The aftermath: Covid, Mortality, and where we go from here. But are you really surprised?

[Thanatos]

I have to be honest…..I always thought this job would kill me.

I did think it would take a little longer than this though….like a slow death. Over time this line of work would just wear me down to a shell of my former self, and then one day I would just fade into the myst like a mythic warrior or something. Like I would be absorbed into the ether, or called up to heaven directly like Elijah (for those of u who are biblical). My grand plan was to take the fortune I had amassed over my lifetime and pay off an OR charge nurse and newspaper obit reporter to write that I had died tragically during a redo penis reduction surgery….but a man can only dream.

Because let’s keep it real now….most of us don’t exactly have the best habits. We eat too much garbage…fast food, late night pizza delivery, vending machines…..most of us drink a lot (at least I do)….I read something recently about how detrimental lack of sleep is to your health. Apparently sleep experts say that even a car alarm going off in the middle of the night interrupts ur micro-sleep (even if u don’t remember it) and has a profound impact on your health….it went on to say you should wear one of those girly eye masks and ear plugs every night….just in case!!!! I mean Jesus, if the average person should put themselves in a deprivation chamber every night to have a chance at a good long healthy life what the hell do those of us with a pager do about that….compound that interest if you’re a surgeon who has to get out of bed in the middle of the night?!?! Multiply x 1000 if u do trauma, transplant or ECMO? Based on that I should probably drop dead any minute anyway, which certainly makes this whole COVID thing less impactful on my overall health.


Perusing social media though the fear is real….doctors, nurses, all essential hospical personnel……terrified that this could kill them. Because make no bones about it, this virus can kill you and me and anyone else. It’s especially grave for those of us working in healthcare that can’t just shelter in place all day….like the gamblers on wall street, politicians, athletes, JCAHO, insurance company CEOs….**** they’re staying home where it’s safe!!

It might make you reflect on your own mortality, which doesn’t seem unreasonable. For the record I personally have almost died a few times, and each one was very different emotionally. I was in a motorcycle accident once in college, before a career in medicine took over….bright sunny day, I was on a 4 lane road in the right most lane with a car to my immediate left. A nice lady in a big SUV pulled up at a stop sign intersection, looked right at me, and pulled out right in front of me. So my options were either to hit the car on my left, hit the lady in the SUV, or fly into the ditch and take my chances and wrestle the monster bike through it. You get about a fraction of a second to decide this btw…..but time slows down dramatically. I remember looking at all the cars around me, I remember looking at my side mirror to calculate if I decided to crash if someone behind me would then run over me. No great options I thought, but in the split second I chose the ditch. Man that hurt, when I finally came to a stop that is. I flew off the bike and wound up in the grass looking up at the sky. I could hear the engine sputtering along and thinking I hope it’s not about to land on me, but really I remember thinking to myself….I really don’t want to die. That’s all I could think…I just really wanted to live. More than anything and more than ever before. In the end I was fine of course…..youth is wasted on the young and all. Bike got trashed but I just had scrapes and bruises….I gave up riding them though (not right away because some of us are smarter than others). Just to clue u in to how sick I am I actually miss riding motocycles…and I’ve decided that if COVID doesn’t kill me I’m going to go buy a really fast one, and take it up in the hills and lean into the turns going way too fast….because why not.

Another time I almost died was on an organ procurement…and we’ve all heard about harvest teams going down in planes and helicopters. It’s always in the back of ur mind I guess…although I usually enjoy them (maybe better not to explore the psychology). I’ve gotten to the point where I don’t tell my wife when I go out on these because it turns her into an emotional wreck….probably not the worst thing I’ve kept from her. I flew somewhere once to pick up a heart and was flying back….hadn’t slept much in days and as any good transplant surgeon knows the flight back is the best! Can’t be paged or called, so turn off the lights and tell the coordinators and students not to wake u under any circumstances. So when my medical student woke up before landing my initial thought was….less than professional. To her credit though she’s a good person….I noticed right away she was shaking. Terrified and at a loss for words, she said “Dr. Thanatos umm…I think u should put ur seatbelt on” This plane was rocking…I felt like I was in a washing machine…..and I was sleeping through this??? Jeez that’s impressive in and of itself….i looked out the window and we were about to land. I could see the ground sort of, it was raining and lightning was flashing, the wind was clearly pushing our little plane around at a whim. This is how ants must feel when a kid burns them with a magnifying glass…just at the mercy of a much more powerful force you can’t even wrap your head around. In a small plane you can look straight ahead and see out the windshield…..and the horizon was oscillating at like 3000 hz. The pilots were panicking and I can tell u that’s really, really not comforting……which is why I never panic in the OR incidentally. Transplant fellowship was a long year, and I remember looking out the window and thinking well……I guess this is it. But time didn’t slow down this time, to be honest I didn’t feel anything really. Maybe that’s what 10 years of continuous fatigue and abuse do to you, it’s almost like I was just angry. I remember thinking **** it…I hope we hit something hard, I don’t want to limp away from this disaster. If I survive they’ll probably make me fish the cooler out of the smoldering heap of ash and go back to work, and frankly I’d rather be dead. So let’s bring this thing down like we mean it, I hope the degenerates who accepted this organ for transplant die of cancer of the eyes. We landed and after skidding around the runway for a bit I lived after all……

I guess what I’m trying to say is that training had caused me to have less faith in humanity in general anyway. Anne Frank, before she died in the holocaust, said that despite everything she still believes people are good at heart….clearly she didn’t do a general surgery residency. Because after that if u come out on the other side still thinking that people are inherently benevolent then you’re a better person than I am….that may not be saying much but still kudos to you, I’ll recommend you for sainthood. But as this thing gets uglier and darker, I’m not surprised by any of it.

Which kinda brings me to the other big observation here….once you get past the fear, the other universal response I’m seeing from us frontline essential workers is anger….shock, betrayal, fury…….at the lack of PPE, lack of response from the powers that be, disgust at the lack of coordination and disinformation by the white house and hospital administrations.

But taking the sum total of all of your experiences in health care, from your first day up until now….are you surpised? Like really surprised? I mean don’t get me wrong, the lack of equipment and preparation and etc is totally criminal……but are you really all that shocked??

As physicians we’re all alone in all of this. Period. But we always have been…..all it takes is a pandemic to make this all the more obvious. I would argue though it’s always been this way, just in less dramatic fashion…..Remember the first time you had to discharge someone on a weekend and there was no social worker? Or when you had to write TPN orders on holidays because nutrition didn’t come in (they would then come in the next day and criticize u harshly for getting the selenium dose incorrect). How many times have you skipped a meal, been NPO inadvertently for 12 hours just to have JCAHO yell at you for drinking coffee in the hallway? How much **** have you had to eat for forgetting to take off a mask in the hallway after a 12 hour operation where the person died and you’re still wrapping your head around it. Ever work for 2 straight days non-stop and have someone lecture you about missing a committee meeting that could have been addressed with a short email? Did you ever think this was a team sport really? How many times have you gone to a meeting and raised concerns about something…..was it ever taken seriously? Did anything ever change??

Again don’t get me wrong….it’s tragic. But none of you really thought that administration had ur back right?? Did you think the politicans would do the right thing by us at the end of the day? If one of your colleagues got sick, missed work or literally dropped dead did you ever think they wouldn’t just step over your corpse and tell your partners or co-residents to get back to work?? Remember the resident who committed suicide in NYC and their coworkers had to walk past the body on the way to work….it’s almost straight out of house of god. And after having one of the most litigious work environments ever, with individual surgical outcomes reporting without any qualifiers for people doing high risk work….now New York is begging people to come out of retirement to help, they’ll even put you up at the Four Seasons.

It’s poetic that those of us essential personnel are taking the risks boldly and some of us will die….but is that surprising either? I’m so proud to be an essential healthcare worker… and the news has been so inspiring…..healthcare workers putting on hefty trash bags and bandanas and going to work. Because that’s who we are….who we’ve always been. Older physicians with underlying health problems feel guilty for not coming in……they try to help with telemedicine. Medical student are volunteering to graduate early and join us in the battle….nurses and Pas have stepped up big, people are re-deploying throughout the hospital to find ways to help. I predict they’ll keep doing it, we all will until the war is over and then we’ll see where we are……it’s all we can think of to do so it is what it is…..

But how many other people are secretly, quietly right now……..looking right, looking left….and saying to their jobs, **** this I’m outta here. If you can’t protect me I’m not bringing this home to my kids, my spouse, my parents. People who can retire may quietly go out into the night and not look back right now…..but what about after this is all over?


To me that’s the real question…..how many will leave after all of this? And how many will never sign up for this career now? Like I say above, I think we always knew. But having the system turn on u, dramatically in your face….that’s gonna be hard to get over for a lot of people. Once the crisis has passed, and everyone’s reflexive sacrificial burdens have passed….a lot of people will peace out of this. And who can blame them?

Today our administration said that if we find ourselves in a real scarcity that healthcare workers wouldn’t get any priority over other people, because it wouldn’t look fair to the public otherwise. I guess I agree with that…..in a John Stuart Mill Utilitarian type of way you can argue it though……… I’m trying not to take it personally. Although if I get this deadly virus at work trying to save a life, and they prioritize some guy who got it on spring break at the beach I will come back and haunt him if he lives and I don’t, but that just seems fair. So maybe I am taking it personally….

