Advance Praise for the Book:

“Sometimes funny, sometimes heart wrenching, and always on the money, placing the patient first and foremost. Dr Hassaballa’s take on life in the ICU may be written for fellow doctors, but it provides a real life window into the joys, challenges and agonies of the ICU wards, experiences shared by the doctors, nurses, caregivers, patients and their families. A must read for new caregivers entering the ICU and a fantastic guide for families seeking to navigate the often daunting world of the ICU. I’d love to see this book on tables in every ICU waiting room across the country.”

Dr. Robert Turner
Founder, Medika Life


“Dr. Hesham Hassaballa brings so much more to the bedside than his medical expertise and skill – he brings his expansive heart and soul to the timeless mission of healing people who arrive at the ICU and gives hope to the families who wait for their recovery. “How Not to Kill Someone in the ICU is a masterful – transparent and transformative – must-read penned by someone who has dreamt of being a physician since childhood and now shoulders the responsibility to search out and speak to the healthcare system’s underlying illnesses. This is a breakthrough book – almost poetry – written by someone who knows what is at stake for all who seek to heal or hope for healing.”

Gil Bashe, Chair Global Health and Purpose, FINN Partners
Editor-in-Chief, Medika Life

The post Dr. Hassaballa’s Latest Book is Now Available: “How Not To Kill Someone in the ICU” appeared first on Medika Life.

The blood counts never came back to normal, even though they were supposed to. The toxic effects of the chemotherapy never went away, even though they were supposed to. The hospital stay was not short, even though it was supposed to be. Everything that could go wrong went so terribly wrong.

Then, on Saturday morning, something changed. Her breathing got worse. She was less responsive. She was immediately transferred to the ICU to get closer monitoring. All throughout the day and night, her organ systems began to fail – one by one. By the end of the night, she was on a ventilator and had to be transferred to another hospital to get dialysis.

Everything continued to deteriorate, and by the following morning, my daughter was dead. She succumbed to gram negative septic shock that caused multiorgan failure. All I could do was watch in horror and grieve over the death of my firstborn, a death I could do nothing to prevent.

This is the ruthless monster that is sepsis. This is the horror that I witnessed firsthand as a father and witness countless times as a physician in the ICU caring for sepsis patients.

Sepsis is defined as organ failure as a result of an abnormal response of the body to an infection. It can be devastating. In a matter of hours, it can take someone from awake, alert, and talking to fighting for his or her very life in shock on a ventilator and dialysis machine. It is the number one diagnosis we see in the ICU, and it has exacted a terrible toll on so many people and their family and loved ones.

We try to always be vigilant against this disease, because it can sneak up on our patients with very little warning. Decades of research have been conducted to try and fight this disease, and there have been many drugs and therapies that have been tried and tried without success. I “grew up” in the era of those drugs and therapies, and I have seen one after the other fail to prevent death and destruction from this disease.

At the same time, it is not hopeless: I have been blessed to help heal countless patients from certain death from sepsis, and seeing them survive this terrible illness brings a feeling of joy that is beyond words to describe. Sepsis can be treated successfully, as long as one is always thinking about it, is aggressive with resuscitation early on, and administers appropriate antibiotic therapy as soon as it is suspected.

September is Sepsis Awareness Month. It is of the utmost importance that we, as ICU clinicians, are ever vigilant against this ruthless monster that ravaged my poor daughter and sent her back to our Precious Beloved. And we should also take some time to remember and pray for all those who have lost their battles with sepsis, as well as their families and loved ones having to move on with the grief of horrible loss. May our Lord ever comfort them in this life and the next. Amen.

The post The Ruthless Monster That Is Sepsis appeared first on Medika Life.

Instead, as we rapidly approach the three year mark of the Covid pandemic, healthcare finds itself in many ways, far the worse for wear, not having benefited financially in any way from the pandemic. Staffing issues persist, doctors, nurses and healthcare professionals having abandoned their posts for greener and, let’s be honest, safer, working environments.

Nothing kills job satisfaction faster than the continued thought of catching a potentially fatal disease each time you go to work. Add to that, frustrated, aggressive and often abusive patients and you can see why many professionals opted for a career change.

Do We Now Face the Pandemic of Poverty?

