Saturday, March 28, 2020

Adjusting to Our "New Normal"

It's hard to image what life was like a month ago since so much has changed. The world seems surreal right now: little to no traffic, the hustle and bustle of our cities gone, and the quiet. So much quiet.

Life has changed significantly in our home, as I attempt to strip at my backdoor after returning from work, wash my hands, wipe my keys, phone, and wallet down, then head up stairs for a shower and change of clothes before familial reentry. I sleep in a different bedroom, shower in a different bathroom, and wonder (like a worker after the Chernobyl accident) what my viral "load" is at any point in time. Every accidentally-aspirated chicken noodle soup noodle and results in a coughing spree clears a room. I scratch my nose: "do I need to wash my hands again?"

Life as a physician is really weird now. We are healers and potential vectors all at the same time.

Yet so far we are lucky. Italy announced 969 deaths in a single day yesterday. Many, if not all of them, died alone. The ripple effect on their families must be enormous. And the poor doctors, nurses, health care workers there. New York is starting to feel this too. Will it get this bad here?

Our hospital system has been very proactive and open about the situation with us. They acknowledge the worldwide shortage of personal protective equipment (PPE). They are conserving necessary supplies for those most likely to confront new patients or those with suspected or confirmed COVID-19. All OR's and emergency procedures require full PPE, which is awkward when a non-COVID-19 patient enters: where is the transition to full PPE made? In the holding area? The lab itself? It's all a work in progress. Ventilators? Enough now, but later? Sands shift.

Still, it's impressive to see an ambulance bay converted to a negative flow screening area. Separate hospital's ICU and inpatient ward adapted for designated for COVID-19 patients. Contignecy plans for overflow are already in place. Outpatient drive-thru testing established for people who are most likely to warrant testing and have taken an online screening questionnaire. Six-foot markers are on the floor in the cafeteria, meetings, if they occur at all, are via Zoom or teleconference. Nearly all patient visits are virtual. Elective cases are a thing of the past. 425 physician volunteers are on standby - for extra duty - sometime.

At first, then percentage of people tested with positive coronavirus tests in 24 hrs was 15.8%, then 17.2%, and this AM was 19.1%. 7% of those hospitalized. Lots and lots of testing, planning, wondering, waiting. Today we admitted more people in a single day than everyone that was admitted when we started monitoring a week ago. It's coming.

The preparation seems so logical, but I wonder: will we be overwhelmed? We really don't know. But the non-COVID patients are still out there too: the LVAD patients with ICD shocks, the kids with broken bones, the baby deliveries, heart attacks, cancer patients, and patients with complete heart block, and more. They haven't stopped coming but they, too, are scared.

It's reassuring to see so many good folks giving it their all: from the doctors, nurses, administrative staff, clerical workers, laboratory staff, environmental workers, engineers and transporters. We work together - we have to - and with that effort comes the rekindling of respect for the special skills of everyone.

Once relatively simple things to treat take much more strategic coordination now. Atrial flutter w/rapid rate in a patient with fever and cough just a month ago would get a TEE/cardioversion without a moment's hesitation. Now, that patient is COVID-tested, isolated, procedures performed in full personal protective equipment, and tensions between colleagues heightened. The truth is, the vast majority of us that contract the disease will recover, but no one wants to be that other statistic. Patients need us. Families need us. So we wear a mask, we wash our hands, we wipe our tools, keys, keyboards, phones, then strip, wash and reenter. Are we effective? Honestly, I have no idea, but what else can we do?

Thanks to everyone who have sent prayers, words of encouragement, and support by staying home. We will all get thorough this.

Take care out there and take comfort in the fact that you're not alone.



Rita said...

You are such a dedicated doctor and wonderful human being, Wes. Thank you for all you do.
God bless you and all those working tirelessly to turn things around. We are grateful for y'all keeping alive the islands of care and sanity that we can anchor to.

Anonymous said...

Sending Love to all those people on the front lines....Thank you for your hard work and dedication......

Anonymous said...

Dr. Wes,

Thank you for your efforts with your patients and as an advocate for physicians.

Stay safe.

Another Anon Anon Wishing You Well said...

Yes, Wes, stay safe!

Dr. Cruz said...

