The worst has not begun and today, I found it hard to go on.

[+ purplekow]

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane.

Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in.

However there is one particular episode that I would like to write about today and a group I would like to salute.

I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest.

I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either.

I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it.

With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway.

I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down.

Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day.

They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone.

I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete.

So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

[+ purplekow]

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane.

Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in.

However there is one particular episode that I would like to write about today and a group I would like to salute.

I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest.

I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either.

I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it.

With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway.

I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down.

Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day.

They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone.

I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete.

So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

[+ Charlie]

The community college in which I taught had a nursing program which was probably the best program in the school. Whenever I got a whole class of student nurses, I felt I had lucked out, because they were the most enthusiastic and responsible students I had, year after year.

[+ tassojunior]

I had to alter a prescription with my Kaiser and was shocked to learn my doctor works from home only doing video appointments and that's the routine for most doctors now at Kaiser. I was told she would be sent on a rotation to Urgent Care but that if someone really needs a personal appointment they try and arrange one somewhere. My northwest DC Medical Center of Kaiser is closed except for the pharmacy and if you must pick up in person they bring it to your car.

 

Is healthcare other than coronavirus not available, much less a priority?

Edited April 24, 2020 by tassojunior

[+ purplekow]

I had to alter a prescription with my Kaiser and was shocked to learn my doctor works from home only doing video appointments and that's the routine for most doctors now at Kaiser. I was told she would be sent on a rotation to Urgent Care but that if someone really needs a personal appointment they try and arrange one somewhere. My northwest DC Medical Center of Kaiser is closed except for the pharmacy and if you must pick up in person they bring it to your car.

 

Is healthcare other than coronavirus not available, much less a priority?

Covid, in some places has overwhelmed the health care system. Some of the first Covid cases we saw at the hospital were doctors and medical office staff. People did not realize that, yes that migraine could be Covid or that diarrhea could be Covid or that sinus congestion could be Covid and that back ache, yep Covid. So the little old lady coming into the office gets Covid in the waiting room or from the staff member taking her blood pressure. We have gotten much smarter about it and I think doctors will be coming back to the office. if a problem can be taken care of with a video visit, that will be the option most providers will take. That method is safer for the patient and for the providers. I do not like it and I think most providers do not like it, but for he near future, Covid rules medical care. The physical can wait. The prescription change can be called into the pharmacy. The swollen, red leg can be done over the video. I would think doctor's offices will start having patients come in for an appointment and have the patients use their car as the waiting room. My cousin wanted an appointment with her doctor and was told she would not be seen until after she had a negative CoVid test. That order was called in, She was looking to be seen for a Gyn problem but as fate would have it, she had Covid.

As much admiration I have for nurses and other personnell as well, during this crisis, I have to admit most doctors have not stepped up. Hospitalists, Intensivists, ER docs all working diligently night and day. Backbreaking and dangerous work. Anesthesiologists, some are great, others are absent. Other specialities? it is really hard to get them to come into the hospital to get things done. A lot of things are being put on hold, not just elective surgeries but other non urgent surgeries as well. Try and get a colonoscopy for a patient for bleeding better jump through every hoop they put up even then it is nearly impossible. An elective colonoscopy? You would have more luck finding a dodo in a Blockbuster Video.

So to answer your question, just like almost every other field, medicine is now shaped by Covid. Medicine, is for the most part All Covid all the time. Yesterday I have 8 patients admitted to the hospital, 7 were Covid, Three of those had something else but they had Covid too. The other, had a cardiac issue for which he got a stress test and an appointment for a cardiac catheterization next month, Will they be doing them electively next month? who knows. So medical care for now and intervention, if needed, later.

Edited April 24, 2020 by purplekow

[+ tassojunior]

Covid, in some places has overwhelmed the health care system. Some of the first Covid cases we saw at the hospital were doctors and medical office staff. People did not realize that, yes that migraine could be Covid or that diarrhea could be Covid or that sinus congestion could be Covid and that back ache, yep Covid. So the little old lady coming into the office gets Covid in the waiting room or from the staff member taking her blood pressure. We have gotten much smarter about it and I think doctors will be coming back to the office. if a problem can be taken care of with a video visit, that will be the option most providers will take. That method is safer for the patient and for the providers. I do not like it and I think most providers do not like it, but for he near future, Covid rules medical care. The physical can wait. The prescription change can be called into the pharmacy. The swollen, red leg can be done over the video. I would think doctor's offices will start having patients come in for an appointment and have the patients use their car as the waiting room. My cousin wanted an appointment with her doctor and was told she would not be seen until after she had a negative CoVid test. That order was called in, She was looking to be seen for a Gyn problem but as fate would have it, she had Covid.