I put a COVID patient on ECMO yesterday…..got a real big dose of the mean version of this virus. I feel fine, and I’m not afraid really…..maybe if I’ve done enough good to outweigh the bad, and I’ll have a nice place to go in the afterlife if I die. But probably not My best friend is another transplant surgeon who does ECMO, we started fellowship together on the same day and both stayed on as staff…….we got together on my patio last weekend (6 feet apart) and drank most of a bottle of bourbon. I told him what I would want for myself, because my wife and family aren’t equipped for this type of decision making, but he would do for me what would need to be done, good or bad. In any event I’ll probably live, I have enough bad habits to be a positive prognostic indicator. I was still hoping this would take a bit longer to kill me though…I’m not as scared as I am disappointed. But I’m not surprised....

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[anonperson]

I have to be honest…..I always thought this job would kill me.

I did think it would take a little longer than this though….like a slow death. Over time this line of work would just wear me down to a shell of my former self, and then one day I would just fade into the myst like a mythic warrior or something. Like I would be absorbed into the ether, or called up to heaven directly like Elijah (for those of u who are biblical). My grand plan was to take the fortune I had amassed over my lifetime and pay off an OR charge nurse and newspaper obit reporter to write that I had died tragically during a redo penis reduction surgery….but a man can only dream.

Because let’s keep it real now….most of us don’t exactly have the best habits. We eat too much garbage…fast food, late night pizza delivery, vending machines…..most of us drink a lot (at least I do)….I read something recently about how detrimental lack of sleep is to your health. Apparently sleep experts say that even a car alarm going off in the middle of the night interrupts ur micro-sleep (even if u don’t remember it) and has a profound impact on your health….it went on to say you should wear one of those girly eye masks and ear plugs every night….just in case!!!! I mean Jesus, if the average person should put themselves in a deprivation chamber every night to have a chance at a good long healthy life what the hell do those of us with a pager do about that….compound that interest if you’re a surgeon who has to get out of bed in the middle of the night?!?! Multiply x 1000 if u do trauma, transplant or ECMO? Based on that I should probably drop dead any minute anyway, which certainly makes this whole COVID thing less impactful on my overall health.


Perusing social media though the fear is real….doctors, nurses, all essential hospical personnel……terrified that this could kill them. Because make no bones about it, this virus can kill you and me and anyone else. It’s especially grave for those of us working in healthcare that can’t just shelter in place all day….like the gamblers on wall street, politicians, athletes, JCAHO, insurance company CEOs….**** they’re staying home where it’s safe!!

It might make you reflect on your own mortality, which doesn’t seem unreasonable. For the record I personally have almost died a few times, and each one was very different emotionally. I was in a motorcycle accident once in college, before a career in medicine took over….bright sunny day, I was on a 4 lane road in the right most lane with a car to my immediate left. A nice lady in a big SUV pulled up at a stop sign intersection, looked right at me, and pulled out right in front of me. So my options were either to hit the car on my left, hit the lady in the SUV, or fly into the ditch and take my chances and wrestle the monster bike through it. You get about a fraction of a second to decide this btw…..but time slows down dramatically. I remember looking at all the cars around me, I remember looking at my side mirror to calculate if I decided to crash if someone behind me would then run over me. No great options I thought, but in the split second I chose the ditch. Man that hurt, when I finally came to a stop that is. I flew off the bike and wound up in the grass looking up at the sky. I could hear the engine sputtering along and thinking I hope it’s not about to land on me, but really I remember thinking to myself….I really don’t want to die. That’s all I could think…I just really wanted to live. More than anything and more than ever before. In the end I was fine of course…..youth is wasted on the young and all. Bike got trashed but I just had scrapes and bruises….I gave up riding them though (not right away because some of us are smarter than others). Just to clue u in to how sick I am I actually miss riding motocycles…and I’ve decided that if COVID doesn’t kill me I’m going to go buy a really fast one, and take it up in the hills and lean into the turns going way too fast….because why not.

Another time I almost died was on an organ procurement…and we’ve all heard about harvest teams going down in planes and helicopters. It’s always in the back of ur mind I guess…although I usually enjoy them (maybe better not to explore the psychology). I’ve gotten to the point where I don’t tell my wife when I go out on these because it turns her into an emotional wreck….probably not the worst thing I’ve kept from her. I flew somewhere once to pick up a heart and was flying back….hadn’t slept much in days and as any good transplant surgeon knows the flight back is the best! Can’t be paged or called, so turn off the lights and tell the coordinators and students not to wake u under any circumstances. So when my medical student woke up before landing my initial thought was….less than professional. To her credit though she’s a good person….I noticed right away she was shaking. Terrified and at a loss for words, she said “Dr. Thanatos umm…I think u should put ur seatbelt on” This plane was rocking…I felt like I was in a washing machine…..and I was sleeping through this??? Jeez that’s impressive in and of itself….i looked out the window and we were about to land. I could see the ground sort of, it was raining and lightning was flashing, the wind was clearly pushing our little plane around at a whim. This is how ants must feel when a kid burns them with a magnifying glass…just at the mercy of a much more powerful force you can’t even wrap your head around. In a small plane you can look straight ahead and see out the windshield…..and the horizon was oscillating at like 3000 hz. The pilots were panicking and I can tell u that’s really, really not comforting……which is why I never panic in the OR incidentally. Transplant fellowship was a long year, and I remember looking out the window and thinking well……I guess this is it. But time didn’t slow down this time, to be honest I didn’t feel anything really. Maybe that’s what 10 years of continuous fatigue and abuse do to you, it’s almost like I was just angry. I remember thinking **** it…I hope we hit something hard, I don’t want to limp away from this disaster. If I survive they’ll probably make me fish the cooler out of the smoldering heap of ash and go back to work, and frankly I’d rather be dead. So let’s bring this thing down like we mean it, I hope the degenerates who accepted this organ for transplant die of cancer of the eyes. We landed and after skidding around the runway for a bit I lived after all……

I guess what I’m trying to say is that training had caused me to have less faith in humanity in general anyway. Anne Frank, before she died in the holocaust, said that despite everything she still believes people are good at heart….clearly she didn’t do a general surgery residency. Because after that if u come out on the other side still thinking that people are inherently benevolent then you’re a better person than I am….that may not be saying much but still kudos to you, I’ll recommend you for sainthood. But as this thing gets uglier and darker, I’m not surprised by any of it.

Which kinda brings me to the other big observation here….once you get past the fear, the other universal response I’m seeing from us frontline essential workers is anger….shock, betrayal, fury…….at the lack of PPE, lack of response from the powers that be, disgust at the lack of coordination and disinformation by the white house and hospital administrations.

But taking the sum total of all of your experiences in health care, from your first day up until now….are you surpised? Like really surprised? I mean don’t get me wrong, the lack of equipment and preparation and etc is totally criminal……but are you really all that shocked??

As physicians we’re all alone in all of this. Period. But we always have been…..all it takes is a pandemic to make this all the more obvious. I would argue though it’s always been this way, just in less dramatic fashion…..Remember the first time you had to discharge someone on a weekend and there was no social worker? Or when you had to write TPN orders on holidays because nutrition didn’t come in (they would then come in the next day and criticize u harshly for getting the selenium dose incorrect). How many times have you skipped a meal, been NPO inadvertently for 12 hours just to have JCAHO yell at you for drinking coffee in the hallway? How much **** have you had to eat for forgetting to take off a mask in the hallway after a 12 hour operation where the person died and you’re still wrapping your head around it. Ever work for 2 straight days non-stop and have someone lecture you about missing a committee meeting that could have been addressed with a short email? Did you ever think this was a team sport really? How many times have you gone to a meeting and raised concerns about something…..was it ever taken seriously? Did anything ever change??

Again don’t get me wrong….it’s tragic. But none of you really thought that administration had ur back right?? Did you think the politicans would do the right thing by us at the end of the day? If one of your colleagues got sick, missed work or literally dropped dead did you ever think they wouldn’t just step over your corpse and tell your partners or co-residents to get back to work?? Remember the resident who committed suicide in NYC and their coworkers had to walk past the body on the way to work….it’s almost straight out of house of god. And after having one of the most litigious work environments ever, with individual surgical outcomes reporting without any qualifiers for people doing high risk work….now New York is begging people to come out of retirement to help, they’ll even put you up at the Four Seasons.

It’s poetic that those of us essential personnel are taking the risks boldly and some of us will die….but is that surprising either? I’m so proud to be an essential healthcare worker… and the news has been so inspiring…..healthcare workers putting on hefty trash bags and bandanas and going to work. Because that’s who we are….who we’ve always been. Older physicians with underlying health problems feel guilty for not coming in……they try to help with telemedicine. Medical student are volunteering to graduate early and join us in the battle….nurses and Pas have stepped up big, people are re-deploying throughout the hospital to find ways to help. I predict they’ll keep doing it, we all will until the war is over and then we’ll see where we are……it’s all we can think of to do so it is what it is…..

