Rebeca Monk, MD

Highland’s new chief of medicine juggles new position as the hospital is flooded by COVID-19 patients in December and early January

By Chris Motola

Q: You’ve recently become the chief of medicine for Highland Hospital. Talk about bad timing.
A: Oh my goodness, it really is. I’ve just gotten off a meeting about the COVID surge. These are really unprecedented times. The number of patients we have, the number of patients hospitalists are taking care of right now are just unheard of. In addition, there is a lot of staff who are becoming sick. So it’s just put such a strain on the system.

Q: Is it mostly Omicron? How serious are the illnesses you’re seeing?
A: We assume it’s mostly Omicron just because of how infectious it is and the rate of rise. But we’re not always checking which variant it is. It is spreading so quickly through the community and, even though it doesn’t tend to be as severe as the delta variant, it’s not causing as many patients to need ventilators and things like that. If you’re vaccinated and boosted, most people aren’t getting that sick.

Q: I understand that the virus is affecting mostly unvaccinated people but we are still seeing a number of vaccinated people getting sick.
A. The people who are vaccinated and boosted who are getting really sick are usually people who have other conditions. Despite that, because it’s so infectious, those who aren’t vaccinated are getting sick and we are seeing deaths in younger patients. It can still affect the lungs, even though it doesn’t tend to affect them as badly as Delta. Just by the sheer numbers, you are going to get some people who get very sick from it.

Q: Is the Highland Hospital ICU strained?
A: Our ICU numbers aren’t rising that much, but our hospitalization numbers are. Often, we’re finding that patients without too many symptoms coming to the hospital for other reasons are testing positive during pre-op screenings. So it’s also delaying care for a lot of people. The numbers we’re seeing in the hospital from people who are sick but not in need of intensive care, or for who it’s complicating other issues is just so great that it’s put a huge strain on the system.

Q: Has it been hard to keep everything manned due to staff infections?
A: It really is. I’m a nephrologist and even just managing all the patients who need dialysis, especially with COVID, it’s just gotten crazy. But in terms of staff, the physicians are doing OK. Many people are getting infected not in the hospital, but outside of it. A lot of nursing staff. A lot of support staff and technicians. It’s affecting the whole hospital. Everyone’s working extra hard, working extra shifts. I think my concern as chief of medicine is burnout. That was actually my major goal getting into administration. I didn’t anticipate it was going to be this bad. Everyone’s doing the work though. I’m very impressed by my staff. They really are an exceptional group of people who put their heads down and plow through. We’ve just never had so many people getting medical services at once, I think in the entire history of our hospital.

Q: How are you addressing burnout?
A: It’s hard right now. We know that there are a bunch of things we can do in general. I have a mindfulness practice that I think has helped with my own resilience. I think everyone knows what they need to do, whether it’s spending time with their family, spending time out in nature, exercising. But it’s hard to combat these systemic issues right now. And there have been some longstanding systemic issues I’ve wanted to address, like the electronic medical record. It keeps us working late into the night even after we’ve seen our patients. We’re on the computer a lot looking at labs, patient messages. There’s an expectation that we’re on the computer 24/7. I was hoping to implement some kind of systemic support. I think right now I’m just trying to support the staff with some lunches and feel supported and healthy.

Q: Beyond staffing, how are hospitals like Highland doing in terms of resources?
A: I think right now we’re doing OK. We’ve been trying to get N95 and KN95 masks for all the staff right now to reduce COVID transmission. The supply chain issues are affecting us, though, in terms of some medications. There’s been a shortage of dialysis supplies. But we’ve got some great pharmacists keeping us as well supplied and stocked as they can. So far we’re doing OK, though. I haven’t heard of any shortage that is keeping us from delivering care.

Q: How much are you still able to practice nephrology?
A: I’m still practicing. I’m seeing some patients in clinics. I still see some patients in the hospital. I’m also the medical director of one of our outpatient dialysis units. I’m probably going to be giving some of it up over time. I hope to continue it to some degree, but this is a big job.

Q: Has COVID-19 had any broad impact on kidney health in your patients?
A: The Delta variant and some others were initially causing some patients to develop kidney disease, but we haven’t seen that so much with Omicron. Right now the big issue is, with dialysis, we don’t want to be mixing our patients with COVID with our patients without it. That’s been logistically challenging. Initially these patients were being sent to the hospital because we didn’t have outpatient COVID capacity. Now we are opening a COVID dialysis unit in an outpatient setting. It’s probably not enough to handle this current surge, though, so it’s still stressing the system.


Name: Rebeca Denise Monk, M.D.
Position: Chief of medicine at Highland Hospital
Hometown: Buffalo
Education: Columbia University
Affiliations: URMC; Highland Hospital; Strong Memorial Hospital
Organizations: National Kidney Foundation; American Society of Nephrology; National Kidney Foundation; American College of Physicians
Family: Husband (David Trawick, M.D.); two sons, two cats
Hobbies: Biking; Cross-country skiing