As much admiration I have for nurses and other personnell as well, during this crisis, I have to admit most doctors have not stepped up. Hospitalists, Intensivists, ER docs all working diligently night and day. Backbreaking and dangerous work. Anesthesiologists, some are great, others are absent. Other specialities? it is really hard to get them to come into the hospital to get things done. A lot of things are being put on hold, not just elective surgeries but other non urgent surgeries as well. Try and get a colonoscopy for a patient for bleeding better jump through every hoop they put up even then it is nearly impossible. An elective colonoscopy? You would have more luck finding a dodo in a Blockbuster Video.

So to answer your question, just like almost every other field, medicine is now shaped by Covid. Medicine, is for the most part All Covid all the time. Yesterday I have 8 patients admitted to the hospital, 7 were Covid, Three of those had something else but they had Covid too. The other, had a cardiac issue for which he got a stress test and an appointment for a cardiac catheterization next month, Will they be doing them electively next month? who knows. So medical care for now and intervention, if needed, later.

 

So what do you do if you have a heart attack or stroke or break your arm? In DC we have plenty of empty beds but it's certain coronavirus infection to go in. This needs to be worked out.

[Despardo]

If it helps, your care for others will forever be remembered and appreciated. I have lost those I loved dearly, and still remember those who took care of them, and though cut short, their last years, months, and days were better for me, them, us because people like you cared so much. The magnitude of the toll of all this will probably never be fully known to people not directly affected, but your reaching out to let us know is a good start. I hope it has helped you.

Thank you for what you are doing. Your post moved me to years. Thy to hang in there. We need you.

[+ Charlie]

So what do you do if you have a heart attack or stroke or break your arm? In DC we have plenty of empty beds but it's certain coronavirus infection to go in. This needs to be worked out.

We just got a notice from our hospital listing all the things you should go to the ER for in addition to COVID-19, including the things you just named. I don't want to die of a heart attack because I'm afraid of catching a virus!

[+ tassojunior]

We just got a notice from our hospital listing all the things you should go to the ER for in addition to COVID-19, including the things you just named. I don't want to die of a heart attack because I'm afraid of catching a virus!

But will the doctors come?

[+ g56whiz]

Covid, in some places has overwhelmed the health care system. Some of the first Covid cases we saw at the hospital were doctors and medical office staff. People did not realize that, yes that migraine could be Covid or that diarrhea could be Covid or that sinus congestion could be Covid and that back ache, yep Covid. So the little old lady coming into the office gets Covid in the waiting room or from the staff member taking her blood pressure. We have gotten much smarter about it and I think doctors will be coming back to the office. if a problem can be taken care of with a video visit, that will be the option most providers will take. That method is safer for the patient and for the providers. I do not like it and I think most providers do not like it, but for he near future, Covid rules medical care. The physical can wait. The prescription change can be called into the pharmacy. The swollen, red leg can be done over the video. I would think doctor's offices will start having patients come in for an appointment and have the patients use their car as the waiting room. My cousin wanted an appointment with her doctor and was told she would not be seen until after she had a negative CoVid test. That order was called in, She was looking to be seen for a Gyn problem but as fate would have it, she had Covid.

As much admiration I have for nurses and other personnell as well, during this crisis, I have to admit most doctors have not stepped up. Hospitalists, Intensivists, ER docs all working diligently night and day. Backbreaking and dangerous work. Anesthesiologists, some are great, others are absent. Other specialities? it is really hard to get them to come into the hospital to get things done. A lot of things are being put on hold, not just elective surgeries but other non urgent surgeries as well. Try and get a colonoscopy for a patient for bleeding better jump through every hoop they put up even then it is nearly impossible. An elective colonoscopy? You would have more luck finding a dodo in a Blockbuster Video.

So to answer your question, just like almost every other field, medicine is now shaped by Covid. Medicine, is for the most part All Covid all the time. Yesterday I have 8 patients admitted to the hospital, 7 were Covid, Three of those had something else but they had Covid too. The other, had a cardiac issue for which he got a stress test and an appointment for a cardiac catheterization next month, Will they be doing them electively next month? who knows. So medical care for now and intervention, if needed, later.

