Growing up, I always thought I wanted to be a teacher, however, when I was 12, my 40-year-old father was diagnosed with chronic myelogenous leukemia. Seeing his diagnosis, treatment, and recovery inspired the dream of becoming a physician. It seemed far-off, but it would not let go of me. I finished medical school in 2005, chose internal medicine because I wanted to treat the whole person, and joined the medical staff here in 2008.
While in medical school, I never really considered the possibility of a pandemic, but during my residency I made a presentation to high school students on the 1918 influenza pandemic. This research and presentation stuck with me, such that six months before COVID emerged, my book club read a book about a pandemic. I can remember telling my fellow readers, “we’re due for one of these.”
The Sunday Oregonian on May 9 carries a special section on Health Care Heroes in the age of COVID-19. Read all the stories and first-person accounts at oregonlive.com/health.
When I first read the data from China, it made me start to worry about how this could affect our health care system and our economy.
Once COVID was here, the biggest challenge was really making sure that the most accurate information was given to the doctors in my group. In relation to personal protective equipment, but also in relation to the planning going forward, adjustments to hospital policy, how we were protecting each other, our patients, and our families/loved ones. We started having daily medical director updates with the most up to date information in emails.
At first, we were following the medical trends and guidance coming out of Asia, Europe and the East Coast, but things were changing rapidly. At that time, we didn’t know about the importance of steroids, of putting patients who were having increased oxygen needs on their stomachs (prone positioning), and all the trial medications that were being used.
As providers, we’re supposed to be experts on all things medical and it was hard to not have answers and have to tell patients, ‘We don’t know yet.’ Our critical care and infectious disease doctors helped to guide our treatment plans, reviewing developing data and adjusting accordingly. We were treating people while we were learning the right way to treat this illness.
Steroids were a big help. The newer treatments with remdesivir, which was a drug that was not previously used much in the hospital, seem to also make a big difference. We have advanced treatments in our ICU called ECMO (extracorporeal membrane oxygenation) which, when used with intubation, has saved lives.
We developed dedicated COVID teams and placed our COVID patients on one or two floors which allowed for the staff to become more adept at managing their special needs. We developed clear guidelines as to what medications should be used and were able to keep a close watch on how we were protecting ourselves. We also started writing our notes in such a way that the information about patients COVID exposure, symptoms and timing were easy to follow. We set up weekly meetings with the infectious disease group to help clarify new trends and treatments. We also gave our providers time to discuss the difficulty they were having with the physical and emotional toll of this work.
I remember one time, I was doing admissions for our COVID team and was meeting with a patient and his wife in our ER. The patient was an elderly man who was on a fair bit of oxygen and was being admitted to the floor. It was clear that this was the last time that his wife would see him while he was in the hospital and then likely in rehab, post stay. Hearing their fear and sadness of being separated was devastating. They had been married for 57 years and had not spent any time apart. She was so worried that this would be the last time they would ever see each other. Their preemptive grief stays with me.
Working this year has made me realize how important it is to work as a team to take care of patients. Not only in the day-to-day care of admitted patients, but as provider-to-provider as we do this work over the long term. Taking care of the caregiver has to be a priority to be able to sustain the high-quality care we give patients.
I am a better physician and leader because of this past year. I have more awareness of what my team needs and have developed the ability to transition quickly to new processes. I am also keenly aware of the need for wellness and balance in my own life which has been integral to being able to move forward during this time of fear and uncertainty
I hope that next time this happens that we will be able to move forward with national guidance and leadership. I hope that we will take the importance of using science and not a political lens to view how we can help our community to improve and survive. I hope that we do not take hugs for granted anymore.
The Link LonkMay 08, 2021 at 10:30PM
https://www.oregonlive.com/coronavirus/2021/05/laura-kuipers-providence-portland-it-was-hard-not-to-have-answers.html
Laura Kuipers, Providence Portland: ‘It was hard not to have answers’ - OregonLive
https://news.google.com/search?q=hard&hl=en-US&gl=US&ceid=US:en
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