#eyeheroes Series, Issue 3;

During the COVID-19 outbreak, many ophthalmologists provided essential medical care. In our third newsletter, New World Medical recognizes the efforts of Dr. Sarwat Salim.

Dr. Sarwat Salim is an internationally recognized glaucoma specialist with a passion for humanitarian work. Besides serving as a Professor of Ophthalmology, Vice-Chair of Clinical and Academic Affairs, and the Director of Glaucoma Service at Tufts University School of Medicine, she has a deep commitment to public health and under-served communities. Her story focuses on the emotions that physicians go through and the situations they find themselves in when they are committed to improving the lives of others.

From a young age, Dr. Salim learned that public service was an essential part of life. “I credit my contributions and humanitarian work to my late father, who continues to inspire me,” she recalls. Watching him and others help those in need, Dr. Salim has sought ways to share her skills and knowledge both locally and globally.

Dr. Salim has traveled extensively around the world, often to developing countries and under-resourced areas, including Iraq and Syria. She provides medical and surgical eye care, with an emphasis on skills transfer and training of local physicians, often under difficult, and even dangerous, circumstances. As part of her work, Dr. Salim has also trained many international fellows in glaucoma, in addition to training fellows in the U.S., who take these new skills to deliver quality eye care in their respective countries.

“It is gratifying and satisfying to help those in need, as it adds meaning and purpose to our own lives,” notes Dr. Salim. “I am very fortunate to be in medicine, and being an eye surgeon allows me to preserve and restore sight, which is one of the most precious senses. I also hope that my commitment to community outreach and humanitarian efforts inspires others to act.”

COVID-19 Brings Humanitarian Work Close to Home

The coronavirus pandemic caused events to shift. Elective procedures were canceled so that hospitals could allocate their resources to COVID-19 patients and preserve their stocks of PPE for emergent cases. However, Dr. Salim did not let her contributions come to a screeching halt. During this time, her activities not only focused on the well-being of her patients, but also on the overall well-being of her colleagues, trainees, and students.

She began to provide in-person services to urgent and emergent patients and started using telehealth platforms for routine patients to ensure continuity of care. Dr. Salim was also deployed to a COVID testing center where hundreds of patients were screened daily for the virus. Somewhat apprehensive, she was put at ease with the availability of adequate PPE for all physicians, nurses, and staff at the testing center. It was also heartwarming for her to receive tokens of gratitude from local businesses and community members, like those shown below, during this difficult and uncertain time.

Dr. Salim did not stop her work there, as her trainees and students were also at the forefront of her mind. She started to focus on expanding educational programs at Tufts and other academic centers that consisted of didactic lectures to keep trainees engaged while they were unable to perform surgery or deliver clinical care. She also served as a research mentor for medical students who are currently applying for ophthalmology residency. Lastly, Dr. Salim became part of a buddy system within her department; colleagues would check on each other’s well-being. Not initially realizing how much fulfillment she would get from her participation, Dr. Salim spent time getting to know her peers on a deeper and more personal level, creating lifelong bonds.

A Testament of Strength

After three months of lock-down, life slowly began to return to “normal.” Now that the hospital began to consider re-opening elective procedures, Dr. Salim began to book her backlog of surgical cases. However, before elective procedures were re-instated, she found herself in an unpredictable situation.

While Dr. Salim was on call, her hospital received a trauma case. A young patient had sustained extensive trauma to his eye, resulting in a ruptured globe which required emergency surgery. The rupture was extensive, deep, irregular, and indicative of severe trauma. The hospital ran a pre-operative COVID-19 test. It came back positive. If it had been an elective procedure, surgery would have been delayed. However, the young patient was at risk of losing his eye, which required the need for immediate surgery. Dr. Salim was about to be the first person on her team to operate on a COVID-19 patient.

For just a few moments, fear, anxiety, and uncertainty kicked in. Dr. Salim consulted with experts, learning how to ensure the safety of her team and herself. Awash with information, she sat in her office and closed her eyes, thinking of how to proceed. “My entire life came back in flashbacks with affirmations of why I became a physician, why I chose academic medicine, and why I chose international work,” Dr. Salim recalls, “It’s my calling.” She found profound strength and realized that she was ready for the challenge. “I knew that I had the strength and faith needed during this difficult time,” she comments.

An Operating Room Like No Other

The operating room felt very different. It was a negative pressure room (an isolation technique used in hospitals to prevent cross-contamination from room to room) with all machines and equipment covered in plastics (shown below). The entire team’s morale seemed subdued because there was minimal communication. Every piece of their protective wear was doubled: hats, goggles, masks, gloves, gowns, and shoe covers.

Dr. Salim tried to mentally treat it like any other case, but it was difficult. She had to adapt to focus and maintain dexterity with the extra pair of goggles and double gloves. She rallied her team and moved as quickly, cautiously, and skillfully as possible to minimize the total operating room time. Dr. Salim wanted to get the job done, help the patient, and keep her team safe.

