Being on the front lines of a historic event is rare. Juan Febres, MD, in his 12 years of practicing medicine, has now served on two.

Dr. Febres, a former senior resident of surgery at UT Health San Antonio and a current fellow in the critical care unit at Lincoln Hospital in the Bronx in New York City, was on call at University Hospital Nov. 5, 2017, when a gunman killed 26 people and injured 20 in a church in Sutherland Springs. Dr. Febres, along with a team of surgeons, nurses and physicians, took on nine of the wounded victims from what would turn out to be the deadliest mass shooting in Texas history.Juan Febres, MD

Two years later, he is in the epicenter of the COVID-19 pandemic. New York City has had the largest number of deaths from the disease in the country that now leads the world in the number of COVID-19 cases and fatalities.

“You start hearing cases and you still think ‘oh this is not going to happen,’” Dr. Febres said. “When we started getting hit with all these admissions and intubations, it took us by surprise.”

New York City’s first confirmed case of COVID-19 was March 1, although new models indicate there may have been as many as 10,700 cases in the city by that date. As the number of coronavirus cases surged, Dr. Febres was tasked with converting the trauma unit and surgery ICU into a makeshift COVID-19 unit to accommodate the sudden flood of patients with pulmonary issues.

“There was very little information. All we had were papers and interviews and programs from China or Europe, but no experience here in the U.S.,” Dr. Febres said. “[Critical care doctors] started taking over the role of taking care of these patients without a clear knowledge of what was going on. And with all these presentations of different ages, different backgrounds and different comorbidities, it was really hard for us to create a clear protocol for these patients.”

In a trauma unit, they are prepared for major injuries caused by falls, vehicle collisions and gunshot wounds. Dr. Febres’ experience with the Sutherland Springs shooting response prepared him for a trauma fellowship in the Bronx.

Nothing could have prepared him for a global pandemic. When it’s been over 100 years since the last pandemic, no one practicing medicine has lived through anything like it, said Ronald Stewart, MD, professor and chair in the Department of Surgery and director of trauma at University Hospital. He was one of the attending surgeons with Dr. Febres on the day of the Sutherland Springs shooting.

“No one in the modern world has been through it anywhere until now, so that’s why it’s so foreign,” he said. “We do trauma care, trauma resuscitation sometimes up to 25 times a day. We have extensive training…and lots of preparation for something like that.”

Prepared or not, Dr. Febres and his colleagues were resilient, resourceful and committed. As the situation in New York worsened, Dr. Febres sent his family to live with other relatives in Texas. He did not see them for six weeks as he helped to treat the inundation of patients in his converted COVID-19 unit.

“It’s hard because people look at us and try to get a sense of security, but also as providers we didn’t know what was going on,” said Dr. Febres.

The pains of unpreparedness have been felt around the globe. And though nothing like the magnitude of New York, the San Antonio community has also faced the virus and all the uncertainties that have come with it.

For Dr. Stewart, the fear and suffering of the pandemic is manageable through the cooperation of committed individuals, noting that the coordinated response of the city, county and medical community has been inspiring to watch unfold.

“We’ve dealt with the unknown by organizing and working on teamwork and cooperation across disciplines,” said Dr. Stewart. “I find comfort and beauty in the efforts of my teammates — the surgeons, the emergency physicians, the pulmonary and critical care physicians, the residents, the nurses, the housekeeping staff — they are all providing a lifesaving service. The entire team does make a difference.”

Now that COVID-19 cases in New York are finally on the decline, and violent crimes in the Bronx are beginning to increase once again, Dr. Febres has converted the temporary COVID-19 unit back to a surgery ICU and is once again treating trauma patients with severe injuries and gunshot wounds. It is business as usual for him.

“Probably later on there is going to be a lot of articles and books about what happened here in these hospitals, that this was a once in a lifetime event for all of us,” said Dr. Febres. “Unfortunately for me, it’s my second once in a lifetime event.”