But how many other people are secretly, quietly right now……..looking right, looking left….and saying to their jobs, **** this I’m outta here. If you can’t protect me I’m not bringing this home to my kids, my spouse, my parents. People who can retire may quietly go out into the night and not look back right now…..but what about after this is all over?


To me that’s the real question…..how many will leave after all of this? And how many will never sign up for this career now? Like I say above, I think we always knew. But having the system turn on u, dramatically in your face….that’s gonna be hard to get over for a lot of people. Once the crisis has passed, and everyone’s reflexive sacrificial burdens have passed….a lot of people will peace out of this. And who can blame them?

Today our administration said that if we find ourselves in a real scarcity that healthcare workers wouldn’t get any priority over other people, because it wouldn’t look fair to the public otherwise. I guess I agree with that…..in a John Stuart Mill Utilitarian type of way you can argue it though……… I’m trying not to take it personally. Although if I get this deadly virus at work trying to save a life, and they prioritize some guy who got it on spring break at the beach I will come back and haunt him if he lives and I don’t, but that just seems fair. So maybe I am taking it personally….

I put a COVID patient on ECMO yesterday…..got a real big dose of the mean version of this virus. I feel fine, and I’m not afraid really…..maybe if I’ve done enough good to outweigh the bad, and I’ll have a nice place to go in the afterlife if I die. But probably not My best friend is another transplant surgeon who does ECMO, we started fellowship together on the same day and both stayed on as staff…….we got together on my patio last weekend (6 feet apart) and drank most of a bottle of bourbon. I told him what I would want for myself, because my wife and family aren’t equipped for this type of decision making, but he would do for me what would need to be done, good or bad. In any event I’ll probably live, I have enough bad habits to be a positive prognostic indicator. I was still hoping this would take a bit longer to kill me though…I’m not as scared as I am disappointed. But I’m not surprised....

Good post.

I was anxious in mid March reading the news about the $hitstorm about to hit the US. Palpitations and sweating like a pig. Almost like I was expecting to get punched in the face by Mike Tyson.

At this point, I'm numb and take my precautions but feel a lot is out of my control. It's a bit liberating I guess. I take in house call doing OB and feel it's just a matter of time until something happens.

My wife is scared. My parents are scared. I feel bad that they are worried about me. My kids are too young to understand thankfully .

We have not been hit as hard as New York but our peak isn't until late April.

But I agree that we are in it alone. Hospitals love to run things so damn lean (staffing, supplies etc) just to save a dollar without regard for safety. The docs will figure it out, because we always do.

This is the end result. People wearing garbage bags, mass shortage of N95 masks.

Admins holed up. Clipboard nazis hiding. JCAHO idiots quiet about reusing N95 masks etc.

We'll just do the best we can

 

[Wordead]

Good post.

I was anxious in mid March reading the news about the $hitstorm about to hit the US. Palpitations and sweating like a pig. Almost like I was expecting to get punched in the face by Mike Tyson.

At this point, I'm numb and take my precautions but feel a lot is out of my control. It's a bit liberating I guess. I take in house call doing OB and feel it's just a matter of time until something happens.

My wife is scared. My parents are scared. I feel bad that they are worried about me. My kids are too young to understand thankfully .

We have not been hit as hard as New York but our peak isn't until late April.

But I agree that we are in it alone. Hospitals love to run things so damn lean (staffing, supplies etc) just to save a dollar without regard for safety. The docs will figure it out, because we always do.

This is the end result. People wearing garbage bags, mass shortage of N95 masks.

Admins holed up. Clipboard nazis hiding. JCAHO idiots quiet about reusing N95 masks etc.

We'll just do the best we can

Or, refuse to work without adequate PPE. I'm not going to work if conditions are like new york. **** that. OMFS chief resident died leaving behind his wife and kids last week. Incredibly nice guy. I heard another resident died as well.

This country voted for an incompetent administration, this country decided to not obey social distancing and go on spring break, are STILL not obeying lockdown, decided to not prep supplies with a 2-3 month head start, private citizens decided to hoard PPE. Why are we paying the price? Let the country burn and face the consequences of its decisions. Because otherwise none of the people who precipitated this crisis will answer for it.

 

[ACSurgeon]

I have to be honest…..I always thought this job would kill me.

I did think it would take a little longer than this though….like a slow death. Over time this line of work would just wear me down to a shell of my former self, and then one day I would just fade into the myst like a mythic warrior or something. Like I would be absorbed into the ether, or called up to heaven directly like Elijah (for those of u who are biblical). My grand plan was to take the fortune I had amassed over my lifetime and pay off an OR charge nurse and newspaper obit reporter to write that I had died tragically during a redo penis reduction surgery….but a man can only dream.

Because let’s keep it real now….most of us don’t exactly have the best habits. We eat too much garbage…fast food, late night pizza delivery, vending machines…..most of us drink a lot (at least I do)….I read something recently about how detrimental lack of sleep is to your health. Apparently sleep experts say that even a car alarm going off in the middle of the night interrupts ur micro-sleep (even if u don’t remember it) and has a profound impact on your health….it went on to say you should wear one of those girly eye masks and ear plugs every night….just in case!!!! I mean Jesus, if the average person should put themselves in a deprivation chamber every night to have a chance at a good long healthy life what the hell do those of us with a pager do about that….compound that interest if you’re a surgeon who has to get out of bed in the middle of the night?!?! Multiply x 1000 if u do trauma, transplant or ECMO? Based on that I should probably drop dead any minute anyway, which certainly makes this whole COVID thing less impactful on my overall health.


Perusing social media though the fear is real….doctors, nurses, all essential hospical personnel……terrified that this could kill them. Because make no bones about it, this virus can kill you and me and anyone else. It’s especially grave for those of us working in healthcare that can’t just shelter in place all day….like the gamblers on wall street, politicians, athletes, JCAHO, insurance company CEOs….**** they’re staying home where it’s safe!!

It might make you reflect on your own mortality, which doesn’t seem unreasonable. For the record I personally have almost died a few times, and each one was very different emotionally. I was in a motorcycle accident once in college, before a career in medicine took over….bright sunny day, I was on a 4 lane road in the right most lane with a car to my immediate left. A nice lady in a big SUV pulled up at a stop sign intersection, looked right at me, and pulled out right in front of me. So my options were either to hit the car on my left, hit the lady in the SUV, or fly into the ditch and take my chances and wrestle the monster bike through it. You get about a fraction of a second to decide this btw…..but time slows down dramatically. I remember looking at all the cars around me, I remember looking at my side mirror to calculate if I decided to crash if someone behind me would then run over me. No great options I thought, but in the split second I chose the ditch. Man that hurt, when I finally came to a stop that is. I flew off the bike and wound up in the grass looking up at the sky. I could hear the engine sputtering along and thinking I hope it’s not about to land on me, but really I remember thinking to myself….I really don’t want to die. That’s all I could think…I just really wanted to live. More than anything and more than ever before. In the end I was fine of course…..youth is wasted on the young and all. Bike got trashed but I just had scrapes and bruises….I gave up riding them though (not right away because some of us are smarter than others). Just to clue u in to how sick I am I actually miss riding motocycles…and I’ve decided that if COVID doesn’t kill me I’m going to go buy a really fast one, and take it up in the hills and lean into the turns going way too fast….because why not.

Another time I almost died was on an organ procurement…and we’ve all heard about harvest teams going down in planes and helicopters. It’s always in the back of ur mind I guess…although I usually enjoy them (maybe better not to explore the psychology). I’ve gotten to the point where I don’t tell my wife when I go out on these because it turns her into an emotional wreck….probably not the worst thing I’ve kept from her. I flew somewhere once to pick up a heart and was flying back….hadn’t slept much in days and as any good transplant surgeon knows the flight back is the best! Can’t be paged or called, so turn off the lights and tell the coordinators and students not to wake u under any circumstances. So when my medical student woke up before landing my initial thought was….less than professional. To her credit though she’s a good person….I noticed right away she was shaking. Terrified and at a loss for words, she said “Dr. Thanatos umm…I think u should put ur seatbelt on” This plane was rocking…I felt like I was in a washing machine…..and I was sleeping through this??? Jeez that’s impressive in and of itself….i looked out the window and we were about to land. I could see the ground sort of, it was raining and lightning was flashing, the wind was clearly pushing our little plane around at a whim. This is how ants must feel when a kid burns them with a magnifying glass…just at the mercy of a much more powerful force you can’t even wrap your head around. In a small plane you can look straight ahead and see out the windshield…..and the horizon was oscillating at like 3000 hz. The pilots were panicking and I can tell u that’s really, really not comforting……which is why I never panic in the OR incidentally. Transplant fellowship was a long year, and I remember looking out the window and thinking well……I guess this is it. But time didn’t slow down this time, to be honest I didn’t feel anything really. Maybe that’s what 10 years of continuous fatigue and abuse do to you, it’s almost like I was just angry. I remember thinking **** it…I hope we hit something hard, I don’t want to limp away from this disaster. If I survive they’ll probably make me fish the cooler out of the smoldering heap of ash and go back to work, and frankly I’d rather be dead. So let’s bring this thing down like we mean it, I hope the degenerates who accepted this organ for transplant die of cancer of the eyes. We landed and after skidding around the runway for a bit I lived after all……

I guess what I’m trying to say is that training had caused me to have less faith in humanity in general anyway. Anne Frank, before she died in the holocaust, said that despite everything she still believes people are good at heart….clearly she didn’t do a general surgery residency. Because after that if u come out on the other side still thinking that people are inherently benevolent then you’re a better person than I am….that may not be saying much but still kudos to you, I’ll recommend you for sainthood. But as this thing gets uglier and darker, I’m not surprised by any of it.

