I haven’t really rethought all that much. I have been guided by my experience and training. I am very passionate that people understand what is the state of the science and the medicine. This will be unpopular so I will buckle up for the blow back on the following statement:
There is nothing really new under the sun. I am not seeing atypical presentations of pulmonary disease that acts differently than any other syndrome from other causes. I am not sure I am explaining my thoughts all that well. What I am seeing is a far more rapid response to more aggressive vent settings. Should we have been doing this all along? I am also seeing that we are bypassing literally 3 - 4 temporizing therapies (High Flow, CPAP, BiPAP) and heading right to the vent. I am not sure this is a good thing, and feel it MAY have been a reaction to possible unconfirmed reports of aerosolizing the virus. In this, perhaps this is an over-reaction?
I know we are hyped up about a lot, and it is nearly impossible to set aside the emotion of the lockdown and practice medicine scientifically and artfully instead of reacting to what we are seeing. The numbers, though, just aren’t there. And if the trend holds in NYC (big if - in my analysis, I have noted that there is a weekend lull if you will, however as some others have pointed out, deaths are probably accurately reported) then perhaps we have an indicator of apex or being very near to it. What I do know, is that there is a not a glut on the healthcare system even in the hottest of spots
I will always be unfailingly honest in my assessment. And when I am wrong I will say it. To you, then, I also add my apologies for being harsh. Here is the story that is not being told...
I walked by a sign at my hospital last night that says heroes work here. Now that we are under lockdown, we as workers enter in a special spot in the hospital away from everyone else. They call it “heroes” walk. I dont feel like a hero, as every time I walk in the hospital it is not lost on me or my colleagues that we are putting our lives, and the lives of our families on the line. I suppose this is true every time we treat, particularly in critical care. But to be called a hero when you are filled with some degree of fear and self doubt feels bad somehow. I am not looking for praise out complements, believe me.
But the first time I took out a laryngoscope and intubated a suspected case, I was frightened and I have handled well over 25,000 airways in my life. Truthfully, we are scared, but every day we put the emotion aside and walk into that ICU and do our best. So I suppose I am asking for a little slack as most of the time this isn’t all that emotional to us. I have had colleagues die of disease that have gotten through an errant needle stick, or become ill with whatever is going around, it is just an ongoing reminder as to our frailty — and we are all in that same boat together.
Lastly, I believe we will get through this. What I am baffled by is the scoreboard mentality and the macabre relationship with death that we are all watching on the media. it is sick. It is not how we are supposed to live. It is not healthy.
I will pray for you and wish you all the health and safety there is. I am now going on a walk in this glorious and beautiful day, I do not have to go back to work for a couple of days, so I will now attend to living instead of disease...
I am sorry for speaking harshly to you. I ask for your forgiveness.
Doctor, after reading your post, I would not fire you. I would instead seek you out to help me. I withdraw my first post to you. It no longer has any meaning.
You are indeed a hero. A real one. There is nothing at all to forgive.
God bless you and your patients, and God bless America.
Sincerely,
Chris
Any jerk can do heroic things when they aren't scared.
Should you have the honor to treat a Medal of Honor patient, ask them if they were scared when they earned it.
I'm willing to bet you won't find one who wasn't terrified!
And I'm willing to bet they'll tell you the ones who didn't come back were the real heroes.
Thank you for your posting and I am recommending others to check out your comments.
Re: 134 - thanks for posting this. Appreciated.
gas_dr:
“I walked by a sign at my hospital last night that says heroes work here.”
gas_dr, it is true that you and your co-workers are Heros. Understand this; Anyone of us, for any uncontrollable reason or planned surgery, we put our lives in your capable hands. Yes, you are a Hero!
When you walk past that sign, remember, you, through your skills have saved a life today.
Thank you, Thank you, Thank you.