A doctor’s diary from a pandemic: Art and medicine

Photo credit: Twin Cities Public Television, tpt.org

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.

Photo credit: Twin Cities Public Television, tpt.org

Links to Hippocrates Cafe: Reflections on the Pandemic

Thanks for checking in. And next time you hear Dr. Jon Hallberg dispense medical wisdom on Minnesota Public Radio, remember he is also a champion of the arts. Awesome.

Subscribe if you wish by entering your e-mail at the top of this page or do the Twitter thing @DrDavidHilden.

David

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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: 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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