The Long Slog of the Pulmonary Consult Service

COVID-19 is disproportionately affecting men, maybe because they have more ACE2 receptors than women, I don’t know. All I know is the male physicians are taking a beating from COVID-19. So, we made the decision to put the female physicians on the “floor” (regular hospital wards) where the risk of COVID-19 infection is actually higher than the ICU, and put the male physicians in the ICU, especially if they have additional risk factors for infection (e.g. older, overweight). It may not seem logical that clinicians are less likely to get infected in the ICU where patients are actually sicker, but many if not most patients are intubated so they aren’t coughing everywhere. (Check out this blog post about the distance that COVID-19 viruses can travel in the air from an infected patient, and the simulation of a cough, CF). This is just another way that COVID-19 has flipped the narrative – we now are doing the equivalent of getting the MEN in the lifeboats because the women and children are more likely to survive.

So, I am now on the Pulmonary Consult service and rounding on the floors. While not as intense as the ICU, it is taxing in a different way. And yesterday was defeating.

It Feels Like a Personal Failure

We fight so hard for our patients every day. Electrolyte imbalances, tachycardia, the overwhelming degree of hypoxemia. We cheer them on, we prone them, we pray for them. Some stay stable, some get sicker. One gentleman I’ve been watching closely for a week – and like a hawk for 36 hours – has the second-most horrific chest x-ray I’ve ever seen. That is saying something. His medical team took it as a personal defeat when I told them he needed to be intubated. That was hard. His dedicated, now all-female team of women physicians, felt like they had failed him. His nurse was upset. It’s strange how we feel we failed the patient when they get worse. We get those whispering words of doubt – it’s as evil as COVID-19. It says things like if only you did this or if you hadn’t done that. While self-reflection and practice improvement should be ongoing – self-flagellation just makes you feel more defeated. So, I am trying not to listen to the whispering words.