Paul Lynch, MD, co-founder and CEO of Arizona Pain, in his office in Scottsdale.
Photo: Ben Scolaro, scolarodesigns.com
Drawing Inspiration to Fight a Deadly Virus
By Edward Araujo, Communications Coordinator, Maricopa County Medical Society
Many Americans list the 9/11 bombings as one of the most impactful moments they’ve experienced. For some, the tragedy inspired them to help others.
Paul Lynch, MD, is one of those people.
As a fourth-year medical student at New York University, he saw the iconic twin towers fall in lower Manhattan. Paul went to Ground Zero to care for the wounded but learned all patients were being taken to St Vincent’s Hospital. Since few survived, the hospital told him there was not much he could do. It took Paul years to process his experience of seeing the loss of human life and feeling paralyzed to assist. Yet, that traumatic experience instilled in Paul a commitment to care for patients.
Fast forward 19 years and a new national tragedy has befallen our country. The COVID-19 pandemic has crippled our many resources, our economy and most importantly killed over 132,000 people. That didn’t stop Dr. Lynch, now a Scottsdale-based pain intervention physician and anesthesiologist, to temporarily leave his successful practice Arizona Pain Specialists in March and head back to New York City to volunteer at Bellevue Hospital, America’s oldest hospital and where he had trained. His former colleagues reached out asking for help and reinforcements. Jumping at the chance to help, his volunteer application was approved, and Dr. Lynch received an emergency license in New York.
New York City during the crisis
The conditions at Bellevue were not for the faint of heart.
The first thing he saw were bodies being put on trucks. “Not just one or two, but 20 trucks in a row, semi-trucks with long trailers. The city had nowhere to put the deceased,” says Dr. Lynch. On the first day he arrived in early April, NYC lost 3,000 people. It was like 9/11 happening each day for the first three days after he arrived.
Dr. Lynch was immediately trained and added to an airway team. On his first day, a 12-hour shift, they intubated 10 patients. That is ten times the average he had experienced on anesthesia teams over a week! They airway team went room to room and floor to floor to intubate patients.
The original plan of doing screenings outside in tents failed quickly. The volume was too high. The tents were used to treat staff who became sick. Wave after wave of patients crashed into the ER.
Initially, each room had two patients who shared one ventilator. That was not keeping people alive. They shifted to keeping two patients in one room if they each had a ventilator and infusion pumps in the hallway. Dr. Lynch says, “As you walked down the ICU, you would see 12 rooms, 24 Christmas trees with infusion pumps, and about 10 infusions going.”
On his fourth day, the U.S. Navy sent close to 200 anesthesiologists and nurse practitioners. With additional personnel, they modified ICU staffing to three to four teams of four which included a critical care fellowship-trained physician, a senior anesthesiologist (like Lynch), and either two physician assistants or physician interns per shift. That model worked very well. Yet the problem is, as Lynch states, “I’m describing one 24-bed unit, we had 10-12 going at the same time. At any one point, we had at least 100 people intubated!”
Dr. Lynch has worked in intensive care units for years. This was very different. On a normal basis, an ICU would have 12 beds, maybe 9 being used, and one bed with a critically ill patient. The rest were kind of transitional, watching people, and mostly everyone would survive. Over an entire month, he maybe saw one death. During the COVID-19 outbreak in New York City, Bellevue had three or four people dying per shift. His experience coincides with data published in the Journal of the American Medical Association (JAMA, 2020;323(20):2052-2059), which showed that, of 5,700 patients hospitalized with COVID-19 in New York City, 88% of people who were intubated ended up dying.
Personal protective equipment was available but hard to come by. Supplies would run out quickly, including oxygen. Even coating before shifts became difficult as gloves and gowns ran out. Bellevue was at twice its capacity.
Dr. Lynch is thankful for the countless out-of-state physicians, nurses and technicians who came to help. The largest initial need was senior critical care physicians, anesthesiologists, and nurses. When reinforcements arrived, everyone really felt supported. Focused on intubating patients, adjusting tubes, and providing anesthesia, Dr. Lynch felt fulfilled in doing his part.
After 18 days at Bellevue, Dr. Lynch tested positive for COVID-19. After quarantining in New York, he returned to Arizona and quarantined for another week without symptoms.
Spinal cord in the office of Paul Lynch, MD.
Photo: Ben Scolaro, scolarodesigns.com
Telling his story
Dr. Lynch explains he really likes to document his experiences. After speaking with a mentor during quarantine, he decided to put together a 15-page document to inform Arizona hospital administrators of his experience in New York. It focused on direction of patient flow, turning negative pressure rooms into positive pressure rooms, and all the decision making.
Then came YouTube, where Dr. Lynch posted two, four, and five-minute videos speaking to his perspective. As he kept making videos, Lynch noticed his personality taking over, and confidence building in what he would say. The responses to his videos, both positive and negative, have been overwhelming but they helped him avoid post-traumatic stress, as the encouragement from positive responses fuels his desire to care. You can find his YouTube channel by searching for “Paul Lynch.”
After New York
Having to leave the Big Apple because he got sick was hard on Lynch. Anyone who practiced intense medicine over 18 days during a pandemic would be affected in some way or another. If any volunteer healthcare professionals experience COVID stress, Lynch hopes they will seek and receive any help needed. Because he always felt so supported in New York, Dr. Lynch does not believe he will have any negative side effects. In one of his videos he mentions, “If nurses would get a thousand people to tell them how amazing they were, they wouldn’t have emotional stress from their jobs.”
