Erica Shenoy, MD, PhD: Learning & Leading During COVID-19

Q:   As an infectious diseases physician at Mass General, Dr. Erica Shenoy specializes in the evaluation in management of infectious diseases. As Associate Chief of the Infection Control Unit at Mass General, her focus is on infection prevention and control, with a special interest in preparedness and response to emerging infectious diseases. For the past several months, Erica’s expertise has been well employed, as she has been a key leader and advisor in the hospital’s planning and response to the COVID-19 pandemic.  

Prior to COVID-19, Erica served in a variety of leadership roles, including as Medical Director of the MGH Regional Emerging Special Pathogens Treatment Center, which is one of 10 centers funded by the Department of Health and Human Services to prepare, train, and provide clinical care for emerging infectious diseases.  

For Erica, the work of providing safe and effective care for patients, as well as enhancing the research and knowledge about these diseases, is critical. So welcome, Erica. It’s really wonderful to have you here today.   

A:   Thanks for having me.  

Q:   I definitely want to talk about COVID-19 and your experiences over the past few months. But I'm wondering if we, could just start at the beginning, and if you could share a little bit more about how and why you became interested in working in infectious diseases. 

A:   So I’ll go back to college. I mean at that point, I’d already decided I wanted to be a physician. And so in college, I did molecular biology. But my minor was in public policy. 

And so I got some exposure there. I spent a year after college working for what then became, the Gates Foundation working on their portfolio around vaccine development and the policy aspects.   

And when I got to med school, I had planned to do the MD and then the PhD, and the PhD being in the health policy program, with a focus in economics. And there, I continued in the PhD part, to be interested in drug development, and what factors drive the development of pharmaceutical interventions.  

And then, as I was in med school and doing my rotations, I had a pretty formative rotation in infectious diseases. And it really was about the people of infectious diseases, and the sorts of patients that we were seeing, incredibly complex. You're not restricted to any one place in the hospital, because infections kind of happen in all organ systems, in all sorts of patients.   

And there was such a breadth to the challenges. The people I met, the attending physicians, the Fellows, the residents on the teams that I was a part of as a med student, really just solidified my interest in infectious diseases. And actually, as I started my internship year, it was one of my first rotations, again, to do infectious diseases with a plan to short-track, which at the time just meant that you applied in your internship year, to do an infectious disease Fellowship. 

So I think all roads, even back in the kind of things I was interested in, in college, working afterwards on malaria vaccine initiative, and the Gates Foundation, and through graduate school and med school, seemed to be pushing me in this direction that I'm so happy and so fortunate to be in this field, at this time. 

Q:  So you mentioned the patients playing a really big role in sort of solidifying your interest. Is there a particular memory or experience you had with a patient early in your career that jumps to mind? 

A:   So it’s probably more of amalgam of different sorts of things that I've noticed in patients, that I've taken care of. So certainly, in internship, when I was doing general medicine, I was drawn towards the patients who had infectious disease issues, or the potential. Because often, we don’t know that it’s going to be an infection, or we’re trying to sort out what's happening in the patient.  

But there were a couple themes that I just find so unique to I.D. For me, it’s really about, you have the patient in front of you. And there is the challenge of the diagnosis. There's the challenge of the treatment. And then there's, every patient has these unique aspects. 

So, for example, when you're trying to devise the antibiotic regimen, you're thinking about what's best for that patient, what treats that particular infection, has the least collateral damage, in terms of interactions with other drugs they might be on. But there's this other part, which is especially, which is the bigger picture in the population picture, that the actions that we do often in I.D., we think of the consequences on a population level. 

And I think that’s also what drew me towards the infection control branching point, which really does deal a lot with thinking about a population health perspective, whether it’s a hospital, or a system, or even broader than that. 

Q:   And I'm really struck by something you said, about the uncertainty, even at the very beginning, with diagnosing a patient. What's it like to sort of live in that with a patient in your field? 