A Rush of Emotions

Upon reaching home, Dr. Salim called her mother. The first question her mother asked was, “How is your patient’s eye? Is it going to be saved?” Until that moment, Dr. Salim had maintained her normally calm, professional demeanor. She had done her job well.

Finally, she felt the weight from the day’s events with tears in her eyes, letting every emotion out that was pent up inside, including fear of the virus, the stressful atmosphere in the operating room, and concerns for the patient’s well-being. She had taken off her “surgeon’s hat” and reflected on the situation from a different perspective. “Sometimes, we never find out the real story as to how patients were inflicted with injuries, but our job is to get the work done and serve them,” notes Dr. Salim. On top of it, she was dealing with two medical conditions, instead of one, in the operating room: COVID-19 and a ruptured eye. She was flooded with a variety of feelings: confusion, despair, frustration, feelings she had never experienced before when operating on a patient.

When the emotions settled down, Dr. Salim revisited the day and came to one, single conclusion: she realized why she signed up to become a doctor. Helping patients, no matter the circumstance, has always been her calling. “Every person or case is unique and has the power to teach us,” notes Dr. Salim. “I hadn’t experienced that many powerful emotions in the operating room in a long time. While it was a difficult situation, it grounded me and reminded me of my purpose in life.”

Dr. Salim is extremely grateful to have had the privilege to serve people all over the world and provide quality eye care to all. Although this experience was overwhelming, due to numerous challenges, she feels humbled that she was chosen to take care of this particular patient.

Read about Yasir’s experience in his own words below:

#eyeheroes Series, Issue 2;

During the COVID-19 outbreak, many ophthalmologists provided essential medical care. In our second newsletter, New World Medical recognizes the efforts of Dr. Teddy Lyu.

Throughout the COVID-19 pandemic, the New World Medical team has regularly checked in with ophthalmologists across the country. We have heard remarkable stories of dedicated physicians who stepped in to help. In this article, we highlight the efforts of Dr. Teddy Lyu and his team, who assisted COVID-19 patients at Elmhurst Hospital. His friends and colleagues, Dr. Cristos Ifantides and Dr. Sarah Avila, nominated Dr. Lyu and contributed to this story.

Dr. Teddy Lyu: A Committed Physician

Dr. Lyu is a fellowship-trained and board-certified ophthalmologist in Brooklyn, New York. In addition to his medical practice, he is an award-winning, beloved Assistant Professor at the Icahn School of Medicine at Mount Sinai. Dr. Lyu often teaches his residents at Elmhurst Hospital, located in Queens. He is married to a physician, and they have three young children.

Dr. Lyu’s Long Hours Make an Impact

According to The New York Times and other sources, Elmhurst Hospital was one of the hardest hit during New York’s coronavirus outbreak. The media described “apocalyptic” conditions, with the hospital sometimes operating at 125% capacity. New York’s mayor, Bill DeBlasio, commented, “Elmhurst Hospital is at the center of responding to this crisis. It ‘s the No. 1 priority of our public hospital system right now”.

When COVID-19 began to appear in New York and Elmhurst Hospital’s ophthalmology clinic became “emergencies only”, Dr. Lyu did not hesitate to step in. As soon as his residents, including Dr. Avila, voluntarily redeployed to fight the novel coronavirus, he quickly volunteered his services in both the emergency room (ER) and on the COVID-19 floors so that he could help sick patients and be with his team. On top of volunteering his services in those two departme- nts, he was also treating glaucoma patients who had COVID-19 so that they could
keep their vision.

Dr. Ifantides, who first became good friends with Dr. Lyu as a medical student, was not surprised about Dr. Lyu’s commitment to the COVID-19 crisis in New York City.
“Teddy’s a soft-spoken person, but he’s very dedicated to his patients. He’d do anything for them,” he notes. “He’s the kind of doctor who will go above and beyond, even when no one is watching.”

Many sick patients were severely ill and needed oxygen supply or oxygen level monitoring. Available oxygen tanks were small; patients would typically run out of oxygen within an hour or two. Additionally, oxygen monitors were not available and were in short supply. As a result, Dr. Lyu and his team were constantly manually checking patients for hypoxia, monitoring tank levels, and replacing oxygen tanks. It was a constant grind, but the ophthalmologist and his residents never stopped. They knew that their work would let the ER’s doctors and other specialists focus on stabilizing more critically ill patients.

Dr. Avila recalls their time together. “As soon as we stepped into the ER, we went right into focus mode,” she notes. The ER was continually over its capacity. When they ran out of beds, they began to line-up patients in pods, beds ,and chairs. “There wasn’t room to walk,” she recalls. “Some patients would have to sit in a chair for two or three days until a bed became available.”

