I've been too busy to post here over the last few months but I thought I'd put a few thoughts down now that I have a few minutes to gather myself. According to EMR records I have had just over 1,100 COVID19 patient encounters as an attending physician since March 8th in both New Orleans and New York City so I feel like I am reasonably credentialed to have an opinion at this point. I am sure a lot of people have will have a lot of different opinions than I will as I'm sure they've had a different experience than I have.
To the public: We are beating this, I am getting better at treating this every day and I continue to learn more and get better at it with every single patient encounter. This is not the flu and your body is naive to it and there is a chance the reaction seriously injures you. Remember, death is only one of a number of outcomes, nobody is talking about the patients I send out with 20% renal function or with 1 infarcted lung and cardiac function of 30%. These are patients in their 30's and 40's who will be attached to me for the rest of their lives, I will know their wive's names and the annoying children who ask too many questions because they will need to see me in the hospital to simply survive for the next 30 years when they get flares and other illnesses that compromise their now poor organ reserve. Most people will have no effect likely as with most infectious exposures, but there is a wide spectrum from asymptomatic to dead.
It is hard to quantify the strain on medical professional's mental health in outbreak areas. I know that mine is stretched to the limit. I don't sleep cause I know what I'm going back into tomorrow, I am frustrated that I cannot help many of these people, my emotional tank is empty because I have to be everyone's family member since their's cannot be there for them, and I am frustrated that I cannot safely care for my other patients who need to see me for unrelated reasons because I will likely make them sick. Right now it is heartening to hear the people of New York raise their voices and bang pots and pans when my shift changes. But I feel that in a few weeks when everyone comes back out there is a chance I will be a pariah when I leave the hospital, the most dangerous person in town and socially toxic. People already cross the street when I walk home in my scrubs.
I need everyone to trust that we are doing everything that we can, that I hold your parent's hand everyday and tell them that you love them even if they can't respond. We're cleaning and feeding them, we're healing in every sense of the word that we can find to right now. I hope that the American people are starting to understand what hospital administrators have known for a while, that your medical professionals will sacrifice pretty much everything to take care of our patients. This isn't a job, and its not just a career, this is a calling to many of us; that God reached down and commanded us to heal those around us.
I haven't seen my family since February, my father had just had a life saving liver transplant and now I am not sure when I'll be able to touch him again. And don't worry, I have him hiding out south of the Pecos river far away from all y'all so that I can cash in on the extra decade of life with him that was just gifted to my family. Every day I want to run away from this so I can go see him again.
To the Providers: data is scarce and of poor quality. Clinical Pearls that I have learned so far:
504.407.1446 - this is my personal cell phone number. If you are a provider with questions about a COVID patient you can text me at anytime and I will respond when I have time. Please do not call, I will not answer.
edit: Sorry for the word vomit, this got a bit carried away and a lot of pent up stuff that is not relevant probably came out.
To the public: We are beating this, I am getting better at treating this every day and I continue to learn more and get better at it with every single patient encounter. This is not the flu and your body is naive to it and there is a chance the reaction seriously injures you. Remember, death is only one of a number of outcomes, nobody is talking about the patients I send out with 20% renal function or with 1 infarcted lung and cardiac function of 30%. These are patients in their 30's and 40's who will be attached to me for the rest of their lives, I will know their wive's names and the annoying children who ask too many questions because they will need to see me in the hospital to simply survive for the next 30 years when they get flares and other illnesses that compromise their now poor organ reserve. Most people will have no effect likely as with most infectious exposures, but there is a wide spectrum from asymptomatic to dead.
It is hard to quantify the strain on medical professional's mental health in outbreak areas. I know that mine is stretched to the limit. I don't sleep cause I know what I'm going back into tomorrow, I am frustrated that I cannot help many of these people, my emotional tank is empty because I have to be everyone's family member since their's cannot be there for them, and I am frustrated that I cannot safely care for my other patients who need to see me for unrelated reasons because I will likely make them sick. Right now it is heartening to hear the people of New York raise their voices and bang pots and pans when my shift changes. But I feel that in a few weeks when everyone comes back out there is a chance I will be a pariah when I leave the hospital, the most dangerous person in town and socially toxic. People already cross the street when I walk home in my scrubs.
I need everyone to trust that we are doing everything that we can, that I hold your parent's hand everyday and tell them that you love them even if they can't respond. We're cleaning and feeding them, we're healing in every sense of the word that we can find to right now. I hope that the American people are starting to understand what hospital administrators have known for a while, that your medical professionals will sacrifice pretty much everything to take care of our patients. This isn't a job, and its not just a career, this is a calling to many of us; that God reached down and commanded us to heal those around us.
I haven't seen my family since February, my father had just had a life saving liver transplant and now I am not sure when I'll be able to touch him again. And don't worry, I have him hiding out south of the Pecos river far away from all y'all so that I can cash in on the extra decade of life with him that was just gifted to my family. Every day I want to run away from this so I can go see him again.
To the Providers: data is scarce and of poor quality. Clinical Pearls that I have learned so far:
- Avoid intubation at all costs. HFNC and with a face mask (for all the mouth breathing), prone them, given them tiny doses of morphine to chase off the dyspnea and let them ride with sats in the 80's and RRs in the 40's for a while to see if they'll improve first, you'll be surprised how many will blast through two days like that and then improve once you can get some anti-inflammatories on board
- Remdesivir and IL-6 inhibitors have been pretty effective for the inflammatory phase, if your hospital doesn't have them yet I'm sorry cause we already bought all of it. Your hospital needs to be buying HFNC and IL-6 inhibitors. I screen all my covid patients for HBV and HIV on admission as I have seen a few wild flares when I didn't take the precaution to check before high dose steroids and IL-6 inhibitors.
- Anticoagulate early and often if there are no contraindications, I avoid with anyone on DAPT already as well unless I can safely stop plavix.
- Fluids are not the devil, try a small bolus and see if you don't watch the sats rise when you improve perfusion a bit. Be cautious but stop treating it like ARDS
- Negative Pressure Rooms will save your staff from getting sick. Besides having enough PPE (which I still don't have by near enough, both masks and gowns) negative pressure will decrease the inoculation load I suspect as the rates of staff illness is amazingly divergent in facilities I've worked in based on this.
- My ideas on effective treatment will continue to change with more experience of myself and other providers I share info with. Good data will come out one day but our patients don't have the time for us to wait, it is currently a trial by fire for us. Open your experiences to your fellow clinicians while we all try to figure this thing out.
504.407.1446 - this is my personal cell phone number. If you are a provider with questions about a COVID patient you can text me at anytime and I will respond when I have time. Please do not call, I will not answer.
edit: Sorry for the word vomit, this got a bit carried away and a lot of pent up stuff that is not relevant probably came out.
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