A:   I.D. is probably not unique to this. But it does have, certain challenges. The cases that come to I.D., they're coming to I.D. because the primary team is stumped, needs assistance.  

There is uncertainty, but it’s really one of the most, like, challenging parts, and exciting parts. Like there is never a dull moment. I feel like each day, I'm learning something. Part of the division here, one of the characteristics is, the kind of phone-a-friend concept. everyone’s willing to pick up the phone if you call them, to say, “You know, I have a really unusual case. And I'm not quite sure what to do about it. Have you seen anything like this?”  

We do that every week, as part of our case conference, and one of the unique features of that is you’ll see some of the most senior I.D. physicians who will say, “ I've done this, this, and this. This is what I think is going on. Does anybody else have any other ideas?”  

And that kind of open learning, and recognition that we see really hard, challenging, unique cases. And that’s probably like the rejuvenating, exciting, never a dull moment, sort of thing. And it might be helped by the fact that, you know, a lot of the organisms that we’re trying to address, they change over time. They develop resistance.   

And, exemplified by COVID, you get new ones, because they come out of what seems like nowhere. And then you have to sort through it.  

Q:   Sure. And we love we to talk about mentors. So I’d love to hear, were there any mentors or people who inspired you early in your career, or played a really active role in supporting you? 

A: So I’ll start with,  the first mentor in my whole life. So those are my parents. They're both physicians. And they had incredible work ethic. They're both immigrants from Argentina.

What I heard from them and what I probably took from them, is how rewarding medicine could be. in graduate school, my mentors in the PhD program were Joe Newhouse and Richard Frank. And they were terrific, because there were only a subset of us who were doing both the M.D. and the PhD. And that’s not always, you, easy to navigate and go between those two worlds, because they're quite different. And especially, when you're doing something like health policy, which is not a traditional kind of PhD track.

And then, I would say, I mentioned that the attendings and the residents and Fellows that were on infectious disease, you know, that made such an impression upon me, because I was instantly, you know, really welcome to be a fully participating member of those teams.  

I was put in touch with David Hooper, who’s the Chief of the Infection Control Unit. And he has been my mentor ever since. So over 10 years of just incredible mentorship. I learned so much from not just the subject matter of infection control, but also about how mentors guide their mentees and give them increasing amounts of responsibility.

 And is always a terrific sounding board for me. So he has been my primary mentor, and really guided me while being here in infection control.

Q:   And so I'm just wondering, for our listeners, if you could maybe describe the key differences between infectious disease and infection control. 

A:  So infectious disease is about the clinical evaluation of patients and diagnosis of infectious disease and treatment of infectious disease. And they're certainly a part of prevention, you know, in the sense that for ensuring that our patients are vaccinated. 

But infection prevention and control is really about creating a safe environment for both patients and for healthcare workers. There's epidemiology that is really critical to it.  

And there's so many aspects of it that, even when I started getting interested in it because of more of an operations issue that I had noticed in the hospital. You know, the more and more you learn about it, the more you realize how integral it is to many aspects of the way things function in a hospital or in a healthcare setting.  

When I was, you know, intern, and even a first year Fellow, you know, I wouldn’t think twice if I passed by, for example, some renovations or construction happening in the hospital. Now I know that all of that work has to come through infection control to think about containment, and reducing potential risks to patients as those things are happening.  

There are so many features and aspects that infection control has input in and can be a value-add to the hospital and to our patients and to the healthcare workers here, that it’s really rewarding, on a totally different way than being a physician is, and dealing one-on-one with your patient, and knowing that you’ve done the best job for that patient. All these things that we’re doing, I’ll never meet all the patients or others who might have a better outcome from it. And it’s just—it’s really a very different feeling, and it’s incredibly rewarding, as a profession.   

Q:   I'm hearing a thread, a thread of learning and discovery, So I'm wondering, are there any maybe challenges or moments, when you think back throughout your career, that really stand out to you?  

