Thread by @medicalaxioms

Lessons Learned from H1N1 October 2009:

I was there as a hospitalist doing a month of nights. What follows is my experience and what I learned.

You know how people say “my dad was in the war but he never talked about it?” These memories are like those. They have been sort of locked away for 10 years.

We didn’t have the forewarning like we do now. We just heard there was an early flu season and the flu was worse. I feel like the beginning of the month was normal. Chest pain. Pneumonia. Pyelonephritis. Asthma exacerbation.

This didn’t change when flu cases came in. The light went on went nurses started saying “I think you need to go see the lady in ER-8.”
“I saw her half an hour ago.”
“She’s on a non rebreather.”
“She was on 2L nasal canula an hour ago.”
“I think she needs to be intubated.”

Without notice, I went from admitting 10 patients a night to 25. I was till admitting pyelo and chest pain, but mainly I became a H1N1 expert. Quickly spotting the young women with diabetes who were likely to crump.

Becoming accustomed to changing my A/P from “supportive care” to “intubate, ventilate, ICU.”

I don’t know if this one will be like that one, but here’s what I learned:

1. For patients who you think have the disease, there is only a singular priority: oxygenation. Make sure everyone is >90% and do whatever is necessary to make sure they are >90% an hour from now (especially an hour before handoff).

2. I forgot to be scared of getting sick. I put on that paper mask and it felt like a NASA space suit.

I never worried about being scared to see the next sick patient. I was to busy to be scared.

3. Don’t develop PPE nihilism. When you run to the door of a CODE, stop and don your mask, then step inside. Wash or foam your hands in an out of every room. Hundreds of times per night.

Keep believing this magic will protect you against anything.

4. Don’t miss all the cases that aren’t the pandemic!!! I saw people miss obvious cases of asthma exacerbation, ACS, heart failure, and bacterial sepsis during these nights. In the midst of this crush of patients, there is still bread and butter.

5. Anticipate the isolation. Driving home after these shifts, everyone seemed normal. Most people were healthy. Sun was shining. Nobody could relate to the military exercise I was undertaking every night.

6. Don’t forget to walk the dog. Nights are weird because you walk in the house bone tired and you know you have to do it again... the same day! Take the dog for a walk. Eat food. Exercise. Like an astronaut on the space station. Stick to your daily schedule.

7. By the grace of god, I didn’t get sick in 2009. This time, if you get sick call out. Patients with sepsis and heart failure exacerbation don’t need your #COVIDー19 on top of it.

8. Support your people. Each and every person was operating at (or beyond) their limit in 2009. Spread thank yous and air high fives liberally. Celebrate every success. Forgive the failures, as your next one is coming right up.

9. Remind yourself it’s not forever. The end is in sight. The next shift will arrive. This wave of patients will slow down. Relief will arrive in due time. You will come out the other end.