It’s been a while and I’m getting pandemic fatigue. I’m too exhausted to do much of anything, including blog posts, but recently I was fortunate to be part of something really special. Happily, my friend and terrific doctor, Dr. Jon Hallberg, has put together something to help us re-connect with the arts. Read on for a brief intro and then look for important links at the end of this post.
Jon is a doctor at M Health Fairview Mill City Clinic, just a Hail Mary pass over USBank Stadium from my office at Hennepin Healthcare in downtown Minneapolis. Jon has for years produced Hippocrates Cafe (info on the live productions here) which is a performance event that explores health care topics through the arts. I’ve been to a live Hippocrates Cafe and was treated to song, poetry, comedy, music, and laughter.
So I am so thankful that Dr. Hallberg, along with his colleague Dr. Renee Crichlow, a talented group of folks at Twin Cities Public Television, and the University of Minnesota Medical School Center for the Art of Medicine, has produced a virtual version of Hippocrates Cafe. It premiered last week on Twin Cities Public Television and now is streaming online. I was honored to be featured in one segment, a one-minute poetry reading of Bouquet by John Patrick Murray which you can watch by clicking the link. (Also, how cool is it that my medical school has a Center for the Art of Medicine program?)
The show also features:
A gorgeous string quartet with members of the Minnesota Orchestra, Minnesota Opera Orchestra, and the St. Paul Chamber Orchestra.
A short film on what Shakespeare really did during the plague lockdown.
A lovely piece composed and played by Covid-19 survivor Nachito Herrera
A song from the voice and soul of Minnesota favorite T. Mychael Rambo.
Porch portraits. Poignant stories from a gorgeous diversity of cultures. Incredible photography. And much more.
I suggest you take an hour and re-connect with the arts. Here are links to stream it online or watch on TV.
Links to Hippocrates Cafe: Reflections on the Pandemic
Somewhere near the top of my “favorite things about my job” is working alongside medical students. It’s a privilege to get to teach – and learn from – medical students from the University of Minnesota Medical School as they are just starting out on their careers.
Sadly, one of the many casualties of this awful Covid-19 situation is that the medical students are gone for a bit. Due to shortages of masks and gowns, the uncertainties of this new disease, and the need to limit exposures, the students have been doing distance learning for the past few months. That means a lot less energy, curiosity, scholarly discussions, bedside teaching, group problem solving, and general excitement about medicine. Students are definitely a positive addition to our healthcare systems and I really miss them. And if you are ever a patient wondering about going to a teaching hospital, I might add that you should feel great about doing so. Students add a valuable depth of curiosity and attention to the well-being of patients. And teaching hospitals are by their very mission really good at staying abreast of latest medical science. The medical students keep us on our toes!
During each academic year I encounter loads of students. In this post I am going to highlight several and shine the spotlight on the next generation of doctors. I thought you ought to meet the men and women who may be your doctor someday and learn a bit about the process of medical education. Each one has given permission to be included. It’s also the 20th anniversary of my own graduation from med school (see photo above) so here’s a nod to the past while looking to the future.
The first years: Out of the classroom and into the hospitals
I know this first bunch of students pretty well. I met the 9 of them literally in their first month of medical school in the fall of 2018 for their Foundations of Clinical Thinking course which I co-facilitated with my friend (and superb medical educator), Dr. Anne Pereira. Our merry band met periodically for the entirety of their first and second years of medical school as we learned to “think like doctors.”
For several hours each week we’d sit around a table and talk through tough cases. The students did most of the work while Anne and I provided color commentary. Some of us talk more (I’m guilty of talking too much, I know, but I’m working on it!) while others are more subdued. Often someone writes on the white board. Usually one of the students brings treats. OK, correction, one of the students usually brought the treats (thanks, Katie!). Sometimes we’d get off track, joking about this or that (does Notre Dame even have a football team?), sometimes we would have a serious discussion about end-of-life issues. Always, though, we grew together as friends and colleagues.
We did that for two years. Then SARS-CoV-2 hit and that ended our group meetings.
(In case any of the students are reading this, I purposely wrote the official acronym for the coronavirus since medical acronyms often came up in our group discussions and I fully intend to pile onto your misery with yet another. BMP, HgB, PMH, ROS, VTE, DVT, NSTEMI, CVA, MVA, GSW, COPD, HIV, CML, LFT, BLT, and on and on and on and on! To that list we can add SARS-CoV-2.)
At the end of the second year of medical school, Anne and I didn’t get to hang out with our FCT group as our last few group meetings were virtual. Even our end-of-year “party” was via Zoom. I guess that’s better than nothing . . . but I miss this bunch! When I’m an old man, one of you may be my surgeon or my Emergency Med doctor, or my grandkid’s pediatrician. One of you may read my x-rays. Maybe one of you will be my primary care doctor and recommend I exercise more and yell at me to get my PSA checked. Just remember when you are hot shot doctors, I knew you when you were wide-eyed first year medical students when you didn’t know diddly about the spleen. Oh wait, I still don’t know diddly about the spleen so I guess I can’t hold that against you.
So here’s a shout out to my friends from FCT group. I’ve seen you go from that “OMG” look in your eyes in the first weeks of med school to your “I can’t wait to start seeing patients” look now that you are ending your 2nd year and entering the life-changing clinical years. You are ready and you are going to rock your clinical rotations and I really hope I’ll see some of you on the hospital wards at Hennepin Healthcare! (Don’t worry, I’ll go easy on you during rounds!)
