A doctor’s diary from a pandemic: We will remember these days

I wrote the following short piece for the Minnesota Chapter of the American College of Physicians of which I am privileged to serve as Governor. I edited it a bit for my colleagues – physicians and all others – at Hennepin Healthcare. I offer it to you here.

We will remember these days.

Some day we will remember standing outside a patient room covered head to toe in hair net, mask, plastic face shield, gown, and gloves. We will remember looking at our nurse colleague similarly covered, look into each other’s eyes, take a deep breath, and walk into that room and once again, for the umpteenth time, be face-to-face with a patient. A patient with COVID-19.

Some day we will remember canceling every CME conference, business meeting, family vacation, wedding, funeral, and family gathering for a whole year and wondered how we will ever re-connect.

Some day we will remember how we learned how to care for our patients over a video connection.

Some day we will remember that crazy time when we put our masks in paper bags so that there would be enough for later.

Some day we will remember taking pay cuts and furloughs so that our hospital and clinics could survive.

Some day we will remember the time when our fellow human beings died without their family by their side.

We will remember these days.

But some day, we will also remember feeling closer to our colleagues than we ever have been and realize that these are our lifelong brothers and sisters.

Some day we will remember that people stood on their balconies to applaud what we do every day.

Some day we will remember that during a pandemic there was still kindness and compassion.

Some day we will remember that we were smart and we were brave.

Some day we will remember that what we do still matters.

We will remember these days. And we will remember what a privilege it is to be a caregiver at Hennepin.

Thanks for reading.

Twitter: @DrDavidHilden

Healthy Matters airs on News Talk 830 WCCO at 7:00 am Sunday morning Central time and streams live at wccoradio.com.

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A doctor’s diary from a pandemic: All about antibodies

Lately many of us are thinking quite a bit about antibodies. When’s the antibody test going to be ready? Can I get a test? Do I have antibodies? Will we be able to give antibodies from one person to another as a treatment? Are antibodies our ticket to resuming our normal lives?

What is an antibody, anyway?

In medicine we talk about antibodies all the time, though I am far from an expert on the subject. I remember learning about them in Immunology lectures from medical school, at least when I wasn’t talking in class. I remember them as Y-shaped thingies in our blood. Yes, “Y-shaped thingies” is the correct medical term. They look like this:

Photo: CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=916435

At least they look that way in the textbook.

Antibodies are the soldiers that live in our blood that fight foreign invaders to our bodies. The really cool thing is that once our bodies have encountered an invader like a virus or a bacteria, our bodies manufacture these antibodies in huge quantities. Those antibodies live in us long into the future so that when our bodies encounter that pathogenic invader at some future point, our bodies recognize it and are able to fight it off much more readily. This is the role of antibodies. When you think of it you may marvel at the elegance of a system that can learn from the past so as to be able to be prepared for future.

But that is exactly what antibodies do. Learn from the past. We as people could learn from our own immune systems about learning from the past!

The big questions in the COVID-19 pandemic may be answered with research into antibodies. So that is why I rolled up my sleeve in the picture above to see if my blood has any antibodies to SARS-CoV-2 (the real name of the COVID-19 virus). I was participating in a research project being conducted at Hennepin Healthcare where I work. The Centers for Disease Control (CDC) is conducting this study at 16 hospital sites around the country to help us understand how the human body is responding to this virus. The study is looking at healthcare workers (nurses, doctors, respiratory therapists, among others) who have been working with patients infected with COVID-19. I guess I qualify. The idea is to see how many of us are developing antibodies.

A quick shout out to Dr. Matt Prekker of Hennepin Healthcare. Not only is he leading the research on this antibody study in healthcare workers, he also is a board-certified doctor in 4 specialties at once: Critical Care, Internal Medicine, Pulmonary Medicine, and Emergency Medicine. Not only that, he is the guy drawing my blood in the picture above and he’s a great guy. He and his team of researchers are worthy of a “thank you” from all of us.

