Day Shift

There is just a different feeling when there are windows in the rooms and the sun is out. I was assigned a day shift in the ICU today. I got up extra early as I had a patient of mine own to see in the hospital before my shift started.  After making sure that the patient was taken care of and a plan was in place, I headed over to the unit.

I am starting to get in a routine for the hospital at this point.  There is a side entrance for staff that we enter. Our temperature is taken, we are asked if we have had a cough or loss of taste.  They have stopped asking if I have been exposed to anyone with known COVID-19 infection. The answer is for just about all of us in the hospital, “yes.”  Our exposure is much different, though, than someone in the community given the protective measures that we take.

I come dressed in clean scrubs and carry my old ones in a plastic bag. After entering the hospital I first go to the scrub machine and deposit the old ones to be cleaned. This give me a “credit” so that when I am done I return to pick up a new clean pair to take home with me.  I wear a mask from the time that I leave my car to the time I get back into it.  This is to keep my hands away from my face.  Every time I touch a door knob, telephone, keyboard, etc I then go and sanitize my hands.

I didn’t actually go into a patient’s room today, but if it were necessary I would don “full PPE.”  This consists of a baseline pair of gloves followed by a gown, booties on my shoes, covering for my head. Another pair of gloves goes on over the sleeves of the gown, followed by an N-95 mask, goggles or face shield.  It is quite the process to go into a room, so everything is geared to minimize unnecessary use of the protective equipment given the shortage around the world.

At the end of my time in the hospital, I go collect a clean pair of scrubs, go to my car and get a bag of clean regular clothes and a new towel. I then head over to my office where we have a shower.  I put my dirty scrubs in a bag for the next day and take a nice, hot shower.  Letting the water run over my head and down my body can be very relaxing. I take a few deep breaths which helps to “wash out” not only the germs but the stress that has built up as well.

Today I was paired with an anesthesiologist. We joked that together we hope to come close to making one whole critical care physician but really we are still probably about 85% of that.  He clearly has experience and expertise in doing procedures (IV lines, intubation, etc) and I have more experience in putting in orders, managing medications and writing notes.  Together we went around and talked with the nurses with all of our assigned patients and then got to work writing their notes and putting in the necessary orders.  Later we reported to the supervising ICU physician and we again went around to each patient and their nurse.  It was a good time to report on what we knew but also to ask questions.  Together we formulated plans.

A few of the patients are clearly getting better and are about ready to come off of the ventilator. A few are not doing well at all and the rest are in a holding pattern.  We called family members of each of the patients and discussed their care and progress.  I found that I was even more comfortable with this aspect than even the ICU doctors.  Communicating to patients and their families is at the core of pretty much everything that I do.

In all, today felt much more upbeat.  It is easy to focus on those patients who are doing poorly but it was so great to call family members on those who are improving and be able to give them hope and good news.  It is an incredibly stressful time for these families who cannot be here to visit their loved ones and show them support.  Given the nature of the disease, some families are dealing with multiple members who are sick at the same time.

So now I am “on call.”  Our tiered level of care is in place and ready to expand should the need arise. The rest of my colleagues will be finishing up their training shifts this week.  I truly enjoyed my shift today.  It is nice, frankly, to be needed and have the skills to be able to help.  That said, wouldn’t it be great for all of us if my skills were not required, that the demand from our community was low enough that our expansion plans are never put into action.