Title:Alumna Channels Cura Personalis Lessons to Psychiatric Care During Pandemic

Q: What was your introduction to Georgetown like?

Garza: I went to boarding school in Connecticut, and when I was looking for colleges, I knew that I didn’t want to be in a rural area, since I had done that in high school. I wanted a more urban atmosphere —something with a more international and diverse population —and my college counselor suggested Georgetown. I didn’t know much about it, but when I visited the campus, I instantly felt a sense of belonging. The diversity and the Catholic roots were really important to me, as well as the service-oriented nature of the university since I had participated in volunteer service projects in high school. I also wanted a more fulfilling experience where I felt that I could continue my own personal growth and spiritual development, and Georgetown really fit the bill for me.

Q: What was your reaction upon learning of your acceptance to Georgetown? Did you immediately know what you wanted to study?

Garza: Georgetown was my first choice, so I was elated and absolutely over the moon when I found out I was accepted. I came in thinking I was going to be pre-med, and was really fortunate to be able to take a breadth of core curriculum courses in philosophy and theology that shaped my spiritual journey. What was really great about my Georgetown experience was not only the typical part of making friends and learning, but also being able to study abroad at the Villa le Balze in Fiesole, Italy. It was a transformative experience and made me feel more confident and independent.

Q: When did you begin thinking more seriously about entering the medical field?

Garza: I ended up taking a couple of years off. I had this opportunity fall into my lap while I was at a career fair at Georgetown. A representative from the Department of Justice was recruiting people to work for the Radiation Exposure Compensation Program that compensates victims of uranium exposure—people who had mined, milled, or transported uranium ore between the 1940s and 1970s that the federal government used to make nuclear weapons—and many of them were unskilled workers, a huge percentage being members of the Navajo Nation who had developed cancer due to carcinogenic exposure. I worked as a claim examiner, and just about a week later, 9/11 happened. That just really shifted things at the job and for me. The rate of our mail-in claims were affected by Anthrax scares, because mailing services were suspended to government buildings. While I was at this job and trying to figure out what the next steps would be, I found it was more meaningful to actually speak with these claimants and their families on the phone, helping them obtain medical records, as opposed to processing and adjudicating the claims. I thought to myself, I really like working with people, and I’d like to go back and pursue the medical school route. I had come into Georgetown thinking both of my parents are doctors, but there were so many opportunities to study the humanities, which I really loved. When I came back and applied for medical school, those same feelings of inspiration swept over me. Though I applied to other medical schools, I found that Georgetown really values humanism in a way that I didn’t see as much at other universities. The cura personalis nature of the university attracted me because I really wanted to connect to people, and be the best doctor I could be in an immersive and well-rounded way.

Q: What does your work look like within the field of psychiatry?

Garza: The speciality I’m in now is consultation-liaison psychiatry, which is a niche arena within the field. I work in a medical hospital and I see patients who are medically ill. They have diverse diagnoses like diabetes, heart conditions, alcoholic cirrhosis. The role of psychiatrists in this setting is varied but can include assisting patients who are having a hard time coping or accepting that they’re sick, or they’re very depressed and demoralized about their illness. Similarly, patients’ illnesses are related to their behavior. For example, when someone who has diabetes is in denial and they don’t want to change their diet or take their insulin, they may end up in a diabetic coma. That’s where we step in as psychiatrists and talk with them to ask, “What is preventing you from taking your insulin? What is it that’s keeping you from following your doctor’s recommendations?”  I try to keep it nonjudgmental and invite the patient to be curious with me about why they are thinking or behaving in the way that they do. In this way, I also get to interact with medical professionals throughout the hospital and we can put our heads together for the sake of our patients. On the other hand, we can also really step up as advocates for our patients, who are frequently disenfranchised, if doctors have a hard time connecting with patients because they are overwhelmed by patients’ psychiatric illnesses.

Q: COVID-19 has really changed how health care spaces operate, particularly this spring in New York. How have you and your colleagues been faring in the wake of the pandemic?

