After a week on #COVID19 service, I have some non-clinical reflections for #hospitalists. This is NOT your regular ward time. I’ll be honest, it was a tough week. I’ll start with the tough stuff. But stick with me – ending with more positivity and some helpful hints.
The need for constant vigilance was exhausting. I felt pretty safe in patient rooms with gown, mask, gloves. But on unit, constantly reminding myself to open doors with a paper towel, wipe computer/phone with bleach before using, not touch face: v. tiring. theguardian.com/society/2020/m…
The frustration of knowing certain patients were going to deteriorate and not being able to do anything about it except watch it happen was very tough emotionally. I’ve been spoiled by modern medicine – in general, I’m not used to feeling quite so helpless.
The emotional toll of seeing sick, terrified patients without any visitors was also high. Made it my top priority to get deteriorating patients to call/video chat family before too late. Sometimes this took hours and use of my own Skype account.
The visiting policy was very hard on families too. They were frantic trying to reach staff every to find out what was going on. Our operators overwhelmed. Gave my personal cell to families of the sickest patients.
Also, everything took so much time. Assume donning+doffing takes 5 min per room entry – with 17 patients on unit that’s 1.5 extra hours just to see everyone once, let alone more often if sick or to see new arrivals after old ones transferred. My days were much longer than usual.
I rented an apartment for the week as I live far from hospital and also wanted to keep my family safe. This was lonely and I missed my kids/husband.
On the plus side: this is a great stint for those of you (like me) who are medical minimalists and #ChoosingWisely fans. On my 58 patients I ordered: 0 CTs, 0 echos, 0 ultrasounds. Turns out, you don’t really need them and minimizes iatrogenic spread and staff exposures.
Also, the goals of minimizing room entry and maximizing situational awareness prompted an outburst of creativity. Partway through the week some nurses had the bright idea of writing the info we most cared about right on the doors: oxygenation. 
Some tips: ditch the rings, the watch, the white coat, the necklaces, the dangly earrings. First time in 18 years I haven’t worn my wedding ring. Weird feeling. But made donning/doffing much safer & easier. I got to pretend #ILookLikeASurgeon!
More tips: A snack bag size ziplock is perfect size for an iPhone. Put it in a clean one every morning. Touchscreen, microphone work just fine through it. Wipe it down with bleach wipes periodically. Discard bag at night to have clean phone in home. (Explains blurry pics.)
Final tip: Hack the EHR. Make a dedicated COVID note template (history/plans monotonously similar). Reconfigure patient list to add crucial info like oxygenation and COVID test result. (Adding O2 was game changer for helping me track sickest patients.) Use COVID order sets.
Lastly, lean on your colleagues. Such amazing support here by hospitalist director @KHochmanMD and the rest of our non-twitter hospitalists; heroic ICU group incl @StermanDaniel @SamParniaMDPhD (& many nontwitter peeps) plus @PaulTestaMD and terrific MCIT team