This is really important research. We used to call this virus the “novel coronavirus” because it is indeed novel – new – to the world. Due to that one fact, there was nobody on the entire planet who had any antibodies in their system. That’s also why it is so deadly because nobody has the foot soldiers – the antibodies – yet in place in their blood.

Once we learn more about the human body response to the virus, we should be able answer many of the questions for which our knowledge is currently lacking:

  • Does getting COVID-19 protect you from future infections? We just don’t know but it will depend on the antibody response and how durable that response is over time.
  • Do people develop antibodies even if they didn’t have symptoms?
  • How quickly does the immune response develop?
  • Importantly, can we use the antibodies from one person to treat another person who is really sick?

Vaccine research is based on immune response as well. Vaccines work by exposing your body to a teeny amount of the virus and allowing your own body to develop its regiment of antibodies. So these areas of research overlap.

I’ve heard it said that science will help get us out of this pandemic. Today I got a first-hand look at how that may look and it gives me renewed hope.

Thanks for reading this blog. Subscribe by e-mail if you wish to receive periodic notifications of future posts. My Twitter account is @DrDavidHilden for occasional updates from me as well.

David

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A doctor’s diary from a pandemic: Giving thanks

At my hospital and clinic system, Hennepin Healthcare, we have a method of communication called the Tiered Huddle system. It’s an innovative and really effective way for communication between people in the organization so that problems can be addressed in real time. These huddles happen every day in small work groups and at senior leadership. One feature, every day, is the “kudo” section in which anybody can recognize the contributions of another. It is a way to give thanks.

In the course of my day I see so many people doing so many things to be thankful for so I’d thought I would do a blog-based kudo session. Here are a few of my colleagues who give me great optimism, even though my hair looks like that picture above!

Nurses

I have often said and I truly believe that nurses are the heart of everything we do. So recently I asked one of our hospital nurses how she was doing. She was covered in PPE (scrubs, gown, face mask, plastic face shield, hair cap). You could barely identify who it was with only her eyes showing. In response, she went on to gesture with her hands at the other nurses around the unit. She said with such a great group of nursing colleagues, she was doing “great!” To nurses: thank you for showing that even in the scariest times, a team of supportive colleagues and a positive outlook makes all the difference.

Food service workers

The cafeteria at Hennepin Healthcare is the liveliest place in the hospital. You can always count on the good nature of the staff there. Often you’ll see people singing along to the music that is always playing prominently on the speakers. And the chefs routinely serve up food that is worthy of a great restaurant. But during COVID, things are a bit more limited, for obvious reasons. But our cafeteria staff still manage to provide food options for us in a safe manner (I do miss the salad bar and Chef Donald fixing me up a plate of cajun shrimp!). They still have the music playing and still come to work with their cheerful faces. Only now those faces are wearing masks. To our food service workers: thank you for providing one place in the hospital still available to healthcare workers that is free of worry and full of joy.

Chaplains, social workers and those who comfort

This is a frightening time for many. Not only for healthcare workers but for patients. It is a sad reality that all hospitals need to limit visitors to the hospital during this pandemic. We have done so as well and it is one of the issues we have struggled with the most.

How do you care for a dying person when their family members can’t be at the bedside? And how do you care for those family members? And how do you care for healthcare workers who themselves are frightened and exhausted?

At our hospital, I have seen our group of spiritual leaders and social workers and palliative care workers and patient representatives and ethics professionals all step up with guidance, support, resources to help, and a loving presence. Our chaplains routinely use technology to help families be with their loved ones, at least as best they can when they can’t be physically present. They put on weekly virtual seminars in which healthcare workers can hear the stories of their colleagues, voice their own emotions, and support one another. I’m really proud to work at a place that focuses on “Trauma Informed Care” and to the idea that we are never alone. To our chaplains and others who support patients and families and staff: thank you.