A:  But COVID has been just an amazing amount of volume, of information coming out, you know, every day. And staying on top of that, and being able to integrate that into our policies, working with different groups, and understanding that the written policy clearly has to be implemented. 

And it’s not like I didn’t know that. I've been helping develop policies for the hospital for a long time. But those policies are developed over longer periods of time. So you have opportunities to really work them through with the people who are going to be at the frontlines implementing. And the pace of change in these last six months, and especially in the first, I would say, three months of it, you know, really required, that quick decisions be made. 

And so I had to rely on, you know, what I had learned in infection prevention and control, and rely on those around me who were great sounding boards, and contributors to those. But really have to make decisions very, very quickly in the span of hours. 

And that, I think, I've learned so much about. And it has helped me grow in this role. And so it makes me think, if we can get through this, and do a good job, and learn, you know, what we could have done better, and what really worked well, that there's not much else you could probably throw at me, at this point, or throw at the times. 

Q:   Yeah, and you mentioned the first three months. So I’d love to hear more, just about the very beginning of the pandemic, what the experience was like for you. And it sounds like you mentioned there was a great foundation already in place for communication and teamwork. But what were those first few months like? 

A:   It almost seems like forever ago, that it happened. But someone actually recently sent me an email that I had sent to them, I think, on January 6th or something. And it was some of the first reports of this pneumonia coming out of China. And like I think my email said something like, “We've got to, you know, make sure this is on our radar.” And things were certainly on our radar in early January. 

And we’d had a few patients presenting to the emergency department, you know, who could have met criteria for being tested. And as we know, things evolved very quickly. And at first, it was a really strong travel component to the risk factors. And there was really restricted testing at the time. So throughout the beginning part of January, we had a couple patients that we were considering COVID in. 

And then, in the third week, we activated our hospital incident command structure. It’s called HICS. And if you had asked me what HICS was pre-Ebola, I probably would have told you I didn’t really know how the hospital operated in an emergency. But it’s a really structured way that the hospital establishes, you know, an organizational structure, a commander, different section chiefs.   

It is definitely what is necessary in a situation where decisions have to be made quickly. And as we activated on the 27th, I remember giving a briefing. And I was literally pulling it together that night, you know. What do we know? What is our initial plan? We had plans established. We were kind of going through those. 

And then we were off. But through February, you know, we started seeing an increase in the number of patients who needed evaluation, but no one had tested positive yet. And things were very, still pretty quiet in Massachusetts at the time. 

And then, you know, it’ll probably be burned in my brain for like my entire life. But in the first week of March, got a call pretty late about multiple individuals presenting to our emergency room at the same time. They had all been at the same event. A few of them were symptomatic. We, you know, got approval to test them. They didn’t need to be admitted, so they went home. 

And then, two days later, I got a call from the Massachusetts Department of Public Health to tell me that those three patients were positive for COVID. And it turned out that that was the beginning of the Biogen outbreak, which has now been chronicled, and now published. And it was in the news. But that Friday morning, when we got those results, I called the patients directly to tell them. Then reached out to public health. 

And we, together, with the Brigham, met with the company, and learned that there was a large number of their employees that were symptomatic and potentially, you know, exposed in this situation. And that there was a need for a rapid establishment of testing sites. And at the time, you know, now you hear, like, “Go get tested. There's testing sites all over the place.” At the time, there wasn’t any. 

And, by that night, We activated. We had all the group that had been working for weeks on our approach to this. Basically established a clinic. And started calling all the employees from our list, to bring them in to get tested. And I left here probably close to one in the morning that night, and really, we didn’t really stop since that moment, just going forward. 

And things really took off in many ways as, you know, the pandemic progressed. And that’s really, I think, the pivot point, where life really, really changed very dramatically, in terms of pretty much everything, and how things have been going since then.   

And the pace has changed. You know, we deactivated our incident command in June, I believe. It was the longest we’d ever activated for an extended period of time. And that reflected, obviously, the severity and the intensity of this whole event. Each day is still incredibly busy with different topics, different issues, but still very much, we’re incredibly active, in terms of the response to COVID right now. 

