I am a critical care physician. I am at the frontlines of this pandemic, in a state of “war” against an unseen enemy that has brought unimaginable destruction in its path.
I arrive at work at 7 a.m. for my shift. I am in a state of hypervigilance. It is a chilly fall day, but in my hospital issue scrubs, I feel warm. I am ready for what is to come.
I …
I am a critical care physician. These are the patients in the ICU.
It started with diarrhea. Then fever before the patient sought care. The infiltrates were impressive. A dry cough with paroxysms that were sometimes uncontrollable. The rapid test came back negative, as did the send out PCR. The patient returned from international travel two days before admission. My index of suspicion was extremely high. Yes, please keep the patient on enhanced respiratory droplet precautions because her viral load in the nasopharynx …
A physician waits in uncertainty
“Do you think we should prepare a will?” I vividly remember saying these words to my wife, also a physician, as we drastically saw COVID cases rise in early March 2020. Just months ago, we heard about the novel coronavirus now known as SARS-CoV-2 but did not grasp the world-changing consequences it would have. Living in Western New York, we were not immediately hit with a surge of cases like …
Life in the emergency department during COVID: a rural physician’s perspective
Mirroring the national surge of COVID-19 infections, this past week, I received a barrage of requests from patients seeking pre-travel COVID-19 tests. Despite urgent pleas from the CDC not to travel this holiday season, Americans seem hellbent on celebrating Thanksgiving the way we always do; around a table with family and friends. If COVID-19 is our mortal enemy, we are playing right into her hands. We are a stubborn nation …
Don’t let a negative COVID-19 test ruin your Thanksgiving
Patients deserve better. They lack access to and engagement with quality care — especially behavioral health care. Behavioral health goes beyond diagnosable mental health — everyone struggles with days that feel depressing or times that induce anxiety — you don’t need a prescription to know this. As of 2019, one in five Americans lived with a diagnosable behavioral health issue like anxiety or depression. That number skyrockets when you add …
Pandemic or not, we’re failing patients when it comes to behavioral health
I enter the hospital to work again. I must work as I have three small children and a husband presently out of work because of COVID. He is “non-essential.”
A violinist is playing at the employee entrance. I know they do this to lift our spirits. But it’s a slow, sad string that reminds me of the titanic. And yes, every day I clock in, I feel as if it’s a …
Pay attention to science and medicine, or else you may be the next careless victim
Finally, 2020 has offered some encouraging news, with Pfizer and Moderna publishing recent results that provide initial evidence of their vaccine’s ability to prevent COVID-19. With the recent promising results from both vaccine trials, it seems like only a matter of time before the FDA approves them. While some hurdles remain before the vaccine’s distribution and availability to the general public, this news is a welcomed relief for many. However, …
Will anyone take the COVID-19 vaccine when it’s approved?
As of November 2020, there are about 11.5 million confirmed cases of COVID-19 and 2,50,000 deaths from COVID-19 disease in the USA. Conspiracy theories thrive in times of great uncertainty, and the COVID-19 pandemic has proven to be a petri dish for them. Misinformation regarding the usage of masks, vaccine safety, and other pseudoscientific theories are thriving on the internet.
Many doctors, nurses, and other health care …
Physicians fight from the social media frontlines
Math was never my favorite subject. However, I was lucky to have good teachers who took the time to help me navigate through high school math and graduate with a final A grade. As I struggled with numbers and equations, calculus and fractions, I was told by one particular teacher to remember the five Ps of math: pen, pencil, paper, patience, and practice.
As of writing this, more than 11 million …
With the surge of information surrounding COVID-19 released in the news this year, an interesting concern arose regarding ibuprofen’s use in patients with COVID-19. In March of 2020, French authorities were the first to investigate anecdotal reports of severe COVID-19 infection in patients who had taken ibuprofen.