For all the good our lockdowns did, and although debate still rages, it is safe to assume that the general consensus now is that they were a terrible, costly mistake, a collective lapse in judgement that the global economy is still staggering to recover from and never may. In lieu of pumping the American stimulus package into the expansion and development of healthcare for the afflicted, the U.S. opted to shut down its economy and pay the public trillions through its now infamous “stimulus” packages.

America was not alone and countries across the globe followed suit. Healthcare, our primary prerogative in times of pandemic, stood by and watched helplessly as trillions upon trillions of dollars flowed, not to healthcare, but into the hands of an imprisoned public.

The Pandemic Has Come, But the Ripple Effect of “Long-Covid” Remains

The pandemic has come, left its mark and although its impact is still felt as new variants sweep through populations, our fear has passed. We now view the disease as would influenza. It evokes a similar nonchalant response in the public, one of “just another disease we have to cope with” and life moves on. We have moved on. Healthcare hasn’t. Many areas are still beset by Covid outbreaks and now a gloomy shadow of another kind looms on the horizon. The long term impacts of Covid, so called “long Covid”, affecting millions and placing further burden on an already creaking healthcare infrastructure.

The Real Legacy of Covid

Perhaps the real legacy of Covid will not be that of the first truly global pandemic in living memory. Perhaps its true place in history will be as the trumpet call that heralded the beginning of the end of healthcare in modern American society. An opportunity missed to reinvigorate an industry with chronic shortcomings, to prepare it to meet the challenges of a new century. An industry desperately starved of investment and facing massive challenges in delivering care to those most in need.

Now, as the WHO braces itself for a possible new global threat from the Monkeypox virus, cases having doubled in the last two weeks, American healthcare finds itself poorly placed to respond. They are still struggling to come to terms with the aftermath of dealing with Covid, their resources, both human and mechanical, drained and supply chain issues still prevail.

In short, a perfect storm awaits. One we have engineered and enabled with poor choices and little foresight. Mark my words, should we be headed for another pandemic on the back of Covid, few will pay heed to the plight of their one true ally. Healthcare.

The post Did Healthcare Just Miss its Bus? 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.

That was the response of a young barista at the coffee shop I was in when she asked whether she was going to get vaccinated. I could only shake my head as I left with my iced latte. And shaking my head in sheer exasperation is all I can do with this current surge in Covid cases.

I just came back from a Covid hotspot, helping staff an intensive care unit in the South. It was bad. Really bad. The hospital and the ICU are filling up with patients, many of them very sick with Covid.

The first day I was there, the hospital was almost full, and there were dozens waiting in the Emergency Room to get beds in the hospital. So, the middle of the afternoon, they erected triage tents in front of the Emergency Department. I never thought – this far into the pandemic – I would ever see those tents again.

Yet, there they were, being absolutely necessary to handle the continuous wave of patients hitting the hospital Emergency Department for all sorts of ailments, not just Covid. Still, the numbers of Covid patients are rising every day, and it is simply exhausting.

Unlike the previous surges, these Covid patients are young, in their 20s-50s. Many of them have no comorbidities and were previously healthy. And they are sick. Very sick. And the worst part? The vast, vast majority – well over 90% – are unvaccinated against Covid-19. This is what is so exasperating.

The vaccines against Covid-19 are widely available in the United States now, free of charge to anyone and everyone. Everyone 12 years of age or older is eligible. The vaccines are incredibly safe and incredibly effective at preventing death and severe illness from Covid.

And yet, so many – like that young woman in the coffee shop – simply refuse to take the shot. As a result, many of them are coming into the hospital gasping for air, going on ventilators, and then dying from Covid weeks later. Every death from Covid has been horrible and senseless, but in this era of widely available vaccines, the deaths are even more senseless than before.

This is why I shake my head in exasperation.

Yes, there are some fully vaccinated people who have gotten infected. That is not surprising. That does not mean the vaccines don’t work. On the contrary, the vaccines are working because the surges in cases and hospitalizations are occurring in those areas of the country with low vaccination rates. The real world data clearly demonstrate just how effective these vaccines have been.

And yet, so many don’t want to be vaccinated, and they are largely the ones who are getting sick and dying from Covid. And I’ve seen them up close in the ICU, and it is frightening to see.

I had hoped we would be over Covid by this summer. I had hoped our country would finally take a breath of relief from this virus. Sadly, this is not the case. I feel for my colleagues all over the country who have not had a break from this pandemic. We are all exhausted from the horrors of what we saw last year and early this year. And now, we have to endure this all over again.

