Dr. Garber’s story is representative of the work of all healthcare professionals at Sansum Clinic’s Pulmonary and Critical Care Department in caring for patients with COVID-19.
Bryan Garber, MD, MS, specializes in pulmonary and critical care medicine for Sansum Clinic. For the past year, his expertise in the management of critical illness and advanced lung disease has placed him on the front lines of our community’s battle against COVID-19 in Cottage Hospital’s busy intensive care unit (ICU), which is staffed by Sansum Clinic and community physicians. While he remains hopeful about the long-term trajectory of the fight against this coronavirus, he believes it is important for people to know how serious the disease can be.
“The majority of people who get COVID-19 recover without significant problems,” he says. “But some people can get very sick with pulmonary illness that can be quite debilitating for a long time. If you are one of the unlucky few who end up with severe COVID pneumonia, it is not something you will recover from quickly. Consequently, these patients don’t move through the system as quickly as typical critical care patients, whose stay in ICU is relatively brief. This prolonged length of stay puts enormous pressure on ICU care, even more than the volume of new patients.”
Dr. Garber was initially drawn to pulmonary medicine and lung health because of his own childhood experience with asthma. “My early career path was driven partly by self-interest,” he says. “Research is me-search. Later, my interest expanded to include critical care medicine because it is a branch of internal medicine that requires doctors to think about the complete patient.”
Critical illness often impacts the entire body, including the brain, lungs, kidneys, circulatory system, and more. Critical care doctors require a thorough understanding of all the major organ systems, and they frequently collaborate with other specialists to extend their knowledge in a team-focused environment. “I couldn’t do my job without the assistance of others,” Dr. Garber says. “We rely quite heavily on numerous medical professionals. The list is extensive and includes virtually every type of medical specialist and a team of nurses, residents, interns, pharmacists, dietitians, social workers, and spiritual caregivers.” Along with Dr. Garber, three other physicians treat patients through Sansum Clinic’s Pulmonary and Critical Care Department. Benton Ashlock, MS, MD; Ann M. Lee, MD; David A. Zisman, MD, MS, FCCP and Dr. Garber provide medical services for patients with critical illness and disorders of the lungs.
The Personal Implications of Providing Critical Care
Along with their current heavy caseload of COVID-19 patients, Dr. Garber and the team commonly treat a variety of critical illnesses including septic shock (which is a profound inflammatory response to infection within the body), heart failure, gastrointestinal bleeding, severe respiratory failure, and many other life-threatening disorders. Essentially, critical care encompasses any patient whose body can no longer sustain its normal physiologic responsibilities resulting in the need for life support. When patients from the emergency room or hospital ward do poorly and their condition declines, they are transferred to the ICU for closer monitoring and further invasive care.
Types of treatment for critical conditions can include blood pressure support using medicines called vasopressors that constrict blood vessels to increase blood pressure, antibiotics, and noninvasive and invasive breathing apparatus. “These are modes of supportive care that allow the human body to recover from whatever insult has occurred,” Dr. Garber explains. “Therapies such as antibiotics and other medications, blood pressure support and breathing machines essentially buy time to allow the body to recover from acute illness.”
Dr. Garber enjoys working in a field of medicine where every case is unique. “Critical care is intellectually stimulating and quite challenging,” he says. “Events I witness in the ICU often stay with me and this COVID-19 pandemic has affected me deeply. When I go home at the end of a shift, I can only sleep knowing I have honestly tried to provide the best care that I am capable of. I approach each patient as if they were my own family.”
The doctor’s family life was impacted in the early days of the pandemic. In March 2020 when there was still so much unknown about the transmission of the disease and the effectiveness of personal protective equipment (PPE) such as face masks, disposable paper medical gowns and exam gloves, Dr. Garber completely isolated himself from his wife and three young children for several months to avoid potentially spreading the virus to them. His in-laws traded places with him and he moved into their home so he would have no direct contact with his family members during his ongoing work caring for critically ill COVID-19 patients. “Any sacrifice like this that we make is miniscule compared to the things that patients and families suffering with a bad case of this disease go through,” he says. “My isolation from my family pales in comparison.”
As time passed and he became more trusting of PPE and the efficacy of personal behavior, Dr. Garber was able to adjust his restrictions and return home. “My wife has taken on a huge burden and has been an incredible support, holding our family together as my work hours have changed and my physical and psychological stress levels have increased during the pandemic,” he continues. “Almost all my colleagues have families and feel similarly. We are grateful for the support of our significant others.”
