Beyond the medical lessons learned from COVID [PODCAST]

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“I am thankful to you SARS-CoV-2 virus as you allowed me to be human again, to make mistakes, and learn from them. You taught me to slow down so that I could reset and redefine my goals. You allowed me to have time for myself, to dream again, and plan my future. You pushed me out of my comfort zone and re-explore what I thought was possible or impossible. You helped me re-embrace my imperfections and love myself just the way I am! You showed me that this pandemic is a circumstance beyond my control and that there will many more circumstances, such as this one in life. However, what will always remain within my control or reach is my own thoughts about, and reaction to, such times. It is up to me now how I want to re-shape them to get to the results I want to see. Thank you, COVID-19, for being a great teacher. I respect you. I am not afraid of you but will always be cautious of you.”

Annie Nawab is a pulmonary and critical care physician.

She shares her story and discusses her KevinMD article, “Beyond the medical lessons learned from COVID.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Annie Nawab. She’s a pulmonary critical care physician, and she wrote the KevinMD article “Beyond the medical lessons learned from COVID.” Annie, welcome to the show.

Annie Nawab: Thank you so much, Kevin, for having me here. It’s my honor to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Annie Nawab: Yes, absolutely. I am a pulmonologist, intensivist, and sleep medicine specialist by training. I completed my internal medicine residency, along with my fellowship in pulmonary critical care and sleep medicine, from the University of Tennessee, Memphis. Then straight out of fellowship, I went to Joplin, Missouri, and I was at Mercy Hospital, where I served as an intensivist, pulmonologist, and sleep medicine specialist. In 2014, I got married and moved to Iowa, and now I am the medical director of the respiratory and sleep lab at Greater Regional Health in Creston, Iowa.

Kevin Pho: So we are now speaking in the middle of December, and we’re in the middle of the latest wave of the COVID pandemic. Working in pulmonary critical care in your hospital, can you share some of the challenges that you’re currently facing?

Annie Nawab: I think, like the rest of the world, the challenges are pretty much the same. It is a little bit more challenging because the hospital setting that I work at is critical access, so it’s a smaller hospital setting as compared to the big university centers. So the resources are very limited, and that’s how we started. We had to work with our limited resources, and that included our PPE, gowns, gloves, and ventilators.

But very quickly, we were able to come up with protocols for ourselves. What was working very well, we got to experience that firsthand. For example, not every patient needs to be on the ventilator, and we were able to manage much earlier than a lot of hospitals in Iowa. We started high-flow oxygen much earlier and saw wonderful results. But when our patients get very sick and they come to the point where they need to be intubated and placed on sophisticated mechanical ventilator settings, we transferred them out.

So that was a little bit different for me because, of course, with my training, I want to do everything that I have learned. But you have to just make those arrangements. Sometimes, I mean, I don’t want to use the word sacrifice, but that is what sometimes is needed, that you just have to look at your own resources, what you can do the best with that, and move forward. Like I said, like anybody else, the challenges are very similar, but the community setting has its own beauty. Patients love you, they are so dependent on you, and they respect your decisions. So we’ve been there for our patients and the rest of our staff, absolutely doing what the rest of America is doing.

Kevin Pho: All right, so let’s go into your KevinMD article, “Beyond the medical lessons learned from COVID.” Now, for those who haven’t read that article, can you walk my audience through it and share the story of why you decided to write it?

Annie Nawab: Yes, absolutely. I think when this pandemic started, like anybody else, I was also surrounded by uncertainty. There were a lot of things. All of a sudden, this virus, which initially we were thinking was from the common cold family of viruses, was going to be just like a regular flu-like illness that we would be dealing with. But very quickly, we realized, no, this is not what’s going on. What happened in China, what was happening in Washington State, things were just going crazy. So very quickly, we started realizing that we don’t have the resources. We don’t have, I will say, the usual things that we need, like PPE, gloves, and gowns. All of a sudden, those things became very scarce to find, even. So I think that I, like any of my colleagues, was surrounded by uncertainty, anger, not knowing what to do, and looking at people not responding to the pandemic appropriately.

You know, Kevin, all our life and through medicine, as you know, we go through so many different trainings. We call these disaster trainings. But it’s kind of so strange that nobody ever prepared us for what to do when a pandemic hits. I mean, we read about it, we watch these movies about pandemics, but we never think that this could happen to us until it happens, right? So that’s what happened. All those movies and things that we were reading became true. So I think when you are not expecting it and something hits you, you just don’t know how to respond, and I felt like that. And I started blaming everything on this virus, right? I was like, “OK, this is wrong because of this virus. This is not happening because of this virus,” like all of us do.