This is a time for medical boards, hospitals, associations to stop hindering physicians- we need to increase our physician workforce to fight this pandemic. This pandemic has exposed the fact that there is a physician shortage. Yet, all I see are measures to increase the non-physician provider presence. This is a time for the NBPAS to advocate for recognition as "certified" which is a brand owned by the ABMS. This is a time to begin advocating on behalf of disenfranchised physicians- who are seeking reentry. Perhaps the Physician Reentry Act (proposed by Rep Sarbanes in 2015) can be revisited and something passed- the act went nowhere.

I got disenfranchised while hospitalized for nearly 9 months due to personal tragedy/trauma. I lost my ABMF "Board Certified" status during this period- had been certified for 15 years prior with the ABFM. I then, in turn, got "certified" by NBPAS with the intention of certifying with ABFM as well when able. But, NBPAS Certification is not recognized by employers, payers in my state (PA). I have maintained my license active which includes maintaining CME requirements, I have an active DEA. I am well (today), have no disciplinary, substance nor malpractice issues- yet, I have not been successful in obtaining employment for 3 years- discharged from Philly VA hospital in early 2017 (admitted mid 2016)- I am an Army veteran. I immediately sought help with the PAOVR before d/c to help me get back into workforce.

I have been trying to get help with reentry programs as my finances have been devastated and reentry programs are extremely costly. I did submit an application to PAMED LifeGuard, but was denied because I am I have an active license, NBPAS certified, Active DEA, up with my CME and am well- it seems I was overqualified! What can I say? I have done everything I could and been diligent in my endeavor to rejoin workforce. I'm a doctor, its what I do!

Now, I am waiting to hear from Drexel Medical School's Refresher program, but it does not include a hands-on preceptorship which is what I need. My references are dated, with each day that goes by, I become more and more disenfranchised . I volunteered for SERVPA (the Commonwealth of Pennsylvania's online registry for medical and non-medical volunteers) which is supposedly where you go to register to volunteer to assist in disasters such as this pandemic.

They are allowing medical students and nursing students to graduate early for the surge response. Med students do not have practical experience, no license, not ABMS board certified as they have not done internship/residency, do not have DEA license and haven't even started CME. I feel I am at least as qualified as one of these medical students!

It amazes and frustrates me that physicians are so regulated and controlled. Its absurd that I have not been able to work for the past three years- its ridiculous that in this time of need I cannot find a place to even volunteer as a physician!

Dr. Cruz said...

Thank you, Dr. Wes, for allowing me to post my comment on your blog.

DrWes said...

Dr. Cruz-

You might want to look at this from the AMA:

Best of luck!

Dr. Cruz said...

Thank you! That is very helpful. I will indeed follow this lead today.

Anonymous said...

The silver lining of the COVID19 crisis is how the American public now perceives hard working physicians. Previously, our concerns were largely dismissed. Now, hard working physicians (especially those working in the trenches) are perceived in a similar manner to the first responders during the 911 tragedy and soldiers fighting terrorism in the battlefield. Doctors are the warriors suiting up to battle an invisible enemy. "Heroes Wear Scrubs" is the new slogan. People are very aware that if they, their family members or people they know become very ill due to COVID 19, it is the doctors who can save their lives.

When this is over, our voice will be stronger in the courtrooms, government and when dealing with various institutions. Can you feel the wheels of karmic justice gradually turning? Take care and don't give up hope.

Anonymous said...

The physician heroes working hard on the front lines are dispensable. The surveillance grid - quality assessment cartel, the "industrial complex" and elites they serve are not.

Physicians are now employed "wage slaves". Physicians are now part of a broad labor force that is being surveilled, assessed, manipulated, reduced and replaced.

Unless doctors become true heroes by organizing, protesting, and improving the decaying situation, the profession will rot. The public will rot. There is an undeclared war/police action against physicians. The wages for not recognizing the situation, organizing, fighting back, and missing the mark in battle is death.

The ABMS/ABIM is about controlling labor and serving their elite masters. The reasons should be obvious by now as doctors become an oppressed and exploited class in the medical labor market.

The profession of medicine is now comprised of data entry clerks/providers coerced into subsidizing their own present and future exploitation. What is happening is medieval with vassals and barons creating mass propaganda, bogus science and illegal demands.

MOC is a powerful weapon, a source of propaganda, fraud, racketeering and oppression leading to mass exploitation of the professional "labor force". MOC needs to be destroyed. It needs to be in every physicians cross-hairs and neutralized.