For some peculiar reason an Rx for glucose test stripes must be in writing. I got back from a multi month trip to Asia mid March just as we went into lockdown. My Rx had expired and I needed a new one. My Doctor had closed his office and probably moved his practice to the the Internet. I called the office multiple times and never got through because the voice mailbox was full. I luckily found a stash of stripes at the bottom of a drawer. I’ll be looking for a new Doctor anon.

[Islesguy]

My last appointment was via telemedicine, but my next one I have to go in because I need get pictures taken of my eyes. Can't do that via telemedicine. The doctor wants me to push it back again, but I am not sure I want to take the chance. I'll see what happens over the next few days before I decide whether I want to wait another month.

 

Whenever I go, I am doing the waiting in the car. Go in and sign in and tell the receptionist to call me to come in. Get eyes dilated, back to car. Get pictures, back to car. See the doc, go home.

[KeepItReal]

My last appointment was via telemedicine, but my next one I have to go in because I need get pictures taken of my eyes. Can't do that via telemedicine. The doctor wants me to push it back again, but I am not sure I want to take the chance. I'll see what happens over the next few days before I decide whether I want to wait another month.

 

Whenever I go, I am doing the waiting in the car. Go in and sign in and tell the receptionist to call me to come in. Get eyes dilated, back to car. Get pictures, back to car. See the doc, go home.

I just got my contact lense prescription renewed through an online service - including using the web cam on my computer to take pictures of my eyes (look left, look right, look up etc). Very convenient.

[Islesguy]

I just got my contact lense prescription renewed through an online service - including using the web cam on my computer to take pictures of my eyes (look left, look right, look up etc). Very convenient.

Interesting but I'm not sure how they can capture the blood vessels without dilation and medical drops and whatever camera they use. I'm sure the doctor would have mentioned it if it was possible.

[instudiocity]

For some peculiar reason an Rx for glucose test stripes must be in writing. I got back from a multi month trip to Asia mid March just as we went into lockdown. My Rx had expired and I needed a new one. My Doctor had closed his office and probably moved his practice to the the Internet. I called the office multiple times and never got through because the voice mailbox was full. I luckily found a stash of stripes at the bottom of a drawer. I’ll be looking for a new Doctor anon.

I get mine online via mail order without a ‘script.

[+ JEC]

@purplekow I am reading this thread for the first time, it is heart-wrenching and I can guess also therapeutic for you to have an outlet for your emotions.

 

I too work in hospitals, in administration though so I am not personally facing the front-line challenges you are. Many of my colleagues are. One of our hospitals has a COVID unit with over 100 beds. We have 2 kinds of patients: (1) patients who are recovering and its' our job to help them recover and (2) patients who aren't going to recover, and we need to free up the bed "upstream". We already know the rest of the story for those patients (and the nurses and doctors caring for them).

 

My hospital system has been planning for this eventuality for years, including having a stockpile of PPE and more ventilators than most. So, at least staff are as safe as they can be. Still, it's terrifying to think about going into that unit. And what so many hospitals and healthcare workers are doing with less.

 

My heart aches for what my colleagues are facing on the front line. I try my best every day to make their lives easier in some way.

 

Thanks for what you are doing every day. As soon as it is possible, take a day.....hopefully your Chief is already thinking about that.

 

Stay well my friend, Jack

[+ purplekow]

So what do you do if you have a heart attack or stroke or break your arm? In DC we have plenty of empty beds but it's certain coronavirus infection to go in. This needs to be worked out.

We are getting more and more non Covid admissions but only those that cannot be treated at home are staying for any period of time. With so many Covid patients in the hospital, the possibility of contagion is high for those Non Covid patients who are in the hospital, However, patients are still be treated for other things. Right now I have 11 patients, 8 are Covid and 3 not. Of those, tomorrow 4 Coiv and two not will be going home. Admitting today, so will see what the morning brings.

[+ purplekow]

Well Monday morning came and while for many who are not working, the weekdays and the weekends are one big blur, for those of us on the hospital schedule, weekends still have some meaning because some of us get the whole weekend off, at least once in a while.