And that is when I was like, “This has got to stop. What’s going on with my life?” Going to work was scary because you just did not know what to expect. People were calling you things like soldiers and superheroes, and I’m like, “You know what? No. What kind of soldier am I? I’m pretty much unarmed. I don’t have enough PPE, I don’t have enough gowns and gloves, and here I have to take care of all these very sick patients.” The things that I practiced in critical care, the things that I knew always worked for my patients with severe respiratory distress syndrome, were not working in these patients. So it was a lot of surprise, and it just caused a lot of emotions to build up.

And I was just browsing through Facebook when I came across, I’m sure you know, my dear friend Dr. Sunny Smith. She is a founder of Empowering Women Physicians and a life coach, and she was giving a summer course. I had no idea what to expect from the course, but I was like, “You know, why not?” I just knew that there was something wrong. I was questioning myself, questioning my passions, questioning why I joined medicine, and all of that. I just knew things had to change. I knew that I needed help of some sort, and that is when I joined that course. And the life coaching that I got completely changed my perspectives.

I was like, “No, all these things that I’m thinking are all in my own mind. I’m creating all this.” How do I, as a physician, respond? So it kept coming back to me: When my patients code, what kind of role do I take at that time? I don’t panic at that time. I’m in the most peaceful state because I know so many people are looking up to me and a life depends on me. So I just kept thinking that this is like that scenario. It’s that big code, but unfortunately it’s this constant code, and there’s no end to it. But am I going to let myself worry unnecessarily and paralyze my thought process, or am I going to be the leader, pick myself up, and say, “OK, sure, this thing is hitting us hard. What can I do differently?”

So I think that’s when, all of a sudden, the vision started changing and my thought process started changing, because I knew, “OK, now, wow.” All along, being a physician and all that, I did not understand that, wow, I really did have 100 percent control over my thoughts and my feelings, and what can I change for it. So we started doing all these little things. The little time-offs, the mandatory time-offs that came, that initially we were very resistant to, where we felt that hospital administrators shouldn’t do that, all of a sudden felt like a blessing. I started enjoying family time and not feeling scared all the time that I was bringing the virus to them.

We sat down, my husband and I, and we’re like, “OK, you know what? Sure, we can get the virus. OK, if we get the virus, what do we do next?” And I think we started preparing ourselves for it. And I think when you start doing that, and our training is like that, you feel very different when it comes and attacks you, in a way. So I think that’s when I felt like I need to share this with my colleagues. I just need to pick up that pen and paper and write down all these amazing things that are happening to me, the lessons that I’m learning that were beyond medicine. Because we just live a medical life, and all we think and breathe is medicine, but there’s so much more to life than just medicine. And that’s when I started writing, and I did not stop. So that’s pretty much how I came up with this article.

Kevin Pho: So you’re talking about all the conflicting feelings that you had, and then you took this course, and now you sound like you’re more in a state of peace, certainly, with those feelings. How long did that take for you to make that transition?

Annie Nawab: Well, you know, the course started in July, and it ended in August. And I think that very quickly, going through that course, meeting my friends, the people who I call my friends, who were physicians, I was like, “Wow, I’m not alone.” Everybody’s going through a similar process. Everybody had similar concerns. Everybody had their own coping mechanism to handle this. And I think that part came very quickly, just a couple of life coaching lessons. Of course, you have to kind of battle with yourself, because you don’t want to share your thoughts and your feelings with anybody. You just bottle everything in, because sometimes you’re just being a big person, and you just go there and you’re like, “I’m going to just do everything that I’ve been taught.” And I think that’s what I was doing.

But when I started talking about it, I started realizing, “You know what? I have control over this.” And there’s a process. Like everything that we learn, you’ve got to learn it; it just doesn’t come to you naturally. And I think that’s the process that happened. I would say in a couple of months I started going through the process, and it’s an ongoing problem. I’m not going to say that I’ve learned everything. Sure, every day brings its different challenges, but you know what? It doesn’t seem like a challenge. It just feels more like a welcome challenge, I will say, if that’s the correct terminology. I just feel, “OK, well, I can do this. What’s the worst thing that’s going to happen? I’m not going to do it. OK, it’s OK. I’m a human. I’m going to make mistakes.”

I could never say that before, because most of us are always running for perfection and did not realize that actually this is not what we need to do. Perfection is important, but at the same time, it can become quite toxic, because it’s just like an endless journey. It’s just an endless run towards it. So I think that now, for me, I’m like, “OK, if I get my job done, it’s OK. It doesn’t have to be an A job every single time. And if I make mistakes, it’s OK, because I’m learning from them.” And I think that was very difficult for me initially to accept, so it’s still an ongoing process.

That’s what has created a lot of passion for something that I knew existed but never knew could be this powerful, and that is life coaching, peer physician coaching. And I am a life coach myself now. I have also completed my training in physician peer coaching. I just want to help my own friends. All of us are in this together. We work so hard. We feel underappreciated so much. We feel the burnout all the time. I went through all of those things that so many of your other friends and colleagues have shared, that the burnout is a real thing.

