I can safely speak for most people when I say that we went into Medicine to help people heal, to help prevent people from dying. This is especially so in Critical Care Medicine. And so, when our patients do die, it is very hard to not take a patient’s death as a failure, not to take it personally.

This was especially true during the pandemic. Over, and over, and over again, we tried our hardest – spent blood, sweat, and tears – to care for Covid patients, and they kept dying despite everything we do. It was very hard not feel like a failure when our patients died.

Dr. Chen’s words brought me such comfort. Death is not a failure, it is a transition. And, like it or not, some of our patients – despite doing everything right and trying our hardest – are going to die. They are going to make the transition.

We need to stop taking it personally. We need to stop feeling like our patients’ death are failures – so long, of course, as we did everything in our power to try and help our patients. And, when it is clear that our patients will die, that they are making that transition, as Dr. Chen puts it, then we need to do all we can to make sure our patients die with dignity and comfort on their own terms. It is much easier said that done, no doubt, and it is essential that we remember it as much as possible.

Helping our patients conquer critical illness is the honor and privilege of a lifetime, a fulfillment of a lifetime dream for me personally. And if we can also help our patients die with dignity and comfort, on their own terms, it is also as Dr. Chen says,

“a huge privilege to be with patients in that setting….to walk alongside them and their families as they are approaching a transition.”

Dr. Elaine Chen, Rush University Medical Center

Very well said indeed.

Listen to the entire conversation with Dr. Chen.

The post Death Is Not A Failure appeared first on Medika Life.

On his first day, he never showed up. When they went to look for him, they found him dead in his hotel room. He went to a gun show, bought a rifle, and shot himself in the chest. I was absolutely speechless in shock and full of grief for him and his family.

This is the face of physician suicide.

He was a very accomplished physician, with so much to offer his patients, the communities in which he served them, and his colleagues, including me. He had so much more good to do for so many years to come. All that came to an abrupt and horrific halt when he took his own life. It is so tragic on so many levels.

September 17 is National Physician Suicide Awareness Day. Approximately 300-400 physicians die by suicide every year, a rate that is more than twice the general population. Any suicide by anyone is an unmitigated tragedy. It is a senseless loss of life, and the concentric circles of grief and sorrow extend well beyond the individual taking his or her own life.

The suicide of a physician – or nurse or any other healthcare professional – is a double tragedy, because now we have lost a healer. We have lost someone who dedicated their lives to help heal the sick and injured. When the healer cannot be healed, it is a problem for all of us, and it is so important that we are aware of this problem and deal with it head on.

The Covid-19 pandemic was very difficult on all of us. We have, I have, seen horrors that cannot be unseen. We have, I have, experienced tragedy on scale that was truly unprecedented. It has left scars on our souls that will last a lifetime. And for some of us, those scars continue to hurt to the point of hopelessness and despair that may lead to suicide.

Please. If you are hurting, please get help. Please. The Physicians Foundation developed the HEART acronym to help us identify the warning signs (or “vital signs”) of physician suicide:

• Health: Talking about wanting to hurt themselves
• Emotions: Feeling hopeless or having no purpose
• Attitude: Having outbursts of anger or sadness
• Relationships: Withdrawing or isolating themselves from family, friends, and coworkers
• Temperament: Acting anxious or agitated; behaving recklessly

Here are some other resources to get help:

• National Suicide Prevention Hotline: 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones.
  • *NEW* – The U.S. has transitioned from the 10-digit National Suicide Prevention Lifeline to 988. Dial this number the same way you would 911.
  • Or, use Lifeline Chat on the web
• Crisis Text Line: The Crisis Text hotline is available 24/7 throughout the U.S. The Crisis Text Line serves anyone in any type of crisis, connecting them with a crisis counselor who can provide support and information. Text “HELLO” to 741741
• NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

Many employers have an Employee Assistance Program (EAP). Please use it. In my organization, we have a free Peer Responder Program, where trained peers are available 24/7 to talk to colleagues who need help. I am blessed and honored to be one of those Peer Responders. Please get help. You are not alone, and please do not suffer alone.

As I said above, any suicide is an absolute tragedy. I have cared for numerous patients who have successfully taken their lives, and it is a tragedy of untold proportions. It is horrific to see. The suicide of a healer is that much worse. We all need to be aware of it and do everything we can to prevent it from happening.