I had this weekend off which meant that this morning was like hundreds of other Mondays I have faced. Two days off and the grim realization that I have to go back to work, this time for the next 12 days. I had peeked into the patient records and I knew before I got there that there was about a dozen new patients and that the majority of them were Covid patients. I also knew that, although on Friday I had sent home three or four patients who had been as sick as you can get with this disease, including one man who had been on a ventilator for 14 days, that there were at least a couple of the new ones and at lest three of the already established patients who might be heading in that same direction.

My call started at 6 AM, meaning any non-insured patients admitted after that hour would be mine. The first call came in at 6"05 waking me a full half hour before my alarm. Two patients admitted just after 6 AM who had been there overnight but who were awaiting test results before admission. I listened to the ER resident's report, agreed that the patients needed to be in the hospital. I gave some preiminary orders and headed back for that last 15 minutes before the alarm. The alarm lost a close race with the phone. Different ER resident and another admission. Sometimes the extra ten minutes sleep can be a blessing, a bit of a refresher before getting up and into the day and other times, like today, that extra ten minutes makes it feel that you have been on a 25 mile march in full battle gear though you have never left the bed.

So by the time I arrived at the hospital an hour and tend minutes or so later, there were the residual number of patients from last weeks lists, the two days of patients which had been admitted to my service over the weekend and the three new patients from the morning. Twelve in total, 9 Covid, three not and then three more in the ICU who were not technically my patients at the moment but who I sent off to the ICU and who would return to my service if they ever left the ICU.

I headed to the ICU to check in. One man, a man that I may have mentioned in an early post here, was completing his 20th day on the ventilator. He was a sturdily built Mexian landscaper who had never been in a hospital. He came in on the first day looking sick but not terrible but he got terrible in a few hours and he has been on a ventilator ever since. He needs medication to keep his blood pressure above shock levels and it is only his previous good health that is keeping him alive at this point. Sadly, his family is in Mexico and he is alone here in the US. IF he should pass, there is no one to claim the remains. No one here to mourn except the staff who have spent three weeks urging him to live. I am not a religious man but I said a prayer for him anyway, what could it hurt?

The second man has also been in the ICU on a ventilator for two weeks. Also young and fit, 37, he is doing slightly better than the previous patient but his is definitely a touch and go situation.

The final patient is a woman I admitted last week and who took a wrong turn and she kept on going, downhill. With the new emphasis on trying to keep patients off ventilators or to limit ventilator use, she was given every medication we have along with high flow oxygen, All to no avail. Friday before I left, I called her husband and took my phone into her room to allow her to speak with him. She does not have a cell phone. After a brief conversation, she said: "Te quiero mi amor". and that was the end. I have no idea if she has spoken with him since. It will definitely be a long time, if at all before she speaks with him again,

I will only mention that of the remaining patients on the regular Covid floors, three went home and two went south. Both of the two who failed were offered convalescent serum and both refused. I expect both to be in the ICU, on a ventilator and remdesivir, before I return in the morning, It is unclear what was frightening to these people about the idea of convalescent serum. In at least one case and likely in both, the families had objections which they passed onto the patients. One patient had signed the consent and then when the IV fluid arrived, she refused. Fortunate for another patient who was a borderline candidate who got her dosage rather than wasting it.

So it goes. New people, new treatments. Still seeing peaks and valleys. in admissions to the hospital and to the ICU but the number of deaths seems to have leveled off.

Tomorrow is another day, Covid care went from being constantly changing to now a routine that the caregivers know by rote. Diagnose. Plaquenyl...probably not but some are still getting it. Zithromax...probably not but some are still getting it. Check the blood inflammation markers, are they going up or going down. Going down, watchful waiting, Going up, hold your breath and when they go too high make sure they have the anticoagulants and the statins and the famotidine (this week's newsmakers has been in use for weeks) the zinc and the vitamin C...what could it hurt. Check the oxygen demand and the respiratory rate. If it is going up give the Tocilizumab and high flow oxygen at 60 liters. Did it turn it around? Yes...breath a sigh of relief. No....convalescent serum, if they will take it. Then wait. Then the step into the abyss. Intubation, ventilation, remdesivir, Levophed, medically induced coma, feeding though a nasal tube and prayer.