Q:   And with those first few patients who were presenting, how much was known about the virus at that point? 

A:   Yeah. So not much. There was probably about a 40-person study that had been published in late January/early February, describing the clinical characteristics. And these had been early on hospitalized patients who were pretty, pretty sick. Because you know, later on, we started learning that there was such a spectrum of disease. And that some people, a proportion of patients never do develop any symptoms. 

But at the time, you know, we knew that there was some severe disease that was reported. And these actual initial patients, they were well enough, obviously, to go home. We had more of a description of the present, the presenting features, and what some of the risk factors would be. And really, at that point, it had been kind of the travel sort of thing. And that started changing in February, when there was some initial community transmission out on the west coast, and then in Washington State. 

And so, after that, you know, we just learned a tremendous amount, not just about the epidemiology, transmission, really treatment, the management of these patients, just incredibly in awe with the clinicians, and all the support staff, who this place as a hospital, was really transformed in so many different ways, and so quickly.  

Like the pace of change is one of those pieces that I think is so prominent, that you could start the day with, you know, this concept of what was going to happen. And then, you know, new things would come up, and you’d have to quickly change, just incredible, dramatic change. And the flexibility, and the dedication of the staff here.  

And then everyone supporting them, and allowing them to do their job,  I was very inspired, and continue to be inspired.  

Q:   And you had mentioned earlier the Ebola crisis that happened a few years ago. Were there any parallels as far as protection response, or the pace between that experience and COVID-19?  

A:  In the beginning part of the Ebola outbreak—and again, like some of these images are like burned in my brain of like kind of seminal moments. And not surprisingly, they like involved individuals I consider mentors, we were all working together.   

And I remember, it was August of 2014 or maybe early September, where the West African outbreak was really, really catching hold. And we had a meeting with leadership from Infectious Disease and Infection Control, and again, the Center for Disaster Management. And the topic was on personal protective equipment. And, you know, what kind of PPE would be our Ebola PPE.  

And, at the time, the guidelines were shifting. And we needed to make decisions based on our best understanding, maybe a little bit ahead of where things might be going.   

And I credit that forward thinking to the people who were in the room, making these decisions, and saying, “Okay. we’re going to go this way. And this is going to be our personal protective equipment ensemble. And now, how do we get the stuff that we need? And how do we train our healthcare workers to use it correctly?”  

And fast-forward to, you know, COVID, and it’s just on such a different scale, because of, obviously, the volume, versus I think, at the end of the Ebola outbreak, I think there were nine or so patients treated at various centers across the United States. We did not have an Ebola patient. We had a couple patients admitted under suspicion of Ebola, who turned out to have something different.   

But nevertheless, you know, the scale of this pandemic, in terms of volume of patients, and it eclipses, at least for the United States, what we experienced, and certainly in West Africa, that the volume was the biggest Ebola outbreak in history.  

But I think on top of those decisions around personal protective equipment, and infection control policy, which are really based in trying to be data-driven, and understand what do we know about transmission? And what is the right path forward that’s protective to our healthcare workers and makes this as safe an environment as possible, is the supply chain that was just totally something that I don’t think anybody has ever dealt with in our facility or across the country.    

Where we had at least about—I think about a couple weeks of a cache. And that was just not, sufficient. Every day, it felt like we had a new challenge, in terms of our supply chain. And we think a lot about PPE and the N95s. But it was also the cleaning products that we use, and the gowns, and other sorts of things that really make our hospital run. 

And so, when you compound kind of the pace of change with respect to information coming out, public health recommendations, and then you super-impose upon that, constrained by—by supply, you have to be—it’s just, it was very, very challenging. And we had to make decisions with imperfect information, maybe in ID I'm used to doing that, because there's a lot of uncertainty. And we make decisions under uncertainty.  

