Most mornings, Dr. Sterling Malish replaces his home clothes with car clothes, then departs his Carmel home, bound for Natividad Medical Center. There, he changes into scrubs, plus a protective gown, gloves, an N95 mask, and a PAPR (Powered Air Purifying Respirator) mask. Then, he enters the COVID ICU for a 12-hour shift that usually runs long.

At the end of his day, Dr. Malish reverses his routine, abandoning his car clothes for the shower, followed by fresh home clothes, so he can greet his wife, public health professor Jennifer Nazareno, and two little girls, ages 7 and 4.

When Malish signed his contract with Natividad in February, COVID was not yet a pandemic. Based in Rhode Island, he had been serving as director of Pulmonary Critical Care and Sleep for Care New England, a five-hospital system. Yet, after enduring a lot of administrative changes, Malish, realizing he really missed clinical work, sought a professional change that would return him to hands-on critical care.

He got what he wanted.

I received a call from my friend, Dr. Chad Medawar, whom I had met during our pulmonary critical-care fellowship at UC Irvine, telling me about an opening at Natividad, he said. Having moved from Los Angeles to Rhode Island five years before, it had always been our plan to come back to California.

Malish and his family moved to the Peninsula in July, just as Natividad was experiencing a dramatic surge in COVID cases.

In my first week at Natividad, everyone was telling me how in the previous five years, theyd never seen the hospital so busy, said Malish. But, Im a pulmonary critical care physician. I could have accepted a job anywhere this year and, most likely, it would have been the same scenario.

At Natividad Medical Center, Dr. Malish and his colleagues spend their shifts in isolation within the COVID ICU, where communication is essential and ongoing, yet requires three times the energy, he says, behind all the personal protective equipment and against the sounds of medical equipment in use.

COVID patients are the sickest patients in the hospital, he said. Their care requires a lot of communication among the medical specialties treating them. Were always thinking three steps ahead. We have to think whats the worst that could happen to this patient, and then be prepared for when it does.

The hospital also has to plan for a surge of new patients, says Malish, which is happening now. He reports more than 60 COVID patients admitted to Natividad as of last week and the number continues to rise. Twelve of those patients, he says, have been in the ICU.

Then there is the added layer, he said, of having to communicate with families, desperate for information about their loved ones, whom they cant visit. This is extremely difficult to explain to all these people were trying to protect.

Despite his desire to return to critical-care medicine, Dr. Malish never imagined he would be called to practice pulmonary medicine during a pandemic. He finds it both exhilarating and exhausting to provide the level of care required by COVID.

Its almost an extension of emergency medicine, he said. I went into critical care because of the acuity of care, and the needs of the patients. I like having to think through the physiology of these patients to figure out how to make them better.

And theres no textbook for COVID, he says. Theyre writing it as they work.

Although each day in the COVID ICU can well exceed the scheduled 12-hour shift, on their days off, Dr. Malish and his colleagues check in on one another to see if they need to provide back-up support.

COVID is something were all dealing with throughout the hospital, he said. A lot of camaraderie and teamwork comes through, and we know were definitely all in this together.

After spending their first 14 years in Texas, twin brothers Sterling and Haven Malish followed their fathers job to Hawaii, where they graduated from high school before returning to the mainland to study the history and sociology of science, with a minor in biology, at the University of Pennsylvania. The appeal was the interdisciplinary approach to science, says Malish, which encouraged students to think outside the box.

While trying to decide whether or not to go to medical school, he said, I spent a summer doing health economics research and realized, although it was interesting work, I couldnt sit in an office all day. I wanted to see the people I was affecting through my work.

Upon graduation from college, the twins returned to Hawaii to attend medical school at the University of Hawaii John A. Burns School of Medicine. Following their residency at USC Medical Center LA County, Sterling Malish went on to UC Irvine to pursue a fellowship in pulmonary disease and critical care medicine, while his brother pursued the same fellowship at USC.

It was at UC Irvine that Dr. Malish met his colleague, Dr. Chad Medawar, before moving on to the University of Michigan to pursue a fellowship in sleep medicine. His brother completed the same fellowship through the Mayo School of Graduate Medical Education, and now practices the same specialties of medicine as his twin, in North Dakota and Jackson Hole, Wyoming.

Ive heard that twins either turn out somewhat similar or make it a point to differentiate themselves, Malish said. It always helped to have a trusted study buddy. Everything we studied enables us to pivot in different directions and relates to what we need to address, particularly during this pandemic.

This holiday season, Sterling Malish and his family spent time tucking into their Carmel home, having traded a large house in the snow for a cottage by the sea, in a Hallmark town with no street addresses. Although they couldnt gather with relatives, they took comfort in trading travel for toys and traditions among their family of four.

We havent had a whole lot of downtime this year, Malish said. Weve been in a tag-team situation, with my wife compensating for my long hours at the hospital, and my giving her a chance to rest when Im home. Just to have time to relax as a family this Christmas was incredibly rejuvenating.

As he returns his attention from Christmas to COVID, Malish gives credit to the respiratory therapists, nurses, and the rest of the staff who have put their lives on hold to work long hours and take on extra shifts in their efforts to save other lives.

We have so many patients and not enough nurses, he said. Our states ability to take care of COVID patients is only as good as the available staff. I read that we hit ICU bed capacity on Christmas. Were placing a lot of hope on the vaccines.

Dr. Malishhas received his first dose of the COVID vaccine, as part of the first tier of recipients, which includes those who serve in health care settings and have potential for direct or indirect exposure to patients or infectious materials, as well as residents of long-term care facilities. In a couple of weeks, he will come in on his day off to receive the second dose.

You really dont want to be high on the vaccine list, he said. Those who make that list are among our most vulnerable populations.

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Moving onto the frontline: A Bay Area doctors story - East Bay Times