Which kinda brings me to the other big observation here….once you get past the fear, the other universal response I’m seeing from us frontline essential workers is anger….shock, betrayal, fury…….at the lack of PPE, lack of response from the powers that be, disgust at the lack of coordination and disinformation by the white house and hospital administrations.

But taking the sum total of all of your experiences in health care, from your first day up until now….are you surpised? Like really surprised? I mean don’t get me wrong, the lack of equipment and preparation and etc is totally criminal……but are you really all that shocked??

As physicians we’re all alone in all of this. Period. But we always have been…..all it takes is a pandemic to make this all the more obvious. I would argue though it’s always been this way, just in less dramatic fashion…..Remember the first time you had to discharge someone on a weekend and there was no social worker? Or when you had to write TPN orders on holidays because nutrition didn’t come in (they would then come in the next day and criticize u harshly for getting the selenium dose incorrect). How many times have you skipped a meal, been NPO inadvertently for 12 hours just to have JCAHO yell at you for drinking coffee in the hallway? How much **** have you had to eat for forgetting to take off a mask in the hallway after a 12 hour operation where the person died and you’re still wrapping your head around it. Ever work for 2 straight days non-stop and have someone lecture you about missing a committee meeting that could have been addressed with a short email? Did you ever think this was a team sport really? How many times have you gone to a meeting and raised concerns about something…..was it ever taken seriously? Did anything ever change??

Again don’t get me wrong….it’s tragic. But none of you really thought that administration had ur back right?? Did you think the politicans would do the right thing by us at the end of the day? If one of your colleagues got sick, missed work or literally dropped dead did you ever think they wouldn’t just step over your corpse and tell your partners or co-residents to get back to work?? Remember the resident who committed suicide in NYC and their coworkers had to walk past the body on the way to work….it’s almost straight out of house of god. And after having one of the most litigious work environments ever, with individual surgical outcomes reporting without any qualifiers for people doing high risk work….now New York is begging people to come out of retirement to help, they’ll even put you up at the Four Seasons.

It’s poetic that those of us essential personnel are taking the risks boldly and some of us will die….but is that surprising either? I’m so proud to be an essential healthcare worker… and the news has been so inspiring…..healthcare workers putting on hefty trash bags and bandanas and going to work. Because that’s who we are….who we’ve always been. Older physicians with underlying health problems feel guilty for not coming in……they try to help with telemedicine. Medical student are volunteering to graduate early and join us in the battle….nurses and Pas have stepped up big, people are re-deploying throughout the hospital to find ways to help. I predict they’ll keep doing it, we all will until the war is over and then we’ll see where we are……it’s all we can think of to do so it is what it is…..

But how many other people are secretly, quietly right now……..looking right, looking left….and saying to their jobs, **** this I’m outta here. If you can’t protect me I’m not bringing this home to my kids, my spouse, my parents. People who can retire may quietly go out into the night and not look back right now…..but what about after this is all over?


To me that’s the real question…..how many will leave after all of this? And how many will never sign up for this career now? Like I say above, I think we always knew. But having the system turn on u, dramatically in your face….that’s gonna be hard to get over for a lot of people. Once the crisis has passed, and everyone’s reflexive sacrificial burdens have passed….a lot of people will peace out of this. And who can blame them?

Today our administration said that if we find ourselves in a real scarcity that healthcare workers wouldn’t get any priority over other people, because it wouldn’t look fair to the public otherwise. I guess I agree with that…..in a John Stuart Mill Utilitarian type of way you can argue it though……… I’m trying not to take it personally. Although if I get this deadly virus at work trying to save a life, and they prioritize some guy who got it on spring break at the beach I will come back and haunt him if he lives and I don’t, but that just seems fair. So maybe I am taking it personally….

I put a COVID patient on ECMO yesterday…..got a real big dose of the mean version of this virus. I feel fine, and I’m not afraid really…..maybe if I’ve done enough good to outweigh the bad, and I’ll have a nice place to go in the afterlife if I die. But probably not My best friend is another transplant surgeon who does ECMO, we started fellowship together on the same day and both stayed on as staff…….we got together on my patio last weekend (6 feet apart) and drank most of a bottle of bourbon. I told him what I would want for myself, because my wife and family aren’t equipped for this type of decision making, but he would do for me what would need to be done, good or bad. In any event I’ll probably live, I have enough bad habits to be a positive prognostic indicator. I was still hoping this would take a bit longer to kill me though…I’m not as scared as I am disappointed. But I’m not surprised....

good post.

Maybe it’ll be time for people to revisit their work-life balance and other priorities. Most physicians are saddled with debt and will have a hell of a time walking away from their job.

I was on the fast track to being an academic trauma surgeon working for a fraction of what a surgeon should be paid and having no life. Then my first child was born and took a different path. Still work hard but have more flexibility and at least feel paid well for my time.

this doesn’t change the fact that in many major US cities highly trained professionals are left picking between employers who by in large have some of the same pros and cons, and have little option for a truly independent practice. This sucks but has become reality for my generation. Not sure how this could ever change.

Don’t get me started on corrupt politics. This is literally what American politics is based on.

 

[HighPriest]

Good post. I think, unfortunately, that the saddest part is that once this is over I don't think anything at all will have changed. I don't think we'll see a mass exodus of physicians. Maybe some nurses. I don't think we'll see a bunch of people avoid medicine as a profession. I think it's more likely you'll see even more people sign up because it'll look heroic to them. Just like you see an uptick in military enlistment when a war first starts.

The saddest part is I think everything you've illustrated is true, and even with this debacle, all of it will continue to be true afterwards.

 

[NYknicks44]

To the OP,

Bravo. Beautifully written. I hope you keep writing and share it with the world

 

[MediCane2006]

This is an incredible post. Thank you. I hope you are staying safe and I'll have a glass of bourbon for you tonight.

 

[Minimal Charge Disease]

If you follow COVID19 Physicians on Twitter you can see the straight up fear mongering and abuse conducted by admins. 100s of retweets but nothing in the media. No change. We have to advocate for ourselves to survive but will we?

 

[ThoracicGuy]

If you follow COVID19 Physicians on Twitter you can see the straight up fear mongering and abuse conducted by admins. 100s of retweets but nothing in the media. No change. We have to advocate for ourselves to survive but will we?
View attachment 302785

Could be worse...

 

[Winged Scapula]

If you follow COVID19 Physicians on Twitter you can see the straight up fear mongering and abuse conducted by admins. 100s of retweets but nothing in the media. No change. We have to advocate for ourselves to survive but will we?
View attachment 302785

Nothing in the media because the average person will look at that and think, "wow that's great money". They have no idea what went into getting to that position, the number of hours worked to make it, the responsibility and liability and of course, the personal risk.

 

[LucidSplash]

Could be worse...

Actually for most, even on IBR, having loan payments and interest suspended for a few months more than makes up for the lack of annual increase.

 

[gulmohr]

Great post (for a surgeon...jk). But seriously, when this shole sh*tstorm started, I thought one of the good things which may come out of it will be admins and the clipboard gestapo getting their comeuppance. That hope has faded.
Although tons of people are still dying in my NYC hospital every day, our ED admissions have started to decline in the last few days. After being nowhere to be seen for the past month, administrative types are now starting to peep over the parapet and will soon be up to their usual nonsensical bullsh*t no doubt.

Thanatos, you should consider writing formally for an outlet with greater reach than this forum as well. The craziest thing about these frauds running our hospitals and healthcare systems is how they seem to have largely flown under the radar for decades as far as the lay public is concerned. The man on the street still thinks of us doctors as the money-grubbers.
It may not ultimately make a difference in the grand scheme of things but you have an eloquent voice and articulate so well what most of us are thinking. Hell, maybe that's the career alternative if you decide to walk away after all of this.

 

[Winged Scapula]

Estimates are that 20% of those dying from COVID are healthcare workers. WE are DYING and some factions of the general public don't appreciate that. Newest FB conspiracy theory:

doctors are fraudulently coding charts with COVID Dx so they can get paid more

For some reason I found myself trying to educate a friend of a HS "friend" (hell, truth be told I don't even remember this guy) about how physicians are paid, how ICD10 documentation works etc. Remind me next time not to even bother with someone who TALKS IN ALL CAPS and uses LOTS of !!!!!!. So apparently even though doctors are dying while Admins are staying home and directing medical management from their Lazy Boy on full salary, we're the greedy ones, falsifying medical records to make Trump look bad and removing "Merica's rights. I just can't.

I'm not a women who is easily scared.

I'm not an anxious person by nature but I've woken up with palpitations.

