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Here’s a guest blog from a friend and colleague who practices Undersea and Hyperbaric Medicine and is also a Critical Care physician. I believe that she should remain anonymous for now. However, I was inspired by the emails and texts she has sent me and thought you would be, too. She’s sending me messages off the cuff – they are “raw” and not edited by her. However, I think that is best. She uses a lot of abbreviations and when I thought it was useful, I explained them in brackets. One day at the right time, I will tell you who she is and we can all thank her properly for her courage and commitment. Here are her COVID-19 Diaries – uncensored.
–Caroline

COVID-19 diaries – Day 5 & 6

I think it is Tuesday now. The days are a blur. Because we closed the ICU to new patients, our population of critically ill COVID-19 patients on ventilators remains at  7 – of which 4 are mine. The other intensivist’s COVID-19 patients are more stable – so I tell her that she’s a much better doctor than I am. In fact, I cannot explain the variability with which it affects even young and healthy people. It is frightening that a healthy 53y old executive with no medical problems is on a 100% NRB [non-rebreather face mask, CF]. He’s scared. He just wants to see his kids again.

I’m now “proning” two patients [managing them intubated, face down, CF] and will probably prone a third by tomorrow. It seems they really “like” it, or I mean their lungs like it because we’re getting sats [oxygen saturations, CF] in the mid to high nineties. The nurses are getting really good at it now and it takes five people compared to nine the first time we did it. Plus the nurses are adding all of these subtle tricks that make the patient more comfortable and safe, which they are just figuring out. I’m so proud of these nurses.

In six days the ICU has become a much stronger unit. We still have some learning to do with deeper sedation and using charts for ideal body weight and peep/FiO2 titration as per ARDSNET. * [The ARDS Network is a clinical research network of approximately 42 hospitals, organized into 12 clinical sites, and a Clinical Coordinating Center (Massachusetts General Hospital) — CF.] Some staff are rock stars and bring their experience from academic institutions. Others need teaching – but honestly, we are all learners.

Some people’s emotions are beginning to show as they adjust to the heavier workloads and worry about seeing their children or grandchildren. I get emails or text messages from people checking on me and it’s so touching. My eyes sting with tears but then blink them away because there’s no time and no place for weeping when patients are so sick and staff have the same fears I do. I just keep focusing on what a good job they’re doing and how hard they’re working to save these patients.

I confess, I am trying to prepare myself. I’ve made a few phone calls to my favorite ID docs and interventional radiologist – telling them that when I get COVID-19 I want them to take care of me and to put in my R IJ [right Internal Jugular vein access, CF]. I have a slim neck of decent length so the line should be easy to place. . . . .I think about things like that now. . . .

I just had a “disagreement” with a colleague about ICU management of these patients.  I have chosen which house officer I will assign to insert HIS internal jugular line when it’s his turn to have covid.  I promise to intervene if the resident hasn’t gotten the IJ going by the tenth or eleventh puncture of his neck. . . . (seriously, did I just say that?)

One of the respiratory therapists said that since it’s so close to Spring and the patients like PEEP [positive end expiratory pressure, CF] so much, he’s going to bring in a box of marshmallow Peeps.

It’s the end of the day and my dear infectious disease colleague — who has been with me for a week since the cases began pouring in – he just called to tell me that he’s covid +. We were rounding together all weekend. So now I am waiting.  . . .

I think we’re at the beginning of a tidal wave. You know when the tsunami tide pulls way out and fish are flopping around on the exposed sea floor? That’s where we are COVID-19 day 7. We’re about to get swept up by a tidal wave.


Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.



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