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Here are the stories you missed on [KevinMD](. Thank you for your continuing readership.
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KevinMD Plus: Apr 6, 2020
[For the first time, my job has betrayed me](
I miss going to work feeling excited and inspired and determined and frustrated and exhausted. Being a doctor has been my magnetic north since I was ten, the longest relationship of my life. Itâs who I am, what Iâm called, how I spend my waking hours, what makes my family most proud of me, and [â¦]
[We are not being too alarmist about COVID-19](
Iâve been reading a lot of posts expressing disappointment with the way that COVID-19 has been covered in the media and worry about the economic consequences of prolonged social distancing. This is long, and you might not care, but hereâs my perspective as a former ICU nurse that witnessed many deaths, a nurse anesthetist who [â¦]
[It is a dark day to be a doctor](
It is a dark time to be a physician. Yes, because of the global pandemic- watching our colleagues in other countries die, staring down the barrel of not enough ventilators, reading the New England Journal of Medicineâs paper on how to choose who gets care and who we allow to die. But we are trained [â¦]
[Fighting COVID-19: Donât let health care workers become collateral damage](
Last weekâs death of the first nurse to die from COVID-19 in New York City infuriated health care colleagues who blamed his death on lack of protective gear. Across the U.S., health care workers are scrambling to design makeshift personal protective equipment, also known as PPE. Nurses are resorting to wearing Hefty trash bags because they have run [â¦]
[Being a medical student during the COVID-19 pandemic](
On March 17th, in a nationwide effort to protect our patients and minimize the overuse of critical primary protective equipment (PPE), the most disposable force in the hospital was removed: our medical students. When I learned of this temporary suspension, I had just finished my first month of inpatient medicine, a defining achievement in the [â¦]
[Do not ask me to sacrifice on the altar of medicine for profit](
I am addicted to Facebook these days. Like everyone else, I am glued to social media, riveted by the drama unfolding around me. I read from the perspective of a primary care doctor in Seattle, the site of the first case of COVID-19 in the country. My friends and family send me regular thanks for [â¦]
[Immunity passports: How to eventually climb out of the COVID-19 pandemic](
During the influenza epidemic of 1918-1920, my great-grandfather, Ralph Norton Mitchell, was in the military. He helped stack the corpses of those who had died from the infection. I shudder to think about what type of personal protective equipment he used. However, his survival reminds me of a feature of all epidemicsâsome individuals have or [â¦]
[The ethics of prescribing during a pandemic](
In times of disaster, marginalized groups often become even further marginalized. Both those of lower socioeconomic status and those with disabilities often are left out of emergency planning, as is evidenced by the current COVID-19 pandemic. From access to testing to ability to acquire needed goods and services to triage policies being adopted from community [â¦]
[The testing cavalry for COVID-19 is coming](
Testing for novel coronavirus is still a serious issue in the U.S. due to a lack of lab capacity, test reagents, nasal swabs, and even personal protective equipment for health care workers. Due to these shortages, the CDC is recommending that COVID-19 testing should not be performed on patients without symptoms and instead be prioritized [â¦]
[The fragile economics of Americaâs emergency departments](
On the front lines, Americaâs emergency departments (ED) are currently in at the center of a crisis treating patients with COVID-19. Emergency physicians and other clinicians are placing themselves and their families at risk. Yet, there is also another important crisis facing hospital-based EDs: surprise billing legislation. Certain forms of surprise billing legislation have the [â¦]
[The hospital doesnât care: Physicians must advocate for themselves](
On Doctorsâ Day, my hospital celebrated our work by giving us each a pair of cheap headphones, and also announced the death of an attending. Though the personal risk to each of us was highlighted by the recent death, the administration did not give hazard pay, or PPE comparable to other countriesâ, or even a [â¦]
[Try social loving instead of social distancing](
Social distancing. It is a mantra that seemed to have been plucked straight out of obscurity for those who had never heard of it before just as the coronavirus pandemic dug its ugly claws into the fabric of American life. And since then, it has been perfusing our cultural ether for the last several weeksâaggressively [â¦]
[Giving birth during the COVID-19 pandemic: an obstetric anesthesiologistâs perspective](
âItâs a strange time to be having a baby,â my patient said as she sat alone in her labor room. The state order to shelter-in-place in California had left her family with few options as her husband had to stay home to take care of their toddler. She is one of many pregnant women who [â¦]
[Are Boston hospitals prioritizing money over the safety of their employees and patients?](