But fortunately, the hard work of so many people across this institution, has gotten us into a better place. And I think we’ve adapted well to what we have. 

Q:   And I feel like, you know, I've read a lot about how COVID-19 compares to influenza and things like that. What's different or challenging about COVID-19 as a virus, in comparison to others? 

A:   You know, the COVID-19 is a new virus. And so that obviously makes it different from, when you're talking about comparing to flu. So new to us, new to us in terms of our lack of any sort of immunity to it. And also, new to us in terms of learning the management, you know, diagnosis management, outcomes related to it. So new in so many different ways. 

A:   Where to start? 

Other aspects relate to, you know, ongoing interest in the fact that we’re learning so much. And I mentioned before that the pace of knowledge has been just so, I don’t know, it’s like a fire hose. You know, it’s just every single day, there's something out there. And part of that is wonderful. But also, part of it has been really challenged by the fact that there is so much out there.  

And a lot of pre-prints and things that are coming out, that initially might look incredibly promising and exciting. And then, once they get through peer review, you know, they're not actually what they appeared to be. And so separating the kind of really important policy altering, you know, things that you need to focus on to think about, you know, does this affect what we’re doing now?  

That was kind of always my question, when I'm like reading something. I'm like, do we need to do something different, based on this new knowledge that, you know, is appearing in this journal? Or, you know, looking to the public health guidance, as it was shifting over time. I'm really focused on, what does it mean practically? And do we need to do anything different? Because I really want to be on the leading edge, in terms of if changes need to be made, we need to make those changes.  

Q:   I guess I’d love to just ask you, you know, we’re in the fall. There's a lot of talk about a second surge. How is Mass General preparing for that?   

A:   So, as I mentioned, you know, that maybe the frenetic pace of what it was like during the surge, and then the months afterwards, it’s been replaced with something different, which is the process by which we kind of ramped up, as we had shut down a lot of the non-emergent and urgent care.  

And then, almost immediately, from that, it’s planning for what comes next. And that planning happens pretty much every day in multiple groups that are meeting on different aspects. And again, this is one of those, you know, areas where no one has a crystal ball. We have to plan for all sorts of continuances. And really, really taking a proactive stance at trying to kind of game plan different scenarios.    

You know, obviously, all of us hope that we don’t really experience anything like what we went through in the spring. And I think that's probably would be unlikely to experience what we went through. We just know so much more, and we have pretty quick levers, in terms of turning things, dialing things back and forward, in terms of distancing and other kind of restrictions that are out there in the community, that enable us to kind of react in a way that we were not able to early on. 

But I think there's other challenges that are different right now than than they were in the spring. And those challenges are that a lot of care was deferred when—and that had bad outcomes for patients. And none of us want that to happen again.  

And so there's a huge effort and a focus on doing everything we can, to ensure as much as possible, that we maintain the routine care, the routine operations. Obviously, within any constraints of regulators, but really focused on, what do we do to make sure that we can continue to provide the care that patients need, and that we don’t have to defer care?   

The second piece is, heading into fall, what will be the impact of flu? You know, there's some preliminary evidence that, in the Southern Hemisphere, it’s been a pretty mild, or like very unusual year. And I sometimes don’t want to say that out loud, because I don’t want to jinx us. But it could be that we have a mild year. And partly, it’s because everything we’re doing to prevent COVID transmission works very well for other respiratory viruses. 

And I think there's also this piece of that, it’s back to school time. And what will that mean, especially for a workforce? I think that everyone is really tired. It was a really, really demanding, you know, time. And it actually hasn’t really let up.   

There really was no letup for so many people that have worked so hard. And then, you compound upon that the issues around, childcare, and trying to basically work multiple jobs at once, while you're here and while you're at home. 

I think there's so much hope that we’ll do well. And I think we just have to plan for all the various scenarios. And, as I mentioned, that’s happening pretty much all day long, I think, around the clock, we've got people working on that, to try to do everything we possibly can, everything within our control, to be able to respond quickly as needed, and to really preserve how we function for our patients, and for our employees. 

