Sister Grace Miriam Usala '07 on the Frontlines of the Pandemic
A religious sister and newly minted doctor, Sister Grace Miriam Usala '07 began her medical service treating COVID-19 patients. In the following Q&A, she talks about Bryn Mawr, her calling, the pandemic, and more.
Tell us about your time at Bryn Mawr.
Bryn Mawr has a reputation for being very secular, and—because I am a woman of faith—I did not know if I would be welcome. Nevertheless, I found the College welcoming. I came across several people also considering a religious vocation. The chaplains were very supportive, and Dr. Francl, my physical chemistry teacher and the cantor at the local parish, was instrumental; she helped teach me how to pray certain prayers and really encouraged me. Dr. Nerz-Stormes, who recently passed, was inspiring. She was constantly fighting cancer, and watching her battle with faith and love gave me a lot of strength and courage.
If you reveal your real self, people are very supportive and they get something from that, too.
How did you come to your vocation?
I'm from a strong Catholic family, and when I was about 12, my mom almost died. It got me thinking about eternal things. What do I want out of life? And at that point, I started to think about a religious vocation.
At the same time, I was a little resistant to the idea. I love research. I love literature. I just wanted to study. So I picked a school where I thought I could avoid a vocation. I had a strong inclination to be a doctor—my dad was a doctor. But I ended up putting that aside to join the Religious Sisters of Mercy of Alma, Mich.
But you still ended up in med school.
I tell people that being a sister is a little like being in the military. Our superiors discern how we should serve. So I was asked to go to medical school. I just completed my internal medicine residency at Georgetown. I am now a primary care provider in Tulsa, Okla., where I will be doing mostly outpatient primary care, although I will keep up my hospital privileges.
Where were you working during the pandemic?
At [MedStar] Georgetown [University Hospital], I first worked in an intermediate care floor. I rounded on and cared for patients with COVID-19 pneumonia as I would patients with other types pneumonia, but wearing protective garb.
After that, I was moved to a “high flow” unit for patients requiring high-flow nasal cannula, which is one level of care below intubation. I was there for two weeks, and at that point the hospital was seeing a surge. Some of our faculty generously stepped away from their specialties to assist us internal medicine residents with care of patients with COVID-19. For example, a general surgeon attending was my “intern” on the high flow unit.
Then I went to the ICU, the intensive care unit, where I took care of intubated COVID-19 patients for two weeks. Then, for my last rotation, I was on the infectious disease consult service, making recommendations about how to use our limited resources to take care of very sick COVID-19 patients—whether they were going to get plasmapheresis (basically, plasma exchange) or Remdesivir, for example.
When I left D.C., we were doing better, but it’s surging now in Oklahoma. Here, I have seen patients recovering from and newly diagnosed with COVID-19 in a free clinic .
What was most challenging for you?
Our main challenge is the social and psychological piece. We are blessed to have enough protective gear so the biggest challenge for me is communication with the patients. To go into the isolation rooms, you have to wear a full gown, gloves, facemask, respirator. Intubated patients can’t talk, and, even if not intubated, sometimes the patients don’t recognize me behind all the gear. And there is a no visitor policy, so no family to assist.
Obviously, it's very difficult for the family members. Some of my patients died, and it is heartbreaking to tell family members they can't see their mother (in person) who's dying. Questions about burial were also disconcerting. We did family Zoom meetings, and I was communicating with the family multiple times a day, often with the assistance of the palliative care service. I would bring an iPad into the room so patient and family could interact. People are surprisingly grateful. They understand the need for precautions.
As a religious sister, I offered prayer. A lot of families, even if they weren't Catholic or Christian, really appreciated that someone was there praying for them.
When I found that COVI19 patients were not getting the sacrament (Anointing of the Sick), I asked for help. After a couple of months, a priest was performing Last Rites with the proper precautions in dying patients’ rooms. I was just one small piece in making that happen, but it was very rewarding to provide that peace to families.
And what was your daily life like?
As a religious sister, I live in a community setting, but for a time I was living in a house separate from the rest of the sisters. Every morning, I would rise at 4 a.m., put on a special habit I had designated specifically for the COVID-19 unit and a modified veil, and drove to the hospital. When I came home, I put my habit in the washer, and then I would go over and see the sisters. I wore a mask whenever I saw them. I ate out on the porch first but then ate in the house, but at a different table. Then I would go back home and sleep and start over again the next day. It was isolating, but my community was very supportive and provided me not only with prayer but also emotional support.
What do we know about how to treat this disease?
We know more than we used to. We understand that we can protect ourselves with the proper equipment, we understand a little bit better how it spreads, we understand that the illness is caused not only by a virus but also sometimes by an “unbalanced” immune response. But we do not have a great grasp on how to prevent COVID-19; we're not much closer to an effective treatment, especially for those who are progressed in the illness; and we don't have a vaccine. And I don't predict that we will for another year.
It’s been a race—a marathon—and things are published astoundingly fast right now, and a lot of them are just observational studies, not randomized controlled trials. Many management decisions are based on weak data. At one point, we considered using anti-coagulants for all COVID-19 patients—in other words, thin people's blood because COVID-19 patients have very viscous blood that tends to clot. But that didn't work. We tried hydroxylchloroquine and azithromycin—two medications that looked promising against COVID-19 or similar viruses in vitro. But these drugs don’t seem to be effective. Now there is a suggestion that steroids and/or Remdesivir might be helpful in some circumstances, but again the data is preliminary.
We have had modest success with exchanging convalescent plasma, but we haven't found the key to manage the dysregulated immune response, especially when people are advanced in the disease.
Are you working or volunteering in response to the COVID-19 pandemic? Drop us a line at email@example.com to tell us your story.