What if I get my 70 yo aunt (who came for a visit in Feb and now is stuck here, afraid to go home to Michigan) sick? What if I can't work? My disability policy isn't generous enough to cover my current lifestyle (yes, I could downsize, could sell all but 1 car, but I don't wanna! <----self pity please ignore). I'm not afraid of dying myself but worry about the dogs. My family would just take them to the pound (or whatever is the PC term these days). Best case scenario is my mother would take them, they would get out and run away or get hit by a car.I literally added a rider to my will setting aside money for their care and dictating to whom they would go if I should die. I worry about those furry knuckleheads. I posted this on FB and my wonderful friends came out in droves to say they'd take my pups. It does make me feel better.

I worry about my patients many of whom are immunosuppressed from chemotherapeutic agents or other medical co-morbidities. Will I get them sick? Will they get me sick? We are JUST getting word that our N95 masks are arriving. Maybe next week. Maybe not. One partner doesn't want t wear them. She was quarantined on the boat in Japan and then San Antonio for weeks and didn't get sick so perhaps she feels invincible. I worry about her.

Local hospital admins here have been horrible in the beginning. They are starting to come around but in the beginning they refused to allow staff to wear masks if they weren't in the ICU taking care of known or suspected COVID patients. It "scared" the patients. Reports of admins even pulling the face masks off employees in the hallways. Now they're allowing "comfort masks" but only supplying masks to RTs, MD/DOs, and nursing staff in the ICU. I can get surgical masks from the OR and admit to "borrowing" some for my office because I couldn't even source ****ing paper masks for my staff. Patients are making us cloth masks and bringing them in, unsolicited. I love those patients. Another brought in THIRTY masks she had made the previous day for me to take to my other office where there are patients on treatment; she remembered being there and wanted to help those that need treatment during these times and she was worried about them.

I guess its true that during times of crisis people really show their worth. I've been so disappointed in the accusations that we are making this all up, in Admins who prize money and reputation over physician safety (one local Admin did take a 20% pay cut, I think that drops his annual compensation from $25 million to $24.5. Guess he will have to sell the second yacht.), in hospitals that want doctors to come and work for free and others who apparently advertise $13,000 a week but then the money never materializes. I am so proud of my colleagues who jumped up and left their families to move to NY and work at great peril to themselves. To work in ICUs with 75 COVID patients, all intubated, and with staff who have little to no ICU experience (nursing staffing agencies are just supplying warm bodies with a license). I am exhausted hearing about their days and the process of dressing, undressing, washing clothes, hair and body multiple times a day (does this really help), putting shoes in the freezer and myriad other practices. It almost sounds like the OCD practices of the paranoid. But I guess we all are a little paranoid right now. Maybe that person who brushed by me in the grocery store has COVID. Perhaps its on the money I was given back in the McDonalds drive through. Hmm...did I expose myself when I typed my PIN into the ATM? So many questions.

The time off has been nice but unproductive. I'd like to report that I've lost 10 lbs, started rowing again and am in the yard doing tree pose. I'm not. I will not come out of this in better shape physically or mentally.

 

[Thanatos]

Or, refuse to work without adequate PPE. I'm not going to work if conditions are like new york. **** that. OMFS chief resident died leaving behind his wife and kids last week. Incredibly nice guy. I heard another resident died as well.

This country voted for an incompetent administration, this country decided to not obey social distancing and go on spring break, are STILL not obeying lockdown, decided to not prep supplies with a 2-3 month head start, private citizens decided to hoard PPE. Why are we paying the price? Let the country burn and face the consequences of its decisions. Because otherwise none of the people who precipitated this crisis will answer for it.

That's a great point i forgot to address actually...what about people that are like **** it and just protest to go to work right now to make a point for the greater good of the system. I've spent years thinking about this very topic ....I remember feeling abused as a resident every day. And when I looked around I saw that some people weren't abused at all...nurses, PAs, MAs....not only were they not abused, but the powers that be were afraid of them. It was because they were absolutely shameless about advocating for themselves....you push a union nurse to do something and they'll threaten to walk right out of the hospital consequences be damned. If people die....so what. They are fearless and relentless when it comes to their own interests....as physicians its beaten into us, that would be wrong. A violation of the sacred hippocratic oath, carefully amended over the years to remove a) tributes to gods no longer worshipped and b) the whole thing about medical education being free (read the original after a few drinks and you'll be throwing ****). But to your point.....what better way to change a system than such dramatic action. If physicians refused to go in until admin got off their ass about something, it would probably get done....it would have to be. But are we willing to do it? Like the man who ate the first oyster, it will take courage.

good post.

Maybe it’ll be time for people to revisit their work-life balance and other priorities. Most physicians are saddled with debt and will have a hell of a time walking away from their job.

I was on the fast track to being an academic trauma surgeon working for a fraction of what a surgeon should be paid and having no life. Then my first child was born and took a different path. Still work hard but have more flexibility and at least feel paid well for my time.

this doesn’t change the fact that in many major US cities highly trained professionals are left picking between employers who by in large have some of the same pros and cons, and have little option for a truly independent practice. This sucks but has become reality for my generation. Not sure how this could ever change.

Don’t get me started on corrupt politics. This is literally what American politics is based on.

I am 100% afraid to admit out loud or reflect on how much i've enjoyed spending a day or two a week sitting around my house the past month....i normally get almost zero days completely off and am typically on call for something or the other 25-ish days a month. I like my job most days and i like operating, even in the middle of the night....i think ur smarter in going another way though. Academic surgery is kind of a scam when you think about it....i really enjoy teaching but could live without the meaningless publication rat race and pursuit of meaningless titles. I've watched more than one division chief or department chair get stabbed in the back by even the nicer people around the office.....

Good post. I think, unfortunately, that the saddest part is that once this is over I don't think anything at all will have changed. I don't think we'll see a mass exodus of physicians. Maybe some nurses. I don't think we'll see a bunch of people avoid medicine as a profession. I think it's more likely you'll see even more people sign up because it'll look heroic to them. Just like you see an uptick in military enlistment when a war first starts.

The saddest part is I think everything you've illustrated is true, and even with this debacle, all of it will continue to be true afterwards.

You know....a few weeks ago I too was optimistic that things could change. Maybe a good dose of death and destruction would change stupid policies.......administration would value and listen to us, our medicine colleagues would respect our opinions as frontline soldiers, hell maybe those clipboard carrying people would exercise some common sense.....but yeah probably not. Recently reality came right back to me.

I had a patient trapped in the hospital waiting for a cabg.....came in with an NSTEMI and now on heparin and nitroglycerin drips. So they're not going anywhere but the morgue without some revascularization.....they've been in the hospital for a few days while cardiology finishes the workup and etc. Then they call me for a CABG because the interventional cards guys don't want to touch it. So I say sure and book the patient for CABG the next morning. Patient has no symptoms but per protocol they test them for COVID like 5 times.....all negative. Sweet! But......turns out the patient had a nurse like a week ago that ended up being positive. So ID, risk management, administration, infection control descend on this poor patient and launch a big investigation.....after another 17 brain swabs decide they're negative and we're all good to go ahead. Perfect.

I wake up early and get to my office, I had just grabbed coffee when it started.....anesthesia calls and says am i sure i want to do this case. Trick question? yes...yes i do want to do this. Will i drop a note? Yes i will. Will i have ID drop a note? Sure.

Then the head of the ICU calls me...am i sure i want to do this? yes....yes i do want to do this. Okay...but they want to keep the patient on COVID precautions because of the potential exposure. *shrug*. Whatever.

Anesthesia calls again....do i want to do this in a negative pressure room? Because that's the policy in COVID precaution patients, and we think it'll be safer for the anesthesia staff to suck out all the bad particles after intubation. Seems reasonable, and I have no problem with that. I get along with my anesthesia colleagues and if they want more protection i'm happy to do that.....the negative pressure room is a little smaller (not a normal cardiac room) so i'll be inconvenienced but i'm okay with that to protect my team.

ID calls....*sigh* What now? So they want us to do this in a positive pressure room because it lowers the risk of wound infection to the patient....and they think they're negative based on all the tests. Hmmm...okay....so then lift the COVID precautions, pronounce him officially negative and we'll do that I guess.

Few minutes go by....phone rings again. In a cruel twist of fate, I've come to really despise the phone ringing. It's always something bad....in junior high i used to sit around and fantasize that all the girls I was crushing on would call me and every time the phone would ring I would get all excited, like it could be one of them. It usually wasn't, and by usually I mean never, but that's another story. So now i'm on a multi-way call with anesthesia, ID, hospital administration. Outwardly I'm like "oh hi everyone" but inside i'm like....there is no way this is a good thing for me.

They tell me they have (admin and ID) talked amongst themselves....and have decided that the poor suffering patient is essentially negative, so we can do this in a positive pressure room (that is riskier for us doing the procedure if they end up having the virus) because they're so confident, as non-combatants, that he's negative and ID thinks this is better for the patient overall. But.....they want us to wear N95's, hoods, face shields, space suits, condoms etc and they won't officially lift the COVID precautions. My anesthesia friends protest, saying that even though the patient's risk of wound infection is hypothetically higher that their risk doing the aerosolizing part of the procedure is definitely higher if they won't officially make them negative.....this being the risk of course of getting a deadly virus that can kill a dozen of us. Admin and ID people ask me, as the attending surgeon, as the captain of the ship, what i want to do then......