I read a study a few years back out of Duke I think, that they had patient's in the ICU for whom people prayed and a matched group who did not have a specific prayer group. The prayer group was not on site. The group did not know the patients and yet those patients did statistically better. Anomoly? God only knows. But that is when I started telling my patients that they should be a non=discriminatory, non=denominational acceptor of prayer. I do not believe it works, but I do it for each and every patient because in the words of the orange haired beach ball, "what could it hurt?" Even prayer from non-believers are heard if any are, one would think.

So even you cynics and naysayers, if you have a few minutes and care to offer a quick. "Hey god, how about getting the guy in room 509 better" it may be the best spent part of your day in isolation.

[Guy Fawkes]

Never forget that You are one of the Heroes!

(We all are praying for you whether you need it or not)

 

[+ nycman]

I am not a religious man but I said a prayer for him anyway, what could it hurt?

There are no atheists in foxholes

So even you cynics and naysayers, if you have a few minutes and care to offer a quick. "Hey god, how about getting the guy in room 509 better" it may be the best spent part of your day in isolation.

Done.

 

My prayers are with you as well PK.

“May whatever gods there be, guide your heart, hands, and mind during these difficult times”.

And on a more personal level...Thank you for your service.

[+ Bryan Dube]

Also young and fit, 37, he is doing slightly better than the previous patient but his is definitely a touch and go situation.

 

Thank you, thank you a thousand times for everything that you're doing right now during this crisis pk. you are a true hero. and we all are forever indebted to you. just curious how many "young/fit" patients you're actually seeing coming in having to be hospitalized, and are they seemingly fit, but maybe have underlying conditions? i'm in sf now sheltering in place, but live in nyc and it makes me nervous as a healthy/relatively fit 37 year old with no underlying conditions who is eager to get back to nyc. :/

?thank you!

[+ purplekow]

First you should know that I am caring for those patients who present to the ER with no local doctor and usually with no insurance. I am the assigned doctor, So the population I see tends to skew younger as I am not seeing, by and large, older patients who have medicare. While sometimes I do see older patients, they are either away from their primary care doctor, say visiting a child or or some reason they do not qualify for medicare. So the patients I am seeing are mostly men, in their forties and fifties with a few in their thirties.

The patient's who are on other services seem to be men more than women and more in their sixties and seventies, we have two patients on ventilators right now who are in their 90s and the families, despite being warned of the likely poor outcome after a prolonged treatment, insisted on everything being done, The cost for these two patient alone will like approach is not exceed one million dollars.

Most of the patients I am seeing are Hispanic. This number is certainly out o proportion to the Hispanic population in the area and it is even out o proportion to the number of uninsured patients in the area. This has me considering whether there is a genetic predisposition to these people becoming sick or perhaps it is more a social predisposition. My ability to work in Spanish has been a big advantage for me as I do no need to rely on telephone translators. I think the patients also appreciated being spoken to in their main language, though, as I have said before, one of the fastest ways to get these patients to speak English is for me to speak Spanish to them, For those familiar with his press conferences, my Spanish is significantly better than Mike Bloomberg's but I still think it probably grates on the ear of native speaker.

As for today's activities, while the admission numbers have been down, three of the patients I admitted yesterday were transferred to the ICU during the night. Two of them were teetering on going to the unit when I left last night but the other just took a nosedive. These rapid nosedives are what I find the most disturbing about caring for these patients. Some patients perk along with perhaps a slow downhill change which can be aggressively treated to try and prevent placement on a ventilator. The few patients that I have had that have nosedived, have done so out of the blue and despite intervention, they have wound up on ventilators and usually for a prolonged period. None of them have come off the ventilator though I did care for one man who came off the ventilator after two weeks, he was not my patient at the onset, he was admitted directly to the ICU. He did go home to great fanfare and of course, the song of the day which is now stuck on Fight Song despite almost universal disdain for that choice.

Thanks to all who have contacted me about these posts. I am glad that you have found them useful.