Now back in Arizona, Dr. Lynch hopes to dispel misconceptions in the news. For example, he states, “A lot of people believe only the elderly die, but that’s not true.” Lynch believes we still need to be mindful of social distancing, wear face masks, wash our hands, and remember young Americans also get sick but act as vectors for the virus to spread. People saying the opposite are spreading false information.
His mentor mentioned something profound to Dr. Lynch, saying, “It’s impossible to make someone appreciate the pandemic when they haven’t seen the devastation. To them, it’s an invisible virus in a faraway place like New York and everything is different in Arizona.” Lynch feels blessed to have seen it with his own eyes, to stop misconceptions from spreading.
At the age of 15, Paul Lynch was inspired by a mission trip to Honduras. People were travelling eight or nine miles to seek medical care. While taking blood pressure and giving out antibiotics, he witnessed the inadequacy of a third world medical system. One day, he saw a man get hit by a car. The medical staff held a makeshift funeral on the same table where he was treated. A feeling of being overwhelmed give Paul the idea he could make a difference by treating people.
Paul initially wanted to become a psychiatrist, since his father is a licensed social worker. He majored in psychology as an undergrad and entered medical school. Yet, tragedy struck during his fourth year, as his mother-in-law was diagnosed with pancreatic cancer. She was in terrible pain, with seven fractures in her spine. Paul was asked by the family to research pain options. He found incredible ways to take away her pain, like a kyphoplasty used to treat fractures in the vertebra. He learned of the celiac plexus block, injections of medications to relieve abdominal pain. Touched by all that could be done for pain, Paul shifted career tracks and got admitted to the anesthesia program at NYU.
Arizona entered the picture with a job at the Mayo Clinic. Although impressed by Mayo’s integrative approach, Dr. Lynch heard a calling to enter private practice. In October of 2017, Lynch and his best friend Tory McJunkin, MD, started Arizona Pain Specialists. Knowing more data showed opioids hurt more people than they helped, Lynch and McJunkin were confident they could make a positive impact in pain medicine.
Dr. Lynch also draws inspiration from tragedies closer to home. Seeing his younger brother battle a heroin addiction for eight years, Dr. Lynch connected his brother to an addition specialist in Arizona who helped save his life.
Paul Lynch, MD, in his office in Scottsdale.
Photo: Ben Scolaro, scolarodesigns.com
Running a business
It is not easy. Dr. Lynch explains how running a practice is both stressful and incredibly rewarding. “Just because you have that inner drive to create, to do your own thing, it’s important for any physician to truly weigh his or her options beforehand,” says Lynch. Balancing their personalities to being either employed or an entrepreneur is important before moving forward. He says, “Once a physician decides to follow that entrepreneurial spirit, they should understand they will have to work at least 60 hours per week, 40-45 hours of direct health care and at least another 20 hours of running their business.”
The difficulty of running a practice, he believes, is connected to the lack of training. He remembers doing a lot of speeches on practice management as one of his earlier practices grew dramatically from 2007 to 2010. He was having close to 1,000 patient referrals a month within 3 years. He had 60 employees before knowing he had to have employee files. It was truly “drinking from the fire hose.” Dr. Lynch says,
“You will make mistakes, but it’s incredibly exhilarating and fun along the way.” Success breeds success, but what keeps him going is the passion to improve patients’ lives.
When it comes to COVID-19 and his role in medicine, Dr. Lynch wants Arizona to proceed slowly. He believes Arizona must continue to lean on telehealth until the virus is extinguished. Telehealth platforms will help to protect the elderly and vulnerable populations. So do masks worn by patients and staff. He says, “Physicians are leaders. When I wear a mask in the clinic, my staff will follow suit because I’m showing them the right behavior.”
Dr. Lynch believes physicians have an incredible opportunity to emerge from the pandemic in a positive light. They can show the best of what medicine has to offer. That includes volunteering in hot spots. He hopes patients realize their doctors want what is best for them. “90% of doctors would wreck their businesses and give up everything to protect their patients and I think that’s really cool,” says Lynch.
The pandemic makes it more difficult to answer questions about the future for physicians in private practice. Dr. Lynch believes preparedness will be key for the next 12-18 months. Instead of a linear approach of seeing patients in the clinic, there is going to be a triangulated approach of seeing patients in the clinic, by telehealth, and through home visits. His practice adjusted by rolling out telehealth services in March, before the state government shut down elective surgeries. His team realized some patients needed to be seen at home whether it was an inpatient visit, doing drug/urine testing, or just to show them how to use devices that could help with their pain. He believes there is a financially viable home model. That may include some adjustments of private practice physicians working with more nurse practitioners and physician assistants. “Ultimately, patients need to be seen and physicians cannot just shut down their clinics. They will have to adjust to having patients come in and going to see them,” says Lynch.
From a mission trip to Honduras to caring for COVID-19 patients in New York, Dr. Paul Lynch remains passionate and as committed as ever to his patients and helping other physicians succeed. Doing so requires staying healthy to care for patients. He offers some simple rules. One, wash your hands. Do it a lot, and use hand sanitizer. Two, wear face masks. That applies to medical staff and patients. Three, observe social distancing of six feet away from each other. Four, screen staff and patients for fever, checking for symptoms. Follow these tips and physicians will have done their best to protect staff and patients.