The post When A Healer Cannot Be Healed appeared first on Medika Life.

Healthcare professionals have entered a field where empathy, compassion, and an ability to relate well to patients are implicitly mandated. But are some of the staff falling through the cracks, is staff shortage playing a highly detrimental role, or is management falling short in their responsibility to care for patients? Maybe all of it must be factored in, but the bottom line is that patients are suffering from a lack of caring in too many instances.

Additionally, any patients who are older, physically or mentally compromised, may be trained, by brutal experiences, and being a “good patient” is the only way to go. Is that how this is coming to fruition in our fields?

Why should a loved one have to almost plead with a medical staffer to truly “take care?” It’s not my speculation but related in an article in the professional literature.

“I know you have a lot of patients, but he’s all I’ve got. Please take care of him like he’s one of yours.” The partner of my hospitalized patient pleaded.

I remember saying something similar to the chief of a specialized unit at a major NYC hospital. “I’ll take care of her like she’s a family member,” he said, and I responded, “I hope you like your family.”

Cheeky, yes, and he didn’t follow through as I had expected, and an instrument was broken during his procedure — but they persisted. He’s dead now, so no family members need to worry about his ineptness.

The Rocky Road of Care

Why would anyone need to plead in a situation where the highest level of care, concern and personal connection should be the norm? It’s because it’s not the norm, and some staff seems to take umbrage at being expected to be helpful and understanding. Mental status exams after anesthesia might be a case in point.

The patient, who had not been adequately sedated and, as a result, the surgery was canceled because of excruciating pain, tried to lighten the nurse’s load at the bedside.

“Do you know your name,” the nurse asked brusquely.

With an attempt at humor (despite the frightening experience), the patient responded, “Yes, I know my name. Do you?”

Screwing up her face, the nurse asked the question once again.

The patient responded, “Do you want to know my name? I’m trying for a little humor here, as you can see,” the patient said. How the patient managed that, I can’t imagine because she had just come from a harrowing, painful experience that now necessitated yet another, later visit to the OR.

No answer from the nurse but a cold stare. The nurse walked away without completing any further questioning, such as the place, the day, and the date. It was incomplete, but who cares? Who would check, and what would the chart show? A mental status had been administered when it was not completed, a deceitful error.

Before the procedure, a port for administering anesthesia had been inserted into the patient’s arm. A nurse, attempting to pull a gown sleeve up for easier access, inadvertently dislodged the port, and another had to be inserted.

“Look what you’ve done,” the young physician inserting the port (without wearing gloves) said to the patient. The patient had done nothing, but she was being blamed now. Wasn’t she anxious enough without this type of treatment, or was that the usual physician-patient banter before surgery?

Waiting for the procedure to be completed and expecting to take the patient home, there was a query. What was the reason the surgery was canceled? “The patient kept moving around,” was the answer to that question. Again, untrue because it was pain caused by inadequate sedation that led to the patient asking the physician to stop because of the pain, and they both agreed.

I’ve always told patients in my office that they need an advocate for medical consultations or a procedure. I know how anxiety affects memory, and I wanted to ensure they got the information as intended. But in an operating room, you have no advocate, and everyone waits outside to be told whatever is convenient for the staff.

Am I being too harsh? I think not because I saw and heard the entire scenario I’ve described. Where do we go from here? How can we improve patient engagement if we have a resistant staff or management who wants procedures, not re-training in something that doesn’t generate more income?

Patients don’t have unions as medical staff are now seeking. The hospitals pay hospital advocates, so where does their feeling of responsibility lie? Inevitably, the patient will be blamed in some way, either overtly or covertly, and this is not acceptable.

To be continued at some time in the future.

The post Why Is There No True, Empathic Patient Engagement or Is There?” appeared first on Medika Life.

A heavy burden has been placed upon medical workers due to the medical crisis. A scientific review on medical staff groups across different countries revealed that their safety was their utmost concern, especially because frontliners treat patients directly. The review cited that nurses in China were worried about their welfare, especially due to the unavailability of personal protective equipment for medical workers. In the early stages of the pandemic, their direct exposure to cases had the potential to lead to life-threatening infections due to the lack of medicines formulated specifically for the virus.