Dr. Lyu’s care was limitless; He would carry weakened patients to the bathroom while they waited in the ER or checked on them to make sure they were okay. “Dr. Lyu was doing nursing jobs, janitorial jobs, technician jobs, anything he could do to help,” Dr. Avila notes. He would even remind people with COVID-19 to eat, drink and charge their cell phones, the basics that are typically overlooked in chaos but meaningful for patients.

It took weeks, but eventually, conditions in the ER improved. Elmhurst Hospital shifted its need for volunteer services from the ER to the ICU where most patients were intubated. “If you’re that sick, you cannot talk to your family. You cannot operate a cell phone or text,” notes Dr. Avila.

While many ophthalmologists have gone back to treating glaucoma patients full time, Dr. Lyu, to this day, is volunteering his time in the ICU if help is needed, even when he is not on call as a volunteer. Right now, his focus remains on sick patients and their families. He gives patients’ families as much time as they need to talk through the situation or ask questions. He will even sit there with an iPad facilitating FaceTime since family members are not permitted in the ICU. He even lets families know when their loved ones finally open their eyes.

His relentless commitment to helping people during the COVID-19 crisis has not waned. Thank you, Dr. Lyu, for your ongoing service, dedication, and sacrifice as a physician to the people of New York.

#eyeheroes Series, Issue 1;

Each week, New World Medical wants to recognize an ophthalmologist who makes a positive impact to benefit humanity. This week, we recognize Dr. Joseph Panarelli.

Dr. Joseph Panarelli, Associate Professor, Department of Ophthalmology, NYU Langone Health, volunteered his time as a front-line worker in New York during the COVID-19 pandemic. During this time, the state was experiencing the peak of the crisis, and struggled to handle the surge in cases. Hospitals were short staffed and functioning at 150% of capacity. A COVID-19 response army was assembled at NYU Langone consisting of volunteer physicians with specialties unrelated to the virus: ophthalmology, endocrinology, rheumatology, etc. He was part of the first wave of volunteers and worked for two weeks, non-stop, for twelve hours each day – eight days volunteering and six days treating glaucoma patients.

On his first day, he didn’t know what to expect. Immediately upon arrival, he was handed patients with serious illnesses that he had not treated in over twelve years, since his med school days: heart failure, sepsis and COVID-19 patients who didn’t require ICU care. Initially frightened and intimidated, Dr. Panarelli had to re-learn the ins and outs of practicing medicine on the floor at the same time as treating patients. In order to do this, he attended midday training lectures in the middle of his patient schedules. Additionally, he served as his own boss since the hospital was short staffed. During training, the COVID-19 unit stood out to him. COVID-19 patients’ doors were closed, and on the door hung a checklist consisting of vitals, oxygen levels and codes allowing for patient monitoring while minimizing the spread of the virus.

Day two was filled with fear and hesitation. The CDC started reporting that the virus was attacking young people. Being young himself, and exposed to the virus every day, the fear of catching COVID-19 and spreading it to his family was at the forefront of his mind, yet he continued to volunteer. His daily routine consisted of admitting new patients, treating them, overseeing discharge plans and ensuring communication occurred with their family. Normally, families were able to sit in waiting rooms, but due to the outbreak, they were not even allowed in the hospital. This was eye-opening for him, and he knew the stress that family members were going through since they could not be present, so he made it a top priority to spend quality time communicating with patients’ families.

On day three, his children woke up just to say “Daddy, we are proud of you”. Overcome with emotion and bearing the weight of the responsibility he had towards his family, he cried on the way to the hospital. This internal struggle dissipated as soon as he stepped back on the hospital floor; he was reminded of why he became a doctor, and those reasons were to save lives and protect patients. This pushed him forward and kept him focused on treating his patients and discharging those that could leave so that their exposure was minimized. Each day ended upon arriving home, where he spent an additional hour thoroughly disinfecting himself and his belongings in order to keep his family safe.

Days 5, 6, 7, 12 and 14 were spent treating urgent glaucoma patients back in the ophthalmology department in NYU. He treated about 3-4 patients a week to ensure that those who were on the verge of losing their sight received immediate care.

Throughout the two weeks. Dr. Panarelli received a tremendous amount of support from the medical teams on the floor, consisting of volunteer nurses, nurse managers, nurse practitioners, administrators and physicians like himself, who flew out on their own dime to join the cause. His gratitude extends to the janitorial staff who exposed themselves everyday by constantly cleaning the equipment and rooms that patients stayed in, and to the valet staff who kept the flow of patients and staff moving.

He was also overtaken with the overwhelming generosity that the public displayed. Coffee shop employees refused to take his payment for coffee, and kids left notes in chalk outside the hospital, thanking people like himself for the work that they were doing.

Dr. Panarelli will never forget this emotional experience. He is extremely grateful to his wife for her support of him in his decision and appreciates his family more than ever.