almost daily, many found themselves stretched beyond exhaustion, fueled only by adrenaline and caffeine. It was hard and often heartbreaking, “but we knew what we had to do to care for everyone,” says Kaminsky. “You had to do the best you could to support the team. Because this isn’t just where we worked. It’s where many of us live, and where we get our care. It’s our community.”

Joining Forces to Help One Another

Traditional disaster relief programs were limited or rendered ineffective by the lockdown, so community leaders banded together to come up with ways to help residents in need. “Sanetta Ponton, executive director of the Metro Community Center, started holding weekly Zoom calls and inviting local nonprofits, people from faith-based organizations, town council and board of education members—just anyone who wanted to help,” recounts Janet Sharma, the coordinator of Age-Friendly Englewood, a local organization dedicated to helping Englewood’s elderly age in place. “We would identify gaps in service and talk about how to address them.”

The group collectively organized volunteers to help nonprofits like The Community Chest and the Bergen Family Center to get groceries to seniors and families sequestered at home. They also worked to bring internet access to low-income families.

Hope came from the way people in the Englewood community stepped up. “From the very beginning, every group in our community reached out and asked how they could help,” says Warren Geller, president and CEO, Englewood Health. In many cases, support came in the form of financial contributions to the hospital foundation’s newly established Power to Prepare Fund, which raised over $4 million.

“With extraordinary strength, resilience, and generosity, our donors create an impact for countless patients at Englewood Health 365 days a year,” says Debra Albanese, executive vice president, Englewood Health Foundation. “During this especially difficult time, we are immensely grateful for the support our donors showed us. Through philanthropic donations big and small, they supported the continuity of high-quality care for all our patients, helped us obtain necessary supplies and equipment to aid in screening and treatment, and delivered much-needed support for our indispensable caregivers on the frontlines.”

Comfort Comes from Caring Neighbors

Restaurant lover Bari Adler created a plan that coupled two goals — supporting healthcare workers with meal deliveries and helping area businesses, especially restaurants, keep their doors open and their workers employed. In March of 2020, $30,000 was raised by the community to buy thousands of meals for hospital workers prepared by local restaurants. “The idea was to give thanks to them for working while the rest of us were home,” she told ABC News. Over the weeks and months to follow, more restaurants, local nonprofits, and residents stepped up to deliver meals to the hospital staff.

Those meals meant far more than sustenance. “It was amazing how we witnessed the community rally together to support local businesses and especially restaurants. In turn these restaurants fed our frontline workers thousands of meals during the toughest time of the pandemic, day in and day out,” said Nancy Bergman, director of food and nutrition.

Inspiring Artwork

Other ideas to inspire and support healthcare workers originated at the hospital and were quickly embraced by people eager to help, explains Cathleen Keavey, RN, nurse manager, ICU, who describes what happened when the hospital approached the Art School at Old Church about creating inspirational whiteboards to display on each floor of the hospital.

“Two artists from the school — Sarah Smith and Donna Dolby — worked with dry erase markers to create amazing displays, each with a different theme, and wrote inspirational messages that reminded nurses that many patients were going home to their families because of them,” says Keavey. “The artists told us they were so happy to come and do something to show the nurses that the community was grateful for their care, and the staff loved them. They brought in some sunshine.”

Also uplifting were students — some as young as kindergartners — who created art, music, and messages organized by their teachers and sent to the hospital over the months to follow. “Their colorful and heartfelt messages on display at nursing stations and throughout the hospital reminded the hospital staff that superheroes were real,” says Barbara Grygotis, RN, senior director, medical/surgical and nursing operations.

Recognition from First Responders

One of the most memorable demonstrations of gratitude and support came at dusk on April 24, when the Englewood Fire Department led a parade of fire, police, and emergency service vehicles around the hospital campus. First responders from more than a dozen Bergen County communities participated, blasting their sirens, flashing their lights, and waving and cheering to the healthcare workers gathered outside and those watching from hospital windows.

The acknowledgment of the work being done at the hospital by first responders sent a powerful message, said Warren Geller, president and CEO, Englewood Health, speaking after the event. “Men and women who put their lives on the line for us came out to honor us,” he said. “I’m speechless. This is what we do. We exist to be here for our community. To be recognized by these folks — what an honor. What a great night,” said Dr. Stephen Brunnquell.

The parade also served as a visual — and audible — reminder of what the entire community of Englewood had been able to achieve. “Coming together during a time when we were all separated from each other showed our tremendous resilience as a community and how connected we truly are,” says Geller.

A Song of Hope

Local musicians George Bosotina and Emily Herring wrote a song for Englewood Health during COVID-19. “For two people in music feeling unable to do anything to make difference, it was a way to give back,” explains Bosotina. “It gave us the chance to use something that we know how to do to help the healthcare teams who were out there every day.”

The song “It Only Gets Better” came to them quickly, fueled by their experience of those early pandemic days. “It was that period in late March 2020 when everyone felt confused, depressed, isolated, and scared, and the song reflected what we were seeing and feeling at the time,” says Herring. “But we also knew there had to be hope, so we wrote about making it through this together.”

Their music and lyrics’ message of resiliency resonated with the hospital staff and community members.

“It Only Gets Better” was released in a special presentation to staff in April 2020, at the height of COVID-19 cases at Englewood. Bosotina and Herring also performed the song live during the Englewood Health COVID-19 Remembrance event in October 2020. In early 2021, it also became the soundtrack of a public service announcement encouraging the community to get vaccinated, jointly performed by students from the Performing Arts School at BergenPAC.

“The act of doing this and it taking on a life of its own gave us a positive experience at a time of a lot of negativity,” says Bosotina. “And it’s so wonderful that the song we wrote was heard by so many and was about something so meaningful.”

