More Notes from the Front Lines

Hi everyone:

I’m finishing Week 2 in the COVID-ICU. Some more notes:

• We can do great things together: We’re working shoulder-to-shoulder with neurologists, neurosurgeons, anesthesiologists, surgeons, dermatologists, pediatricians, cardiologists, gastroenterologists, and hospitalists. We’ve converted cancer floors into ICUs. We’ve flipped patients onto their bellies and we’ve pulled many back from the brink. We can do great things when we work together.
• Be patient: After a week away, I returned to many familiar names; several are getting better. It takes time to recover from COVID. It pays to wait.
• Details matter: Clipboards and checklists. System by system. Start the heparin. Stop the antibiotics. Replete the potassium. Pull the line. Hold the sedation. Call the family. Hydroxychloroquine probably doesn’t work, but paying attention is a wonder drug.
  
• Save your ears: When you wear facemasks all day, the elastic bands cut into your skin. Get a surgical cap or headband with buttons to anchor the bands. My ears are indebted to Rebecca Slotkin and the Girl Scouts.
• Get in there: PPE keeps us safe. Go into the rooms. Examine the patients. Answer their questions and reassure them. Study the ventilators. Help the nurses with a boost.
  
• COVID is devastating: Some patients succumb no matter how hard we try. We do our best to keep them comfortable and we bring their families to the bedside to say good-bye. We may withdraw life support, but we never withdraw care.
• Know your physiology: These patients are really complicated, so I’m glad I studied in medical school. Why is the blood pressure tanking? Why is she hypoxemic? Why is he breathing so fast? Where did that anion gap come from? You can figure it out. When you understand the physiology, you know what to do.
• Less is more: Low tidal volumes save lives and lightening sedation saves brains. COVID tempts us to do more, but hold back. Wait. Be gentle. Sometimes, what these patients need most is time to heal.
• Listen to the nurses and respiratory therapists: When patients are crumping, the nurses know first. When patients buck the ventilator, the respiratory therapists know what to do. Nurses and therapists bail me out every day. They’re our best friends. Word to my fellow physicians: listen to the experts. Listening saves lives.
• Sneakers: Why shoes? Sneakers forever.
• Read: I try to read every day. Pathology, pathophysiology, radiology, hematology, immunology. There’s so much to learn about COVID, and the more you know, the more you understand, the more you can help your patients.
  
• We don’t seek fame and glory: We seek pizza and chocolate.

And with that, I’m off to join my team on NP15,

Mark

PS Happy Mother‘s Day!

MDS