With the arrival of the coronavirus in the U.S. this spring, many Americans found themselves isolating in their homes for weeks with only those closest to them. For Jacqueline Mahal WG94 G99, the early days of the pandemic were a different story.
As an attending physician in emergency medicine at New York City’s Jacobi Medical Center, she played a crucial role in providing critical care to infected patients. Mahal, who is also an assistant professor at Albert Einstein College of Medicine in the city, spoke with Wharton Magazine this summer about those early days, her path to a medical career, the people who have kept her grounded during this difficult time, and more.
Wharton Magazine: Can you describe your experience as part of the emergency department early on in the crisis?
Jacqueline Mahal: When I look at the charted curves like the one from the New York Times, I think of March and April — the peak in the city — as a very overwhelming time.
In this acute phase, patients started to arrive hypoxic and very sick; they were not just trickling in, but suddenly our waiting room and ED was filled with patients who all had similar complaints. This is very unusual for an emergency department, where we typically have a diversity of clinical presentations, no matter the volume. It became fast-paced, crowded, and dismal very quickly.
The most dismal part of it was that the tools and approach that we use for hypoxia weren’t working for these patients. It was a horrible feeling of helplessness and fear. Over the course of those two months, we all worked 12-hour shifts and then went home and did more work to understand what this virus was. And slowly, through our community and learning from each other, we started to do some things differently that seemed to help patients — we felt we had some tools. Then it all started to go away.
By mid- to late May, our emergency department felt empty. We had layers and layers of staffing — nurses and doctors who had come in from all over the country — but in May we were at maybe 20 percent of our normal volume. People were scared to come and get help for other conditions, even as the number of new COVID diagnoses dropped. By the end of June, our volume started to creep back up.
WM: What were some of the things you and your colleagues brought back to the emergency department from your work and research at home?
JM: This was a team effort across the board. We would talk about medicines, all the trials that were starting, but in the emergency room we were most concerned with stabilizing patients’ respiratory status. People were coming in with low oxygen levels, so we were trying to figure out the best way to manage their hypoxia — and typically that’s intubation. But that wasn’t really working well; the patients were getting worse with it, so we were looking for alternatives and some of them — particularly noninvasive ventilators — were controversial because they were aerosolizing the virus. So initially we weren’t using them, but then we did, and they seemed to provide some hope for patients.
WM: Why did you suddenly see the drop-off in patients you mentioned?
JM: It was social distancing. We started implementing social distancing in March, but in the meantime it was like a wall coming because we hadn’t social distanced earlier.
WM: Do you have any suggestions for Wharton graduates who don’t have medical degrees but still want to help?
JM: The most important thing right now is for everyone to be observant of measures that are intended to slow the spread. Wear a mask, practice social distancing, and be thoughtful about attending events or gatherings. The cause is to keep the nation healthy, and the best way to do that wherever you live in the country is to wear a mask and be aware that this is real and we do not have any inherent immunity to it.
WM: Your career is unlike most Wharton grads. What led you to pursue a path in emergency medicine?
JM: I was quite young going to business school compared to my classmates. I was about 24 or 25 and had one job before arriving at Wharton, working as a subcontractor for the U.S. government. I didn’t go to business school to be a banker or consultant, although I did both of those things after getting my degree. From early on, I wanted to — not to be cliché — help people. I chose to go to business school because at the time I was really interested in female-owned businesses for wealth creation in Africa.
My world opened up at Wharton, and I thought, “I should really learn how to use these skills; I should really understand finance and how it’s applied, the markets, how businesses are run.” I spent a year in investment banking at Bankers Trust after and then did four-and-a-half years consulting at Monitor. For roughly my last two years at Monitor, I worked in pharmaceutical consulting, where I did market research and spoke to doctors. That helped me realize that I wanted to do something more hands-on. It took me a long time to make the switch. The pivot wasn’t a sharp turn; it was a long, curved arc of discovery and questioning.
WM: You also manage service grants as part of your work. Can you talk a little about them?
JM: For the last four years, I’ve had two publicly funded grants — one through New York State and one through the New York City Department of Health and Mental Hygiene. The health department grant is to help provide appropriate medical care for HIV-positive patients and HIV-negative patients who are at risk of becoming HIV positive — for example, making sure HIV-positive patients are on antiretroviral treatment and can keep their viral loads down, and for HIV-negative patients who are at higher risk, making sure they get medicines or have access to a doctor to speak about anything they need to remain HIV negative.
The other grant is through New York State’s Office of Addiction Services and Supports and is a response to the opioid pandemic, which we don’t really talk about much anymore, but it’s still out there. The grant was to initiate buprenorphine, which is a treatment for opioid withdrawal, in the emergency department. Both grants are ending this year, and continuous funding will be delayed because of COVID, but I am hopeful that some aspect of these programs can continue until funding is available.
WM: With all the grim news in the past few months, is there anything in particular that’s kept you optimistic?
JM: Frankly, it’s been really hard at times. My three children and husband have been helping me tremendously. Being a mother has been particularly helpful because it’s kept me grounded. Also, my friends; I have a Lauder friend, Allison Berey G94 WG94, who texted me every day in March and April to check in on me, and I had a neighbor who cooked for me because my family wasn’t around for a couple weeks. I would come home and she would have dinner at my back door every day. These small acts of kindness really helped.