Estoy bailando.

Our hospital has started playing the Rocky Theme Song over the PA system to announce every COVID discharge. A welcome replacement of the constant "Bleps" heard even just a week ago. I don't know whose idea it was, but I must admit it was a good one. It's been awhile since we could laugh and dance. We all needed something good!

This is not just something good for us. This is something good for the world. Listen to it, and know what it means. How do you not at least join in a slight head bob?
This is for the patients, this is for the nurses, for the housekeepers, for the cafeteria workers, the postal workers, sanitation workers, teachers reaching their students remotely, the moms and dads working from home and keeping up with home schooling, this is for everyone fighting the frontlines on their knees and staying home!



I've appreciated Alicia Keys ever since "Empire State of Mind" and second her "Good Job" to everyone doing their part, respecting the need to social distance and to play their role in this war whether that role is at home, in a virtual classroom or boardroom, in a kitchen, in a hospital, etc.

For the confused feelings starting to creep out and invade society, for those disgruntled and unable to understand their isolation. For those finding it difficult to sacrifice in order to protect their fellow humankind... we can not falter in prayer! Pray for patience and understanding to take hold. Pray that self-sacrificing Love, as demonstrated by our Example, Jesus Christ, can be shared and exhibited greater than the confusion, the isolation and the fear. Pray that humanity can accept and return that kind of love at such a needful time as this.



Pray that we can all one day dance together!
Much Love and Prayer.


"Good Job"
Alicia Keys

You're the engine that makes all things go
And you're always in disguise, my hero
I see your light in the dark
Smile in my face when we all know it's hard
There's no way to ever pay you back
Bless your heart, know I love you for that
Honest and selfless
I don't know if this helps it but

Good Job
You're doing a good job
You're doing a good job
Don't get too down
The world needs you now
Know that you matter
Matter matter yeah

Six in the morning
And soon as you walk through that door
Everyone needs you again
The world's out of order
It's not as sound
When you're not around
All day on your feet
Hard to
Keep that energy
I know
When it feels like the end of the road
You don't let go
You just press forward
You're the engine that makes all things go
Always in disguise, my hero
I see a light in the dark
Smile in my face
When we all know it's hard
There is no way to ever pay you back
Bless your heart
Know I love you for that
Honest and selfless
I don't know if this helps it but

Good Job
You're doing a good job
You're doing a good job
Don't get too down
The world needs you now
Know that you matter
Matter matter yeah

The Mothers
The Fathers
The Teachers that reach us
Strangers to friends
That show up in the end
From the bottom to the top
The listeners that hear us
This for you
You make me fearles

Estoy ser humano, hueso y carne, débil y agotable.

 I have a confession. I sometimes get these ideas of grandeur. I wouldn't go as far as to say delusion of grandeur, I know I'm nothing except for the grace of God. But, sometimes my adrenaline kicks in and I keep going on my own steam forgetting to draw from that grace, only remembering my human limits as I come to a sputtering halt.
I'm referring to last week, after two incredibly busy weeks at the hospital. By the time I was able to get myself home last Saturday I wasn't capable of doing much more than maintaining fetal position in bed for at least 15 hours. And it took at least a full 24 hours to feel like myself again. Sigh. There is a reason God designed the Earth to rotate, giving us day and night. There is a reason He declared a day of rest. We are his creation, and He knows what we need. The human body, as utterly awesome as it was fashioned, is still just that... human.


All of my co-residents have been given clearance to return to work. Which means that a few of my extra calls have been redistributed once again, and my schedule is a bit more manageable. For which I am very thankful.
Despite everyone being back, we unfortunately still don't see each other often on account of the new times. a.k.a. COVID coverage and no elective surgeries. But no one complains, we see the numbers starting to improve. One of the COVID ICUs (the last one to be converted to COVID) has now been the first one to be closed and emptied of COVID patients. The total COVID inpatient census at the hospital has trickled down over the past week or so, due to lower amount of daily admissions combined with steady discharges (either to home or heaven). We see those numbers and take great caution to believe them, bracing ourselves mentally for what could potentially happen once restrictions are lifted. Hence, noone complains, because no one really talks about it much anymore. We've adapted to our new normal. Even the bruises on the bridges of our noses from the N95s are becoming calloused and numb and the skin of our hands becoming ever drier and itchy from constant purell and washing, but that's just our noses and hands adjusting and adapting as well.

My co-resident took the following photo the other day:

The hospital campus with empty parking lots... Deserted hospitals: patients fighting for their lives, many loosing that battle, without family or loved ones to comfort them. When a family member asks me about visiting I direct them to the nursing manager and then watch as the law is laid down not having the heart to tell them no myself. These hospitals are a war zone, and no exceptions are made.

Much Love and Prayers.

Estoy preguntandome cuál será el normal nuevo.

