In episode 11, President Bob Iuliano and family practice physician Melissa Zook ’94 discuss the strain that COVID-19 has put on essential workers and the healthcare system, particularly in rural Kentucky, where Zook works and lives.
In Episode 11 of Conversations Beneath the Cupola, podcast host, Gettysburg College President Robert W. Iuliano, is joined by family practice physician Melissa Zook ’94. Iuliano and Zook discuss the strain that COVID-19 has put on essential workers and the healthcare system, particularly in rural Kentucky, where Zook works and lives.
The episode begins with Zook detailing the journey that led her to being a physician in Kentucky. She says she knew that she wanted to do something to make a difference in the world, and becoming a doctor aligned well with her skills and passions. She credits part of her success and the strong relationships she’s built with her patients to her Gettysburg College liberal arts education.
The conversation continues as Zook explains how her work and life in rural Kentucky has shifted due to COVID-19. The counties she serves are among the poorest in the nation, and the area at large struggles with food insecurity. She says the rural environment has helped slow the spread of the virus, so that their already-minimal medical resources are not depleted, but it has also been a challenge to provide medical advice remotely when most of her patients do not have internet or cellular connections.
Looking forward, Zook says she hopes that we do not simply go back to our lives and pretend that COVID-19 never happened once it becomes more widely under control—rather, we need to be aware of the lasting risks and effects.
The episode concludes with an anecdotal “Slice of Life” told from the president’s perspective. Iuliano builds off of the topic discussed at the end of his conversation with Zook—the significance of remembering to say, “Thank you.” In that spirit, Iuliano shined light on the Gettysburg College Women’s Volleyball team, who participated in what they called “A Week of Gratitude” on their Facebook and Instagram accounts. It was their way to say, “Thank you” to all the essential personnel who are working on the frontlines to keep the country functioning and safe.
Guests featured in this episode
Melissa Zook ’94, a family practice physician. She is board certified in family medicine, addiction medicine and infectious disease. She is also particularly interested in providing a safe haven for LGBTQ patients, and treating families caught in the addiction crisis.
Melissa Zook: Quite honestly, the thing that really gets to me the most, is when people would actually just say thank you. They just acknowledge, “Hey, we know you’re working on the front line. We really appreciate the work that you do. Thank you.” That means to me as much as anything else.
President Bob Iuliano: Hi and welcome to Conversations Beneath the Cupola, a Gettysburg College podcast. I’m Bob Iuliano, president of the College and your host. If you’ve listened to recent episodes of this podcast, you know that we’ve been trying to make sense of the significant changes that the pandemic has brought to the way we live and work. We’ve benefited from the expertise of members of the Gettysburg College faculty, who have offered thoughts about the political, economic, health-related, and social impact of the outbreak.
President Bob Iuliano: Today, we move from the academy, to one of the front lines, the delivery of healthcare. We’re privileged to be joined by Melissa Zook, a 1994 Gettysburg graduate who works as a family practice physician in rural Kentucky. Melissa is board certified in family medicine, addiction medicine and infectious disease. And she’s particularly interested in providing a safe haven for LGBTQ patients, and treating families caught in the addiction crisis.
President Bob Iuliano: She works in systems that have already been under severe stress given regional poverty, and which now have the added burden of the pandemic with which to contend. Melissa, thank you. As I think you know, I’m in my first year at the college, and one of the things that’s really been important to me and I think really reflects the heritage of the college is the importance of this place graduating students, who are going to go out there into the world and have an impact. You so much embody that spirit of the college by your work as a physician in a rural, poor and underserved community. So maybe that’s the place to start this conversation, as a means of context setting. But what led you first, down the path of wanting to be a doctor, but then more specifically, a doctor in the setting in which you’re practicing?
Melissa Zook: Well, I had a... I graduated in May of 1994 ,not really quite sure what I wanted to do with my life. I knew I wanted to do something that made a difference in the world, but I didn’t know exactly what that looked like. And I actually went to my family doctor, and had a very profound conversation. He said, “Oh, you should go to medical school. You’d be great.” And I was like, “Well, I’m not smart enough.” I wasn’t a math and science person. And he’s like, “You can do it.” And it was actually something I had really wanted to do as a kid. I love Mash. I loved Doc Baker from Little House on the Prairie, which no one younger than me knows. And so I thought about, and I was like, “I really think I need to try.”