Growing evidence suggests that the novel COVID-19 virus can be aerosolized. To adequately protect employees, providers require not just âdroplet,â but âairborneâ precautions and the appropriate healthcare worker personal protective equipment (PPE). Appropriate PPE mandates an N95 mask. News reports for weeks have described hospitals working without the necessary protection for health care providers. This [â¦]
[A call to arms for hospital administrators](
As the medical director of a Midwest community emergency department that has yet to see the New York City-levels of devastation, I am begging hospital administrators across the country to begin leading their front line health care workers in preparation to meet the enemy head-on. It has become painfully clear in our hospital daily incident [â¦]
[Should physicians shy away from accepting their mortalities?](
In between snippets of conversation exchanged with my husband about how the first day of remote learning went for our 9 year old and whether the latest nanny was likely to quit given health risks associated with working in a two-physician frontline worker household in the context of COVID-19, we also discuss some potentially dangerous [â¦]
[Medicine will make you sick if you donât sleep](
Itâs 8 p.m., and I stumble into my apartment and fall into bed. Somehow, I avoided nodding off in the car driving home. I just finished a 36-hour shift, something I thought was an inhumane task. Somehow, I survived on two hours of sleep, incessant phone calls, pages, and a granola bar. This morning I [â¦]
[Health care workers are precious jewels. Treat them as such.](
An emergency room physician, who I interviewed recently, rented an Airbnb to protect his wife from the virus. He is now separated from his family, alone and fighting to keep safe in New York City, with limited resources and PPE or personal protection equipment. When we turn what is vital to our physicianâs protection into an [â¦]
[Doctors in harmâs way: The stage was set for a PPE shortage long before COVID-19](
When the COVID-19 pandemic is finally over, health care providers around the world will be asking themselves how we got here. Buying PPE off eBay. Soliciting the public to sew masks. While, as a country, we could have been better prepared, it would not have been practical to stockpile the 3.5 billion masks that HHS [â¦]
[Virtual care for surgical subspecialties](
As a 4th-year neurosurgery resident, Iâve tried to sink my heels into every aspect of neurosurgical care in order to harness the skills, the knowledge, and the confidence to know that Iâll be ready to provide exceptional care to my own patients at the end of seven years of training. If you asked me before [â¦]
[Within the COVID-19 tragedy, there are real people admirably grappling with their new realities](
Arrival to isolation room 45: Recently diagnosed with COVID-19, brought in by ambulance for re-evaluation. I don my new uniform of colorful barriers: red-rimmed eye shield, green N-95, yellow gown, purple gloves. I carefully walk through two sets of doors into the room and find the most sterile spot. I used to touch, shake hands, [â¦]
[A few weeks into COVID-19: Alternating between sadness, fear, optimism, and anger](
Fourteen days of social distancing have passed. Emotions are high all around. The wicked foreboding of the mysteriously menacing novel Coronavirus has spared no one. Everyone is scared. The cleaning staff, scrubbing, and wiping just one more time. The techs, maintaining stoicism behind masked faces. The patients, eyes darting with fear. The nurses, bravely caring [â¦]
[The heart of Americaâs health care system is failing](
In college, I learned about the Frank-Starling law of the heart. It is fascinating and demonstrates just one of the bewildering number of human physiologic responses needed to adapt to the demands we place upon our bodies every day. In brief, the Frank-Starling law states that a healthy, normally functioning heart will respond to increases [â¦]
[Redefining the role of psychiatrists in the time of COVID-19](
The unparalleled and pervasive nature of the evolving COVID-19 pandemic has touched all of us in some way. There is limited, albeit growing, research on the mental health effects of disasters. A recent review article pointed out the potentially negative consequences of prolonged quarantine, while other research from Wuhan, China, highlighted the impact of COVID-19, particularly amongst healthcare personnel. Psychiatrists [â¦]
[What about the other 80%? Medical students at all levels of training can help beat COVID-19.](
The global pandemic of COVID-19 presents a serious threat of overwhelming our health care systemâs capacity. With the lack of a clear, decisive response from the federal government to minimize early virus transmission, itâs becoming rapidly clear that the spike in critical patients flooding the health care system within Italy will likely soon be a problem that [â¦]
[Ignoring COVID-19 wonât make it go away](
Ignoring a problem wonât make it go away. I say this all the time, with love and compassion, to my patients who are having trouble accepting a diagnosis. Ignoring your Type 2 Diabetes, for example, wonât make it any less real. It will only land you in renal failure and on dialysis, or with a [â¦]
[Coronavirus exposes the reality of income-driven health inequality](
Itâs maddening to see the differences in health outcomes between the rich and the poor. Even more unsettling is reflecting upon the psychological pain accumulated when living in a fad-obsessed materialistic comparison-creating society, the postponed dreams, and the day to day compromise that those with less have to endure â thoughts that may be far [â¦]
