How are you doing?

[Telamir]

---

Members don't see this ad.

So how's everyone doing with this whole social isolation/quarantine/covid 19 going on? What has your hospital/practice done to cope with this? Any interesting non-coronavirus related cases you've seen?

Personally I'm doing alright. I'm able to do some of my night shifts from home to minimize exposure, and I'm doing the stroke alerts in the E.D. through telemed whenever able instead of going down to the E.D. I think hospitals need to differentiate between "nice to have" and "must have" neuro consults. One case springs to mind of someone who global anoxic brain injury who was also suspected to have COVID. MRI was catastrophic but I still had to go into the room to examine and write a consult and then talk to family. It felt a little...unnecessary maybe. Other than that volumes are down believe it or not. There hasn't been talks about "repurposing me" yet though. My expenses are super low cause I'm not eating out/doing much either!

One thing that sucks is the social isolation though. My girlfriend is a ICU nurse so obviously that worries me, and my friends outside of work will probably not want to see me/hang out with me until this is all done (more than however long social isolation lasts) since of course I have more exposure than they do.

So anyway, how's everyone doing?

 

[deathmerchant]

So how's everyone doing with this whole social isolation/quarantine/covid 19 going on? What has your hospital/practice done to cope with this? Any interesting non-coronavirus related cases you've seen?

Personally I'm doing alright. I'm able to do some of my night shifts from home to minimize exposure, and I'm doing the stroke alerts in the E.D. through telemed whenever able instead of going down to the E.D. I think hospitals need to differentiate between "nice to have" and "must have" neuro consults. One case springs to mind of someone who global anoxic brain injury who was also suspected to have COVID. MRI was catastrophic but I still had to go into the room to examine and write a consult and then talk to family. It felt a little...unnecessary maybe. Other than that volumes are down believe it or not. There hasn't been talks about "repurposing me" yet though. My expenses are super low cause I'm not eating out/doing much either!

One thing that sucks is the social isolation though. My girlfriend is a ICU nurse so obviously that worries me, and my friends outside of work will probably not want to see me/hang out with me until this is all done (more than however long social isolation lasts) since of course I have more exposure than they do.

So anyway, how's everyone doing?

It is getting very frustrating for me honestly. Inpatient is super light. I have cancelled most of my outpatients. I do few tele-visits for outpatient f/u. I try to not go in patient rooms whenever possible and just ask the nurse about the patient or examine/talk to them quickly from the door. I haven't had any cool Covid related Neuro pathology yet, but I've read about some cases of GBS, necrotizing encephalitis. There are reports it is causing Neuro-psychiatric issues which I think is just TME.

I spend couple of hours in the hospital, but i don't know what to do with this free time. Cant travel anywhere or even eat out. There's only so many podcasts that one can listen to!

 

[Telamir]

Inpatient has been pretty light at my institution too. Honestly I'm just enjoying it right now. I don't see outpatients so that's not an issue for me. I have done what you described though. Had a 1st time seizure consult w/ abnormal EEG so I had the conversation from the door and had the "moves everything, smiles symmetrically" exam haha.

I've had some interesting cases too, I had a CNS B Cell Lymphoma recently, as well as a HMG-CoA antibody necrotizing myopathy, and a new diagnosis of MG on a vent.

As far as what to do with free time: I basically go on a drive once a day, watch TV, and PC video games or something. Otherwise yeah I'm pretty bored. I just looked at my expenses and it's ridiculous how much less I'm spending without going to bars/restaurants, etc.

 

[neglect]

First two weeks were very hard to unplug. I’d just come off call, which was in the early days, so it was very stressful. In part that’s due to the fact my parents in law moved in, and if they get this thing they will probably do poorly, having most of the RFs. At the onset, I’m pretty sure I was the first person in my group to enter a COVID RO patient’s room. Then everything went silent.

We’re now doing telemedicine at a fraction of what we were, have all taken paycuts (easy to swallow when you’re the boss, if I were doing hazard pay and asked to swallow a pay cut, I’d probably quit), so essentially working part time. I love my work, conducting clinical trials, but we stopped enrolling. Those currently enrolled are kinda on auto-pilot, so they’re still coming in. But they don’t need much from me. There’s much less for me to manage.

