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!


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!



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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


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.



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.



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.
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