BLEP!
The increasingly familiar indication of a new announcement coming over the PA system. We all pause to hear where the next Code Blue is located. I'm starting to dread that BLEP! On the rare occasion it's not a Code Blue is momentary reason for rejoicing! Last night at one point there were three bleps in a 30 minute span, and we went from one straight to the next.
I paused to ask our medicine resident colleagues the other day how they are holding up. Codes have become their new normal, but 3 in 30 minutes is more than usual for us. My junior on call with me last night has a friend at Montefiore, designated COVID hospital in the city, and reports on his shift he averages a code every 15-30 minutes.... for 12 hours straight.

We admitted a kidney transplant patient the other night on call whose presentation looked like COVID, smelled like COVID, and sure enough, it was COVID. On interview in the ED, he had this look on his face like he knew something he wasn't telling us. Like he was trying to cover something up, dead set on being as brave as possible, despite being terrified. In my gut I knew this wasn't going to end well, and any other time I would have admitted him to an ICU... but this isn't any other time, and in the ED he was maintaining his saturation with minimal supplemental oxygen via nasal cannula. So he was admitted to the COVID floor. By morning, despite best wishes, he was one of those Bleps.

I keep checking stats hoping the rise in cases will slow, but it doesn't and the black bar of deaths at the top just keeps getting thicker and thicker.

 Last night on call, I had set my goggles down at some point and forgotten them, only realizing when I was set to go see a new patient rule/out COVID, and they weren't sittting on top of my head for me to pull down. I felt as naked as one does when they forget to wear their watch to which they are accustomed, and paced back and forth outside the door as my junior went in without me, with his goggles and splash guard in place. I grabbed my backup goggles, and then later found my usual goggles again so walked around with two goggles on top of my head. A much better feeling than not having any, and no one said anything. It made me wonder though... is this going to stay the new normal? Even after COVID is controlled, even after we are all vaccinated?

Proning teams have also become a new normal at the hospital. You see them walking down the hallway in a group, going from ICU to ICU clad in bunny suits, turning patients one by one. Physiologically, a patient in acute respiratory distress syndrome (ARDS) like that caused by COVID is aided by being placed in prone positioning. There are rotorest beds available that will rotate a patient itself, however they are special order beds, expense and few in number. It's not possible to put all of our patients on such beds, so they are manually flipped twice a day. By the time the proning team finishes with morning rounds, it's about time to start the afternoon round of turns.

Much Love and Prayers.

Estoy ajustando.

Dare I say, a new normal is settling on the hospital during this time of COVID. The shock of what the virus is capable of, the stress of being overwhelmed, the fear and isolation acutely glaring have all become glazed over as we desensitize and adjust. Co-residents that have been out sick are slowly improving and with that, are able to start returning to work. No one ever talks about how the operating rooms used to be fully operational, except to express just how long ago it seems that they were. New York was predicted to plateau this week, and it seems to be the case. I now fear that with a plateau of new admissions, if we all catch and try to hold that glimmer of hope, a second spike of cases may be more detrimental than these past two months (emotionally and psychologically speaking). I wonder what this coming week will bring? What is expected is new admissions to stay plateau'd, but deaths continue to spike as patients that have lingered for the past couple of weeks finally succumb. Along with the plateau at Westchester, have come a handful of patients improving and slowly, one by one coming off the ventilators in a successful manner. They are few, but nice to see.

The persistent busyness of the pediatric surgery service has helped this past week to fly by for me. I get to be one of the few surgery residents that still is operating during this time. As far away from the hospital that all should stay these days, little kids unfortunately still get sick, or fall off their skateboards and bicycles, etc. Or in one particular case, as I was discussing surgery with mom while facetiming with dad, it became painfully obvious that up to that point no one had used the term 'cancer' with them. Despite being separated and scared, they handled everything well. Even post operatively, Mom pointed at the ventilator and expressed "we're lucky to have that aren't we?" I was rather surprised at their own understanding of what was not openly expressed to them of what it means to be sick in the current times.

Now is not a time to be sick, and if sick pray you don't need hospitalization. However, emergencies still happen. This past week an article was published in the New York Times, "Where Have All the Heart Attacks Gone?" There is a noticeable decline in heart attack and stroke presentations to hospitals, not only in the US but globally. My past few weeks on cardiac surgery, I still performed bypass surgery for many, but not at the rate that I was expecting, or was in the past normal for the Cardiac surgeons.  In addition, there was not a single acute dissection that presented during my time on the service.  On general surgery call, I keep expecting patients to show up with acute abdomens after having stayed at home for days with belly pain instead of coming to the hospital and presenting only after their only option is to rush to the OR. But, that has not really been happening either. I'm sure any cause and effect will make much more sense retrospectively, but for the time being, I just pray that its simply true emergencies are in fact at a low and not just ignored.

Much Love and Prayers

Estoy con los niños.