Aside from defending themselves against infection, the review emphasized that medical staff were also battling against fatigue and burnout. Despite the diverse roles and responsibilities of healthcare workers, the majority of medical professionals had to devote extra time to ensure hospital’s weren’t overwhelmed. And in line with the new health regulations and procedures, health administrators spent more time creating and implementing relevant hospital policies for sanitation and care. Medical technologists also worked overtime in laboratories to ensure a quick turnaround for the results of COVID-19 tests. The aforementioned review also mentioned that a nurse in Toronto had to work multiple 12-hour shifts in the emergency department with no breaks to cater to all admitted patients.

The Gaps Causing the Alarming Struggles of Medical Frontliners

Given that medical frontliners are overworked and at risk in their workplaces, a review on the mental health impact of the pandemic revealed that one out of every four healthcare workers was diagnosed with mild anxiety, depression, or insomnia. One study in the review highlighted that healthcare workers experienced anxiety and fear, especially since they felt inadequately prepared to handle the pandemic on a hospital-level.

Other studies have also emphasized the importance of training regarding COVID-19 infection and control, especially from authority figures within the workplace. The lack of training for the pandemic made frontline workers feel vulnerable to the infectious disease, causing them to experience even more mental distress.

Apart from training hospital workers on handling a pandemic, it is also important to ease the burden on medical frontliners by providing equal access to vaccines. One of our articles emphasized that prioritizing wealthy countries and placing value on profits in vaccine distribution is a form of injustice to everyone. Without a collective response, we’ve seen that the virus will only mutate and develop powerful variants that current vaccine options are unable to fully defend against. Due to the unequal distribution of vaccines, healthcare workers will have to risk their health and endure longer shifts every time infection rates surge.

Healthcare workers continue to struggle because of the unsystematic responses to the pandemic. While they were burdened by the lack of preparations for the first waves of the virus, they continue to be overworked and over-exposed because of the inequality in vaccine distributions. To properly honor the heroes of the pandemic, it’s important to explore how medical systems and care interventions can be improved.

The post Why Healthcare Workers Struggle Amidst the Ongoing Pandemic appeared first on Medika Life.

“Wait!! Don’t tell me! I haven’t done it yet!”

Almost every day, these words are likely repeated all across our country, if not the world. Every day, I look forward to the next crack at guessing the five-letter word within six tries, and I look forward to sharing my results with my family and friends. My nine-year-old son also loves the game, and he and I have frequently collaborated to guess the word together. It was a brilliant – and also quite lucrative – idea. I love the game.

Now there are apps that have been developed that do the same thing, and they allow users to play the game repeatedly. It’s not the same experience; it’s not the same excitement.

And this shows how important shared experience truly is.

What makes Wordle so much fun is that everyone is doing it at the same time. There is only one word per day. And, once you make the guess, you can share your experience with the world. And in that shared experience is fulfillment that a repeated “Wordle” app simply does not provide.

Share experience helps remind us that we are not alone. It reminds us that we are part of a larger whole, and in that shared experience there is comfort and fellowship. Religious faithful engage in shared experience all the time, whether it be in weekly worship sessions or larger spiritual events such as Lent – going on now – or Ramadan, which starts on April 2. Wordle is yet another one of these shared experiences.

We in healthcare have been enveloped in an unprecedented shared experience going on three years now. In the beginning, there was the thrill of being on the front lines of the “global pandemic.” As that thrill faded with the relentless waves of death and suffering, we then had a shared experience of grief and pain. And now, we have a shared experience of anger and exhaustion.

And in those shared experiences is comfort and fellowship, something we as human beings can hardly forgo.

What’s more, the experience of Wordle solidifies how important it is for us human beings to be together. Having seen what this virus can do to people, I was sympathetic to the impulse to lock down society, so we don’t cause more death and destruction and overwhelm the healthcare system (which causes further death and destruction).

The cost of that, it is becoming very clear, was high in many instances. Human beings don’t do well when they are isolated. It is a tough balance, and I hope we can learn how to do things better the next time a pandemic hits our shores (which is inevitable).

Wordle shows how fulfilling shared experiences are. I hope that – in this unprecedented time of division – we can use whatever means to come together as a people. It is essential for our survival as a people.