I’ll do more thank you comments in future posts. Lots of people to thank . . . security officers, interpreters, environmental service workers . . . the list goes on.

Hope you are all well! Subscribe to this blog by e-mail if you wish, and follow me on Twitter @DrDavidHilden.

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A doctor’s diary from a pandemic: Finding comfort

Meet Zoe, our 15 1/2 year old dog. Just look at that face! Zoe has no idea about coronavirus and social distancing is just not a thing for her. Her concerns today are the same as they were a couple months ago before the big pandemic hit: food, sleeping, and the occasional walk outside even though she limps now and can barely walk 50 feet. And if we’re having popcorn – her favorite – life is simply grand for this old pupper.

Don’t you wish you had the zen like live-in-the-moment life of a dog?

Our lives, alas, are a bit more complicated. Here at the hospital of Hennepin Healthcare, the halls where patient care is not done are as quiet at 12 noon as they usually are at 2:00 am. On the patient care units, the nurses and doctors and food service people and all the staff are busy doing what they do best – caring for people. Only now they are all gowned up and wearing face shields and masks. Lack of facial expressions between patients and nurses and doctors means eye contact is critical and surprisingly effective.

But all this leaves me to wonder about where we find comfort in our lives. For me, art has always been one of those areas of comfort. Whether it be live theater, orchestral or rock concerts, gallery shows or movies at a theater . . . these are things I miss.

Some ideas of stuff to do

So here’s what I’m doing to get a bit of comfort even while working in a hospital and doing my best at social distancing. And yes, I’ve resorted to putting up pictures of my dog. It’s come to that.

Minnesota Orchestra At Home. This is an awesome series of world-class musicians playing in their own homes. Check out Principal Cellist Tony Ross with his mother-in-law on the piano. They play Solveig’s Song by Grieg and it is beautiful, complete with his dog faithfully keeping everything on the up and up. Or Fei Xie and Christopher Marshall doing a bassoon duet. Even Maestro Vanska breaks out the clarinet with Concertmaster Erin Keefe playing a piece of his own composition. This Little Light of Mine by a brass quintet! There are many more and I recommend them to you for a quick bit of music and fun. Click the link above to see the musician videos.

Streaming on TV. OK, like nearly everybody, I’m watching stuff on the tube. My only problem is that I don’t really have any “shows” since Julie and I finished watching every episode of The Great British Baking Show before the pandemic hit. That show was our favorite (“it’s all in the bake” you know). But I still have episodes of Mrs. Maisel and The Crown to watch. And the new PBS Masterpiece mini-series World on Fire looks really good, at least based on Episode 1. And what to make of the Tiger King series. Oh dear. I watched the first episode and I’m just not sure I have the inner fortitude to watch another. Sort of like watching a train wreck in real time on that one.

How about books? I’m currently about 300 pages into David Blight’s Frederick Douglass. This is a hefty read but I am learning so much about the 19th century’s most famous orator. Here is something I didn’t know . . . it is largely thought that more people heard Frederick Douglass speak than any other person of the entire 19th century. And he was probably the most photographed person of that century as well. I found that super cool.

I’m also trying to remember to just be still every day. Not always successfully.

So we carry on with whatever comforts we can find. I hope you are finding some ways to find comfort amid the isolation if you are at home, and some comfort amid the chaos if you are working in healthcare/grocery stores/public safety/trucking/shipping companies . . . or any of the others out there keeping us going in important jobs.

Or you could always just chill out like Zoe the urban animal. Not a care in the world for that beast.

Follow me on Twitter @DrDavidHilden, subscribe to this blog by e-mail above. All kinds of ways to stay connected!

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A doctor’s diary from a pandemic: Caring for the caregivers

Many of you have reached out to me and my colleagues in healthcare with words of support, thanks, and encouragement. It means more than you know that the doctors and nurses and therapists and mental health workers and cafeteria workers and housekeeping staff – all of us – get uplifted in the hearts of our community.