Melissa Zook: And so it took me about two years of education between Gettysburg and getting into medical school. But it was one of those decisions that once the decision was made, every door just seemed to open. It just... I think it was meant to be. And I got to Kentucky. After I graduated from Gettysburg, the first year I did a Fellowship through the Congressional Hunger Center, looking at hunger in America. And so I spent six months in a field placement in Eastern Kentucky, and then six months in Washington D.C working on food policy and legislation. So with the USDA, and food stamps, the school lunch program, things like that. And I fell in love with Kentucky when I did that.
Melissa Zook: And so when I went to medical school, I had a national health service work scholarship. So in exchange for my education, the department of health and human services paid for most of my education. And I came back to consecutive through that program. And my commitment was for four years. And then I stayed a total of eight years at my first job. That first job. And then I moved to a practice in the neighboring County about eight years ago, I guess.
President Bob Iuliano: And so it’s been 16 years in Kentucky, and probably not what the 18 year old version of you thought you were going to do, at least when you walked through the Gates of Gettysburg. It sounds like, at least.
Melissa Zook: Yes. Not at all.
President Bob Iuliano: Did Gettysburg end up influencing your arc at all? It certainly doesn’t sound like it did intellectually per se. But has it had an impact in the way that you practice, or the way you think about the relationship that you have with your patients?
Melissa Zook: Absolutely. I was very involved. The center for public service came about when I was a student there. And I was very involved in activities with the center for public service. And also I did a study abroad program. And I did a program through Augsburg College, which was an immersion program in Mexico. And so very different than most study abroad programs. We studied on the border, and at the bus station in New Galas, they gave us $100 and said, “We’ll see you a week in Cuernavaca. Good luck.” And so it was very... We lived with regular families. We picked coffee beans. We followed workers around to see what they did. So it was a very, very different kind of program. And that really was what got my heart going for social justice.
Melissa Zook: And then the CPS sort of helped me to, and the work I did with with CPS really helped to move that forward. And so I knew that I wanted to do something like that. And actually as a history major, it has been very helpful to me in learning how to interview patients. Doing oral histories with Dr. Birkner has really transitioned very easily into interviewing patients. And also, learning how to do good research is helpful, and good writing is helpful in any career.
President Bob Iuliano: Wow, that’s a great answer. I think Michael Birkner will be smiling when he hears that. So set the stage a little bit for us if you would, about sort of pre-Coronavirus. What your practice looks like. Help us understand a little bit better the geography and the socioeconomic realities that you have confronted through your work in Rural Kentucky.
Melissa Zook: Sure. So the counties that I serve, are among the poorest in the nation. If you look at County rankings in terms of socioeconomic factors or health factors, the probably 15 County area where my patients come from, generally fall in the bottom 50, and some of them are in the bottom 10 in this country. So very, very poor people. Very isolated. People have crown up living in their hollers with multiple generations of the same family. And very underserved. So the first County that I worked in for the first eight years did not have a hospital. Did not have any women’s services. Any pregnancy services. So our office actually had a little emergency room, and I in between seeing patients, would see whoever rang the doorbell that day, and came into our little emergency room. So anything from heart failure to heart attacks, to setting fractures, to pulling out fish hooks. Things that happened in the country.
Melissa Zook: And as my practice has evolved, I now do a lot more addiction medicine, because the opiate crisis has really centered in Eastern Kentucky. And so I do a lot of addiction medicine, and I do it in the context of helping young families. I see a lot of generations of the same family with addiction. And I see lots of young moms. So my goal is to do well visits with babies, at the same time I’m doing adult visits for addiction. And I’m trying to do total healthcare as a family doctor. So I might also treat their diabetes, or their lung disease from smoking, so that they can come to one place. And it helps to...
Melissa Zook: My goal is to help keep families together, help them being broken apart by going to jail on drug charges, or dealing with health and human services, and losing custody of their children. So by seeing everybody and working with everybody, it enables me to educate people a little bit more. I know how the babies are doing, how good their parenting skills are. It really makes a big difference. And then I also started doing HIV care, about five or six years ago. And I’m the only HIV provider in the Eastern half of the state.
