Surviving COVID Brings Renewed Meaning to the Practice of a Hospitalist Leader

What doesn’t break us makes us stronger.

Looking at Behfar Dianati, a confident-yet-soft-spoken, immaculately dressed hospitalist medical director at a major hospital in suburban Illinois, one would never imagine he had seen war up close.

Growing up in the 1980s, he witnessed the Iran-Iraq War, losing his close relative and childhood friend. As a teenager, he recalls wearing his business suit to sleep. If my house gets bombed at night, at least I will go with dignity.

Despite the horror and chaos around him, he persevered to graduate from medical school and eventually traveled to France for his internal medicine residency. In 2004, chasing the American dream, he moved with his wife and two children to United States.

Up close and personal with COVID

Things haven’t been the same for Behfar since early March of this year when he got sick.

At the time, he made his rounds wearing minimal personal protection equipment (PPE), unaware that the COVID-19 pandemic was around the corner. A few days after admitting a patient with influenza symptoms, he came down with myalgias, cough, and a headache. He did what most healthcare workers do and popped a Tylenol. He just didn’t have the luxury of getting ill.

A few days later, his wife, Parisa (who has asthma), developed respiratory failure due to COVID. She eventually became so ill that she required intubation and a 10-day ICU stay.

Witnessing illness and death daily is part of our hospitalist profession. But the sense of impending doom is more profound, and the fear of mortality quite raw, when it is your loved one in the hospital bed.

Behfar was isolated from his critically ill wife due to visitor restrictions. Per his hospital’s quarantine rules, he was also forced to isolate at home for 14 days. Soon, both of his children tested positive for COVID. The pandemic had hit home.

For Behfar, the silver lining in this tragic turn of events was seeing his community rally behind his stricken family. Each day, a neighbor arrived on his doorstep with a home-cooked meal. The kids on their street made get-well cards for Parisa. Friends took turns grocery shopping for his household.

Small gestures of kindness carried his family through. Just when COVID had suddenly and dramatically crippled his life, his community lifted him with hope.

Once a leader, always a leader

Behfar had two families to think of. While his wife was in the ICU fighting COVID, his work family was short-staffed and struggling. He wanted to help them, but he was stuck home in quarantine.

Then, another physician from his team got sick. As medical director, Behfar’s hospital looked to him for a solution.

The saying “constraint inspires creativity” could not be more accurate. At this time, the hospitalist team was still rounding on patients in person. Working tirelessly with hospital administration, Behfar set up virtual rounding for COVID patients. He even donated his personal iPad to this project.

Operationalizing virtual rounding required strong nursing collaboration. It involved clustering care of all COVID positive patients by coordinating nursing bed side care with provider virtual rounds; onboarding the nurses on the software nuances of a tele-visit; framing the need for tele-visits to the patients and families and addressing their reservations.

The physical exam was done through observation and nurse assistance. The nurses would go in the room with the iPad and were instructed regarding certain exams like inspection, palpation, pulse check, cardiopulmonary auscultation and neuro-check. They now have an electronic stethoscope that syncs through the telemedicine platform so the provider can hear the auscultation remotely. For billing, the telehealth waiver and telehealth services modifier were added.

Fortunately, as medical director, Behfar had already laid the foundation by working closely with nursing and case management for many years. His strong ties made it possible to get the program up and running in just seven days.

Behfar then took charge of virtually managing all his hospital’s COVID patients from his home office. He shouldered this responsibility for 14 straight days as his short-staffed team on the front lines carried the remaining patient census – a true testament to the value of teamwork.

Our experiences shape us

Experiencing this terrible pandemic firsthand as a patient, husband, father, and medical director has changed Behfar. Helplessly watching Parisa on Facetime, alone and intubated in the ICU — unable to hold her hand, desperate for updates on her progress — showed him a glimpse of what our patients and their families go through every day.

The pandemic has forced all of us to innovate and think outside the box. More importantly, it has made us reach within and bring out our most compassionate selves. With steely determination, Behfar reflects:

“I now see my patients through a whole new lens. I have been on the other side and can empathize. I resolve to spend more time with my patients, be available to their needs, and simply be present. Our patients are truly suffering. They need our listening ear and comforting words as much as they need our strong clinical skills.

“I am grateful my wife survived COVID. I am grateful for my hospital team, who helped operationalize telehealth rounding from scratch in just seven days. But mostly, I am grateful to be in this noble profession of healing.”

As Vituity’s Director of Quality and Performance, I coach health care teams on communication skills and ways to improve patient and provider experience. Almost always, the physicians who excel in patient experience metrics are the ones who have a personal story, a reason why they are in medicine, and find it their calling. Behfar is one such gem, and our profession is lucky to have him. I challenge each one of us to introspect, dig deep, and find our “why.”