Q:   Yeah. So I definitely wanted to talk about wellbeing during the pandemic, and moving forward. But before that, I'm just wondering, you talked about the challenges that are ahead. Sort of in tandem with that, —or what policies or practices were implemented throughout the past few months, that you're hoping will continue?  

A:  I would maybe say that there's a huge amount of generation of knowledge here. I'm sure every hospital feels this way. But I would say clinically, operationally, there is just an enormous amount of learning that went on, both things that worked well, and things that we would do differently.  

And underlying all of that, I see a theme of innovation. So they say that necessity is the mother of invention. And necessity was all around us for months and months and months. And there was some tremendous innovation. Now, not all of it, you know, ended up being something that we’ll take forward. But there are certain sort of practices, ways of delivering care, that I think we will take with us, and will have been something that we probably may not have gotten to, had we not had to be forced into making these sort of creative clinical and operational decisions. 

And people have said a lot about virtual care, and some of the benefits of that. And I think that’s really true. I think that will stick around with us. I think from a clinical perspective, the bedside clinicians did a really, really amazing job at being incredibly flexible and incorporating new algorithms as things were changing.  

And, you know, on a day-to-day basis, trying to amass the information that they were reading about clinical care, and then turn that into practice. And, you know, normally, as I mentioned with policies, you’ve got time. You know, you bring it to rural groups. You go through probably three committees. You know, you're really working your way through. And so, by the time you get to the final, it’s been really well vetted. 

We just didn’t have the time for that. And so there is, I think, a certain personality, a characteristic that I saw here, which was being flexible, understanding that it’s not going to be perfect. But everyone is focused on the same goal. And because of that, we’re going to improve and evolve really quickly. And we’re going to take what's good and what we learn and keep moving forward with that. 

And so I think the innovation across the board, in almost every aspect of how this hospital runs, and how we take care of patients, there are so many good things that have come out of that, that I really hope that we take forward. And I expect we will. And that our—you know, our future patients will—will benefit from that. 

Q:   And that flexibility, was that a natural thing to internalize during all of this?  

A:   Well, it can be a little unnerving, right. But, on the other hand, you just got to do what you have to do. As things picked up, we recognized that, you know, when you're in an emergency situation, and decisions have to be made, you trust the people making the decisions. I had absolute trust in my colleagues making, you know, the decisions that they had to make. And I think they had trust in me.  

And you learn quickly. And, you know, there are advantages of moving quickly. 

As you implement quickly, and you have a process in place to actually respond to the questions that people have, and modify things quickly, you can make a lot of progress. And I don’t even want to know how many versions of the different policies that I worked on were on. Like sometimes I'm like cringing, “Oh my gosh, I'm on version 11. Okay. This is where we are today.”  

But it’s kind of how we’ve had to move forward. And you know, it is what it is. It’s COVID life, is what I'm referring to it as. 

Q:   It’s just amazing. Has this changed or impacted your outlook on your field or your work? 

A:   You could probably tell that I love what I do, and I loved it before, before all of this. You know, there's no doubt that there was a lot of stress all around.  

But I was happy, to be useful and to have like practical skills that can be implemented in a situation like this. And again, hearkening back to like the mentorship I've had over the years, that was instrumental in probably getting me to the point where I would, you know, have the confidence to describe what I thought was the right path, also have the, you know, humility to say, “I don’t know. And what do other people think?” 

And so I would never ever consider a different career path. It’s really just such a great mixture of direct patient impact and, you know, the bigger picture. 

Q:   And so I’d love to just circle back to sort of that wellbeing piece of all of this during the pandemic. And there was so much discussion just on mental health in general. But also, of the frontline workers. Or how did you maintain your own personal wellbeing throughout all of this? 

A:   Well, honestly, you know, I'm sure I could have done better. But you know, I have a really strong support structure, at work.   

