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Practicing in a "War Zone"
Jared Marcucci, MD ’10, MS ’06, medical director of the emergency department at Community First Medical Center in Chicago’s Portage Park neighborhood, discusses his ED’s experience with COVID and how his own positive test for antibodies moved CFMC to join clinical studies underway on therapeutic plasma transfusion.
Maybe it was all of the deaths Jared Marcucci, MD ’10, MS ’06 witnessed last spring as COVID patients poured into his emergency department that made him aggressively seek out every opportunity to heal, including the donation of his own plasma, rich in antibodies from a mysterious and all-too-often deadly disease.
A little more than a week after a woman in Chicago became the second reported case of COVID-19 in the nation, Dr. Marcucci, medical director of the emergency department at Community First Medical Center (CFMC) on Chicago’s Northwest Side, experienced something highly unusual: a little hoarseness, a little congestion.
“Despite many exposures in the ED over more than a decade, I have never been sick, not even a cold,” Dr. Marcucci said matter-of-factly. “It lasted two or three days, and I didn’t think much of it.”
But after he and his wife tested positive for COVID-19 antibodies in April as the number of cases in Illinois soared, he extrapolated that he had likely contracted a mild case of the virus. He then focused intently on how his plasma might help boost immunity in seriously ill COVID patients. He eventually donated through the American Red Cross and worked for approval for his own hospital to join the Convalescent Plasma Expanded Access Program led by the Mayo Clinic.
“I hope our own patients can directly benefit,” said Dr. Marcucci, who compared the spike in patients with COVID at CFMC last spring — between 60 and 80 patients per day presenting to the ED — to “practicing in a war zone.”
“The Illinois Department of Public Health said no diversions, so we just had to figure it out,” he said. “We were boarding patients in our ED, doing ICU care there. We were reaching maximum capacity on ventilators. We were communicating with other ED physicians online in discussion groups. Initially we thought this was a lot like SARS or flu, so we have to intubate early. But then we realized this is more like a high-altitude pulmonary edema, HPE, and that we needed to avoid intubation as long as possible. We saw dynamically occurring pulmonary embolisms and young strokes.”
More discussion among ED and ICU physicians led to treatment with the anticoagulant Lovenox, blood thinners on arrival and proning.
“Our nurses and staff are the real heroes — coming up with best practices in the face of daily change, working together to figure it out, going above and beyond despite their own anxiety and stress around potential exposure.”
Dr. Marcucci was 36 when he graduated from Chicago Medical School. He matched into his top choice for residency at University of Illinois at Chicago, where he also completed a fellowship in bedside ultrasound.
“Emergency medicine, at the end of the day, is helping people and doing right by people,” he said. “I like the idea of taking care of everyone who shows up. It’s a privilege, a spiritual experience, to share intensely personal moments with people. Maybe I have to deliver the worst news they’re ever going to get.”
A student who once shadowed Dr. Marcucci watched him share the worst news — the loss of a child — with a family before taking a deep breath and walking into the next bay to treat a patient in the middle of a heart attack. “How?” the student asked.
“I owe it to my patients,” Dr. Marcucci said. “Their grief in that moment is not my grief, though it will be someday. I need to be there in that moment but I can’t carry it to the next patient. If I do, I can’t give them the attention they need.
“I process it all — the good and the bad— at night.”