They even let us take a picture one day in the swanky little room in the med school where we met. That’s our group of newly-minted 3rd year medical students in the photo above: Peter Kassis Akal, Heather Oas, Justin Lynch, Cecilia DiCaprio, Christian Ndekwe, John McCarron, Charles Warner, Katherine Casty, and Samantha Gibson.
The homestretch: the intensity of the clinical years
I met Anna Ayers Looby last fall when I barged into the team rounding room on one of the nursing units of Hennepin County Medical Center. These team rooms are where our “rounds” happen with teams consisting of an attending physician (me), a senior resident physician, a couple of interns, and one or two medical students. Often there is a pharmacist present and sometimes some other health professionals. Usually the room is strewn with empty coffee cups growing various fungi in them, a half-eaten pizza from 6 days ago, a bunch of white coats on hooks, and for some reason a disco ball or a stuffed unicorn sitting on the shelf.
Anna was starting out her 3rd year of medical school and thus she was learning how to put her book knowledge into real clinical practice with real people, real diseases, and real consequences.
Since my time with Anna nearly a year ago, she has now started her 4th and final year of medical school, which is that transition year in which medical students are at the top of their game in terms of book smarts. I always thought that some of the most knowledgeable people in medicine are 4th year medical students. They know just about everything, probably because they are always getting ready for some life-or-death high-stakes exam.
This is the year of medical school where students also have to make the huge decision about what speciality they wish to pursue. Surgery? Pediatrics? OB-Gyn? Family Medicine? Radiology? Or the best one, Internal Medicine (that’s my specialty!). So it is a big year.
I remember Anna on that rotation last fall. She was really smart and she gave superb presentations. Nobody is born with the skills to do a high-quality presentation of a patient’s case to a veteran attending physician in front of a group of people all of whom are senior to you in experience. It can be an intimidating task but it is a critical skill to learn as a medical student. Some students ramble on for what seems like hours and make the attending physician tend toward daydreaming about what’s for lunch. Others finish their thoughts in about 60 seconds, unsure of what to say next and having forgotten some key bit of information, like say, the vital signs. But Anna was just great at her presentations.
But this isn’t supposed to be a critique of her clinical skills. What I remember most about Anna is her obvious leadership skills in patient advocacy and her commitment to society. She is the type of future leader who will change things. She is grounded in the belief that we need to strive for justice in healthcare for all people, especially the most vulnerable among us. She’s open about that and it is incredibly inspiring.
Anna tells me that she is leaning toward becoming an Obstetrician-Gynecologist. If that pans out, there will be countless women who will benefit from her care. No matter what she ends up doing, though, Anna will make a difference. Although I must say I think Internal Medicine provides better donuts on rounds. Just throwing that out there for her consideration.
A new start: our newest doctors
These last two medical students are not actually students anymore as I write this. They are real doctors now, having graduated from medical school last month and just this week starting up their internship. I met them in the past on our inpatient patient care teams at Hennepin Healthcare/HCMC. Their stories are so different from my own and so I want to celebrate these two new doctors who both happen to be people of color and spent some of their lives in East Africa. Please read about them:
Dr. Mohamed Artan came to Minnesota most recently from Tennessee after his family escaped the conflict in his native Somalia and subsequent life as refugees in Kenya. With that background, he studied Biochemistry and Cellular and Molecular Biology and worked as an East African cultural liaison. In med school he worked to mentor and empower students of color. I swear the students are all over-achievers these days! I found in Artan an engaged, animated, inquisitive guy who gave rapid-fire patient presentations, thorough and complete, and his enthusiasm for learning was contagious. Here’s a brand new doctor who has seen inequities in the world and has the ability and commitment to do something about it. So glad he will be training with us here in Minneapolis in Internal Medicine.
Dr. Olivia Ondigi was also in her 3rd year of medical school when I met her. She is smart and has a keen curiosity. She also has a humble and kind demeanor along with a rich and deep perspective on medicine and society. I remember talking to her about her life as a US-born woman of color who grew up in Kenya, then returned to the United States. As such she brings a perspective to medicine so desperately needed in our profession. Olivia readily speaks with empathy for people who are unlike herself which, when you think about it, is really what you hope a doctor will do. Couple that with a warm personality and Olivia is exactly what this world needs in a doctor. She’s off to Virginia now to pursue her Internal Medicine residency and I can’t wait to see where her career takes her.
So there’s a glimpse at the future of medicine. I intended to write this post to highlight the absence of medical students in our clinical settings and relate that to the Covid-19 pandemic and how that bummed me out. But as I wrote it and reflected on this bunch, and as I wrote their names and posted their pictures, I didn’t want to talk about Covid-19. I felt hopeful. This cross-section of students from the University of Minnesota Medical School reminded me that the future of medicine is in good hands.
So for letting me embarass you a bit on this post and for your commitment to the patients you are privileged to serve, thank you to Peter, Heather, Justin, Cecilia, Christian, John, Chuck, Katie, Sami, Anna, Artan, and Olivia.
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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.
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:
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.
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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!
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.
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!
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:
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.
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.
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.
“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.