[HS2020]

I do not usually have a difficult time coping. Life is hard and mine has been easier than most. But today, I have just hit the wall. Working in a New Jersey Hospital is not nearly as difficult right now as working in a NYC Hospital. We have most equipment. We have beds. We have staff. We have patients and each day we have more and more patients. Right now the numbers are not overwhelming but they are increasing and more and more compromises are being made. Most of the staff are just doing their job. But there is an air of anxiety and trepidation hanging around every corner. There are hollowed shells walking the halls. Fear and uncertainty is everywhere. There are no laughs not even at jokes with a dark humor,

 

I went into work today and started the day as part of a physician conference call. The conference call was to inform us that the governor has given physicians immunity. This is not being widely publicized. Essentially, within the scope of good medical practice, we cannot be be sued for actions that previously would have been not only malpractice but quite possibly criminal. That is, we were informed of the plans for the upcoming ventilator shortage. It is not first come first served as it is in the toilet paper aisle. There is no hoarding or buying for a friend, When the respirators are 90% in use, which is the case in several hospitals in New Jersey, then patients are assigned a color code. Green patients are those that get to keep the respirators. Yellow are the patients about whom clinical status and general condition are favorable. Red are the patients that are first in line to have their respirators removed should others in higher categories need them. Blue, well blue never get the respirator from the onset.

 

I could barely contain my anger, fear, frustration, and utter disappointment. We knew this was coming, I knew it was coming but now it is here and it is a palpable real pain, physical, mental, emotional and spiritual. We were given guidelines as to what to tell family members when it is time to take their loved one off the ventilator. They do no have the final word. There is an appeals process, but that process can only last 30 minutes while the patient waiting for the ventilator is manually ventilated, Two more hours will be needed to clean the ventilator and reequip it.

 

Three people will take turns manually ventilating the patient, Oh did I mention that once you are assigned a color, the person coming off the respirator would have had to be on the respirator for 5 days, so theoretically long enough to turn the corner and get themselves into a higher color group. However, the decision as to who comes off the respirator is made by random computer selection of those in the lowest category.

This is not to say that the assignment of the color group is random.

 

Patient's are stratified by a variety of factors, age NOT being one of them.

 

Today, I had a new patient with possible Covid admitted to my service. She is 87 with a touch of dementia and lives at her daughter's home with a loving family. I spoke with her daughter on the phone to get information about her mother. She told me to try and do everything to help her mother but that if it was clear that there was no hope of her returning to her previous level of functioning, or close to it, that her mother had decided long ago that she did not want to live that kind of life.

 

When I went into see the patient, I gowned and gloved and on the way in , I noticed her lunch tray and decided to give a hand to the other staff by bringing it in. PPE (personal protection equipment ) is still sufficient but not plentiful so my act saved one set. I brought her lunch tray in with me and saw a pleasant looking woman who appeared about 15 years younger than her age. She had eyes closed and did not respond when I called her name. I put down her lunch tray next to her untouched breakfast tray and did my exam. She appeared to be comfortable and was definitely someone who was doing much better than her numbers (lab values vital signs and other measurable qualities). I went to leave and the empty breakfast tray and the new lunch tray just haunted me. I opened the packet for her utensils and the vanilla pudding put a bit on the spoon and placed it by her lips. She opened her lips and took a taste. Then another. Some of her fruit cup and then most of her mashed potatoes followed. A bit of meatloaf and then the rest of her pudding. She said nothing. She did not open her eyes, even as I tried to coax her to do so. Finally, on a bit of the meatloaf.

 

She refused to open. Another offer and another refusal and so I knew after 30 minutes of being fed, she was not taking any more. I said out loud to her, I guess that is it for now and as I left I heard her faintly say: Thank you. I turned and her eyes were open and then, a second later, they closed again. For that second they were so clear and blue and aware and I imagined her quite the beauty in her youth. After that second, she was back in that space where she was when I walked in, but she had let me know she was there.

 

Next week, her condition may worsen and she will be a blue. She won't get a chance at a life saving machine, She will likely pass alone in a hospital with a loving daughter sitting at home hoping for all the world for her mother to get better. Even if I could do more medically, which I cannot, I could not alter her course. Even now, the most I could do for her he be present, give her some pudding and hope that time and some combination of medications we are giving her make a difference,

 

I do not usually have difficulty coping, but today I hit the wall and next week this day will be the good old days when I had 30 minutes to spend with one patient.

Beautiful and heartbreaking.

[+ stevenkesslar]

The few patients that I have had that have nosedived, have done so out of the blue and despite intervention, they have wound up on ventilators and usually for a prolonged period. None of them have come off the ventilator though I did care for one man who came off the ventilator after two weeks, he was not my patient at the onset, he was admitted directly to the ICU. He did go home to great fanfare and of course, the song of the day which is now stuck on Fight Song despite almost universal disdain for that choice.