Well....selfishly I can't do a longer procedure in all that gear. Maybe I'm a prima donna, but i don't like to operate in anything that impairs my vision or my tactile sensation. I don't routinely wear eye protection and I single glove...even for Hep C and HIV....I tape my mask down the same way everytime, I put my loupes and headlight on in the same order everytime....I'm not even that type A (I think) but I do think these things matter. I remember reading about Jerry Rice taping his jersey down so it wouldn't be untucked during a game.....which seems mostly aesthetic. But my ability to see and feel is not just for looks....it is critical to my ability to do my job and I take that very seriously. I know the anesthesiologist well, and they're legit. Good doctor and a good friend...with a family, including young children. Usually very solid....I can feel their fear coming through the phone.

So.....I flexed. Using my surgeon voice, I said if the admin and ID won't lift the restrictions or have the confidence to say we don't have to wear the full COVID PPE, then they're not sure enough for me to do this in a way that doesn't provide the most protection for my team actually doing the work. While I understand the patient may have more risk, we're talking one person versus a dozen people.....the dozen people of course being highly specialized health care providers who may go on to save hundreds of people in the next few weeks, if not thousands and thousands over the course of their respective careers. So as the attending surgeon I want to do this in a negative pressure room to protect my team...that's what I want to do, so there. Book my case, in the room I want, right now, final answer, end of discussion.

There was a long awkward pause....and I let it float. First person to talk in a negotiation loses, and if I'm bold enough to do this job i'm courageous enough to make ppl a little uncomfortable. The admin person comes on and says "well....after talking to ID and risk management we've decided this should be positive pressure and that's what it's gonna be. If the patient has a complication we can't justify it with the negative tests.....but we're going to insist on you using all the PPE and staying on COVID precautions afterwards, just in case. We just wanted to have the phone call to make sure....u know....that everyone knew. And that you had the opportunity to...you know.....let your team know. And....you know....see how they all felt"

So it's up to me, but not really....and they value my opinion but won't do what i say regardless. Fuming....I made a joke that wasn't really a joke....something along the lines of "yeah that's cool we'll all just get exposed maybe to a deadly airborne viral pathogen and die hahahahaha that's cool as long as you can still bill for the cabg should be all good." Clearly feeling like I had crossed the line, the admin went into the corporate damage control mode, saying they would provide us with all the good PPE and we would be fine as long as we were careful, that this is about patient safety and minimizing their wound infection risk after talking to ID who feels strongly about this....dodging the obvious logical cluster they're advocating for by calling them COVID negative for purposes of covering themselves on paper legally but not protecting us the workers by putting it in the proper room (per actual protocol they created) while demanding we wear spacesuits so if we get sick we can't complain..... and putting me in the incredibly awkward position of feeling like I have to agree with them.......to put my team in danger to help the patient, when I can't help but shake the feeling I should be pushing harder to protect my friends as the commander here. It's the perfect lose-lose situation.....if i throw a fit they cancel the case and the patient suffers......if they die I've neglected them. If i go with the flow, my team......my fellows, anesthesia, perfusion, nursing.....the people looking at me to lead them, the people who toil and slave and sweat to help me.....well.....that help me be me. To do what I am supposed to do in the OR.....these people are now at risk, and their families and etc. It was a weird mix of feelings.....all i felt primarily was nausea.
Already pretty angry, I called the ID person privately to complain about the logical inconsistency and lack of fortitude to make a definitive call on if this patient has the big bad COVID.....or not. Because you have to be one or the other. And how I felt like they weren't being rational, and I didn't appreciate being put in this position. Their response was, I swear to god: "You know, for a surgeon you seem a little squeamish about all this......."

In that moment I felt my whole medical career flash before my eyes. I was so furious my admin actually walked into my office when i was yelling into the phone "Why don't you come down to the OR and scrub in during the intubation and take a deep breath of some aerosolized particles instead of sitting in your office where it's safe while we do all the goddamn work you ****ing loser"

I'm not an angry person....I think. And i'll probably get in trouble for all this.....but I've never backed down from a good fight before, and maybe now is the time. In the time of the global plague, maybe now is the time to fight back. I'll let you know how it goes......the patient did well and I still don't have a dry cough or a fever. I didn't wear all that extra PPE, and if I die at least i wasn't hypercarbic all day. I have been tired though.....

To the OP,

Bravo. Beautifully written. I hope you keep writing and share it with the world

This is an incredible post. Thank you. I hope you are staying safe and I'll have a glass of bourbon for you tonight.

Thank you kindly, but I must warn you i am quite susceptible to flattery.

Actually for most, even on IBR, having loan payments and interest suspended for a few months more than makes up for the lack of annual increase.

How sad is that lol!!! I have to say though....having a GME office send that email out in the middle of a global pandemic when residents are afraid they might be contracting a deadly illness? Sounds like someone needs a PR firm.....

I don't know......have any of you ever been talking to an upset family member of a patient about something stupid?? Like....they're mad that they don't get ESPN2 because some lady that worked in the ED told them we did, and they don't understand how someone within the mighty organization could have made such a grave error???? You look beyond them to see your patient recovering well....and u think about how close they came to absolute catastrophe in the OR, and how they'll never understand just how close they came to not leaving that room alive? You politely smile and nod, because dammit ur a professional....but really all you can think in the back fo your head is a) this is stupid and b) i really, really have to go to the bathroom.

And because of reason B more than anything you really want to excuse yourself, and you think about all the explanations you could give. But you don't...you sit there and smile and nod....you don't want to get hit by the press-gainey or get the lawsuit if they don't like you.....but really you inherently understand as a member of society that has achieved great levels of success that in some situations the optics are absolutely critical to the overall long lasting flavor of a situation. This is what kills me about GME and residency program administration everywhere....no one can be that tone deaf...it defies explanation.

I cannot think of a better example of what residency was all about...."Dear residents, thank you for putting your lives on the line. In times of great uncertainty, many are working feverishly to make the world a better place. We on the other hand, took the time to have a meeting and send this email cutting your salary. Knowing full well you can't do anything about it, we encourage you to get back to work. Hugs and Kisses, your GME office". Jesus......you couldn't make that up if you tried.

Great post (for a surgeon...jk). But seriously, when this shole sh*tstorm started, I thought one of the good things which may come out of it will be admins and the clipboard gestapo getting their comeuppance. That hope has faded.
Although tons of people are still dying in my NYC hospital every day, our ED admissions have started to decline in the last few days. After being nowhere to be seen for the past month, administrative types are now starting to peep over the parapet and will soon be up to their usual nonsensical bullsh*t no doubt.

Thanatos, you should consider writing formally for an outlet with greater reach than this forum as well. The craziest thing about these frauds running our hospitals and healthcare systems is how they seem to have largely flown under the radar for decades as far as the lay public is concerned. The man on the street still thinks of us doctors as the money-grubbers.
It may not ultimately make a difference in the grand scheme of things but you have an eloquent voice and articulate so well what most of us are thinking. Hell, maybe that's the career alternative if you decide to walk away after all of this.

Agree that the hope is fading fast.....i guess i'm not surprised by that either in the end. The stoic philosophers believed that you shouldn't look at a glass as half full or half empty.....but to just marvel at the glass. Like wow, we have this amazing vessel that can hold a liquid, not change it's flavor, and allow us to see within it from the outside. That's amazing, and it could be worse....we might not have a glass at all. For a minute I was seeing the glass as half full.....more recently I agree, the admins are coming back slowly....and now i'm back to being happy I just have a glass. For now.

You're too kind to me I think, a rarity for the internet in general, but I do thank you. I wish I could agree with the eloquence, but really it's just me sitting in my home office loaded on Wild Turkey ranting into the keyboard. If I couldn't be a doctor I would love to be a writer, and all the greats have been famous drunks (Hemingway, Thompson, Wallace, Joyce, Capote, Cheever, Faulkner). Have any of you ever tried to write a story though.....it's really hard. I read an editorial once by a physician who was writing a book.....he got loaded on booze and furiously toiled away over everything he could think of and took it to an editor. The editor told him.....yeah this is great and all....but all you have is the middle of a book. You don't have a beginning and an end....just the middle. And if u ever try to write i think you'll find it to be true.....how do you start and how do u end? The middle is where we live our everyday lives, it's where the action is. Your first day as a doctor was already the middle, like going to war the battle was already going on u just walked into it. Your beginning and ending is unique to you, but not relatable necessarily. Hemingway would famously write dialogue in pencil, over and over and over....trying to make it work. So maybe i'll try to be a race car driver instead.

Estimates are that 20% of those dying from COVID are healthcare workers. WE are DYING and some factions of the general public don't appreciate that. Newest FB conspiracy theory:

doctors are fraudulently coding charts with COVID Dx so they can get paid more

For some reason I found myself trying to educate a friend of a HS "friend" (hell, truth be told I don't even remember this guy) about how physicians are paid, how ICD10 documentation works etc. Remind me next time not to even bother with someone who TALKS IN ALL CAPS and uses LOTS of !!!!!!. So apparently even though doctors are dying while Admins are staying home and directing medical management from their Lazy Boy on full salary, we're the greedy ones, falsifying medical records to make Trump look bad and removing "Merica's rights. I just can't.