Speaking for the physicians (and the nurses, I’m sure) . . . we all went into this to be of service to others, and indeed, we all did “sign up for this.” But nobody expected to work with this level of anxiety. Nobody expected the level of worry that we may be exposing our families. Really nobody expected any of this.

So at Hennepin Healthcare, we are offering small but real ways to support our colleagues. Just yesterday our Foundation provided food for the staff in the ICU and nursing units. To see our CEO Jennifer DeCubellis delivering 215 sandwiches to our staff is what we are all about.

Our Office of Provider Services provides healthy snacks in a quiet place of the hospital so that we can get away for just a minute. The manager in Labor & Delivery brought snacks for the nursing staff in that unit which must be present 24/7. Someone offered to cut hair. Our spiritual support team is made up of chaplains and spiritual healers who reach out to us every day. (I know, they reach out to me personally and for that I am grateful).

People in the community continue to offer masks and donations and words of support. From all of us, thank you for this.

Our anesthesia department even did a secret dropoff of this coveted item to colleagues:

So we carry on, in what feels like the calm before the storm which is surely coming. Except even the calm isn’t so calm, because here in Minnesota we are gearing up for what our friends in New York are seeing now. I have a friend who is an Emergency Medicine doctor in Boston. Her strength is inspiring.

And so we take a collective deep breath and come back to the hospital and clinic the next day.

If you want to support the healthcare workers of Hennepin Healthcare, here are some ways:

  • Write a word of thanks on our online thank-you page.
  • Make a donation to the Hennepin Healthcare Foundation who will put it to good use in support of our staff. Just click the “Donate” button at the top. While on the site, you can learn much more about COVID-19, set up E-Visits, see a message from Jennifer DeCubellis our CEO, and much more.
  • Perhaps most importantly, you can help by staying home. I mean really, stay home as much as you can. Consolidate trips to the grocery store so that you don’t go so often. Don’t congregate in groups ever, even when outside. What you do now will affect how our hospitals are able to manage in a few weeks.

So thank you!

David

@DrDavidHilden

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A doctor’s diary from a pandemic: Mental illness

Almost every day I walk through the patient care areas of our hospital at Hennepin Healthcare and lately I’ve been visiting the staff and patients in our 6 psychiatry units. Since I’m an internist, meaning I care for people with medical illness, I usual focus on patients on the internal medicine floors. But walking through the psychiatry units reminded me of the unique place people who experience mental illness are in.

At our hospital, just about 1 in 4 patients in the hospital is in a psychiatric unit with a mental health diagnosis. Possibly that is more than you realized previously. They are representative of all of us: rich and poor, young and old, urban and rural, you name it. Mental illness is a reality for all of our community. Furthermore, our mental health system is fragmented and historically we have not adequately provided a system robust enough to provide the care people need and deserve. So this pandemic presents unique challenges.

The current COVID-19 pandemic presents is hard enough for all of us. It produces anxiety in people who previously had not experienced such things. But for those who are experiencing mood disorders, psychoses, and other severe mental health conditions, it can be especially troubling. Coping with everyday life can be challenging in the best of times for people experiencing mental health issues. During this pandemic it can be crisis-provoking.

But the staff in the psychiatry units at Hennepin (and every other hospital) are skilled and dedicated to patients with mental illness. Here’s some insider info . . . the psychiatry units are not like regular hospital hallways that you may have in your head. They are more like a dorm at a college, with rooms down the halls around a common area when patients and staff co-mingle, eat together, watch TV together, and help each other heal. They have rooms for group therapy which are vital to the healing process. They have a kitchen-area where people have access to snacks. The nursing desks are centrally located which allows for lots of interaction.

All of this is challenging to do when coronavirus is on the mind of everybody. How do you do social distancing in that setting? How do the doctors and nurses and therapists promote healing when part of healing is socialization and group activities? How do you calm frazzled nerves when someone in a common area coughs or sneezes? How do you do all this when the length of hospitalization is measured in many days or even weeks?