Honestly I think I defined myself for so long by what I did, that without it I’ve had a major adjustment. Like a phantom itch, it’s just shy of distressing for about two weeks. With time the itch faded and I’m better. I’m mountain biking nearly every day, have had zoom meetups with old friends, and really appreciate my priviledge - that’s the word for it. I don’t have to worry about how to pay mortgage or rent, have plenty of cash reserves, etc. Was able to donate some food to those on the front lines, which made me feel great.

Family is fine. Kids have gone a bit feral. Out of school and one is loving it, has gone into full teen mode. The other is a stress ball and wants to do more homework. We’re doing well as a group, every night have dinner together and then watch a movie (1917: great. Hobbit: great. LOTR: a chore. Kids hated Aliens, but loved Alita. Mandalorian is unwatchable). In addition to exercise, I’ve also found that alcohol really helps just relax. Nothing crazy, just a beer or 3. I know that’s not a good thing, don’t want to trigger anyone, but I find it helps so I’m gonna stick to it.

 

[Telamir]

I haven't taken a paycut yet. I would not be surprised if there is one incoming for a few months or something. The hospital offered a "salary guarantee" to those who were on production in exchange for agreeing to be "repurposed" if necessary which is good for them but no hazard pay has been offered even for nurses which is bull****. I can afford the cut if needed (although I wouldn't be happy about it) but I think some of my colleagues are "living at the edge" and super worried about getting a paycut even if temporary. I don't do academic work currently besides resident teaching (medicine resident on rotation) and medical students, but the medical school has paused all the MS3-4 rotations.

I do the zoom/google hangouts with a few friends which is nice. I'm into cars, and I have a few fun ones I can take around for a brief drive daily just to get out of the house. I rent a house but like you don't have to worry about making payments. I found myself drinking LESS alcohol than before, actually. I only do it socially with friends and since I'm not seeing them I'm just not drinking. I used to have 1-3 beers 3-4 times a week on my weeks off before all this happened. Don't miss it, either.

 

[neglect]

I haven't taken a paycut yet. I would not be surprised if there is one incoming for a few months or something. The hospital offered a "salary guarantee" to those who were on production in exchange for agreeing to be "repurposed" if necessary which is good for them but no hazard pay has been offered even for nurses which is bull****. I can afford the cut if needed (although I wouldn't be happy about it) but I think some of my colleagues are "living at the edge" and super worried about getting a paycut even if temporary. I don't do academic work currently besides resident teaching (medicine resident on rotation) and medical students, but the medical school has paused all the MS3-4 rotations.

I do the zoom/google hangouts with a few friends which is nice. I'm into cars, and I have a few fun ones I can take around for a brief drive daily just to get out of the house. I rent a house but like you don't have to worry about making payments. I found myself drinking LESS alcohol than before, actually. I only do it socially with friends and since I'm not seeing them I'm just not drinking. I used to have 1-3 beers 3-4 times a week on my weeks off before all this happened. Don't miss it, either.

This is exactly why it is best to live under one's means.

 

[Postictal Raiden]

On the residency side:

In my program, all of the residents were pulled from electives and now only covering inpatient service. Residents split into two teams: one covers the service and the other is on quarantine (and for backup). Alternate every week.

Census has been record low, but enough to keep the on residents busy and engaged.

 

[neglect]

On the residency side:

In my program, all of the residents were pulled from electives and now only covering inpatient service. Residents split into two teams: one covers the service and the other is on quarantine (and for backup). Alternate every week.

Census has been record low, but enough to keep the on residents busy and engaged.

Thanks for the update. I cannot imagine being in training right now. Stay tough. These are hard times.

Edit: this NYT bio of grace and professionalism makes me proud of medicine. A New Doctor Faces the Coronavirus in Queens

 

[Telamir]

I think that approach is fine, so long as there is protection for residents. If they turn residents into operation human shield then that would most surely NOT be okay. I think ED/IM/FM/anyone in the front line residents should be getting hazard pay, but that's another discussion entirely. I've seen how some scummy PDs in other specialties have dealt with this and it's honestly very disappointing to say the least.