President Bob Iuliano: Wow. Well, and it sounds like you’re doing this in a resource startup context, but also where the necessity of trust matters enormously. And so that as you take care of the whole family, you’re really beginning to create that bond of trust that will permit, I suspect these families to accept your advice as best they can.
Melissa Zook: I think also, the thing that people tell me all the time is, I’m just a regular person. I’m not one of those stuck up doctors. And again, I think that comes somewhat from the background of learning to do oral histories and talking to people. I just think people have a story no matter who you are, no matter where you come from. Everyone has a story to tell. And I’ll tell you some of these stories, they blow me away. What people have suffered and been through before they ended up at my door. And people will tell me, “Well, you’re the first doctor who ever sat down in their room with me. And the first doctor who ever shook my hand.” Or, “The first doctor who ever treated me with any sort of respect. You didn’t just tell me to get out and leave.” And that makes all the difference in the world. It’s just humanity and good manners, and my mom and dad taught me that.
President Bob Iuliano: Well, that’s interesting. We could have a longer conversation I think about the changes in the healthcare delivery system generally, and how it’s become more impersonal because of the economics of it. But let’s not go there instead. Let’s talk about, so you gave us a sense of what your practice has been like. We’re now in the midst of this pandemic. Has it changed? Has it affected your counties in a significant way? And how do you see it again impacting the way in which you’re delivering care to your patients?
Melissa Zook: It really, I’m sure, I know you talked to some other folks. It really is an evolving thing. Literally every day, we’re updating our policies for infection control, for how we triage patients, for who we allow to come in. We’ve gone to a lot of telephone calls and video calls with our patients through Zoom, for those who can do it. We see them... I might usually see 25 to 30 people a day in the office, and now I might see a total of three or four. We’re trying to keep people home.
Melissa Zook: We’re delaying care. We’re delaying laboratory assessments. All preventive services like mammograms, preventative colonoscopies. All of those things are sort of being indefinitely delayed. People will call all the time and say, "Well, I’m sick." And you can’t assess somebody very well over the phone. It’s very frustrating. Even if they have access to a computer, which most of my patients don’t, it’s very hard to figure out who’s sick and who’s not sick, and how rapidly someone needs something. Because everything really is on lockdown. We haven’t had too many cases of COVID. We have a local nursing home that’s been absolutely devastated by it. But in terms of people who’ve been in the hospital and people have been testing positive, it’s not high. But it’s actually terrifying to people. And so they’re getting the message that they need to stay home, and for the most part they are.
President Bob Iuliano: Well and you said earlier, as you were describing your general practice, that part of what you try to do is connect to the families as a whole. And so you must be seeing social and other economic impacts that transcend the four corners of your delivery of medical care. Is that right? And if so, what are some of those consequences?
Melissa Zook: One of the big ones really has been food insecurity. It’s the time of year where people’s... Most of my patients keep very big gardens that they really depend on. And in this time of the year, what they put up for the winter to store and can, is almost gone. And that there’s nothing that they can put in the ground yet. So that extra padding for food is gone. And most of my patients already live in what we call food deserts, where it’s hard to get access to fresh food. But with all the shortages, people... The staple of the Kentucky diet is soup beans and cornbread, which is actually a very nutritious meal. But you can’t get cornmeal. You can’t get soup beans. You can’t get rice. You can’t... A lot of places you can’t find a 50 pound bag of potatoes.
Melissa Zook: So the food shortages are really hitting people very hard, and the local food pantries have been hit very hard. They’ve been out of food for a while. So that’s been a very big one. And then of course, the people not working, has also had a big impact. Even on our staff. We’ve had to furlough some staff for the time being. And while the governor has done a really great job at trying to keep people safe. Keep people home. They’ve expanded unemployment benefits. There’s such a flood of people applying for unemployment benefits, that people are waiting weeks and weeks until they can get their checks.
President Bob Iuliano: And I think that experience is being felt elsewhere, not just in Kentucky. And maybe you’ve begun to answer this, but obviously the federal government has devoted a lot of resources to the response to COVID-19. Have you seen any of that having an impact where you are?
