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Notes from the Front Line

April 26, 2020
by Mark David Siegel

Hi everyone,

A few notes from the front line:

  • Almost all COVID patients have hypertension, diabetes, hyperlipidemia, and/or obesity.
  • Most patients are people of color
  • The stories are similar: several days of worsening cough, fatigue, and shortness of breath, culminating in respiratory failure
  • Our youngest patient is 29, the oldest 100.
  • The ARDS is generally severe and responds to standard interventions: low tidal volume ventilation, proning, sedation, inhaled vasodilators, and neuromuscular blockade
  • Good critical care is crucial: stay organized, round at least twice a day, complete the MICU check list, avoid over-sedation, and collaborate with the nurses and respiratory therapists
  • We planned well: we have most of the equipment and staff we need
  • Once you go into patients’ rooms a few times, it gets much less scary and the worrying goes away
  • You get used to wearing masks.
  • Reading glasses don’t fit under goggles
  • Laughing and courage go hand in hand
  • I witnessed countless moments of supreme humanity, like an intern sitting for over an hour with a dying patient and a resident staying long past her shift to comfort her grieving family
  • Fellows and attendings from other departments are making key contributions
  • You can get creative with head coverings
  • We’re stuffed: Pizza from Pepe’s and Eli’s, chocolate and cookies from grateful patients.
  • We have phenomenal nurses, respiratory therapists, APPs, PCAs, residents, fellows, and attendings
  • Legendary nurses are back in the ICU, emerging from the PACU, billing, and administration
  • Though families can’t be there, the patients aren’t alone; the doctors, nurses, and respiratory therapists treat patients like family
  • Well-rested residents can rise to any challenge (thank you Chiefs for the spectacular schedule)
  • Our mortality rate seems lower than reported (fingers crossed, but that’s what I’m seeing)
  • Scrubs are fashionable and comfy
  • The community lifts us
  • The goal isn’t to be a hero. We do what we’ve trained to do. We support one another. We help our patients. We show up.

And now it’s off to join my team.


Submitted by Mark David Siegel on April 26, 2020