The initial concern involved the ACE-2 receptor. The theoretical concern was that NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen might …
The ibuprofen COVID-19 paradox
“Physician burnout” and “physician wellness” are now ubiquitous terms in the health care profession. For example, the ACGME’s common program requirements for residency now have an entire section dedicated to “well-being.” In addition to the numerous avenues currently available for physicians to improve their own wellness, I would also like to propose psychoanalysis as an option to consider by sharing my own journey as an analysand (person undergoing psychoanalysis) with …
Psychoanalysis for physician wellness
Like most situations that physicians encounter in their work, end-of-life conversations are not easy and require preparation and training. Yet these patient discussions are among the most satisfying I’ve experienced in my career because they’ve made me feel that I’ve made a true difference, offering comfort and a certain level of control to patients and families who are enduring difficult decisions.
Throughout my years as a practicing internist, I’ve had dozens …
End-of-life conversations: Why physicians should embrace the responsibility
I received so many messages from my last post, and I figured it would be useful to perhaps answer some of them for all to see.
Is it safe to see family over Thanksgiving?
Yes. If you live with them. That’s it. The only potentially safe alternative is requiring guests to self-quarantine at home for two weeks prior. Unfortunately, it’s already less …
Is it safe to see family over Thanksgiving? And other holiday pandemic tips.
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“As you know, his condition has been worsening dramatically over the past week. He is unable to breathe without the non-rebreather since last night. Today may be a good time for a goodbye visit.” I told the family of my COVID-19 positive patient who was DNR/DNI (Do not resuscitate/do not intubate).
In my second year of residency in obstetrics and gynecology, I thought that the days of caring for a male …
Using the COVID experience to build durable relationships with my patients
February 24, 1991, and I wait. I wait on the edge of my cot under the pitched canopy of my far-away canvas home; its sides pulsating from the ever-present wind; sand somehow traversing the walls, everything inside airbrushed a pastel tan; outside the surrounding Saudi Arabian desert limitless in all directions. The winds of war have been blowing, and the time has come. There are 10 of us inside the …
We are again at war with another unseen enemy
As cases of COVID-19 sore around the nation, the days of New York as the epicenter of the pandemic have become a distant memory for this emergency room doctor. Did the government really once send us refrigerated trucks for our dead and a naval ship for our sick? Did we really sit masked, goggled, and wrapped in plastic while sweating out shift after shift surrounded by coughing, gasping coronavirus infected …
The long months of winter are coming. Will we be ready?
On November 9th, the governor of North Dakota, Doug Burgum, decided to allow hospital workers with COVID-19 to continue to come to work. He required that they be asymptomatic and that they only work on COVID-19 wards with COVID-19 patients. Given at-capacity hospitals and skyrocketing case counts in that state, health care workers (HCW) had asked state leadership to take extraordinary measures to curb disease spread. HCW were (and are) …
The problem with allowing COVID-positive health care workers to continue working
“Those who cannot remember the past are condemned to repeat it” is a quote by George Santayana.
It rings true in so many facets of life and medicine. In my career in psychiatry, I have held fast to this treatise.
Psychiatry, as a practice, has changed over the years. We operate with the knowledge that we must always remember our past, especially since our past has been quite …
Weighing the ethics of paternalism and autonomy
I rarely post more than pictures on Facebook. In fact, I rarely use Facebook for much of anything anymore. But I need you all to just listen for a second.
I’m scared. For you and for me.
I need you all to take a minute and think of the last time that you interacted in-person with someone who does not live in your home. Did you …
We are making sacrifices for you. Please make a sacrifice for us.
As the mother of a child born with hypoplastic left heart syndrome, besides going through four open-heart surgeries and coding, my son has also had eight abdominal surgeries, including a Ladd’s procedure and resection of his colon. William also functions without his appendix, spleen, and gall bladder. In addition to every kind of therapy imaginable, he has had to endure pamidronate infusions, daily shots, G-tube feedings, and TPN. Who knows …
Thank you pediatric medical professionals, as we fondly bid you adieu
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