The post Wordle Highlights the Essential Nature of Shared Experience appeared first on Medika Life.

Genetics were against him. His father died at 58 and an older brother died at 61, both of heart disease. To manage his cardiovascular risks, my father-in-law embraced prevention through diet and exercise, and relied on science and medical adherence – even successfully seeking an ablation for a reoccurring arrhythmia as he neared 90. His actions enabled him to exert a measure of control over his life journey.

Throughout that journey, his medical care was exemplary, but during the final 13 days of his life – 12 spent in a hospital and the last precious day at home, where he passed peacefully from one world to the next, surrounded by people who loved him with all their hearts – I saw what America needs to do to improve care, comfort and costs. I saw that even in state-of-the-art care settings, much work needs to be done to improve collaboration and performance in the service of the patient.

Seven years ago, I penned a piece on the fragmented medical system. I wrote that our system of care is not patient-centric, it is self-centered.  While the intention of health professionals to help and heal is exceptional, it’s unclear whether the system they work within is set up to enable them to succeed in complex care situations.

When Finn Partners released a survey in February 2016 on our fragmented health system, I wrote that despite “the talk, the concept of consumer – in this case, the patient – as the king has yet to be realized within the health community. Health professionals, payers, the pharma industry and policy decision-makers have a responsibility to be better patient resources. Providing a clearer path for patients to navigate the system may improve outcomes and reduce costs – it’s still a missing magic ingredient.”

Respect for Patients Must Be At the Heart of Care

Staff is overstretched everywhere now, and that impacts collaboration and coordination of care. One nurse’s comment in response to information shared by one of my father-in-law’s caregivers exemplified this persistent and underlying problem: “I don’t have time to read the My Chart (EHR) file.”

During the 12 days my father-in-law was hospitalized, he had different 10 nurses assigned to oversee his care. The hospitalist assigned to him changed three times.  The nephrologist also rotated. Staff overlooked the sign posted over my father-in-law’s bed that stated: “Make Sure Patient Has Hearing Aids On,” and diagnosed him with cognitive challenges.  And, despite the sign and constant caregiver reminders to floor staff, they first lost one of his hearing aids and then the other days later – $6,000 of high-tech that had connected him to the world, gone.

Forget Interoperability Nurses Have No Time to Read EHRs

If care providers do not have sufficient bandwidth to read about the medical history of their patients, you can forget about interoperability playing a role in improved care. If the system does not demand that caregivers look over recent tests conducted by other physicians – or allow them the time to do review – then you can forget the optimal use of resources.  No matter how innovative medications, treatments or modalities of care are, if these elements aren’t being effectively coordinated for the patient, those therapeutics may as well not exist.

My friend and industry colleague John Nosta, an innovation theorist, often says, “Cultures crushes innovation.” These past two weeks, I once again saw the “Nosta Theory” at work.  To be clear, we should not be pointing the finger of blame for this situation at physicians, nurses or allied health professionals on the hospital floor. Healers want to heal just as much as those who are ill want to be helped.  But care professionals have to work within the system that the hospital creates, and if the system does not support their efforts or make the best use of their abilities, energy and dedication, what is to be done?

Change Starts with Awareness

In one of three books that he published, my father-in-law, an internist, psychiatrist and sports psychologist, wrote: “When people say, ‘I’ll never change,’ what does that mean? They might mean, ‘I’ll never be able to change my awareness.’ And they may not realize that such a change is often the first step in changing other aspects of their experience.”

The United States boasts one of the most advanced health systems in the world, and leaders within the system seem fully aware they need to change. It’s time to build on that awareness and take critical steps toward improving health delivery and coordination of care – and to move from a system that leads directly to health professional burn-out, avoidable deaths, and spiraling care costs to one that puts people – patients and their caregivers – first.

___________________________________________________________

[This Medika.Life article is dedicated to caregivers, who advocate for their loved ones with courage and hope. It is dedicated to patients who must secure their place at the decision-making table. It is dedicated to health professionals who must be given both the tools of innovation and the supportive culture of collaboration to do their best possible work toward healing.]

The post Cutting-Edge Innovation Is Not Enough To Save Lives appeared first on Medika Life.