 

Hope this is okay to post on your thread. It's probably has been posted elsewhere. But it's good to focus on good news, or at least better news.

 

WATCH: BATES ALUM JACK ALLARD LEAVES HOSPITAL AFTER COVID-19 BATTLE

 

[MEDIA=twitter]1251148677768286213[/MEDIA]

 

I assume that is his Mom and Dad waiting for him outside. 25 years, a great athlete, no pre-existing conditions, and in a medically induced coma on respirator for a few weeks. And, happily, he lived and walked out of the hospital.

 

I remember reading some story a few years back about how some young gorgeous bodybuilder in his 20's died of the flu. I don't even recall, but I think somehow he ended up in septic shock when bacteria got into his blood stream. All that stuff is above my paygrade.

 

My point is that it is fair to say that healthy young men and women dying of the flu every year is not exactly normal, but it is possible. But this is different. There's just too many stories of healthy young people like this guy almost dying, or getting strokes, or at least being laid up in the hospital, sometimes on respirators. And as you say it seems somewhat inexplicable. Some people, for some reason, just nose dive. There is story after story of that happening.

 

This guy is from New Jersey, although he ended up in a clinical trial in a Pennsylvania hospital. Thank God for the doctors and nurses and all the support staff that are dedicated to keeping everyone they can alive.

[+ purplekow]

Hope this is okay to post on your thread. It's probably has been posted elsewhere. But it's good to focus on good news, or at least better news.

 

WATCH: BATES ALUM JACK ALLARD LEAVES HOSPITAL AFTER COVID-19 BATTLE

 

[MEDIA=twitter]1251148677768286213[/MEDIA]

 

I assume that is his Mom and Dad waiting for him outside. 25 years, a great athlete, no pre-existing conditions, and in a medically induced coma on respirator for a few weeks. And, happily, he lived and walked out of the hospital.

 

I remember reading some story a few years back about how some young gorgeous bodybuilder in his 20's died of the flu. I don't even recall, but I think somehow he ended up in septic shock when bacteria got into his blood stream. All that stuff is above my paygrade.

 

My point is that it is fair to say that healthy young men and women dying of the flu every year is not exactly normal, but it is possible. But this is different. There's just too many stories of healthy young people like this guy almost dying, or getting strokes, or at least being laid up in the hospital, sometimes on respirators. And as you say it seems somewhat inexplicable. Some people, for some reason, just nose dive. There is story after story of that happening.

 

This guy is from New Jersey, although he ended up in a clinical trial in a Pennsylvania hospital. Thank God for the doctors and nurses and all the support staff that are dedicated to keeping everyone they can alive.

We all need to see this. It is the goal we have for each and every patient we treat.

[+ Charlie]

Hope this is okay to post on your thread. It's probably has been posted elsewhere. But it's good to focus on good news, or at least better news.

 

WATCH: BATES ALUM JACK ALLARD LEAVES HOSPITAL AFTER COVID-19 BATTLE

 

[MEDIA=twitter]1251148677768286213[/MEDIA]

 

I assume that is his Mom and Dad waiting for him outside. 25 years, a great athlete, no pre-existing conditions, and in a medically induced coma on respirator for a few weeks. And, happily, he lived and walked out of the hospital.

 

I remember reading some story a few years back about how some young gorgeous bodybuilder in his 20's died of the flu. I don't even recall, but I think somehow he ended up in septic shock when bacteria got into his blood stream. All that stuff is above my paygrade.

 

My point is that it is fair to say that healthy young men and women dying of the flu every year is not exactly normal, but it is possible. But this is different. There's just too many stories of healthy young people like this guy almost dying, or getting strokes, or at least being laid up in the hospital, sometimes on respirators. And as you say it seems somewhat inexplicable. Some people, for some reason, just nose dive. There is story after story of that happening.

 

This guy is from New Jersey, although he ended up in a clinical trial in a Pennsylvania hospital. Thank God for the doctors and nurses and all the support staff that are dedicated to keeping everyone they can alive.

Unfortunately, since this disease is so new, we have no way of knowing what the longterm effects of having the disease will be for young people like Jack after they have "recovered." According to yesterday's LA Times, people who have had even mild forms of the disease are showing clinical abnormalities in their lungs and hearts in follow-up exams.