Deep Breaths

Every now and then it is good to step back and take a deep breath.  My night was spent tossing and turning and waking up far too early but for the first time in two weeks, I did not have to go into the hospital today.  All my hospitalized patients had been sent home.  Even before Corona, this is quite rare.  As such, I was able to stay home and do all me “telemedicine” visits here.  My team and I at the office have gotten a bit more organized with how we do this.  Last week, I was calling the patients on my own, seeing about getting them on some sort of video platform, going through all the things that my medical assistant would usually do for when patients are brought back to a room.  It seems like it took more than 15 minutes before I could even ask how they were doing.

This week we have gotten more efficient. Now my assistant does the leg work and she let’s me know when I can give them a call and what platform they find the easiest.  Since I can mostly focus on their health and their concerns as opposed to all the technicalities, the visits go more smoothly.

I am slated to do my first hospital ICU shift at the end of next week after 3-4 others have already done theirs. I’ll be able to learn from their experience. I feel much more calm about the whole situation for now.  Every day seems to bring a new twist or challenge though so we’ll adapt and change as needed.  

I did have to confront my own mortality today but not as you might expect.  There is nothing like trying to keep up with your twenty year old son on a bike that makes you realize you “ain’t what you used to be.”  I used to be able to take him on the hills-not any more! It was fun to get outside and be with him again even if he takes my breath away.

Heaven Help Us

Each day brings a new turn of events. Today started with a text informing us that Missouri Baptist Hospital was being asked to double the amount of ICU beds to 80.  This will require turning an entire floor of rooms into ICU rooms.  Smaller, outlying hospitals with limited ICU capability and essentially no ICU physicians will be sending their sick patients up to us.  Staffing all these beds will put into action the back up plan we had previously made, much faster than anticipated.  Our ICU doctors will now take on a supervisory role with teams.  On each team there will be an Internal Medicine physician such as myself and an anesthesiologist. We will adjust medicines, write orders, notes, talk to the families, arrange for discharges.  The anesthesiologists will do the procedures to intubate (insert the breathing tube in the airway) and putting in central lines. They will also manage the ventilator settings.  Each team is to take care of 15 patients. This will start next week.
I have never been involved in going to war but I imagine there are some similar feelings.  Sure it is scary, but this is what I do.  I take care of people and I wouldn’t have it any other way.  We will take every precaution that we can to be safe but there is certainly risk involved.  I did not look forward to coming home and telling my wife.  I have put a lot of stress on her.

Tonight I decided I needed some extra help from on high.  In our church we do not have a paid ministry.  Every worthy male who desires, can be ordained to the priesthood. This is how we can function at home without going to our church buildings and not miss a beat.  I asked my son, who returned from a two year mission for our church, to give me a priesthood blessing.  We video conferenced our other children. It was a sacred experience for me.  During the blessing he told me that angels would be sent to watch over me.  For the first time since my father passed, I felt his presence during the blessing and knew that God would allow him to be with me.

I don’t know exactly what lay in store in the days to come, but I have faith to move forward calling on Heaven to help on the way.

Party Time

I once listened to a motivational speech by a cancer patient who was going through chemotherapy and advised, “It’s ok to have a pity party, just don’t invite everyone to it.”  Today just feels “heavy.”  There isn’t one thing that happened to feel more weight than other days.  I think it is just cumulative. I had no idea it was “doctor’s day” until a patient sent me a message wishing me a good one.

I now have three patients that have tested positive for the disease.  I haven’t been around any of them.  One we spoke to on Friday and she ended up going to the ER and was admitted with pneumonia.  She turned around real quick and was actually discharged home before her COVID test came back positive.  Another is in her 80’s and has cancer. Thankfully, she is getting better, but finding the best way for her to be taken care out of the hospital is looking to be a challenge.

We met as a practice via zoom tonight to get an update on setting up the “respiratory clinic.”  That will be ready to go by the end of the week.  It will help take some of the load off of the ER and keep sick people out of our offices to reduce further transmission.  It seems that testing is starting to open up but now we are being told that there are not enough swabs to go around.  This frightens me more than anything.  If we can’t test medium risk individuals I fear that we won’t be able to head off the virus.  We’ll have to continue mass isolation strategies.  It is like doing surgery with a sledge hammer instead of a scalpel.