“This is What We Do”

In April 2020, Dr. Stephen Brunnquell did an interview with Steve Inskeep for Morning Edition on NPR. Unlike the dozens of television appearances he’d done to talk about being on the frontlines of the COVID-19 response, which were taped and edited down to 20-second clips, this was done live. “At one point he heard something in my voice, and he commented on it. And he was right, and it almost took my breath away. I was so proud of what we were doing at Englewood because it involved everyone. What the nurses had to do was incredible. And the surgeons pitching in, and people making phone calls, and the support coming from the community. It was all of that, and the host heard it in my voice. All of us, working together, sustained each other.”

But Dr. Brunnquell also notes that as extraordinary as the events of the past year and a half have been, and as unsparing as Englewood’s response was and continues to be, in another sense, this has been a kind of caring as usual. “My whole career has been about getting ready for this. It’s what we do. We take care of people. We never thought we’d see something like this, but this is what I signed up for,” says Dr. Brunnquell. “It was painful, but we didn’t walk away. We didn’t flinch. This is what we do.”

Caring for the Whole Person

One of the most difficult challenges for patients with COVID-19 was the lengthy isolation and separation from family and friends. Finding ways to support patients beyond clinical care “became a crucial part of helping them recover,” says Lorraine Johnson, RN, senior coordinator of patient and family engagement. “We realized that patients and their families needed human contact, if not in person, then virtually,” says Johnson. The team committed themselves to making contact with every patient, every day. “We wanted them to know they weren’t alone.”

Existing phones were replaced with ones that after a few rings would pick up automatically and switch to intercom mode, so that even the sickest patients could hear a human voice calling to check on them. “Even if the patient didn’t have the strength to lift their hand to pick up the receiver, my voice would be in the room,” says Johnson. “And it would be magic. And I would be able to say, ‘You sound clearer. You sound much better today.’ ”

The team also created a concierge service to bring patients whatever they might need, from cell phone chargers to clothes to wear when they were finally sent home. If a patient wanted something different to eat or a social worker to talk to, it would be taken care of. Staff redeployed from other departments became the lifeline for patients and their families to stay connected. The COVID-19 team served as an extension of the ICU team now caring for a majority of hospitalized patients. Oncologists, cardiologists, and surgeons stepped in to provide medical updates for families allowing intensivists and hospitalists to focus on caring for the most critically ill. “Providers whose practices were sidelined by the pandemic helped treatment teams however they could and were just incredible. ‘Where do you need me? Where can I add the most value?’ ” says Dr. Alexandra Gottdiener, chief of medicine. “They inspired us all with their willingness to pitch in and help.”

Another effort spearheaded by the patient relations team sought to fill in personal details about patients, many of whom were ventilated and couldn’t speak. “ ‘Tell me about your loved one,’ we would ask families,” Johnson says. “ ‘What are they like? Do they have a nickname? What’s their favorite thing to eat? What do they like to watch on TV? What can you give us so that when they wake up, it will make them smile?’ Families sent us pictures, of the dog and the house on the lake and the wedding.” The photos were made into a collage, laminated, and put on the door of the patient’s room “so that when someone went into that room, they’d know who those patients were and could connect with them on a human level,” she says.

Diversity and Inclusion Education Council

Reaching the Community

The challenge is education and access — teaching about the vaccine, overcoming hesitancy, and encouraging people to get the shot. “The biggest concern was how are we going to get the vaccine to the most vulnerable parts of our population,” says GaEun Joung, pharmacy director.

Connecting directly to “the 90-year-old who didn’t even own a computer,” Dr. Brunnquell says, helped prevent many people from falling through the cracks.

The hospital organized additional vaccine events to help ensure that as many people as possible received potentially lifesaving doses. The team worked with religious leaders in communities of color to help overcome understandable and historical reluctance to receiving vaccinations. “We spoke with local religious leaders and listened very carefully to the concerns of many who were hesitant to receive the vaccine,” says Dr. Brunnquell. “We held virtual town hall meetings. We invited community groups to a dialogue to reduce anxiety and fear of the vaccines and their history. We came together to provide access to the highest levels of experts in the scientific community to answer their questions and to confront doubt and fear head on.”

One vaccine event in downtown Englewood resulted in some 90 percent of a single senior housing development being vaccinated, Dr. Brunnquell recalls. The hospital also reached out to undocumented residents, promising to vaccinate while protecting identities. “We saw those who were coming to the vaccination clinics, and then the people who were not coming because they had concerns about the vaccine,” says GaEun Joung.

Preparing for the Road Ahead

When the next historic challenge arrives, whether borne by virus or something else, the healthcare team at Englewood Health will feel that much more prepared to serve the community. “We should always seek to learn from every experience,” Hoffman says. “We all want to be innovative on our own timeline,” she adds. “This was a reminder that sometimes innovation doesn’t come on our timeline.”

The pandemic called on workers to tap reserves of strength they may not have known they possessed. It also required the strength to admit one’s vulnerabilities. “This has taught me to rely on others, not just for the work that needs to be done, but for emotional support,” says Victoria Lange, senior director of operations and physician integration for the Englewood Health Physician Network.

Healthcare workers leaned on one another, and on social workers made available throughout the crisis. “We needed to talk to people about things. You don’t know what someone else is going through or if they had lost a loved one,” Lange says. “It was OK to be scared, and mad. And as long as you talked to people about it and didn’t try to hold that in, it was fine. A lot of people here felt comfortable with being open, and I think that’s the way to get through anything.”

Despite all the uncertainties and moments of true despair, the experience for many at Englewood Health underscored why they do what they do. Says Hoffman: “When you work in healthcare, you’re there because you care about people. You expect that when you’re called upon, you’re going to serve.”