I was primed to become a doctor from an early age. Both of my parents are physicians who talked shop at the dinner table, so I grew up with an appreciation for the complexity of the human body. I also had two experiences where family members were really sick and having a great doctor changed the trajectory of their lives. Being able to have that impact seemed incredibly meaningful; and I decided to specialize in Emergency Medicine because it seemed to offer that chance, on steroids.

Like so many, I thought practicing medicine would be similar to what I saw on Scrubs or Grey’s Anatomy, where you’re presented with an immense diversity of medical problems to solve through brand-new, exciting, innovative procedures. But the reality is the opposite; by design, it’s not that exciting, because you shouldn’t be doing something that you haven’t done a hundred times before, that you could probably do in your sleep. That’s what’s best for the patient.

Then COVID happened. For the first time in decades, we were figuring things out from square one. In the beginning, we didn’t know the best science or treatments. Working in the ER at The Mount Sinai Hospital and Elmhurst Hospital in New York City—which was dubbed “the epicenter,” I got to see the progression of the virus. We went from “This is just a bad version of the flu; why is everyone freaking out?” to “Holy crap, there’s a lot of sick people coming in,” to “Oh my God, are we going to run out of ventilators?”

Our volume of cases doubled, with the number of critically ill people requiring a ventilator increasing over tenfold. At the peak, that meant every 20 minutes you’d have a patient come in whose oxygen level was 40 or 60 percent. I remember one shift at the end of March where we were crushed by the number of patients, and for the first time in my career I had to specifically schedule extra time after my shift to complete all of the death certificates for patients who died that day. There’s a surreal soundtrack to this scene that has stayed with me, where we had 30 ventilators in a room going at once, all buzzing and beeping a different tune and tempo. It was such a crushing, insane experience that I don’t think I’ll ever feel overwhelmed again for the rest of my career.

Terrible as it was, it forced us to innovate. As an example, the standard protocol for putting a patient on a ventilator involves first bringing oxygen levels up as close to 100 percent as possible before gently placing a breathing tube. But doing this was impossible for many COVID patients. They were often at 40 percent and quickly going down to 30; one patient, in front of my eyes, went down to zero. I didn’t even know the oxygen monitor could read that low. We had to cut out the usual steps and prioritize speed.

The silver lining in all of this is that people have realized the emperor has no clothes. For decades, we’ve recognized that healthcare innovates dramatically slower than other industries. Some of that is for good reason, because people’s lives are at stake. But it’s also due to an ossified payment system that pays for quantity without regard to quality and opaque regulations, in fact one study found that nearly 80 percent of the rules patients and physicians cited as barriers to great care were basically rumors. Plus, we have a cultural aversion to innovation; my final lecture of medical school started with the professor advising, “Don’t be that doctor that tries new things out. Let it be on the market for at least five years before you start prescribing it.” COVID broke through all of that. We sent over 2,000 low-oxygen patients home with a $20 pulse oximetry machine and checked in on them with Zoom to prioritize hospital beds, something that was unheard of just a few months ago. We shortened the average time from when a study is published to when it is applied in clinical practice from a decade down to just a few days. And we built hospital beds in the convention center and Central Park. Patient-centered innovation is finally happening, and it’s up to all of us to make sure it continues.

On a more personal note, I’ve learned two big things from working in the ER. I’m humbler in terms of what science knows and how predictive it can be. Masks were out, until they were in. And I hope I can approach future problems with the objectivity of Dr. Fauci: “I don’t have any horse in the game one way or the other. I just look at the data.” Second, I’ve been reminded of the importance of the human connection. In the depths of the pandemic, a pleasant dementia patient in her 90s who didn’t want a breathing tube was lying comfortably on a stretcher, oblivious to her plummeting oxygen levels. I felt terrible because I couldn’t do anything for her, so I decided to FaceTime her son. Her entire extended family was on the couch, crying, and they asked for me to hold the phone up to her ear. They whispered prayers and saw her peacefully take her last breath. They were so appreciative of having experienced that moment of closure; that has really stuck with me. There weren’t any medical therapies to alter the course of what was about to happen, but being there virtually brought them so much peace and comfort during a difficult time. The power of that has been understated in medicine, and perhaps in society more broadly. Going forward, I hope we can emphasize that human connection more.

Omar Z. Maniya has served on the American Medical Association’s Board of Trustees, as president of the Emergency Medicine Residents’ Association, and was named a 40 under 40 Health Care Innovator by MedTech Boston. After recovering from COVID-19 in early March, he returned to practicing emergency medicine at The Mount Sinai Hospital in Manhattan and Elmhurst Hospital in Queens, New York.

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