[We treat self-sacrifice as a currency in medicine](
The world of COVID-19 has two poles: the frontline workers bravely putting themselves at risk for the greater good, exiled to tents in their backyards to protect their families â and the rest of humanity, asked to do its part by staying home. As a medical student, I have felt somewhat untethered â aligned in [â¦]
[3 tips for inner peace in this COVID-19 world](
The world is impacted by coronavirus. The same advancements in civilization that allow us to travel and experience new cultures are the very thing that has blurred our borders and made everyone susceptible to the virus. We are observers and participants at the same time. Schools are closed and shifting to long-distance learning models. Conferences [â¦]
[A doctorâs message to ICE: Release asylum seekers to prevent COVID-19 spread](
With COVID-19 spreading rapidly throughout the nation, we need to work together to save as many lives as possible. This includes asylum seekers who are detained for entry-related offenses. Asylum seekers are among the most vulnerable groups globally. They are mothers, husbands, and children fleeing violence, poverty, and persecution. With few options, they arrive to [â¦]
[Ophthalmology in the era of COVID-19](
We are in the midst of the novel coronavirus (COVID-19) pandemic. The numbers are scary and changing by the day and hour. Johns Hopkins University has a real-time dashboard where you can monitor global cases. Cases in China have leveled off, while elsewhere in the world, cases are on the rise. At the time of this [â¦]
[I wonât sacrifice myself when I canât get a damn mask](
Nurses are responsible for patient care. They are the ones at the bedside 24/7. There is no one who spends more time with individual patients. They are the ones most in danger in the coronavirus pandemic. The news gets grimmer every day about the inevitable surge coming across the country. Forecast of death tolls in [â¦]
[My uncleâs battle against COVID-19](
I just lost my uncle to COVID-19. I am writing this to honor him because I cannot leave the country to travel to Canada to see him, I could not visit him in the hospital when he needed us the most, I cannot attend his funeral, and I could not tell him in person how [â¦]
[How far are you willing to go to survive COVID-19?](
As doctors, we know how this disease progresses. We know the prognosis for patients who need to be on a ventilator. We know that if we have a cardiac arrest during the course of COVID infection, our prognosis gets much grimmer. Faced with this knowledge, how do you decide how far you are willing to [â¦]
[From a physician to our leaders](
Since graduating from medical school in 2002, I have seen a disturbing trend in the lives of doctors. For years, physicians have been squeezed from every direction. Insurance companies and hospitals are constantly fighting to remove our autonomy. The amount of paperwork we are required to produce has skyrocketed over the past 20 years, combined [â¦]
[Domestic violence and social isolation during COVID-19](
As the coronavirus pandemic spreads across the country, states are mandating âstay at homeâ orders; and with these orders comes further social isolation for domestic violence (DV) survivors and their families. Many recent articles highlight the potential risks for DV victims âstuck at homeâ with their abusers as their opportunities to seek help and support [â¦]
[COVID-19 and the Hippocratic Oath](
On a sticky summer day four years ago, a class of eager medical students and I harmoniously chimed the Hippocratic oath, binding us to the highest standards and code of medical ethics. As newly accepted and unassuming medical students, how could we understand the sacred nature of this rehearsed and recited âcovenant?â While pledging the [â¦]
[Health care workers are here for you. Do your part to keep them safe.](
The front desk staff member who checks you in at your primary care physicianâs office is 64 years old with a history of hypertension and coronary artery disease. She unexpectedly became a widower five years ago and is planning to work until the age of 68 to secure adequate retirement savings. She is worried about [â¦]
[What COVID-19 means for all medical students](
Coronavirus is sweeping across the world, cities are shutting down, hospitals overflowing, the economy crashing, and suddenly your cranial nerve mnemonic feels like the last thing you should be focusing on. But while the world screeches to a halt, medical students are finding themselves in an unexpected limbo, somewhere between the front lines of healthcare [â¦]
[In the coronavirus crisis, for-profit health care kills doctorsâ spirits](
I am a physician. I have worked hard to get where I am in life. I went into medicine for many reasons. The intellectual challenges. Being in a field with lots of human interaction. And of course to help people. I went into emergency medicine because I ultimately couldnât decide on a single specialty. I [â¦]
[Even as a pediatrician, I didnât realize stress started so young](
Despite four years of medical school, three years of residency, and over a decade in practice, I was never taught the profound connection between high childhood stress and increased risk of chronic disease. It was at a community event sponsored by our local school district that I first learned it, as I watched the documentary [â¦]
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