I'm not a women who is easily scared.

I'm not an anxious person by nature but I've woken up with palpitations.

What if I get my 70 yo aunt (who came for a visit in Feb and now is stuck here, afraid to go home to Michigan) sick? What if I can't work? My disability policy isn't generous enough to cover my current lifestyle (yes, I could downsize, could sell all but 1 car, but I don't wanna! <----self pity please ignore). I'm not afraid of dying myself but worry about the dogs. My family would just take them to the pound (or whatever is the PC term these days). Best case scenario is my mother would take them, they would get out and run away or get hit by a car.I literally added a rider to my will setting aside money for their care and dictating to whom they would go if I should die. I worry about those furry knuckleheads. I posted this on FB and my wonderful friends came out in droves to say they'd take my pups. It does make me feel better.

I worry about my patients many of whom are immunosuppressed from chemotherapeutic agents or other medical co-morbidities. Will I get them sick? Will they get me sick? We are JUST getting word that our N95 masks are arriving. Maybe next week. Maybe not. One partner doesn't want t wear them. She was quarantined on the boat in Japan and then San Antonio for weeks and didn't get sick so perhaps she feels invincible. I worry about her.

Local hospital admins here have been horrible in the beginning. They are starting to come around but in the beginning they refused to allow staff to wear masks if they weren't in the ICU taking care of known or suspected COVID patients. It "scared" the patients. Reports of admins even pulling the face masks off employees in the hallways. Now they're allowing "comfort masks" but only supplying masks to RTs, MD/DOs, and nursing staff in the ICU. I can get surgical masks from the OR and admit to "borrowing" some for my office because I couldn't even source ****ing paper masks for my staff. Patients are making us cloth masks and bringing them in, unsolicited. I love those patients. Another brought in THIRTY masks she had made the previous day for me to take to my other office where there are patients on treatment; she remembered being there and wanted to help those that need treatment during these times and she was worried about them.

I guess its true that during times of crisis people really show their worth. I've been so disappointed in the accusations that we are making this all up, in Admins who prize money and reputation over physician safety (one local Admin did take a 20% pay cut, I think that drops his annual compensation from $25 million to $24.5. Guess he will have to sell the second yacht.), in hospitals that want doctors to come and work for free and others who apparently advertise $13,000 a week but then the money never materializes. I am so proud of my colleagues who jumped up and left their families to move to NY and work at great peril to themselves. To work in ICUs with 75 COVID patients, all intubated, and with staff who have little to no ICU experience (nursing staffing agencies are just supplying warm bodies with a license). I am exhausted hearing about their days and the process of dressing, undressing, washing clothes, hair and body multiple times a day (does this really help), putting shoes in the freezer and myriad other practices. It almost sounds like the OCD practices of the paranoid. But I guess we all are a little paranoid right now. Maybe that person who brushed by me in the grocery store has COVID. Perhaps its on the money I was given back in the McDonalds drive through. Hmm...did I expose myself when I typed my PIN into the ATM? So many questions.

The time off has been nice but unproductive. I'd like to report that I've lost 10 lbs, started rowing again and am in the yard doing tree pose. I'm not. I will not come out of this in better shape physically or mentally.

So I've been reading your posts for years and years......and to all of you casually passing through you need to know this lady is a total bad ass. I think this is a perfect example of what we've all been talking about.....the plague is coming for all of us and even then you don't have any concerns for your personal safety. You worry about the rest.....who will care for your dogs, u worry about your family and partners.....you are concerned about your patients.....you're breaking the rules to protect your staff.....maybe that's just who we are as people. If only the public knew....the money grubbing doctor (who doesn't make nearly as much as insurance company executives, administration, etc) at the end of they day is still not looking out for themselves, they worry about the people in their orbit that matter to them first.

Despite all of my negativity though.....honestly sometimes I think there is evidence that it all shines through. What I love about your post the most is the part about the patients sewing masks and bringing them in because they think it will help us. Sometimes I get cynical (shocking, I know) about all of this.....but at the end of the day, honestly, the patients come through for us too. For every dingus ingrate there are a million patients who love us.....I will only admit anonymously that I have a drawer full of thank you letters from them and sometimes I read them when I'm feeling bad about all of this....I would deny the **** out of it in person though. A cardiac surgeon with feelings.....please spare me the tears. I've had years of my life where I felt nothing. But at the end of the day maybe there is a silver lining.

I think most dramatically though you touch on my biggest fear in all of this.....you feel like you won't come out of this in good shape. If a legend like yourself isn't feeling great about all this either, well ****. I'm gonna need more booze.

 

[ThoracicGuy]

That's a great point i forgot to address actually...what about people that are like **** it and just protest to go to work right now to make a point for the greater good of the system. I've spent years thinking about this very topic ....I remember feeling abused as a resident every day. And when I looked around I saw that some people weren't abused at all...nurses, PAs, MAs....not only were they not abused, but the powers that be were afraid of them. It was because they were absolutely shameless about advocating for themselves....you push a union nurse to do something and they'll threaten to walk right out of the hospital consequences be damned. If people die....so what. They are fearless and relentless when it comes to their own interests....as physicians its beaten into us, that would be wrong. A violation of the sacred hippocratic oath, carefully amended over the years to remove a) tributes to gods no longer worshipped and b) the whole thing about medical education being free (read the original after a few drinks and you'll be throwing ****). But to your point.....what better way to change a system than such dramatic action. If physicians refused to go in until admin got off their ass about something, it would probably get done....it would have to be. But are we willing to do it? Like the man who ate the first oyster, it will take courage.




I am 100% afraid to admit out loud or reflect on how much i've enjoyed spending a day or two a week sitting around my house the past month....i normally get almost zero days completely off and am typically on call for something or the other 25-ish days a month. I like my job most days and i like operating, even in the middle of the night....i think ur smarter in going another way though. Academic surgery is kind of a scam when you think about it....i really enjoy teaching but could live without the meaningless publication rat race and pursuit of meaningless titles. I've watched more than one division chief or department chair get stabbed in the back by even the nicer people around the office.....




You know....a few weeks ago I too was optimistic that things could change. Maybe a good dose of death and destruction would change stupid policies.......administration would value and listen to us, our medicine colleagues would respect our opinions as frontline soldiers, hell maybe those clipboard carrying people would exercise some common sense.....but yeah probably not. Recently reality came right back to me.

I had a patient trapped in the hospital waiting for a cabg.....came in with an NSTEMI and now on heparin and nitroglycerin drips. So they're not going anywhere but the morgue without some revascularization.....they've been in the hospital for a few days while cardiology finishes the workup and etc. Then they call me for a CABG because the interventional cards guys don't want to touch it. So I say sure and book the patient for CABG the next morning. Patient has no symptoms but per protocol they test them for COVID like 5 times.....all negative. Sweet! But......turns out the patient had a nurse like a week ago that ended up being positive. So ID, risk management, administration, infection control descend on this poor patient and launch a big investigation.....after another 17 brain swabs decide they're negative and we're all good to go ahead. Perfect.

I wake up early and get to my office, I had just grabbed coffee when it started.....anesthesia calls and says am i sure i want to do this case. Trick question? yes...yes i do want to do this. Will i drop a note? Yes i will. Will i have ID drop a note? Sure.

Then the head of the ICU calls me...am i sure i want to do this? yes....yes i do want to do this. Okay...but they want to keep the patient on COVID precautions because of the potential exposure. *shrug*. Whatever.

Anesthesia calls again....do i want to do this in a negative pressure room? Because that's the policy in COVID precaution patients, and we think it'll be safer for the anesthesia staff to suck out all the bad particles after intubation. Seems reasonable, and I have no problem with that. I get along with my anesthesia colleagues and if they want more protection i'm happy to do that.....the negative pressure room is a little smaller (not a normal cardiac room) so i'll be inconvenienced but i'm okay with that to protect my team.

ID calls....*sigh* What now? So they want us to do this in a positive pressure room because it lowers the risk of wound infection to the patient....and they think they're negative based on all the tests. Hmmm...okay....so then lift the COVID precautions, pronounce him officially negative and we'll do that I guess.

Few minutes go by....phone rings again. In a cruel twist of fate, I've come to really despise the phone ringing. It's always something bad....in junior high i used to sit around and fantasize that all the girls I was crushing on would call me and every time the phone would ring I would get all excited, like it could be one of them. It usually wasn't, and by usually I mean never, but that's another story. So now i'm on a multi-way call with anesthesia, ID, hospital administration. Outwardly I'm like "oh hi everyone" but inside i'm like....there is no way this is a good thing for me.

They tell me they have (admin and ID) talked amongst themselves....and have decided that the poor suffering patient is essentially negative, so we can do this in a positive pressure room (that is riskier for us doing the procedure if they end up having the virus) because they're so confident, as non-combatants, that he's negative and ID thinks this is better for the patient overall. But.....they want us to wear N95's, hoods, face shields, space suits, condoms etc and they won't officially lift the COVID precautions. My anesthesia friends protest, saying that even though the patient's risk of wound infection is hypothetically higher that their risk doing the aerosolizing part of the procedure is definitely higher if they won't officially make them negative.....this being the risk of course of getting a deadly virus that can kill a dozen of us. Admin and ID people ask me, as the attending surgeon, as the captain of the ship, what i want to do then......

