WesElyMD Profile picture
26 May, 13 tweets, 9 min read
1/🧵 Imagine 2 people, madly in love & married 28 years, in an impossible situation, both lives on the line & separated by different hospitals. Then imagine 2 sets of #nurses & #doctors separately determined to overcome ⛰ of obstacles…
(shared w perm)

#MedTwitter #NurseTwitter
2/ Last night this is what happened…

NOTE: the family wants to share their story to offer a glimpse of love ❤️ on all levels

For 3 years, Mark took care of Sharon, his #bride, as she battled breast #cancer. It relentlessly spread to her bones. He never stopped giving.
3/ She could tell he was spent and getting sick himself. “Mark, let’s get you to the doctor!” “Not until you are well, Sharon.” He remained laser focused on her every need. As she became weaker, he took her to get admitted yesterday.

#marriage #life #caregivers
4/ Once Sharon was safely under our @VUMChealth team’s care, he gave out. Being a #Veteran, his weakness and shock brought him to our @DeptVetAffairs Nashville VA next door, where he was admitted to our ICU service apparently dying.

#medstudenttwitter #TipsForNewDocs
5/ Mark’s abdomen was rapidly enlarging, and astute nurses & docs in the night diagnosed him with hemorrhagic shock. This is a dual story of the family’s love plus that of my colleagues, #frontlineheroes in both medical centers. It’s happening in your town, too. We know that!
6/ Both teams called each other and said, “He’s got to see her as he dies.” And “She’s begging to be with him.” Urgently, they hatched the plan. “Let’s put her in a wheelchair and take Sharon to Mark.” But her #pain was too great. She couldn’t tolerate it.

7/ Because of #COVID19, tunnels allowing bed access between the 2 hospitals have been on total #LockDown over a year. No one has passed. Policemen at both centers were contacted. Thank you ❤️ VA nurse Becky Sneed & Dr. @RobertoTombazzi, VUMC nurse @LauriannaB & Dr. Laura Price!
8/ Despite strict orders never to unlock those doors and hundreds of previous requests denied, uniformed officers👮‍♀️at both centers grabbed special keys 🔑 and opened those doors. Sharon & her team of #caregivers became the first people allowed to pass since #COVID #LongCovid.
9/ Back to the unimaginably breathtaking image above…taken from a monitor outside the room with permission granted today by Sharon and her daughter @AngelaRange1 as I sat with the family.

No words 😔
10/ Imagine decades of shared experiences, loving embraces, ups and downs, raising a family...all culminating in dual impending deaths separated by medical centers worlds apart & seemingly insurmountable odds…racing against time.

Can it be done?
11/ Love overpowers all. It really does. Beds juxtaposed, lying again side by side. She reaching out to hold him. “You are the love of my life, Mark.” He musters, “I’ll love you forever.” And her, “Don’t party till I get there.” And sang their song “Right Here, Right Now!”
Today I walked from the VA where Mark died to Vanderbilt where Sharon was lying. I stopped by a #COVID pts room & borrowed @charliemackesy’s book I’d given her. The boy, mole, fox & horse had more work to do! Sharon was gracious as I read. Tears were shed. #Healing...
👏 All credit goes to the residents & nurses who pulled off this beautiful act of loving kindness. ❤️They simply wouldn’t take no for an answer & saw to it that the right thing was done for these spouses & their family. I bow down to them and learn!
#MedTwitter #AcademicTwitter

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More from @WesElyMD

25 May
1/🧵 Lung Scarring in #COVID19 – what’s the deal?
I got a birds eye view of #LongCOVID yesterday from my patient who’s still on Oxygen at 8 months. WHY?