So we are going through all that, but the question is, are we going to just sit and be a victim, or do something about that? And I think that’s the journey I want to take my colleagues on. Let’s have a plan, a better plan. Let’s not hate something that we loved all our life, and we continue to enhance medicine. It’s quite sad when I hear how my friends are getting burnt out and they’re leaving medicine. So I think that before it’s too late, I want to jump in and help all my friends not to dislike or hate the profession that’s so amazing, because we need loving physicians and caring physicians. But it’s a burnout, realizing it and dealing with it, and there are so many amazing ways to do that.

Kevin Pho: We’re talking to Annie Nawab. She is a pulmonary critical care physician, and she wrote the KevinMD article “Beyond the medical lessons learned from COVID.” What you said was so right about burnout increasing even during the pandemic. Physician burnout already was at a 50 percent rate, and the pandemic has exacerbated that. Now, for those physicians who are burnt out and experiencing the symptoms that you were feeling earlier on, what are your top actionable tips of what they can do right now?

Annie Nawab: It’s a very good question, Kevin, because I think that the first thing, my biggest tip, will be: Please do not feel that you’re alone. I think it’s just that one split second when I realized that I was surrounded by physicians during this course who were facing and feeling the same feelings. So what this means is we are all human beings. Once we realize that, then we know that we’re going to make mistakes. We know as long as we’re learning from them, they are not, quote unquote, mistakes.

So I think the most important thing is recognizing. We are so intelligent; we can, in a split second, look at the patient and know there’s something wrong happening. So do the same analysis on yourself, right? If something is not clicking, if you think that there’s something wrong, recognize it and ask for help. And it is amazing how many different ways are available. You can do it yourself just by recognizing the thought process. Just look at your thoughts and see: Are these really serving me well, or are they just making me insane and crazy? I think it’s a very quick answer that comes along: “You know what? Yeah, sure, this is a thought.” Because, you know, it is.

I once read this, and it’s just such a beautiful thing to say, that your brain is like this untamed toddler. It just kind of runs around going crazy, and you just have to find ways to train it, pretty much. So yeah, we’re going to have an insane, crazy number of thoughts, because that’s what the brain does. But does that mean for every thought we have to go and carry out an action? No.

And I think when the burnout starts happening, it’s a very typical pattern. Everything seems bleak. All of a sudden, you start pointing fingers at everything except your own self. It is very tough to say to yourself, “I could be at fault also.” And there is a pattern, and once you recognize that, then that’s when you write these thoughts down and find somebody to talk to. And you’ll find yourself pretty much coming out of that state. And I’m not saying it’s going to get better. I’m not going to say all of a sudden you’re not going to be tired, all of us are not going to be exhausted, or all of a sudden you’re going to be this superhuman person. No, none of that. We just recognize, “Yes, it is happening to us. It’s time to take a break. It’s time to sit down. It’s time to spend time with your loved ones, change our scenery, and then come back to what we can do the best.”

Kevin Pho: And my final question, Annie: What’s your take-home message that you want to leave with the KevinMD audience?

Annie Nawab: So I think there are a couple of things that I really want to do, if I may. One lesson, one thing that I want to share, is purely with our general public. Please understand that we are not soldiers. We are not superhumans. We are not superheroes. We are human beings. We are in this profession for a reason. We are here to treat, to save lives with compassion. And to be called and labeled these things puts unnecessary stress that is not needed, because we are all human beings. We’re going to make mistakes. We also have families.

And I think that all of us need to do our part, because, Kevin, all of us, I will say the majority of us, know that this profession, this noble profession, is our calling. We are here for a reason, and we’re going to continue to provide the best care, because this is the oath we took: to provide the best care, save lives, and do no harm. This is the oath that all of us took. However, having said that, all of the other people need to also realize their role. So we need your help. We need your help to wear masks and social distance. Please don’t be in those gatherings, smaller gatherings, where you’re going to cause this virus to keep going crazy. It’s telling us something. It’s teaching us something, that sometimes it’s OK to be away from each other. It’s OK to maintain distance and still love. And I think that is what we need to do. If we all do our part, we can do so much. We can make such a huge difference.

And I think, lastly, this is purely for my physician friends and all the health care workers: You’re all amazing, wonderful, and worthy. All these tough times may knock us down, but they cannot knock us out. Our unity is what makes us amazing. We need to stay in a union. We need to be together in this, and we need to help each other, respect each other, love our lives, and know that you must take care of yourself before you’re going to provide the best care to anybody.

Kevin Pho: Annie, thank you so much for sharing your time and insight, and thanks again for being on the show.

Annie Nawab: Thank you so much, Kevin. I appreciate that.

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