 

[Neurogeneral]

On the residency side:

In my program, all of the residents were pulled from electives and now only covering inpatient service. Residents split into two teams: one covers the service and the other is on quarantine (and for backup). Alternate every week.

Census has been record low, but enough to keep the on residents busy and engaged.

I have heard that every resident in my prior residency program has been "redeployed" at one point or another to take care of COVID patients. Of course, this is in one of the COVID hot spots. Neurology has been turned into a consultative service and the stroke unit along with the general Neurology floor has been turned into COVID care units. It's not just Neurology that has been redeployed. Ortho, Ophtho, rads, etc. as well.

 

[Postictal Raiden]

I have heard that every resident in my prior residency program has been "redeployed" at one point or another to take care of COVID patients. Of course, this is in one of the COVID hot spots. Neurology has been turned into a consultative service and the stroke unit along with the general Neurology floor has been turned into COVID care units. It's not just Neurology that has been redeployed. Ortho, Ophtho, rads, etc. as well.

Yeah, this must be in NY or other catastrophically affected places. Fortunately, in the Western region, things are still very manageable...for now. No one has been repurposed in my hospital. Even 80% of the IM residents are working from home to reduce exposure. What can I say, we must have excellent attendings who work hard to ensure the protection of both, the patients and the residents.

With that said, if poop hits the fan, everyone will be drafted to help and we all understand that. However, until then, we are keeping things lean and efficient.

 

[Neurogeneral]

What are you guys doing for EMG's during these times? In my system, EMG's and EEG's have been cancelled. I have been hearing that in the 1-2 weeks, things are going to be resumed as they were in terms of testing, procedures, etc.

I gotta tell you that I am somewhat nervous about doing EMG's again so soon. The main reason for my reservations are that we have to spend a lot of time very close to the patients during the conduction and needle exam. The patients are being screened for cough, fevers, etc at the hospital entrance, but COVID is so easily spread from those that are asymptomatic.....

When it comes to our clinic, we are currently doing virtual neurology in our clinics, which is nice but also has some obvious limitations in terms of assessing for instance neuromuscular patients. To address this issue, we are working towards having specific days when patients can come into the office to be seen

In terms of inpatients consults, I am thus far seeing everyone in person. I have not had to see anyone yet that is either suspected or confirmed COVD. I wear a surgical mask and do a quick targeted neuro-exam but otherwise keep at least a six-feet distance from patients.

Any thoughts?

 

[GuillainMollaret]

I gotta tell you that I am somewhat nervous about doing EMG's again so soon. The main reason for my reservations are that we have to spend a lot of time very close to the patients during the conduction and needle exam. The patients are being screened for cough, fevers, etc at the hospital entrance, but COVID is so easily spread from those that are asymptomatic.....

We never stopped doing EMGs (not my decision btw). Our EMG volume is about 10 to 20% of what it used to be as most patients choose to stay away and we try to focus on the more "urgent" ones like motor neuron and myopathy evals, but some patients with routine stuff like CTS are still insisting on showing up.

I wear a mask and 90% of the patients also choose to wear a mask. Not ideal but it's worked out okay so far.

 

[neglect]

We never stopped doing EMGs (not my decision btw). Our EMG volume is about 10 to 20% of what it used to be as most patients choose to stay away and we try to focus on the more "urgent" ones like motor neuron and myopathy evals, but some patients with routine stuff like CTS are still insisting on showing up.

I wear a mask and 90% of the patients also choose to wear a mask. Not ideal but it's worked out okay so far.

How is it not your decision to weigh risk and benefit of a medical procedure? I don't get that.

I'm not even ordering low probability blood work or imaging on my patients.

 

[Telamir]

I think where I'm at EMGs have been canceled except for if I need one (with good justification) inpatient. EEGs continue, but I feel bad for the EEG techs. As you know, some of these covid patients are intubated, and under anesthetics/meds or as a feature of encephalopathy many will have weird movements and EEGs are ordered constantly for "rule out seizure", along with neuro consults from time to time. I've been able to deflect some of these (ridiculous, one guy had a BUN 84, ammonia 90, PCO2 80, etc), but others unfortunately happen. I feel bad when these studies are requested or when I have to request one myself (had to request one recently for brain death) cause I don't want to put them in more risk than is absolutely necessary.

