The world of medicine has always produced its share of heroes. And rarely more so than during the COVID-19 pandemic, where simply showing up to work as a front-line health care provider can itself require heroics. Focused as we have been on the pandemic, it’s easy to forget that the world hasn’t stopped turning. As fearful as pandemic morbidity may be, the quotidian circle of life continues with babies being born every day. Fortunately there are expert, dedicated professionals like Dr. Melissa Grier, who have continued to provide vital routine obstetrics and prenatal care to an insured and relatively healthy population, but also to the chronically underserved who are most at risk yet without prenatal coverage or otherwise reasonable access to care of any kind.
Dr. Grier grew up in Michigan and attended medical school there. She came west to complete her residency at the University of Southern California and “moving to Pasadena just seemed like a natural progression,” she says. Immediately following her residency, she established a private practice, but has been associated with Huntington Hospital from the beginning, an experience she greatly values. “I feel like I am the physician I am for having worked at the Huntington,” she says.
It was during medical school that Dr. Grier settled on Obstetrics and Gynecology as her area of specialty. According to Dr. Grier, she was “looking for something that was relatively fast paced but with the opportunity to work with a relatively healthy population. The fact that most people would not necessarily have a lot of co-morbidities but still required medical or surgical intervention was intriguing to me.”
She also appreciates how her type of practice ties her closely to the community she serves. “It’s really nice to know people for years,” she says. “I’ve been working in this community for 15 years…when I see patients it’s not exactly social, but we are social beings and that connection makes it so rewarding. It’s like seeing friends and family.”
It’s not only Dr. Grier’s private practice that has occupied her time, however. She continues to be on call for consultation at the Huntington Hospital emergency room and spent a considerable amount of time driving out to Lancaster to lend her skills to what she calls a “very underserved community.”
I wonder if she sees treating the uninsured and underserved as a calling. “I think as a physician we’re all called to help out where ever we can,” she says. “And to be of service in that (emergency) environment is incredibly rewarding.” In contrast to Pasadena, where there are some 60 physicians listed in the labor and delivery call book for OB-GYNs, out in Lancaster and the Inland Empire with a larger population and significantly larger geographic area, there are “only six or seven private practitioners and one Kaiser practice,” says Grier. While her Pasadena practice serves almost exclusively women who have had regular access to prenatal care since the 12th week of pregnancy or so, out in Lancaster Grier estimates that 30-40% of the patients she saw had no prenatal care until three or four weeks before their due date, and often none at all.
“It’s just a very different population,” she says. “You really are guiding these people down what can be a pretty precarious path. It certainly challenges your skills and education…but when you get to the other side and the baby is healthy and the mom is healthy, it’s just incredibly rewarding.” It’s also obviously exhausting. Working 24-hour shifts taking care of people who previously have had no care at all is not infinitely sustainable, and Grier has scaled back her time in Lancaster to focus on her practice, while remaining on call at Huntington Hospital.
It’s not like she’s taking a break, however. I soon learn Dr. Grier has done as many as five cesarean sections in a single night. That seems like some pretty heavy lifting I think, but in this environment, Dr. Grier’s work can be as much about saving lives as delivering them. As she puts it, “doing C-section after C-section, delivery after delivery, that is crazy, but you’re still relatively in control of those situations. More crazy is when you have a patient who is in danger of bleeding to death. Trying to keep them alive are the craziest nights.”
A global pandemic, of course, can only complicate an already complicated situation, and Grier, her practice, and the hospital where she works have all made significant adjustments. N95 masks, a facial shield, a gown over a gown, and protective gloves all are now standard. Still, “it’s stressful and a little anxiety-provoking to walk around the hospital in all your protective gear, and never be really sure when the ER calls you down to see a patient with a fever…” says Dr. Grier.
“I don’t know what is going to happen,” she says regarding the reopening of local businesses. “But I think we have to be prepared. Things could get worse when we open up.” In her practice, Grier saw one pregnant COVID-positive patient at the end of March, just days after the Safer at Home Order. Then nothing in all of April and May. In June, she saw two more COVID-positive patients, and though she expects to see more, she says, “We’ve been really lucky so far with our hospital experience with COVID.”
In the end, Dr. Grier is optimistically hopeful. Though she’s at pains to convey the seriousness of the situation, she also believes that “there is something that we can all learn from this. There is an opportunity for growth here.” For her personally, that has meant an opportunity to see a lot of patients via telemedicine. So far, she’s found it not only necessary during the pandemic, but an unexpectedly effective method of communication. In fact, she’s noticed her patients focusing more readily on the teleconsultations that they did when meeting in person. Pre-COVID, the insurance-mandated bureaucratic hoops that were required often made telemedicine impractical. But as Dr. Grier puts it, “Medicare and Medicaid dropped all those requirements around telehealth. I don’t have a large Medicare population and I don’t do Medi-Cal. But fortunately, all the insurance companies followed suit and we were able to deliver care via telemedicine, and I think that is absolutely the best part.”
Undoubtedly, many things will have changed drastically on the other side of this pandemic, and an increase in telemedicine and the efficiency it holds may well be in the cards as Dr. Grier’s experience portends. Fortunately for the underserved and those in distress in our community, Dr. Grier will continue to be there in person as well when the emergency C-sections pile up and saving a life is as critical as delivering one.