Well....selfishly I can't do a longer procedure in all that gear. Maybe I'm a prima donna, but i don't like to operate in anything that impairs my vision or my tactile sensation. I don't routinely wear eye protection and I single glove...even for Hep C and HIV....I tape my mask down the same way everytime, I put my loupes and headlight on in the same order everytime....I'm not even that type A (I think) but I do think these things matter. I remember reading about Jerry Rice taping his jersey down so it wouldn't be untucked during a game.....which seems mostly aesthetic. But my ability to see and feel is not just for looks....it is critical to my ability to do my job and I take that very seriously. I know the anesthesiologist well, and they're legit. Good doctor and a good friend...with a family, including young children. Usually very solid....I can feel their fear coming through the phone.

So.....I flexed. Using my surgeon voice, I said if the admin and ID won't lift the restrictions or have the confidence to say we don't have to wear the full COVID PPE, then they're not sure enough for me to do this in a way that doesn't provide the most protection for my team actually doing the work. While I understand the patient may have more risk, we're talking one person versus a dozen people.....the dozen people of course being highly specialized health care providers who may go on to save hundreds of people in the next few weeks, if not thousands and thousands over the course of their respective careers. So as the attending surgeon I want to do this in a negative pressure room to protect my team...that's what I want to do, so there. Book my case, in the room I want, right now, final answer, end of discussion.

There was a long awkward pause....and I let it float. First person to talk in a negotiation loses, and if I'm bold enough to do this job i'm courageous enough to make ppl a little uncomfortable. The admin person comes on and says "well....after talking to ID and risk management we've decided this should be positive pressure and that's what it's gonna be. If the patient has a complication we can't justify it with the negative tests.....but we're going to insist on you using all the PPE and staying on COVID precautions afterwards, just in case. We just wanted to have the phone call to make sure....u know....that everyone knew. And that you had the opportunity to...you know.....let your team know. And....you know....see how they all felt"

So it's up to me, but not really....and they value my opinion but won't do what i say regardless. Fuming....I made a joke that wasn't really a joke....something along the lines of "yeah that's cool we'll all just get exposed maybe to a deadly airborne viral pathogen and die hahahahaha that's cool as long as you can still bill for the cabg should be all good." Clearly feeling like I had crossed the line, the admin went into the corporate damage control mode, saying they would provide us with all the good PPE and we would be fine as long as we were careful, that this is about patient safety and minimizing their wound infection risk after talking to ID who feels strongly about this....dodging the obvious logical cluster they're advocating for by calling them COVID negative for purposes of covering themselves on paper legally but not protecting us the workers by putting it in the proper room (per actual protocol they created) while demanding we wear spacesuits so if we get sick we can't complain..... and putting me in the incredibly awkward position of feeling like I have to agree with them.......to put my team in danger to help the patient, when I can't help but shake the feeling I should be pushing harder to protect my friends as the commander here. It's the perfect lose-lose situation.....if i throw a fit they cancel the case and the patient suffers......if they die I've neglected them. If i go with the flow, my team......my fellows, anesthesia, perfusion, nursing.....the people looking at me to lead them, the people who toil and slave and sweat to help me.....well.....that help me be me. To do what I am supposed to do in the OR.....these people are now at risk, and their families and etc. It was a weird mix of feelings.....all i felt primarily was nausea.
Already pretty angry, I called the ID person privately to complain about the logical inconsistency and lack of fortitude to make a definitive call on if this patient has the big bad COVID.....or not. Because you have to be one or the other. And how I felt like they weren't being rational, and I didn't appreciate being put in this position. Their response was, I swear to god: "You know, for a surgeon you seem a little squeamish about all this......."

In that moment I felt my whole medical career flash before my eyes. I was so furious my admin actually walked into my office when i was yelling into the phone "Why don't you come down to the OR and scrub in during the intubation and take a deep breath of some aerosolized particles instead of sitting in your office where it's safe while we do all the goddamn work you ****ing loser"

I'm not an angry person....I think. And i'll probably get in trouble for all this.....but I've never backed down from a good fight before, and maybe now is the time. In the time of the global plague, maybe now is the time to fight back. I'll let you know how it goes......the patient did well and I still don't have a dry cough or a fever. I didn't wear all that extra PPE, and if I die at least i wasn't hypercarbic all day. I have been tired though.....




Thank you kindly, but I must warn you i am quite susceptible to flattery.



How sad is that lol!!! I have to say though....having a GME office send that email out in the middle of a global pandemic when residents are afraid they might be contracting a deadly illness? Sounds like someone needs a PR firm.....

I don't know......have any of you ever been talking to an upset family member of a patient about something stupid?? Like....they're mad that they don't get ESPN2 because some lady that worked in the ED told them we did, and they don't understand how someone within the mighty organization could have made such a grave error???? You look beyond them to see your patient recovering well....and u think about how close they came to absolute catastrophe in the OR, and how they'll never understand just how close they came to not leaving that room alive? You politely smile and nod, because dammit ur a professional....but really all you can think in the back fo your head is a) this is stupid and b) i really, really have to go to the bathroom.

And because of reason B more than anything you really want to excuse yourself, and you think about all the explanations you could give. But you don't...you sit there and smile and nod....you don't want to get hit by the press-gainey or get the lawsuit if they don't like you.....but really you inherently understand as a member of society that has achieved great levels of success that in some situations the optics are absolutely critical to the overall long lasting flavor of a situation. This is what kills me about GME and residency program administration everywhere....no one can be that tone deaf...it defies explanation.

I cannot think of a better example of what residency was all about...."Dear residents, thank you for putting your lives on the line. In times of great uncertainty, many are working feverishly to make the world a better place. We on the other hand, took the time to have a meeting and send this email cutting your salary. Knowing full well you can't do anything about it, we encourage you to get back to work. Hugs and Kisses, your GME office". Jesus......you couldn't make that up if you tried.





Agree that the hope is fading fast.....i guess i'm not surprised by that either in the end. The stoic philosophers believed that you shouldn't look at a glass as half full or half empty.....but to just marvel at the glass. Like wow, we have this amazing vessel that can hold a liquid, not change it's flavor, and allow us to see within it from the outside. That's amazing, and it could be worse....we might not have a glass at all. For a minute I was seeing the glass as half full.....more recently I agree, the admins are coming back slowly....and now i'm back to being happy I just have a glass. For now.

You're too kind to me I think, a rarity for the internet in general, but I do thank you. I wish I could agree with the eloquence, but really it's just me sitting in my home office loaded on Wild Turkey ranting into the keyboard. If I couldn't be a doctor I would love to be a writer, and all the greats have been famous drunks (Hemingway, Thompson, Wallace, Joyce, Capote, Cheever, Faulkner). Have any of you ever tried to write a story though.....it's really hard. I read an editorial once by a physician who was writing a book.....he got loaded on booze and furiously toiled away over everything he could think of and took it to an editor. The editor told him.....yeah this is great and all....but all you have is the middle of a book. You don't have a beginning and an end....just the middle. And if u ever try to write i think you'll find it to be true.....how do you start and how do u end? The middle is where we live our everyday lives, it's where the action is. Your first day as a doctor was already the middle, like going to war the battle was already going on u just walked into it. Your beginning and ending is unique to you, but not relatable necessarily. Hemingway would famously write dialogue in pencil, over and over and over....trying to make it work. So maybe i'll try to be a race car driver instead.



So I've been reading your posts for years and years......and to all of you casually passing through you need to know this lady is a total bad ass. I think this is a perfect example of what we've all been talking about.....the plague is coming for all of us and even then you don't have any concerns for your personal safety. You worry about the rest.....who will care for your dogs, u worry about your family and partners.....you are concerned about your patients.....you're breaking the rules to protect your staff.....maybe that's just who we are as people. If only the public knew....the money grubbing doctor (who doesn't make nearly as much as insurance company executives, administration, etc) at the end of they day is still not looking out for themselves, they worry about the people in their orbit that matter to them first.

Despite all of my negativity though.....honestly sometimes I think there is evidence that it all shines through. What I love about your post the most is the part about the patients sewing masks and bringing them in because they think it will help us. Sometimes I get cynical (shocking, I know) about all of this.....but at the end of the day, honestly, the patients come through for us too. For every dingus ingrate there are a million patients who love us.....I will only admit anonymously that I have a drawer full of thank you letters from them and sometimes I read them when I'm feeling bad about all of this....I would deny the **** out of it in person though. A cardiac surgeon with feelings.....please spare me the tears. I've had years of my life where I felt nothing. But at the end of the day maybe there is a silver lining.

I think most dramatically though you touch on my biggest fear in all of this.....you feel like you won't come out of this in good shape. If a legend like yourself isn't feeling great about all this either, well ****. I'm gonna need more booze.

Just wanted to say, your ID experiences, I feel that.

Great post.