This is how it has felt caring for critically ill COVID patients throughout this pandemic. Patient after patient comes to the ICU, and with each one, we have some semblance of hope that this one will be different. Maybe this one will be the one who beats the odds and survives with a good outcome. Then, more often than not, we watch them die after suffering terrible affliction. Just this past week, we lost count of the number of patients who died of COVID. And there are even more who will likely not survive.

This has happened again, and again, and again. It is absolutely exhausting. And it makes me feel like I’m Sisyphus, endlessly pushing that large and heavy boulder up the hill, only to have the boulder fall back down. In fact, a “Sisyphean task” is one that seems fruitless and absolutely impossible to complete.

It is so hard to keep going, and it is taking an enormous amount of effort to resist the urge to give up and “just swim down.” But here’s the thing: we have to keep going, because our patients need us. They are relying on us to be there for them at their most vulnerable moments.

Yet, as I think about it, the reality of the situation is different, and in this, we should take heart. When we are in the thick of things – caring for our patients – it may seem that we are alone, endlessly pushing that boulder up the hill. But we are not alone. We do not have to shoulder the burden alone.

For we physicians, we have our partners and colleagues that will help us push the boulder up the hill. The same is true with our nursing, respiratory therapy, and care technician colleagues: they are also not alone, and their colleagues and teammates will also help push that boulder up the hill. And, we all have each other, and we all will help each other push that boulder up the hill.

Yes, it is still difficult. Yes, the boulder is very heavy, and the hill is very steep. But we are not alone, and we need to lean on each other and use our collective strength to see through the pandemic together.

I truly hope and sincerely pray that we are finally at the beginning of the end of the pandemic and crisis phase of SARS CoV-2. I truly hope and sincerely pray that we will finally be over the scourge and madness and death. I truly hope and sincerely pray that the tragedy of this pandemic will finally come to an end. It cannot come soon enough.

Yet, we need to always remember that we are not Sisyphus. Sisyphus was truly alone, and he was forever punished by having to bear an impossible burden alone. We are not Sisyphus. We are not alone. We have each other, and together we will win, and we will behold the beauty at the top of the hill, gleefully watching that boulder crash down the hill into the sea of oblivion.

The post Of Sisyphus and COVID appeared first on Medika Life.

I keep reading that hospitalizations are way less; cases are milder; and the disease is not as bad as that with previous variants, such as Delta. 

If that’s the case, I’m not seeing that at all where I am (outside of Chicago). This wave is the worst one we’ve yet endured. 

Almost half of all the beds in my hospital are occupied by Covid patients. More than half of my ICU is Covid patients, and all of them — every single one — is on a ventilator. We have surpassed our record numbers from last Fall, and the end is not in sight at all. And, every hour, more and more Covid patients keep coming to our hospital. 

On top of all this, we are all exhausted after nearly two years battling Covid on the front lines. We are spent — physically and emotionally. Moreover, so many staff are out sick with Covid, and it is causing stress and wreaking havoc on every level. Everyone is on edge. 

In fact, I asked my Hospital Medicine colleagues about whether they thought this latest Omicron wave was “mild.” One said straight up, “It’s bullshit.” The other said, “Hell no!” 

So, Omicron “mild”? Hardly. 

Now, I can’t say for sure that all of the people coming in sick with Covid are infected with the Omicron variant. They very well may be left over Delta infections. And, based on what I have been seeing my multiple vaccinated family members and colleagues getting infected with Covid, their illnesses are indeed mild. 

Here is the operative word of that last sentence: vaccinated.

For the overwhelming majority of those who are vaccinated, Covid is a mild illness. In my hospital, about 90% of those hospitalized are unvaccinated. In my ICU, my patients are not old nursing home residents: the vast majority are between 40 and 60 years old. They are fathers, husbands, sisters, and daughters. And every single one of them is unvaccinated. Every. Single. One.

So, really, for an unvaccinated person, is the Omicron strain all that “milder”? I really don’t think so. And, as one my colleagues told me, “‘Mild dead’ is still dead.” Amen, sister. 

This is the absolute worst wave yet. Covid cases among my group of ICU specialists across the country have shot straight upwards, and we will definitely surpass the last horrific wave. We are so done with this virus, and the problem is the virus is not done with us. We are doing our best and trying to stand as tall as possible. But, it is so very hard. 