Over the years I have become rather close to some of my colleagues in psychiatry and I appreciate the skill set of a psychiatry nurse or doctor so much more than I did a few years ago. So I write this post to honor those who care for people with mental illness and in support of those among us who are experiencing mental illness. During this pandemic – but really any time – I hope we all will check up on our friends and neighbors who may be struggling and to reach out to them by phone or from across the yard from a safe distance and offer a word of support.

Check out Minnesota NAMI for online courses and support.

For more good resources on mental illness, including COVID-19 information, check out the National Alliance on Mental Illness.

Follow me on Twitter if you wish @DrDavidHilden

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A doctor’s diary from a pandemic: Social distancing in the hospital

So how exactly does one practice social distancing in a hospital?

We are struggling with how to be present for each other and for our patients all while keeping our distance. Those two priorities are sometimes – but not always – mutually exclusive. Being present is literally one of the tenets of person-centered care while keeping six feet apart is literally one of the tenets of social distancing.

Make no mistake, social distancing is necessary and we can do it. To prove it to you, check out our cafeteria at Hennepin Healthcare in this picture:

Yup, we moved out all the tables to ensure we don’t get too close. Oh, we still stop and greet each other in the hallways, but do so from a reasonable 6 feet apart. Most meetings are by video or phone which is a mixed blessing: good becaues meetings are shorter and more to the point but bad because there is something lost when colleagues can’t see each other or laugh together or have a back-and-forth exchange of ideas. And coffee shops and gift shops are closed. The hallways in the areas of the hospital not directly involved in patient care seem oddly quiet.

So like you at home, we do our best to be present while being far apart.

But what about our patients? The hallways on the patient care floors are still buzzing with the usual activities of patient care. But with patients, how does one practice social distancing? This one is way harder. Masks make it harder to read the face of people, for instance. It is hard enough to give hard and potentially scary news to a patient but even harder when you are wearing a surgical mask and gown and standing across the room.

How about human touch, that most basic part of being a doctor or nurse? If I’m not going to gain any meaningul knowledge that will help you by listening to your chest with my stethoscope, I probably shouldn’t take the risk and I should not touch you at all.

Perhaps hardest of all and the aspect of this COVID-19 pandemic that I can’t get my head and heart around is the restrictions on visitors when someone is critically ill. Our hospital has rightfully limited all visitors to just one at at time to prevent transmission of COVID-19. It is absolutely the right thing to do to protect as many patients and visitors and staff as possible. But some hospitals in the US have limited visitors to zero and we may get to that point as well. We have some extreme end-of-life compassionate care exceptions, but even those exceptions will be less frequent if this pandemic worsens.

There was a piece in the New York Times, called I’m on the Front Lines. I Have No Plans for This.” It is written by a critical care doctor, Dr. Daniela Lamas, at Brigham and Women’s Hospital in Boston. This is a US hospital. I have friends who are doctors there. This isn’t some far off hospital in another country. This is in one of our country’s premier hospitals. I encourage you to read what Dr. Lamas writes about the real possibility of a “medical solitary confinement” in which patients in COVID-19 wards may be dying alone.

I doubt I’ll ever truly come to accept the possibility that people will be alone while critically ill. I never want to see that. So that is why we practice, and you should practice, social distancing.

Thanks for checking in with this free-form, stream-of-consciousness diary from a pandemic. I’ll write more in a couple days.

