1/🧵An Epiphany: #delirium treated w touch & eye contact, day by day...his mom cried, “He won’t let us help him shake this damned disease.” Finally his mind cleared. “What matters to you? How can I help?” Slowly, surely, he asked, “Doc, can you help me stop drinking?”💔 #Recovery
2/ #GroundZero. What a privilege it is to witness someone enter a long-awaited epiphany that opens the door to so much recovery. Unfortunately, in my early years as a doc, I thought, “Well, this isn’t critical care, so I’ll move on & let someone else take over.”
4/ Consistently I find that my patients provide me more healing and teach me more than I’ll ever gift 🎁 out to them. At least now I know that when a patient’s ICU needs are small but she asks, “Doc, how do I stop drinking & tame my addiction?” my response is…
5/…to sit & listen. Not to offer advice unless asked. To be present. To validate. To teach about the disease of addiction. To make sure the entire group knows it’s a family disease. Everyone will be a participant in recovery, yet each is responsible only for him/her self.
6/ Recovery is never a one-size-fits-all. Everyone has to enter into his/her own program. He wanted this, and we navigated him to professional help and rehab, including #AA and the family to #Alanon. We discussed his choices, healthy boundaries, and taking it one day at a time.
7/fin
The most important things were he was asking for help & as his physician, I was extending my hand. It was a start for both of us.
“Recovery takes time, self-refection, the ability to hear exactly what it is that you need, and the wish for a better life.”
Polly Drew #hope
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1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇
2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…
3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.
What’s going on here? And why it’s key in #COVID19
It’s quite simple: we finally had the #wisdom to ask Mr. D the right question! He and his wife encouraged us to use this picture to teach what we learned.
Mr. D was a pre-#COVID patient. On this day, he was taken off the vent after a MONTH. The incessant mantra had been, “What’s the matter WITH Mr. D?” He was surprised when we asked, “What matters TO you, Mr. D?”
3/ He has a tracheostomy, as you can see. We insert this airway through the neck to improve #comfort when someone is on a vent well beyond 10 days. He’s more comfortable because he no longer has a tube in his mouth. We used a program called the #A2Fbundle to reduce his #delirium.
1/🧵 AGEISM: Never be discouraged by age AND don’t judge others by age. Chronological age is a bogus constraint in life. I read today of some great examples of iconic people who did crazy cool things after 7 decades of life. See these & realize age is NOT a limitation... #MedEd
3/ Bonus 😀: German athlete Johanna Quaas at 86 y/o is the world’s oldest gymnast at age 86. She’s a retired P.E. teacher & started in this sport at age 56.
Im a doctor who is now spending more & more time daily caring for #LongHaulers (pts w LongCOVID). I just got a TINY dose of what it must feel like to be unheard and unseen…AND I want to apologize to you.
2/ I just keep hearing you say, “Doc, why doesn’t anyone believe me? My friends look at me and think I’m fine, even as I feel further and further adrift. I’m not myself and I can’t tell if I ever will be again. #COVID has ruined my life.”
3/ Yesterday as my plan landed, my phone vibrated. It was the wife of a former ICU #COVID pt, now trached & living on a vent in an LTAC, asking how she can get his new docs to understand & carefully manage her husband’s ongoing #LongCOVID & Post-Intensive Care Syndrome (#PICS).
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)
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.
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!