What keeps me going is the love and support of my wife and family.  My faith keeps me strong and I make sure to spend time in the scriptures everyday.  I also just had to get outside this evening so I jumped on my bike and did my short loop which includes Marshall Road-a nice steady long hill that always takes it out of you.  That may have been my best therapy yet.  Lastly, patient after patient has reached out in gratitude and always ends by saying, “we are praying for you.”  The sustaining strength of those prayers is the best gift I could ever receive on this day set apart to honor physicians.

Mind the Gap

When the ER called this weekend and let me know that the next new admission had metastatic cancer and was being admitted for diverticulitis, I immediately felt a pit in my stomach.  Over the years, I have seen time and time again where a patient with cancer presents to the ER who is clearly declining.  What often happens, is that the ER sees that they are sick and then will find something on imaging that will allow them to admit the patient to the hospital.  Usually it is “pneumonia.”  It is never pneumonia. It is cancer and it is time to have “the talk.”  This time there was a little bit of inflammation around the colon, but there was cancer everywhere.

As I came to see him we talked about the diagnosis but then I asked him what kind of care he wanted as things got worse and the cancer progressed.  He tearfully confessed that he was tired of seeing doctors. He was tired of feeling sick, of having no appetite, of having no energy.  He just wanted to go home and be with his family.  You see, with the COVID craze we are all in, he is not allowed to have any visitors.  He asked me to call his wife so we got on speaker phone together.  She was rather upset that he was considering stopping the treatments but as we discussed everything together, she started to see things from his eyes and softened quite a bit.

It broke my heart to not just have these conversations with them but that they couldn’t do this together.  This time of isolation can tear us apart if we are not careful.  At the hospital, I am trying to take the extra time to call the families that would otherwise be there.

In stark contrast, we met all together as a family today to discuss scriptures as our Sunday worship.  It is rare to have all of us together, but we could do it thanks to technology.  I was finishing at the hospital, everyone else was at the home and we included a good friend and my in-laws as well.  We had such a good discussion together.  How blessed I felt to feel so close to each of them despite our separation.

Later today I connected with my mother and my son on a three way call to wish him a happy birthday.  I also called my cousin to catch up.  It had been too long since I took the time to call.  Sometimes when we strip our lives down to the bare necessities, we remember what is the most important.  Let’s not let this time of isolation to distance the gaps with those we love.  With some effort, we can reconnect and grow even close.  It is time to mind the gap.

The Crowned Prince of Peace

 Being on call, I cover 10 doctors for the weekend.  Last night there was a flurry of activity with six people being admitted to the hospital. Two for possible COVID. The dedicated floor is getting more and more patients on it but thankfully we still have capacity.  I am on the other floors and am grateful for those that are willing to work with the COVID patients.

The day went smoothly. The mood in the hospital is somber but cordial.  A smile goes a long way. There is a sense that we are all in this together. The unspoken truth is that we know that there are some among us who will get sick and there may be some that succumb to the illness.  A part of me wishes that I could just get a mild form so that I could become immune.  That is a very small part because even routine colds tend to linger due to a history of childhood asthma.  I like to think I am quite healthy and have stayed in good shape. Though that is true, but I am closer to 60 than many of my colleagues.  I would love to just get the vaccine some day.

Seeing the news is sobering. We all see what is happening in the big cities across America.  I feel a thud in the pit of my stomach. So much of this could have been avoided.  We missed a huge opportunity to reign this in. I don’t know what happened that our ability to test is so much worse than other countries.  I assumed since South Korea and China could test so many people that as soon as we saw cases here, we would be able to do the same. I was dismayed that we had access to so few tests. Now our country is paying the price for this huge mistake.

I still have faith that bright days will come again but it will be after much tribulation.  A welcome package was left on my door step today, a box full of isolation gowns. There are so many good people in this world.  My faith remains intact. We start our fast for this Corona stricken world tonight.  The virus may have been given this royal name of Corona, but I will place my faith in He who wears the Father’s crown, the Prince of Peace, the King of Kings, the Great Emmanuel. He sits on the right hand of our Father.  He is our Advocate, our Redeemer, our Deliverer, our All.

Tumultuous Times

Friday March 27, 2020
My mind has not been quiet.  I was up at 4:00 AM just because it wouldn’t stop spinning. Listening to a lecture from George Handley, a BYU Literature Professor who I went to high school with, helped distract my mind.  I have been reading the Book of Mormon in spanish the last few months and finished it today.  How I love that second witness of Jesus Christ.  Gina describes her disquiet as being in her heart, as in “my heart was not good today.”  For sure these are unsettled times.