A third of our program has been devoted to the COVID units under management of the surgical teams. Of the remaining 2/3, a few of us are out with COVID, which leaves approximately half of the typical resident pool to hold down the fort, covering the hospital and general surgery call. In order to make this possible, some services have been dissolved, and others combined. There are usually about 12 services that we cover on any given day. This has been siphoned down to 5 services in order to have adequate resident coverage on all services. And at a minimum, we have all at least doubled up on call.

Unfortunately, our schedule continues to change daily. Last week, I was scheduled to start covering the COVID units today. After multiple changes, I instead actually started on the pediatric surgery service today. I told them whereever they needed me. And I ment it, I'm happy to keep the peds service up and running. But then even today, my team changed. Then another one of my coresidents had to leave the call pool, causing shuffling of the call schedule yet again. And tomorrow, which resident is going to have to leave the call pool? How many more calls will we each have to pick up by the end of this block? I may have had to yell at the wall a little bit... Flexibility can only help you to a certain point when playing Twister.  So I yelled at an inanimate object, but even while venting I still ment it, I know I did, wherever they need me. Whenever they need me. We'll all get through this together. Especially if we are there to catch each other, support each other, and allow venting when needed. ;)

We've had the first coworkers requiring hospitalization, and co-resident's families being admitted as well. Some have expressed more fear as it hits closer and closer to home seemingly daily. To be honest... there's a part of me welcoming the increasingly heavy schedule. It will keep me busy.

Much love and prayers.

P.S. still asymptomatic

Estamos luchando juntos, batalla y guerra.

Underneath the masks and behind the shields the same familiar eyes look back at me, but the hospital is hardly recognizable anymore. This isn't what anyone had planned. And if you look long enough at those eyes, you'll see what they're all trying to hide. This has never been seen before.

I have never seen anything like this. I have seen a traumatic brain injury patient's brain start to herniate and loose all ability to auto-regulate itself, core temperatures reaching 107+, cooking themselves from the inside out. I have seen a patient become horridly septic from an infection, their bodies releasing floods of acute phase reactants causing chaos and ending in multi-organ failure. But this virus... it does it all, and it does it fast.

With no cure, it's all supportive medicine that we are able to provide. When the lungs, can no longer be lungs...we can intubate and ventilate. When the kidneys, can no longer be kidneys, we can dialyze. When the heart, can no longer be a heart we can perform chest compressions. And so on, and so forth. But when it all happens at the same time.... with patients lined up to follow suit...

Our units are full, but the cases are still coming. On call the other night, we had three deaths in our COVID units, and that was just our units I'm not sure about the others. By morning, all three rooms already had patients slotted to fill them. My Attending admitted that we have to average a certain number of deaths daily in order to keep up with the cases coming in. One of my co-resident's wife is a Palliative Care Attending in the city at Columbia, where they have a COVID palliative unit. Patients coming in that go straight to palliation rather than intubation, etc. In short... the curve is not flat enough.

The hospital tells us that we are supposed to wear our masks for at least a week. On call the other day was my fourth day of that particular N95, and it kept breaking on me. I'd tie it back together and pretend like it was still doing its job. It broke for the fourth time when I was in the ED in the middle of a procedure. I walked through the ED unprotected with broken N95 in hand, and had them show me where their masks were locked up so I could get a new one. They couldn't deny me a new mask before my week was up that way.

That same call we had a trauma come in, transfer from an outside hospital with a brain injury. He had walked to the post office yesterday, healthy guy out to enjoy some fresh air. On his walk home he had fallen and hit his head. When he came to us, he was stable, even from a brain injury perspective. On CXR my co-resident pointed to his left lung field and said it looked like COVID. The patient had no symptoms, and in denial I chalked it up to my co-resident being jumpy. However, due to concern for rib fracture and contusion a CT chest was obtained... his lungs were filled with COVID consistent findings. Test was run, and by morning he was positive and one of the patient's slotted to take one of the newly opened beds in our COVID units. He was healthy, asymptomatic and had just walked to the post office spreading COVID the whole way. The hospital is now starting to test all traumas for COVID.

This morning, when I scrolled through social media, I was filled with a new feeling. For the first time instead of frustration, I was relieved and encouraged to be reminded that the vast majority of people in this world are healthy, and that their biggest worry is being bored, or stress about home-schooling, etc. That I needed to take a step back from the 3% of the 1% and breathe.

I think again of those eyes looking back at me from behind mask and shield.  There's a deeper thought they're all trying to hide. Deeper than this has never been seen before.  The fact that we are not in control, are merely reacting to what continues coming. The frontliners of this war, are not the frontliners of the various battles being raged around the globe. Those willing to take to knee and pray are the true frontliners. We all have the opportunity to fight this on the frontlines. Pray on behalf of the healthcare workers, the scientists, the parents coming to the end of their patience, the newly unemployed, etc. Pray for humanity.

Much Love and Prayer.

PS still asymptomatic.