David

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A doctor’s diary from a pandemic: “To don and to doff”

“Here ye, here ye, a decree has gone out to all ye who hath ears, that thou shalt don and doff personal protective equipment with alacrity but not beforeth thou shalt have cleansed thy hands for a greatly long time whilst humming a jolly ditty for 20 seconds, lest thou besmirch thy garments and thy personhood with the dread pestilence”

March 21, 2020

Such is the state of affairs at the hospital. Healthcare workers have always worn protective equipment when dealing with germs and diseases and other nastiness, but we’ve taken it to a whole new level now. People around the hospital now throw around terms like PPE (personal protective equipment), don (to put on), and doff (to take off) like they are some new millennial-inspired texting shortcuts. We don and we doff like champs – but you may be surprised to learn that there is a right way and a wrong way to put on a gown. Turns out many of us need a bit of a refresher course, so at Hennepin Healthcare we have a pedal-to-the-metal education campaign in full force, headed up by our awesome in-house educational team (thanks, Chris, Steph, and Dr. Meghan!).

Every day during our COVID madness I find people who are contributing to keeping us prepared. Our donning and doffing educational plan involves a) posters around the hospital campus, b) high-quality training videos produced by our in-house team, and c) people roaming the halls to do real-time, in-person, and supportive education to all of us about how to put on (don) and take off (doff) our PPE.

Hand hygiene. Mask. Gowns. Gloves. Face shields. Who wipes down the doorknob. Who goes in the room. Who stands outside with a donning-doffing checklist to make sure we do it right. How to take the darn gown off (it isn’t as simple as you think!). This is what we talk about every day.

Some are born to doff, some achieve doffing, and some have doffing thrust upon them.

We even have a PPE Conservation Team who is tasked with safe-guarding our limited supply of protective gear. We struggle with the lack of adequate supplies. Our hospital carefully counts and controls how many masks we have left, how many gowns, how many gloves. Some of it is locked up in a secret location. And my friends, hospitals do not have enough for now.

So we have all become expert donners and doffers (OK, are those really words?) at the hospital. Doing our best to stay safe all while conserving what we have. Yup.

It isn’t for lack of trying, or lack of willingness to buy more gear. Supplies are just not available in our country in the amounts we need them. We should all take a collective sigh at that fact. And then we should all insist of our national leaders that they correct that. Masks are not rocket science. We can do this.

To don or not to don, that is the question.

Actually, there is no question. We don. We doff.

OK, I actually wrote a post about the exciting world of putting on gowns. If you made it this far, thanks!

In the end, I believe this pandemic will make our communities stronger. Check back often for more of my random thoughts from a hospital in the midst of a pandemic. Subscribe by e-mail to get notifications if you wish.

David

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A doctor’s diary from a pandemic: “This too shall pass”

Hi, friends –

Today I am starting a new regular feature on myhealthymatters.org.  I, like you, have found life turned upside-down as we collectively struggle through the COVID-19 pandemic. In my role as a physician in a safety-net hospital, it has consumed my time as well as the mental and emotional energy of all 6,000 Hennepin Healthcare employees.

I offer this series, “A doctor’s diary from a pandemic” to you for some perspectives from inside a US healthcare system.  This will not be a data-packed feature (go to cdc.gov for reliable COVID-19 information).  Rather, it will be my barely-edited reflections in real-time.  Hopefully you will find it informational, perhaps a source of solace, or at least mildly amusing.  Read on and look for posts nearly daily.
David Continue reading “A doctor’s diary from a pandemic: “This too shall pass”” Facebooktwitterredditpinterestlinkedinmail

COVID-19: What it’s all about?

On our Sunday, March 8 show Dr. Caitlin Eccles-Radtke joined us for a conversation about COVID-19. She’s an infectious disease and infection prevention specialist at Hennepin Healthcare. You can listen to the entire show via podcast using this link: https://wccoradio.radio.com/media/audio-channel/healthy-matters-3-8-20

David Hilden, MD:

I have Dr. Caitlin Eccles-Radtke in the studio in Minneapolis. Dr. Eccles-Radtke is an infectious disease expert and has been helping lead our COVID-19 efforts at Hennepin Healthcare. So Caitlin, thank you for being on the show and welcome.

Caitlin Eccles-Radtke, MD:

Thanks for having me, Dave. Continue reading “COVID-19: What it’s all about?” Facebooktwitterredditpinterestlinkedinmail