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May 18, 2020 | Midwestern University
Dr. Lai’s aerosol box. That could be the answer. Leslie Easley, D.O., FACOI, a 2007 graduate from the Midwestern University Arizona College of Osteopathic Medicine, had a good feeling about the possibilities that her colleague Dr. Judy Wu’s photo represented. It was a feeling she embraced – the insight, the inspiration that practicing medicine always provided her even in the most challenging times.
Calling this past year “challenging” was a vast understatement, no question about it. 2019 was barely over a month old when her father passed away. Then, that summer, she suffered an interuterine fetal demise 36 weeks into her pregnancy. Three days later, her husband died of a sudden illness.
Coming back to work when the last time she had been in a hospital was to say goodbye to her daughter and husband was one of the most difficult things she could remember doing, even after months to work through everything that had happened. But practicing medicine is not just Dr. Easley’s job. “I realized more than ever that I love what I do,” she says. “And medicine was calling for me. Nothing could keep me away.”
Even significant personal tragedy gets put into perspective when you work in a discipline that directly involves you in other people’s health struggles. Practicing medicine becomes therapeutic – because in these situations, you know you can make a difference. All that matters is the moment when you can impact people’s lives in a positive way.
So Dr. Easley went back to work, taking each opportunity she could, day by day, to make a difference.
And then came COVID-19.
“The PTSD hit me like a truck,” she admits. “I hadn’t known that I would be without half my family after this year, and now here I was facing uncertainty again.”
Would the virus affect her? Would it affect her son London? What about the rest of her family? So much unknown… except medicine. It was all she knew, and it offered her a measure of certainty. So she went back to her calling.
Dr. Easley and her colleagues at Sound Physicians, specialists in acute care and hospital medicine, found themselves at the start of the COVID-19 pandemic brainstorming ideas and best practices for dealing with a virus of indeterminate transmission modes. During a multidisciplinary discussion session, they quickly realized that if the virus was aerosolized, healthcare workers were at significant risk – even with personal protective equipment (PPE) in place – because of the large number of airway procedures being performed on COVID-19 patients. The virus’ aggressive nature paired with aerosol transmission meant that virus particles could breach PPE and infect the caregivers as well; already there were stories filtering back that healthcare professionals were starting to fall gravely ill with COVID-19 themselves after treating patients.
During the discussion, Dr. Easley’s colleague Dr. Judy Wu brought up the idea of using an aerosol box, a concept designed by Taiwanese physician Dr. Lai Hsien-yung that was being employed with excellent outcomes in several locations, including Taiwan and New York. The aerosol box is made out of acrylic or transparent polycarbonate sheets and sits over the patient’s head, covering it from behind, above, and at the sides, while staying open at the shoulders for ventilation. Two access holes allow the healthcare provider’s hands access to perform airway procedures such as intubation; the providers are protected on three sides by protective panels. Even better, the box could be cleaned with a solution of 70% alcohol or bleach and then reused on the next patient.
Dr. Easley quickly found the plans for Dr. Lai’s aerosol box online – freely available under the Creative Commons license – and then reviewed studies of the box’s efficacy. The studies showed that the box would be a simple but extremely effective addition to their process. She knew that the box would save lives. Now the question was how to get it produced quickly in the face of a rapidly expanding pandemic.
“I had this design for the aerosol box in hand, but I had no way to produce it and I didn’t know anyone who was making them locally,” she recalls. “So I posted a picture of Dr. Lai and the aerosol box to our neighborhood Facebook group one night to see if anyone had any ideas.”
One of the members of her Facebook group was Kim Van der Veen, co-founder of the Burgeon Group, a company that makes adaptive learning spaces in public libraries. “I had never had professional experience with them in the past,” says Dr. Easley. “But they were familiar with production materials and had designed boxes similar to the aerosol box for other uses. They did research regarding medical-grade polycarbonate that would stand up to the cleaning products used in hospitals and could hold up to repeated use and stress.”
By the time Dr. Easley got home from her shift the next night, a package from the Burgeon Group was waiting for her. Inside was the first prototype of her aerosol box.
“I took it to work the next day and had our teams try it out,” she says. Less than five days later, based on feedback from Dr. Easley and her peers, Burgeon Group delivered the final product to Abrazo West Campus, an acute care community hospital in Goodyear. It was used that same day on a COVID-19 patient.
They had named it the London Box, after Dr. Easley’s son.
Now, months later, Dr. Easley remains on the front lines of the COVID-19 battle in Arizona. Armed with the London Box, she and her colleagues’ odds of coming home safe to their families every night have improved dramatically. The process by which the London Box came into being, she notes, is being replicated throughout the profession as medical professionals go on the offensive against the virus. “I feel like the pandemic has brought us back to basics in a way and helped us come together to find a solution,” she says. “We have seen a sharing of scientific data like never before to come up with treatments and vaccines. We haven’t seen this level of interprofessional cooperation in a long time.”
But at the start of every shift, she is reminded every day that, at its core, the practice of medicine comes down to one simple interaction – the professional with the patient. As a Midwestern University graduate, she knows that, in the moment, every other consideration fades away. Whatever else is going on in your life or in the world, when it comes time to practice medicine, it is a single face-to-face moment shared between two people. It is a moment of inspiration, a moment of communication, and a moment of consolation.
“It doesn’t matter what’s happening in another state or another country,” Dr. Easley says, “It’s just us.”