So, you know, being around people, working really hard with them, and knowing we’re all in it together, I think you know, it pushes you through. And so you kind of put things aside that, if you had time to think about them, maybe they would be more jarring, or really worry about them.  

Outside of work, I have a great family support structure. There's no doubt that that was just incredibly important. And I just would keep reminding myself. That like, this is our first pandemic. All of our intentions and our rationale and our thinking and what is underlying the decisions we’re making is based on the best available knowledge that we have at the time, recognizing that, more knowledge will come. 

We will shift as we need to shift. And I think that kind of approach has really meant that, you go with the flow. And you really just keep moving forward.  

But certainly, there was huge amount of stress and concerns about wellbeing that, throughout all of our staff—and I know it’s frontline healthcare workers, think all the support staff who are around them, it was just a ton of change. And all of us can handle change throughout our lives. But it was so compressed, and so kind of all-encompassing, for so many aspects. 

I'm trying to think of like one thing about your daily routine that didn’t change. But everything changed. And was all happening at the same time. And it was changing, you know, day-to-day, week to week. And so that is just very jarring. 

And there have been a lot of efforts here at MGH to really focus on the wellbeing aspect, and to call it out by its name, because I think for a long time, our profession, and many professions, you know, you just, you push through it. And that has consequences. And so they need to be really called out. There's a science to this. It’s not my area of expertise. But like other things I’ll rely on those people who know what they're doing, to tell me, you know, this is what the recommendations are. And these are the resources we have available.  

So I would say, I gained a lot of strength from the people around me, and from just knowing that, like, the path forward is the path that we’re going on. And I didn’t want to get, you know, too hung up on mistakes that might be made around it, because I know that our goals were totally aligned about patient safety and healthcare worker safety, and getting through this together. 

Q:   And I'm glad you mentioned routine, I mean I know I've struggled with it, and I know a lot of people have sort of that loss of routine and schedule. Is that something that you felt or you saw your colleagues internalizing in any way? 

A: I mean I was working many, many more hours than probably I've ever worked.  

But I think there were disruptions in people’s schedules that are important to recognize. You know, if you are now remote, and before you had those interactions with your colleagues, It’s not the same, right, that kind of interactions with your friends,. You know, it’s a very blurred line, right.  

We spend so much time at work. And we like the people we work with. And you know, we might go out after work and hang out with people. We just can't really do all the things that we used to do. We can't even sit together at work and have a meal, unless we’re six feet apart. And so I think that that disruption in kind of normal routines and normal engagement with other people is certainly challenging. And I do worry.  

I didn’t think I mentioned this. But looking into the fall, that we get tired of it. And we let our guard down. And I just worry about that, because I don’t know anybody who would rather not wear a mask. And I personally would like life to go back to the way it was. And we all kind of want that to happen. But we’re not there yet. And we won't be there for a little bit. 

And I think the reality of that setting in, after kind of the— just relief that the surge was over, the reality of where we are going forward, it’s—you know, some days you're like, “I really just am sick of it. I'm sick of it. I want things to go back to normal.” And then I just, when I get that way, I think, you know what? There's little things in life that are normal. And I’ll focus on those. And we’ll just keep going. And we will get out of this, because there's just too many smart people working on vaccine development and other things, that we will get out of this. 

Q:   So thank you so much, Erica, that was really great. Thank you.  

A:   You're welcome.

Q:   That’s great. Thank you so much. And lastly, just my final questions that we ask every guest. 

A:   Yeah. 

Q:   What's the best advice you’ve ever gotten? 

A: to not shy away from a challenge. To be really curious. And ask for help. So I think that's something that maybe we don’t do as often as we should. 

If your goal is to be the best physician or whatever your profession is, you have to learn from others. And not all of that is going to be in a book or in a paper or anything that you can get your hands on, or any part of your own experience. That you have to reach out to people and seek out that sort of guidance. 

Q:   Wow. That’s great. What rituals help you have a successful day? 