A Growing Knowledge Base Supports Difficult Decisions
Dr. Garber says prevention is crucial as the number of COVID-19 cases remains high. He echoes the messages of public health officials about the importance of physical distancing, mask wearing, and hand washing. “The spread still seems to be driven by social gatherings,” he warns. “But there are many cases where we can’t pinpoint exactly where the inciting event was. Like most other infectious diseases, it circulates in families and groups. There are super-spreader events. But it also spreads simply through day-to-day existence.”
He acknowledges that this risk creates a huge psychological and economic toll as people adjust their lifestyles and behaviors to avoid potential infectious contact. “As a society, we’re trying to find the right balance,” he says. “I would not want to be one of the officials who need to make the difficult decisions about social and business restrictions because I don’t think the issue is clear cut. There are no absolutes.”
One piece of good news the doctor shares is that the precautions people have been taking for COVID-19 work for other infectious diseases. “We are seeing a lot less of other preventable illnesses and infections, such as influenza, because of the protective actions people are taking,” he explains. “Humans are naturally social creatures and we long for interaction, but that may not always be the best thing for our health.”
Dr. Garber explains that while the cause of complications with COVID-19 can often be traced to preexisting conditions such as diabetes, obesity and pulmonary disease, sometimes the reason for severe cases remains a mystery. “There is probably some underlying risk factor that we have yet to identify,” he says. “We sometimes simply attribute severe cases to bad luck, because we don’t fully understand the virus. Eventually we may discover more definitive reasons. We have learned a lot about this disease and how to care for patients, but there are still a lot of unknowns.”
Staying Hopeful Amidst the Challenges
The severe conditions Dr. Garber has witnessed in ICU over the past year have impacted his perspective on life. “No matter how demanding my work is, at the end of the day I get to go home,” he says. “And the unfortunate reality is, if you’re a patient with severe COVID, you’re not going home. And you may never go home. Seeing the worst-case scenarios of the virus makes it easy to not sweat the small stuff in day-to-day existence. A pandemic reframes priorities. My Sansum Clinic colleagues in critical care agree. We feel privileged to have our health, a roof over our head, and employment—which cannot be said for everybody.”
Despite the gravity of the pandemic, Dr. Garber remains hopeful. “I am optimistic that as vaccination efforts increase, we will see improved control of the virus,” he says. “The data from the available vaccines looks quite promising as far as their efficacy against the studied variant of COVID-19, and hopefully against the newer strains as well. I’m impressed by the speed with which they were developed and I’m confident that the rollout of the vaccine will get smoother as availability increases.”
Medical science is steadily advancing in its understanding of COVID-19. Dr. Garber tracks the ongoing research and discoveries about the virus closely. “There are some interventions that have been proven to be effective, but there is yet to be a cure,” he says. “Right now, the best cure is prevention. Maintain a healthy lifestyle and diet. Wear a mask and practice social distancing. Get the vaccination when it becomes available to you.”
As the vaccine rollout moves forward, Dr. Garber believes society will eventually be able to return to some sense of normalcy. “Most people in our community have done a good job adopting the recommendations that the CDC and the Department of Public Health have shared,” he says. “I am optimistic that the restrictions on our lives that we have all experienced will be limited in duration. But this is still something that is affecting our community profoundly, so I advise people to stick to those restrictions. It is not worth the risk of getting this illness.”
Extreme demands and challenges notwithstanding, Dr. Garber feels honored to have the opportunity to practice in the critical care environment. “The reality of critical care medicine is patients either recover from a very serious illness and return to a normal life, or they don’t,” he says. “Unfortunately, sometimes the outcome is not a cure. In those cases, we can help people as they reflect on what they want at the end of their life. Oftentimes patients are so sick that we are unable to have much direct interaction with them. We work with family members and help them cope with these challenging issues. Caring for these patients and interacting with their families at a watershed time in their lives is a privilege.”
Dr. Bryan Garber specializes in pulmonary and critical care medicine with an emphasis in management of advanced lung disease. He graduated from UCLA David Geffen School of Medicine and is certified with the American Board of Internal Medicine in Internal Medicine, Critical Care Medicine, and Pulmonary Medicine. He joined the Sansum Clinic medical staff in 2018.
Sansum Clinic Pulmonary and Critical Care Medicine; 301 W. Pueblo St. Santa Barbara, CA 93105. (805) 898-3400.