This is why I shake my head in exasperation. I am fighting with every cell in my body not to give in to anger.

The post I Just Came Back From a COVID Hotspot: It’s Bad. Real Bad. appeared first on Medika Life.

He became so much worse: he couldn’t breathe. He was restless. He became increasingly agitated.

Then, his heart just stopped. We called a CODE BLUE. We started CPR, and I placed a breathing tube into his lungs. His heart came back, but it was not to last.

I placed him on every medicine I had to try to help his heart beat more forcefully. Nothing was working. When I did an ultrasound of the heart, it was barely beating — even though he was on rocket fuel for the heart. In spite of everything we were doing, we could not save him. He died within hours of coming to the ICU.

It was sad, and I really felt for the family at the bedside. At the same time, I didn’t have the same feeling I had when I took care of a Covid patient who suffered the same fate. I’ve faced death so many times in the ICU. But with Covid it was different, and I’ve figured out why.

Fear.

I didn’t have the fear and dread that I had taking care of Covid patients. You see, I wasn’t scared of catching cardiogenic shock from the patient. I am not scared of catching diabetic ketoacidosis. I am not scared, even, to catch someone’s septic shock, even though it is possible to catch some infections like C. difficile or tuberculosis.

I am scared of catching SARS CoV-2. I am deathly scared of getting Covid and then bringing it home to my family. This disease is so horrific and so new, and we still don’t know what are the long-term effects from this disease. This unknown, this uncertainty, leads to a great amount of fear. And that fear permeates everything when caring for patients who are suffering from Covid-19.

Never before have we had a disease like Covid-19. Sure, we’ve had influenza, and even very bad influenza pandemics like H1N1. We have never had something as bad as Covid-19; something as horrific as Covid-19; something as deadly as Covid-19.

And it’s “transmitted through the air,” as someone famously said recently. It’s so contagious, and that fact adds to the menace of the disease. And when you have dozens of these patients at the same time — all on ventilators, all super sick — the fear and dread can be overwhelming. It was overwhelming.

Yes, we had PPE, and I was and still am extremely grateful for it. The PPE works, too. And we have some treatments now that seem to be effective for Covid. Still, it’s hard to shake the fear, especially when you see firsthand what horror this disease can cause on its victims.

On the one hand, a little bit of fear can be productive. It ensures vigilance: vigilance for hand washing, vigilance for wearing PPE, vigilance for making sure I don’t catch or transit this disease to others.

On the other hand, too much fear can be paralyzing, and I must also be vigilant against letting the very natural fear I have of Covid-19 from taking over. While several thousand of my healthcare colleagues have indeed gotten Covid, and some have even died, the vast majority of us in healthcare have remained safe from this disease. And I thank God for that.

I’ve faced death many times over as a critical care physician, but I’ve never been as affected as I have been with Covid-19. Fear has a lot to do with that. Going forward, I must remain vigilant: vigilant against catching this disease, and also vigilant against letting my fear get the best of me.

The post What is it About Covid That Makes it Worse appeared first on Medika Life.

How can a physician trained in dermatology, pediatrics, obstetrics, podiatry, or orthopedic surgery suddenly be pulled into life-saving, gut-wrenching work as an emergency medicine physician? What prepared them for this, and how can they perform adequately when no one has a few minutes to prepare them for the next emergency patient who needs ventilation? How do they handle the dreadful death toll of this virus? What about their medical ethical mandates when triage is indicated?

The practice of medicine for many of these out-of-specialty physicians will be and is dramatically different during the present and future pandemics. Once working in private offices, group practices, or standing in state-of-the-art operating rooms, these physicians will find themselves propelled from 20th-century medicine into new standards of 21st-century medicine within months. New-normal medicine will be uncharted territory and will tax many of their beliefs about healthcare.

Work may, at times, be in field hospitals set up by the military or in settings that formally were used for other purposes, including hotels, convention centers, factories, warehouses, tents, and even ships. Their former, somewhat predictable, daily routine will no longer be the routine that continues. How will it affect them?

Suicide Statistics Provide a Small Window

The consequences are far-reaching not only for the physicians but for their families and their fortunes. Physicians are not immune to emotion, and we know that by the statistics that lay out, in an eye-opening fashion, the suicide data relative to physicians.