A:   Schedule. So as late as I go to bed at night, I really, really try to wake up at the same early time. And that’s part of just making sure that lots of things can happen in the morning before you get out the door. And I try to leave as little to chance as possible, knowing that I can't control everything. So part of what I do is like I’ll control the things that are possible, but not freak out if things don’t go the way they are.  

The other ritual is that I don’t go to bed before the lunches are made for school. That if like, you know, this is very specific, but like daycare, that you have to have this little box of stuff, now, that they take, and their little form filled out about their symptom. I have it all ready to go. So basically, my only job in the morning is to get myself ready, and get, you know, whichever kid I'm taking that day out the door. 

And that, I think, as late as it is at night, getting that done, makes me more relaxed in the morning, because I've kind of taken some of the uncertainty out of getting stuff done at the last minute. And that’s just something that I've done for a long time. I don’t like to leave things to the potential for chaos in the morning, because you never know what's going to happen.  

I think the other piece is certain routines, I don’t like going to the supermarket. But I like to take like one kid at a time, or maybe at max two kids at a time, because it’s a time that we are hanging out, and I'm not at the computer, or doing email, or doing other things. I'm like focusing on something that’s pretty mundane. as much as I really don’t like going to the supermarket as a task, I do like going with them.  

And it can be a little bit unnerving when things get a little chaotic. But it’s still like nice time that I'm completely focused on them, and hanging out with them, versus being distracted. 

Q:   If you weren’t a doctor, what would you be? 

A:   That’s a great question. I think I was really meant to be a doctor. I had a—When I was probably in sixth grade, I thought I might want to do like politics. But that was such a fleeting thought. And everything about medicine is just incredibly interesting. Maybe something I would do would be more in the operations area. 

Because one of the things that I find myself really drawn to, and you know, both in my kind of clinical practice, and in infection control is finding ways to do things better, and the kind of nitty-gritty of making something actually happen. And what constantly surprises me is, things that look very simple and seem very straightforward, have so many different things that could possibly go wrong. 

And I kind of like that challenge of, how can we make this most efficient? And working with all those different role groups, to make something from start to finish. For some reason, I really like those sorts of challenges. And so I guess, if I weren’t a doctor, maybe I would be doing something related to maybe operations. 

Q:   What's the best decision you’ve ever made?  

A:  probably the person I chose to marry was a very important decision. Total, you know, champion for me. Support. I think that was one of the best decisions I think I've ever made in my life.  

I think obviously, going into medicine I do remember, when I finally got the first med school acceptance I had this sense of relief. I'm like, I'm really going to be a doctor. You know, it didn’t matter where it was, that first acceptance. I'm like, this is it. I'm really going to be a doctor.  

Q:   Do you have any guilty pleasures? 

A:   Well, sometimes I watch Netflix,my husband and I are watching various series. And as much as I tell myself that we won't like watch the next episode, and binge on a particular series, we end up doing that. 

And then I was thinking about it today, because I try not to—I just needed to relax and listen to music.

And my daughter had made me a play list, and it was called “Actually Good Songs.” Because I guess she really finds my taste in music not so good. And so I'm really up to date with One Direction, with Jonas Brothers. I have a lot of—I would say that that was a guilty pleasure when I clicked on the “Actually Good Songs” play list, actually yesterday. And I listened to it again today. So I guess that is a guilty pleasure

Q:   That’s great. What do you consider your super power to be? 

A:   I try to be organized. But I also try not to be too held to that. Like the recognition that things just happen, and you’ve got to go with it. That’s just experience and learning over the years different things.  

But that’s not to say that, you know, things aren’t stressful, and you wish you had more patience in life. But I think I've learned that, for most things, you know, you control what you can control. And then you just realize that there are things that are going to happen. And you roll with it. And you—you rely on the others around you to get through it. And we’ll get through it in the end.  

Q:   Great. Thank you so much, Erica. It was such a pleasure to speak with you today. 

A:   Thank you. You're welcome.