We’re at work for you, please stay home for us

Jeramie Lu Photography | Available for travel Worldwide | www.JeramieLu.com

Perspective from your Healthcare Provider and Police Officers during the COVID-19 Pandemic.

You’ve heard this phrase commonly lately, “we’re at work for you, please stay home for us”. Every single person plays an active role during this outbreak, even though staying home may not feel very proactive. As a Public service worker, many of us will get COVID-19. We are not immune to circumstance. Although precautions are heightened, our exposure makes it inevitable. This pandemic will claim us too.

To be completely honest, just last week with COVID-19 on the rise, my family and I talked about ‘Getting the Hell out of Dodge’ so to speak. I am a Nurse Practitioner in Gynecology Oncology and practice in all three local hospitals; my husband is a Police officer working Patrol to protect your neighborhood. Needless to say, we are unable to Shelter in place. The idea of retreating to a smaller town to protect our immediate family with isolation and refuge was tempting.

There is a constant plethora of emotion surrounding COVID-19.

I was envious of the families that get to stay home with their kids and play together; as I wish I had several weeks to make silly memories at home. However, I am grateful for being a healthcare provider to have the capacity to care for others during a time of need.

Jeramie Lu Photography | Available for travel Worldwide | www.JeramieLu.com

Our careers require commitment to our Community, and we are proud to serve with America to fight this pandemic. I would, however, like to share a Healthcare provider and Police officer’s perspective.

Venturing out daily into a world that has grown closer together, yet further apart during COVID-19.

We continue our morning routine as normal as possible, biding each other with “Have a good day at work babe”. This otherwise caring phrase is now underlined with an ominous “Be safe out there” feeling. My day is started by entering a place where the sick dwell and those infected with coronavirus seek refuge, a hospital. I am screened with a series of questions, showing my badge and then having my temperature taken. I understand this is precautionary measure to protect us all; but it still feels like an episode of Contagion. There are patient’s who need care, and unfortunately cancer does not halt for a virus.

We are given one N95 mask for our personal protection, ONE. A disposable mask developed for a one time use is now the sole personal protection equipment I have available. I am only able to get a new N95 mask from the hospital if my current has been saturated in bodily secretions or blood; and even then we must give our personal identity to be sure the resources are not being abused. I care for patient’s undergoing chemotherapy daily. Their immune system is already compromised, yet I am being asked to “wash my disposable gloves between each patient”, as opposed to disposing them as they were intended.

This COVID-19 seems Surreal. Our resources are strained but we can still overcome this pandemic. These circumstances are temporary and I will continue to do my part to slow the curve.

Psalm 138:3 When I called, you answered me; you made me bold and stouthearted.

Our Police Officers are working hard. They are not able to limit their exposure. If there is a 911 call, they will go. My husband constantly reminds me; he made an oath to protect and serve. I admire his Integrity. Although I cannot speak for him, I can share with you what I know. I know that there is protective segregation within the department. They understandably anticipate the first wave of patrol police officers to fall, and have isolated them in a separate building as to not infect the others. Once they go down… (once My Husband “goes down”) they plan to replace him with another. It’s methodical. It’s brilliant. And truly admirable of the officers who continue to serve. But that doesn’t make it any less scary having the anticipation of bringing COVID-19 home.

Jeramie Lu Photography | Available for travel Worldwide | www.JeramieLu.com

Police Officers are not seeking Recognition, rather acting as member’s of a society that we believe in. Please help us stay safe by staying at home to protect yourself and others.

2 Timothy 1:7 For God did not give us a spirit of timidity, but a spirit of power, of love and of self-discipline.

Healthcare providers and Police Officers are a few of the MANY workers keeping us going. THANK YOU to the many many other under-recognized courier services, grocery store clerks, childcare workers for keeping my family and our community safe while I take care of you.

The biggest perspective I would like to share is that your healthcare providers are your neighbors. Your Police Officers are normal people that comes home to our families every night. My mom not only continues to work full time from home (as many of you are too), but does so while watching her two grandkids so that we can continue to care for YOU. If we are exposed to coronavirus at work, then so are our kids at home. And an even higher risk and susceptible to become more vulnerable, my mom.

Jeramie Lu Photography | Available for travel Worldwide | www.JeramieLu.com

So THANK YOU for staying home.

Many of you are continuing to work from home and we appreciate your diligence. Thank you to all the teachers printing curriculum and grading online so that our children can continue to learn. To all you Fitness gurus showing us how to stay sane and workout from home. To all the recipe makers inspiring nutrition while isolated. Thank you to all the many many many American’s who are struggling without work, but still staying home to slow the curve. COVID-19 will pass and we will look back to see how strong we’ve grown together while apart.

Philipians 4:6  “Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God.”

To our Healthcare Providers: The more information we share the better equipped we become. Here is helpful information written by a front line physician with extensive COVID-19 experience

Keeping Corona Virus from infecting HCW  by Atual Gawande  (Being Mortal , Complications) 

************************************************************************

From Dr. Callister 

Every one of my colleagues and I have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable

2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic

CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%

CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.

Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition

I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Outcomes

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I do wear a MaxAir PAPR the entire shift and I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.

3 COMMENTS

  1. traditionalmomlife | 4th Apr 20

    Thank you for this! I can relate on many levels as I too work in healthcare, as a nurse, and my husband also works as an essential employee. We will all get through this by working together ❤ Thank you!

  2. Patricia Cruz-Hernandez | 4th Apr 20

    Loved reading your story amiga. Stay safe. Stay strong. See you in OR #17 🙂

Leave A Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Verified by MonsterInsights