Behind the Masks: Physicians Helping Patients Beat COVID-19
May 5, 2020
The images are everywhere: doctors and nurses, sheathed in gowns, masks, gloves, and face shields. The media generally deliver 30-second sound bites of drama. What kind of people actually step into this gear and up to the hard work of caring for coronavirus patients?
Many are hospitalists, a job title relatively new in American medicine. Trained as internists, these physicians oversee patients’ care throughout hospitalization. Where your primary care physician might once have taken on this responsibility, major medical centers now employ specialists in hospital medicine to follow patients — especially those with complicated cases who need many days or weeks of treatment.
In January, as UChicago Medicine began planning for the pandemic, hospitalists stepped to the fore. They helped set up special, stand-alone COVID-19 units — separate from intensive care, where patients might be unconscious or on ventilators — to reduce the potential for cross-contamination. To minimize the risk of “handoffs,” when caregivers change shifts, the hospitalists would work 12 hours straight, with extra days off to manage the inevitable fatigue from the demands of wearing — and regularly changing — personal protective equipment. Organizing this way would provide intensive experience for doctors treating those with a completely new, poorly understood disease.
Vivian Lee, MD, and Danny Ash, MD, were two of the first volunteers. Married to other hospitalists and without children, they felt ready to take on the challenge. As the numbers of infections grew and more patients were admitted, many more hospitalists would join them.
Their patients were seriously ill. Many had multiple underlying conditions, especially diabetes and cardiovascular disease, and the hospitalists carefully monitored and modified the complex medication regimens required.
But treating a new disease also involved many novel challenges. “We learned so much from one another and the individual strengths and research interests of each of our coworkers,” says Ash.
The urgency of the situation encouraged them to reach out to former classmates across the country and develop new “best practices” on the fly. Lee noticed that “proning” patients — turning them onto their abdomens, a technique often used for patients on ventilators — seemed to increase oxygen levels in non-intubated COVID-19 patients as well. Lee found her former residency partner, now at Ohio State, had the same experience, and they started proning patients much more aggressively. “Walls between institutions built up over time have fallen, and we are learning fluidly from colleagues all across the country,” says Lee.
Lee also found that ordinary, non-verbal communication can be lost under layers of personal protective equipment. One innovation she introduced: “face cards” with each hospitalist’s photo and title, so patients could see what they look like without all the protective gear — just one way to create a human touch.
Both Ash and Lee admit that visitor restrictions, though critical, can be devastating to patients’ morale. They have treated several members of the same family, just rooms away, unable to visit each other. One patient, isolated from her partner at home, was devastated to learn that he had died there while she was in the hospital. In another instance, a patient watched her partner pass away at home from COVID-19, only to be hospitalized with the virus herself a few days later.
Even discharging patients from the hospital after COVID-19 is complex. Many live alone or have no one at home to support their recovery, and few skilled nursing or long-term care facilities accept COVID patients. Patients who do have family to care for them fear infecting vulnerable people at home.
The most important message Lee and Ash want to share about their experiences to those sheltering at home? “Stay there,” says Ash, unequivocally. “Unless you have a family member seriously ill or unable to breathe, it’s easy to make the cost-benefit analysis that staying home is excessive. But social isolation is critical to stopping this pandemic, and early, decisive leadership here has kept cases down. We are risking our lives — and willing to do so. But everyone else needs to hold up their side of the bargain.”
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