 

[neglect]

I think where I'm at EMGs have been canceled except for if I need one (with good justification) inpatient. EEGs continue, but I feel bad for the EEG techs. As you know, some of these covid patients are intubated, and under anesthetics/meds or as a feature of encephalopathy many will have weird movements and EEGs are ordered constantly for "rule out seizure", along with neuro consults from time to time. I've been able to deflect some of these (ridiculous, one guy had a BUN 84, ammonia 90, PCO2 80, etc), but others unfortunately happen. I feel bad when these studies are requested or when I have to request one myself (had to request one recently for brain death) cause I don't want to put them in more risk than is absolutely necessary.

The real shame are those who fail to think in this manner outside the pandemic. The technicians are humans, their work should have meaning. Yet I see so many BS abuses of their time. Someone with a BUN of 84 having an EEG should be an event akin to rain on the Sahara. But we abuse the system with low probability tests to make up for lack of thought, and now that we're in the middle of a time of scarcity, we see inertia.

If one needs a radiologist to tell you 80% of the diagnoses, look inward and get better.

 

[Neurogeneral]

I think where I'm at EMGs have been canceled except for if I need one (with good justification) inpatient. EEGs continue, but I feel bad for the EEG techs. As you know, some of these covid patients are intubated, and under anesthetics/meds or as a feature of encephalopathy many will have weird movements and EEGs are ordered constantly for "rule out seizure", along with neuro consults from time to time. I've been able to deflect some of these (ridiculous, one guy had a BUN 84, ammonia 90, PCO2 80, etc), but others unfortunately happen. I feel bad when these studies are requested or when I have to request one myself (had to request one recently for brain death) cause I don't want to put them in more risk than is absolutely necessary.

A couple of weeks ago, I had a consult for a confirmed COVID patient for syncope. He was recovering from a stay in the ICU. He had a history of A Fib, sick sinus syndrome, and even V tach (all reported by cardiology). Apparently, he momentarily became lightheaded and passed out while bending forward. I got consulted for syncope. I called the referring Hospitalist and we discussed that this event was likely due to some vaso vagal response or possibly related to his heart rhythm problems. I discussed there being no need to expose the Eeg or Mri technicians either as part of any possible work up and use up a whole bunch of already scarce PPE. He agreed to discontinue the consult. This is what I am gonna do for these types of consults during these times.

 

[cerebral edema]

I got a consult for a verified COVID+ patient in the ICU who told the internist that her hand shook a few days prior. No one saw it. Rule out Parkinson’s disease. ‍♂️

 

[Telamir]

You said no. Right? RIGHT!?

 

[cerebral edema]

You said no. Right? RIGHT!?

In a politically sensitive way, yep

 

[neglect]

A couple of weeks ago, I had a consult for a confirmed COVID patient for syncope. He was recovering from a stay in the ICU. He had a history of A Fib, sick sinus syndrome, and even V tach (all reported by cardiology). Apparently, he momentarily became lightheaded and passed out while bending forward. I got consulted for syncope. I called the referring Hospitalist and we discussed that this event was likely due to some vaso vagal response or possibly related to his heart rhythm problems. I discussed there being no need to expose the Eeg or Mri technicians either as part of any possible work up and use up a whole bunch of already scarce PPE. He agreed to discontinue the consult. This is what I am gonna do for these types of consults during these times.

I got a consult for a verified COVID+ patient in the ICU who told the internist that her hand shook a few days prior. No one saw it. Rule out Parkinson’s disease. ‍♂

Ah, the return of the nonsense consult. So wrong it difficult to formulate an impression that doesn't insult. Nature is healing.

First 1-2 weeks were a bit rough. Felt untethered. Now I cannot imagine working as hard as I once did. I'm extremely privileged, don't have to worry about rent, mortgage, food. This mid-life semi-retirement is not a terrible thing.

 

[Telamir]

I will say even with a low hospital census nowadays non-sults have gotten more painful to do.