Garza: I’ve seen dozens of patients who have contracted COVID-19, and there are definitely some challenges to taking care of them. Early on, the medical staff certainly felt apprehension and fear about seeing these patients and getting sick themselves. The sheer volume of patients forced our hospital to totally restructure itself. There was a big push to discharge everyone who wasn’t critically ill over the course of a week. Regular medical floors were being converted to ICUs, new ventilation systems were being used once standard vents were running out, and specialists in other departments were being redeployed as medical and critical care doctors. That didn’t happen to anyone directly in my division because they still needed us to manage delirious patients and other psychiatric emergencies, but some of our residents had to switch gears and go back to ICU. Even in our capacity as psychiatrists, we were able to assist our colleagues in a consultative way as they cared for patients, so being able to be physically present for our colleagues was really special and reassuring to them.

There were some challenges during the pandemic, namely several of us got sick. At that time that we were sick—there were a cluster of five or six of us in my division of 13 people—there were not enough tests for us. We did not meet the requirements to receive a test because the limited quantities were reserved for the critically ill, so we did not know if we had COVID. Therefore, as a precautionary measure, the hospital mandated that we stay at home. During late March to early April, many of us were working from home and that was really tough.

Q: How did your team adapt to providing care virtually for your patients?

Garza: We need to be there to feel out what’s happening with our medically complex patients. Traditionally, our specialty had not used telehealth, but we had to figure out quickly how to see patients in a way that was confidential, safe, and accurate. We were able to learn and implement the use of HIPAA-compliant software to see patients remotely via iPads and smartphones. With the influx of patients, however, we quickly saw that we did not have enough technology to carry this out. The hospital had even ordered more iPads, but there was a backlog because all the hospitals nationwide were ordering iPads. So in order to get a quick hold of the technology we needed, I actually turned to the Georgetown University Alumni Association Facebook page.

Q: What was the response like when you relayed a call to your fellow Hoya alumni community?

Garza: I just plainly laid it out in a post, saying I really need to hit you guys up right now. We have so many patients in the hospital now that we can’t see because there is not enough personal protective equipment for us to see our patients. There are no visitors allowed and it’s really hard for our patients that aren’t allowed to see their families. There are patients who are dying and don’t have the chance to say goodbye to their families, and we need to help make this better. If you have an old iPad or an old tablet that you aren’t using, please send it to me. Some classmates were so generous and sent what they had from afar, and I’m forever grateful to them and for the Hoya community for supporting me. Even those who couldn’t send tablets still wrote encouraging messages, which was amazing and helpful as well.

Luckily, our hospital was able to overcome some of those PPE shortages, and right now, we have enough. I’ve been back in the hospital since mid-April and have been donning scrubs, a N95 face mask, gown, face shield, gloves … the whole getup,and going into patients’ rooms.

Q: What’s been the biggest adjustment or change in bedside manner since the pandemic?

Garza: It’s been challenging because it’s about connecting, eye contact, and having a reassuringly normal human interaction. In the hospital, people can feel dehumanized. People are always poking them, waking them up, drawing their blood, coming in early in the morning and late at night. So much of what I do is to provide a sense of care and humanity, because I’m interested and want to know how you’re eating, how you’re sleeping, how you’re feeling. How can we help you feel better? How can help you preserve your dignity even though you’re sick? A lot of times, it’s really the smallest things that can help people feel better and more normal and empowered. That’s what I’m in the business of doing, and reminding my colleagues of that. It’s really hard to do at times when my face is completely covered. In some ways, I guess the telehealth aspect has allowed us to do that, because in that space, we aren’t rushing in or out of a room with PPE and we can just talk with patients who miss having one-on-one interactions. There are pros and cons to some of the innovations we adopted, but we had to figure out a way to make it work.

Q: What advice would you give to the Georgetown community as we navigate the next months of a potential virus resurgence?

Garza: That’s tough, because I have those nervous feelings sometimes, too. I would say, now that we’re a few months in and we have the data, we should continue following what the science has shown us works best, which is staying at home, social distancing, wearing a mask, and washing our hands. Our numbers are steadily declining here in New York, which is great, and while I understand that it’s painful and terrible to be cooped up in quarantine and we want things to go back to normal, we have to have a long game in mind. For many of us, we are in a privileged position to ask ourselves the question, “How can I take care of myself in this time of isolation?” For thousands of others on the frontlines, including food delivery workers and those in vulnerable work conditions, it’s a lot easier said than done, but I think we should feel empowered that we know what can turn things around when this second wave hits. And what’s just as important is remembering that as a community, we can remain physically distant, but still be socially present for one another.