“Suicide is the second most common cause of death for 10-to 34-year-olds in the United States. The average age of matriculating medical students in 2017–2018 was 24. Thus, it should come as no surprise that medical students, residents, and attendings — like other Americans — are affected by suicide and mental illness.” An estimated 300 physicians commit suicide each year, but that statistic is old and doesn’t factor in a pandemic with all of its increased stress and potential burnout in addition to PTSD (post-traumatic stress disorder).

Out of Specialty Work

Graduating medical students take the Hippocratic Oath, which sets their career course in terms of ethics and morals. The newly-minted physicians expect to undergo grueling years of advanced training. Each specialty has been carefully evaluated for their interest and their skill-level.

Personalities, too, were included in the search for their future career goals. Once the COVID-19 hit, the best-laid plans of new docs went awry in directions no one could predict.

Not all physicians are “people” people but now their choices would be limited by a pandemic. Some would have preferred the solitude of a lab or the absolute authority of the operating room rather than the M.A.S.H environments into which they were thrown.

Challenging is one of the words most often used by physicians and nurses who were placed into unfamiliar circumstances where they needed to refresh or learn new medical protocols. The main concern, now for all, was how to protect themselves and their families, once they were off shift. They knew they were dealing with an incredibly deadly, contagious virus, and it clung to clothing, cardboard, metal, and several other materials and hours if not days.

The virus was also resistant to heat, presenting an additional difficulty in labs and treatment rooms. It wasn’t easily killed or removed.

Even the protective materials that were to be used required special procedures for removal. An additional concern was whether or not there would be adequate masks and gowns on the next shift. If the work didn’t demand yeoman-like skills, the anxiety of not having PPEs (Personal Effective Equipment) available heightened the stress.

Whoever thought needed supplies or machines wouldn’t be there when needed for treatment or to save a life? It was out of the realm in which they had trained.

Ethical Concerns Arise

The difficulty which presented itself was whether or not to refuse reassignment to an ED (emergency department) or chance catching the virus while working in the ED. Did physicians come to their work as a “calling” or a profession that made difficult ethical choices a part of the bargain?

Some in healthcare would refuse to work if PPEs weren’t in adequate supply. Was ethics involved at all here? Is it mandatory that physicians and other healthcare workers put themselves in situations of extreme risk and death to satisfy their oath to serve? What does a physician do in situations of scarcity where staff or equipment is at a premium?

One article has addressed this situation in a forward-thinking manner. “Educators should begin to teach “scarcity thinking” in medical schools, residencies, and other training situations, with a focus on practical guidance for contingency planning and a deep understanding of the ethical principles of implementing crisis standards of care.” We can put this under “lessons learned” during a pandemic.

Is working in an area in which the MD is not a specialist an ethical issue? A medical license does not indicate a need to be a specialist and often states the person is qualified to practice medicine and surgery. But a license is poor protection.

The duty to treat has come up against new ethical issues outside areas of specialization. And the situation is not contained in one area of the country or the world or to one specialty. “We’re hearing a lot of anxieties from specialists who don’t know what the right thing to do is for their patients,” said Dr. Megan Ranney, an emergency physician in Rhode Island. “Dermatologists, ophthalmologists, we’re even hearing from dentists.”

As a result of the difficulty of the pandemic, “U.S. medical professionals on the front line of the coronavirus pandemic are lobbying policymakers for protection from potential malpractice lawsuits as hospital triage care and physicians take on roles outside their specialties.”

For any physician or healthcare professional, COVID-19 difficulties can be daunting. In the case of physicians wishing to volunteer or to come out of retirement, the American Medical Association has provided a series of guides.

For employed physicians, the AMA has another bit of assistance in “a guide that concisely covers key strategic, legal, and contractual considerations. The information is not to be construed as legal or financial advice, but it is meant to help physicians understand their rights and the opportunities available to them.”

In the greater scheme of things, a physician, NP (nurse practitioner), PA (physician’s assistant), or another licensed medical professional has to weigh the moral/ethical issues as well as the legal ones. Guides may provide some valuable information, but the law isn’t always so clear-cut on many matters, and medicine is one of them.

The swirl of a pandemic created in 2020 will change all of us and the world in which we live, the hospitals in which we work and the labs where advances are made to name a few. Many other changes may come as surprises or welcomed advances but that’s not for us to know today. We await a better tomorrow after this dark night in which we now find ourselves.

The post Ethical Dilemmas of Physicians During a Pandemic appeared first on Medika Life.