Melissa Zook: Unfortunately, not really. No. The money for small businesses ran out almost immediately. So the people, small businesses, have not been able to benefit from that. We fortunately haven’t needed things like the ventilators and a lot of the PPE. So that’s not been an issue. But the economic promises that people have been looking for, really have not been able to reach Eastern Kentucky.
President Bob Iuliano: Yeah. And we’ll see what happens with additional stimulus proposals under evaluation. So we’ve talked a little bit about the economic effects. When a case does arise, do you have the resources to test and to respond appropriately?
Melissa Zook: That’s just starting to come about. We’ve just started expanding there. There’s now a test site that’s within about five miles of us. Until last week, the closest test site was about 20 miles away, and it would take seven to 10 days for the test results to come back. Now with this new site, that’s just about five miles away, you can get a test. You can... It’s a drive through testing service, so patients don’t have to get out of their cars. I don’t have to see them personally. I can interview them on the phone, and if I think that they qualify, they have to meet a list of criteria to qualify for the test, I can go ahead and order the test and send them over to the testing site. And now tests are coming back in 24 to 48 hours. So that’s much more helpful.
President Bob Iuliano: And when you... Have you had a patient who has tested positive?
Melissa Zook: I have had one. And I’ve had... Actually no, that’s not true. I’ve had three, mostly related to the nursing home that I was telling you about that’s been devastated by it.
President Bob Iuliano: And does the state... Does the area have resources to deal, I guess at the moment you’re not at the point where the system has been overwhelmed, though the system sounds pretty fragile to begin with. But does it have the resources to deal with cases as they do arise?
Melissa Zook: At this point we do, because we don’t have very many. I would be very worried, if we didn’t have the social distancing, and people didn’t stay home, and we didn’t have the PPE that we do. It would not take very many cases to overrun it. We have a very small ICU with just a few beds, and just a few ventilators, and so we would absolutely not be able to care for more than the few patients that we’ve had.
President Bob Iuliano: Gettysburg, as you know, is in South central Pennsylvania, and has its rural aspects too, and it sounds like you’re in a rural setting as well. It’s my sense that social distancing is a little bit easier in the more rural settings, but it has other impacts, including the possibility of isolation. What are you seeing there, in the trade off between the potential benefits of the rural setting versus its costs?
Melissa Zook: I think in one way, we have a lot of families. A lot of hidden homelessness in terms of a lot of families living together under one roof, multiple generations. And so in that way, it could be spread. Except that mostly people don’t go anywhere. They’re used to being home. They’re used to being far away from their neighbors, or they’re used to being in their cars, and separated. So I think in that way people aren’t too troubled by it. Although we do have a rural transportation service that has shut down, because of... It’s a little minibus.
President Bob Iuliano: Yeah.
Melissa Zook: And that shut down. And that’s been a big problem trying to get people transported back and forth to the available appointments that there are.
President Bob Iuliano: That makes sense. Again, perhaps because you have not been as deeply immersed, thankfully, given the other stresses on the system with the Coronavirus, you may not have a clear view on this, but you’re the first practicing physician we’ve talked to. As you pay attention to the media accounts of the pandemic, from your perspective, do you see things that you wish were being covered differently, or where you feel like the relevant information isn’t really getting out there?
Melissa Zook: Looking from a state government point of view, I think the government’s have done... The governors have done a great job trying to educate people. I think in Kentucky we’ve done a great job with our governor, and our state physician general. I do think in general they’ve done a good job of trying to get out the most accurate information with social distancing. About what the risks are. The thing is, it’s such an evolving situation. We don’t always know the people who are at most risk. I do wish we could see a little bit more about some of the other impacts. The other economic impacts. The other social impacts of the disease. But I think in terms of accurate medical information it’s been... I don’t think it’s been overstated.
President Bob Iuliano: Yeah. That seems right to me. And one of the things we’re recognizing as a college, is that it is an evolving situation. And we’re trying as hard as we can, to stay up to date with what the public health officials regard as the best information that one has about the arc of the virus. Because obviously, as we think about what we’re doing as a community, that matters to us. We’re going to make decisions that are driven at least in significant part, by the scientific information that we have available to us.
President Bob Iuliano: So one of the questions I’ve asked just about everybody I’ve interviewed, which I acknowledge Melissa, as somewhat an unfair question, because of the perspective born by history, and we don’t have much perspective yet because we’re in the middle of this. But from your vantage point, as you think about the longterm consequences of the pandemic, what do you think they’re going to be, and will they be different, say where you are, than they will be in Gettysburg or in a big urban environment.