Let’s unpack what happens in the 🫁 and why it’s such a life-changing disease is for so many...
#MedTwitter #NurseTwitter
2/ 4-months after #COVID, this @JAMA_current study found 51% of N=478 pts had >=1 #LongCOVID symptom that wasn’t there before. 63% of those w CT scans had lung problems, with 1 in 5 showing scarring. What else?...
3/ This JAMA study also showed this important array of symptoms that essentially constitute #LongCOVID – 31% gross fatigue, 21% cognitive problems, and 23/18/7% anxiety, depression & PTSD. Their outsides look normal, but they aren’t!
Read 7 tweets
24 May
1/ 🎥 Asymptomatic #COVID = Silent Spreaders
This short video from @EricTopol & @Danieloran summarizes key issues about Asymptomatic Spread of #COVID19. Watch & then read the🧵for my unpacking…there is so much at stake!
#Pandemic #Vaccinate
2/ In 2020, @danieloran & @EricTopol predicted that up to 40-45% of people infected w #COVID19 were totally asymptomatic, meaning HUGE risk of silently spreading the disease to others. 👁 highlights

Next tweet for the UPDATE...


#MedTwitter #NurseTwitter
3/ Now we know ~1 in 3 people infected with #SARSCoV2 remain asymptomatic. This is based on 61 studies & ~1,800,000 pts! Also, of those who test + w/out any symptoms, 75% stay asymptomatic.  This poses a HUGE risk of silent spread to high risk patients.

Read 8 tweets
20 May
1/🧵#COVID19 Compassion

Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. He’s chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. He’s afraid of tight-fitting a bipap mask.

2/ The intern said, “I never saw a patient whose respiratory rate was twice his oxygen saturation!” Yep, last night his O2 sats dropped to 30% and he was breathing 60 times a minute! By morning he was 85% sat and RR was 28. Better but tenuous.

#TipsForNewDocs #MedStudentTwitter
3/ All of this raises some complicated ethical + treatment questions that I’d like to cover. We addressed this on rounds several times this week & at times it got a bit heated. His #nurse said she noticed herself flushed, mad, and heart rate >130…why?
Read 13 tweets
17 May
1/🧵This figure from CHEST on early tracheostomy in #COVID19 pts is helpful for 2 reasons: it points out different ways of care. Read the BLUE circles clockwise & then switch to OUTER RED ARROWS clockwise again. Clear and True.


#medtwitter #nursetwitter Image
2/ The #COVID pt with ARDS + Sepsis on a ventilator is TOO often subjected to TONS of sedation, which adds brain injury, immobilization & development of physical disability. NEW DISEASES added to the original problem. We call this Post-Intensive Care Syndrome #PICS. Image
3/ Early tracheostomy around day 10 can help (not always!) as outlined in the RED ARROWS. The goal is to lessen the added injury by waking people up, getting them out of bed and early mobilization plus talking with family. This is done via the #A2Fbundle. @SCCM Image
Read 4 tweets
13 May
1/ 🧵 Mentor-Mentee topic: MEANWHILES
Mentees often tell me they feel stuck in time with no progress in achieving their goals. This is a Meanwhile. As humans, we want to get through meanwhiles, but they are important times of growth. Don’t rush meanwhiles!

Some thoughts…
2/ When I was in college, a mentor taught me about the 3 major types of meanwhiles.

1. Uneventful Occurrence.
2. Unknowing.
3. Not Yet.

Don’t let fear drive you past the riches of these meanwhiles!

Let’s break them down…
3/ Meanwhiles of Uneventful Occurrence:
Tedium is not just OK. It’s necessary. Ordinary times are preparation for fruit to come. Let the grace of your routine establish sustainable balance in your life…one day at a time…in this we grow.
Read 8 tweets
12 May
1/ Steroids in #COVID19?🧵

N=428. In 1 study we go from
1. statistically significant ⬆️ Deaths w steroids
2. to no difference by adjusting
3. to statistically significant ⬇️ Deaths by subgroup phenotyping of inflammation…

All in the same study? Let’s unpack this...
2/ Chen et al built on a 2014 @LancetRM study by Dr. Calfee of 1,022 pts, showing that sick people on a ventilator w ARDS (think #COVID19) are of 2 types, 1 of which is Hyperinflammatory (storm of inflammation) who might benefit from drugs like steroids.

3/ First Chen tried to overcome the biases associated with their observational data & showed that some observational methods (eg, multivariable regression including baseline SOI) can give the exact wrong answer (HR 1.97) because it does not include temporal biases.
Read 7 tweets

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