I kept my mind distracted for most of the day, busy with talking to patients about the rest of their lives that still matter.  “Yes, you can still exercise. Go outside and go for a walk.  Just keep your distance.”  We talked of diabetes and high blood pressure.  We talked about limiting alcohol intake.  One patient stopped going to his AA meetings because they were cancelled.  He agreed to sign up for the virtual one.

I headed to the hospital in the afternoon and ended up seeing patients needing admission for non COVID reasons, kidney failure, kidney infection and a heart attack.  The ER was tense and busy.  Everyone had masks on.  It was a busier than it has been for awhile.  I know that the COVID floors took more admissions today.

The nurses on the floor were awesome.  No one is allowed to have a visitor now unless they are in the last stages of dying.  I saw first hand how the nurses were making sure to reach out to families.  I am often given thanks for “being on the front lines” but I am not alone.  There are nurses and transport workers and the janitorial staff.  We all carry risk of contracting this virus.  I am grateful to all of them. Their courage is quiet but firm, even palpable.

This evening I received notice that a “respiratory clinic” has been approved at Missouri Baptist.  This will be available so that those not sick enough for the hospital can be tested and treated all in a situation where exposure will be minimized and the protective equipment can be used the most efficiently.  This was pioneered at Vanderbilt and should help save lives and keep staff safe.

President Nelson, our prophet and leader of our church has asked that all members fast and pray for the world this coming Sunday in regards to the virus.  We typically fast once a month and as part of our worship, we donate money to help care for the poor and the needy.  Even if you are not a member of my church, I invite you to join with us in asking Heaven’s blessing be upon us all.  Consider donating to your favorite food pantry or charity.  Together with the Lord’s help we will make it through these tumultuous times, of that I am certain.

Bamboo in a Typhoon

Thursday March 26, 2020

I woke up this morning and after reading my usual chapter in the scriptures, turned to see the latest news.  It was like watching a newscast of a typhoon tearing into a coastal city as I read of New York’s skyrocketing case load and death rate.  As feared, the cases have completely overcome the health department’s ability to search out contacts, isolate them and snuff out the epidemic.  They are bracing for the worst which is still to come.  Projections of being out of protective equipment and ventilators within two weeks is chilling.

I feel like we in St. Louis are like those inland cities which will get hit hard by the storm but have some time to prepare.  We can button down the hatches, put plywood on our windows and hunker down hard. The more we socially isolate, the better chance we have of the virus petering out and going away.  If we don’t, we will suffer the same consequences of those cities being hard hit right now.  The severity of our storm will be commensurate with our preparation.

Certainly there will be a wave of those who will get sick and require hospitalization and ICU care.  Tonight I participated in a conference call for all the doctors on staff at Missouri Baptist Hospital, where I work.  Two weeks ago our administration gathered together the physician leaders across medicine, surgery, anesthesia, ICU, ER and nursing.  They have met daily and have been putting together a plan to weather this storm.

As we primary care physicians have moved to telemedicine in order to touch base with our patients, the surgeons and other specialists have cancelled all routine procedures.  The ER has reformulated how patients are seen so that anyone who might have COVID virus is sent to a different entrance and fast tracked to appropriate care. There is one doctor and one nurse in charge of all such patients that need hospital admission and they work closely with the ICU team and the ER.  There is a dedicated elevator for these patients and their own floor of the hospital.  Assuming demand becomes excessive there are plans for mobilizing physician such as myself to take over the non COVID patients that need care or even help in the ICU.  Our anesthesiologists have all agreed to assist in the ICU as have our pulmonologists.

Tonight in the call, each physician/nurse leader described their part in the plan.  I was filled with emotion to be part of a team of dedicated professionals who are willing to do what it takes to care for the ill and maximize the safety of all those around them.  When the ICU physician was asked to report he said, “The ICU is like bamboo in a typhoon, we may bend but we won’t break!”

We likewise need to stand strong where we stand. Planted on the rock of Jesus Christ, we become a team of believers, willing to do whatever is asked to help those who have lost their way. Teaching his sons this very lesson, the prophet Helaman declared, “And now my sons, remember, remember that it is upon the rock of our Redeemer, who is Christ, the Son of God, that ye must build your foundation; that when the devil shall send forth his mighty winds, yea his shafts in the whirlwind, yea when all his hail and his mighty storm shall beat upon you, it shall have no power over you to drag you down to the gulf of misery and endless wo, because of the rock upon which ye are built, which is a sure foundation, a foundation where on if men build they cannot fall.”