Omicron “mild”? I’m surely not seeing it. 

The post Omicron “Mild”? Hardly. appeared first on Medika Life.

These were the words of my partner in the ICU, signing out a woman who was suffering from ongoing bleeding from her gastrointestinal tract. She came into the hospital for a routine endoscopy. Suddenly, she started bleeding. She not only “kept me busy,” but I did not leave her bedside for my entire shift – more than 7 hours.

Her bleeding was relentless. Despite everything I was doing for her, she kept bleeding. We gave blood transfusion after blood transfusion. She kept bleeding. I sent her to the Radiology suite to get an angiogram and have metal coils placed inside the blood vessels. I was there in the suite, and I watched the blood vessels get blocked. She kept bleeding.

I had the Gastroenterology specialist come back and look into her stomach again with a camera, to see if he can do anything to stop it. She kept bleeding. Finally, after virtually emptying the blood bank and trying everything else, I called the General Surgeon to come and take her to the operating room.

The only way he could stop the bleeding was to take out her entire stomach.

She was in terrible shock, and she required multiple medications to support her blood pressure. I had to keep her deeply sedated on a breathing machine. And yet, she survived. She was then transferred to the University for more advanced surgery to connect her intestines to her esophagus.

She survived, and I pray she will have a full recovery from this horrific illness.

With the relentless waves of COVID-19, it is so very easy to give up hope and say, “Why even bother?” It is so very easy to “just swim down” and succumb to hopelessness and despair. And yet, cases such as these remind me that, there is still joy in the ICU. It is not all death and despair. By the grace of God, I am still able to help someone survive critical illness and live another day to be with family and others whom they love.

With COVID clouding over all that we do in the ICU, I have to remind myself that I can still do good and help people. It is not all doom and gloom. Yes, I had a long shift taking care of this patient, and it was exhausting – both physically and mentally. At the same time, it is so thrilling to know that my patient – who I thought was going to bleed to death – survived and will hopefully do well after this terrible affliction. This case has helped me combat and resist the hopelessness that COVID can easily instill.

Even in the midst of another COVID winter, there is still joy in the ICU. I can still help people heal and not helplessly watch them die. I will always try to remember this case and not despair. There is still joy in the ICU.

The post There Is Still Joy In The ICU appeared first on Medika Life.

As I reflect back on all that has happened since early 2020, when SARS CoV-2 hit our shores in full force, it does nothing if it has not left me awe-struck. There has been so much that we at the bedside have experienced. There has been so much that we at the bedside have seen that cannot be unseen.

It has been tough. Really tough.

So many of us are totally spent – physically, emotionally, and spiritually. So many of us are saying, “Why bother?” We are totally done with the virus, but the problem is the virus is not done with us.

We are not ready for another surge, but the surges continue to come, and we have no choice but to face them head on. I think I can speak for most – if not all of us – at the bedside when I say that we will never be the same after the pandemic is over, whenever that day is.

And yet, after everything that COVID has done, I am still so very grateful.

So many people sarcastically say, “Living the dream” when asked how they are doing. For me, I am living my dream. Ever since I have been a little boy, I have only ever wanted to be a doctor. It was my life dream. Now, each and every day, I go to work and truly live my dream.

I am so very grateful.

I am grateful to be one of the privileged few to care for the sick. I am grateful to be one of the privileged few to care for the very sick – those critically ill in the ICU. I am grateful to be one of the privileged few to care for people at their most vulnerable point. I am grateful to be able to help someone survive critical illness and be as well as possible or, if death is inevitable, help them die with dignity without suffering and pain.

Each and every day, complete strangers put their faith and trust in me to help them feel better and navigate a truly horrific time. I can never take this faith and trust for granted. While I cannot be successful all of the time, I can stand tall knowing that I have fought as hard I could with each and every patient. I can stand tall knowing that I did all that I could and tried my best.

And for that, I am so very grateful. Even after everything that has happened with the pandemic, and through all the pain and distress, I am still so very grateful.

Whenever I get the urge to just “swim down,” I try my hardest to step back and take it all in: that I am one of the privileged few to care for the sick. And I say a prayer of thanksgiving, because I am so very grateful.

The post After Everything COVID Has Done, I Am Still So Grateful appeared first on Medika Life.