Melissa Zook: I’ve been actually thinking about that question, and I want to say that things will be different. I worry that people... We tend to have a short memory. And I do worry that people are going to sort of... Once quarantine is over, people are going to go back to their lives and kind of forget all of this ever happened, is my fear. Or it will be very difficult to convince people to do this again, if we have another round of this in the winter, next winter. But my fear is that, it’s not going to leave us. You MERS has stayed pretty much in the middle East. And SARS sort of came and went. And so I’m worried though, that this is going to linger with us longer and it’s going to, I don’t think until people are personally affected by it, which many people here have not been, in terms of a loved one who’s sick, I don’t think that they’re really going to understand just how dangerous this virus is.
President Bob Iuliano: So let me then wrap this up if I can, Melissa. Obviously this is a challenging time for healthcare providers across the globe. And it’s also a moment where we’ve seen people want to figure out how can they best acknowledge the sacrifices that healthcare providers are making. People having to deal with difficult choices of, “How do I treat my patients, and then still go home? And what risks am I presenting to my family?” Do you have thoughts about, again, from the front lines, about the best ways that the rest of us can acknowledge the really remarkable work that healthcare providers are doing, living to the best of the profession, about putting the welfare of their patients first. How can we acknowledge that as we go about our lives, and want to say thank you?
Melissa Zook: Quite honestly, the thing that really gets to me the most is when people would actually just say thank you. They just acknowledge, “Hey, we know you’re working on the front line. We really appreciate the work that you do. Thank you.” That means to me as much as anything else. And I think the other thing that really would be very appreciated, is just people really following our advice, doing the things that we suggest. If you can keep yourself healthy, that puts less work on me. So if you can stay home, and you can take good care of yourself, and you can social distance, that’s less people that I have to worry about getting sick. Because I do worry about everyone. But I just appreciate when people say thank you.
President Bob Iuliano: Well, let’s end with that now, and I will leave you with just one other point. There are challenges that colleges and universities are confronting as well, as we try to figure out how to navigate what is unprecedented in our lifetime, at least. And it will not surprise you Melissa, given what you know about this place. That the overwhelming sentiments that have been expressed to me, is simply one of thank you. Which isn’t really about me, it is a statement about the nature of this place. And the fact that people care about one another, and they are grateful for what everybody does for one another. So your Alma mater is quick to say thank you. And I will end by saying thank you to you, for the work that you do, for the way in which you go about doing it. As I started this podcast, I said that you embodied the best of what we hope for in our alums. And I’m grateful for the opportunity to say hello to you today.
Melissa Zook: Well, very lovely to meet you. Thank you very much.
President Bob Iuliano: As our interview with Melissa’s reflected, sometimes the most powerful thing we can do to one another is simply to say thank you. In that spirit, the women’s volleyball team participated in what they called “A Week of Gratitude” on their Facebook and Instagram account. It really was a way to say thank you to the college personnel, and faculty, who are keeping the college and our students going through this time. One of the people who wrote in, was Lizzie Coon, a graduate of the class of 2014. Who like Dr. Zook, is working on the front lines of the healthcare industry. She wrote, “It has been such a whirlwind these past few weeks.”
President Bob Iuliano: On March 18th, the children’s hospital of Philadelphia was able to open up the first pediatric mobile COVID-19 testing site. It was amazing to work with such dedicated doctors, MAs, nurses, security officers and facilities employees, to implement this project on such short notice. Since then, we’ve been able to test children who are important carriers of the disease, and get employees who are negative back to work. It’s been inspiring to watch the medical community band together to respond to this health crisis. As well as to feel the love in the city of Philadelphia. Thank you, Lizzie, for what you’re doing. And for the entire community, just say thank you to your loved ones and to the people who are helping you as we navigate these challenging times.
President Bob Iuliano: Thanks for listening. If you’ve enjoyed this conversation, and want to be notified of future episodes, please subscribe to conversations beneath the cupola, by visiting gettysburg.edu for wherever you get your podcasts. If you have a topic or suggestion for a future podcast, please email email@example.com. Thank you. And until next time.