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COVID - From a doc on the front lines

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COVID - From a doc on the front lines

Old 04-22-2020, 01:39 PM
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Default COVID - From a doc on the front lines

A doc who I know posted this message from a friend and colleague of his today. It might give some insight.

​​​​​​From Dr R:

I've been too busy to post here over the last few months but I thought I'd put a few thoughts down now that I have a few minutes to gather myself. According to EMR records I have had just over 1,100 COVID19 patient encounters as an attending physician since March 8th in both New Orleans and New York City so I feel like I am reasonably credentialed to have an opinion at this point. I am sure a lot of people have will have a lot of different opinions than I will as I'm sure they've had a different experience than I have.

To the public: We are beating this, I am getting better at treating this every day and I continue to learn more and get better at it with every single patient encounter. This is not the flu and your body is naive to it and there is a chance the reaction seriously injures you. Remember, death is only one of a number of outcomes, nobody is talking about the patients I send out with 20% renal function or with 1 infarcted lung and cardiac function of 30%. These are patients in their 30's and 40's who will be attached to me for the rest of their lives, I will know their wive's names and the annoying children who ask too many questions because they will need to see me in the hospital to simply survive for the next 30 years when they get flares and other illnesses that compromise their now poor organ reserve. Most people will have no effect likely as with most infectious exposures, but there is a wide spectrum from asymptomatic to dead.

It is hard to quantify the strain on medical professional's mental health in outbreak areas. I know that mine is stretched to the limit. I don't sleep cause I know what I'm going back into tomorrow, I am frustrated that I cannot help many of these people, my emotional tank is empty because I have to be everyone's family member since their's cannot be there for them, and I am frustrated that I cannot safely care for my other patients who need to see me for unrelated reasons because I will likely make them sick. Right now it is heartening to hear the people of New York raise their voices and bang pots and pans when my shift changes. But I feel that in a few weeks when everyone comes back out there is a chance I will be a pariah when I leave the hospital, the most dangerous person in town and socially toxic. People already cross the street when I walk home in my scrubs.

I need everyone to trust that we are doing everything that we can, that I hold your parent's hand everyday and tell them that you love them even if they can't respond. We're cleaning and feeding them, we're healing in every sense of the word that we can find to right now. I hope that the American people are starting to understand what hospital administrators have known for a while, that your medical professionals will sacrifice pretty much everything to take care of our patients. This isn't a job, and its not just a career, this is a calling to many of us; that God reached down and commanded us to heal those around us.

I haven't seen my family since February, my father had just had a life saving liver transplant and now I am not sure when I'll be able to touch him again. And don't worry, I have him hiding out south of the Pecos river far away from all y'all so that I can cash in on the extra decade of life with him that was just gifted to my family. Every day I want to run away from this so I can go see him again.


To the Providers: data is scarce and of poor quality. Clinical Pearls that I have learned so far:
Avoid intubation at all costs. HFNC and with a face mask (for all the mouth breathing), prone them, given them tiny doses of morphine to chase off the dyspnea and let them ride with sats in the 80's and RRs in the 40's for a while to see if they'll improve first, you'll be surprised how many will blast through two days like that and then improve once you can get some anti-inflammatories on board
Remdesivir and IL-6 inhibitors have been pretty effective for the inflammatory phase, if your hospital doesn't have them yet I'm sorry cause we already bought all of it. Your hospital needs to be buying HFNC and IL-6 inhibitors. I screen all my covid patients for HBV and HIV on admission as I have seen a few wild flares when I didn't take the precaution to check before high dose steroids and IL-6 inhibitors.
Anticoagulate early and often if there are no contraindications, I avoid with anyone on DAPT already as well unless I can safely stop plavix.
Fluids are not the devil, try a small bolus and see if you don't watch the sats rise when you improve perfusion a bit. Be cautious but stop treating it like ARDS
Negative Pressure Rooms will save your staff from getting sick. Besides having enough PPE (which I still don't have by near enough, both masks and gowns) negative pressure will decrease the inoculation load I suspect as the rates of staff illness is amazingly divergent in facilities I've worked in based on this.
My ideas on effective treatment will continue to change with more experience of myself and other providers I share info with. Good data will come out one day but our patients don't have the time for us to wait, it is currently a trial by fire for us. Open your experiences to your fellow clinicians while we all try to figure this out.


Last edited by dspencer; 04-22-2020 at 01:48 PM.
Old 04-22-2020, 01:58 PM
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Thank you for the insight .
Old 04-22-2020, 02:13 PM
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Thank you. I follow that Board also.
Old 04-22-2020, 02:14 PM
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Thank you and thank the good Dr. for me .
Old 04-22-2020, 02:22 PM
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Which board is this from?
Old 04-22-2020, 03:27 PM
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It's a COVID Forum on a site called Texags. Like other on-line forums, some of the forums are just political rants, but they have one forum that they have tried to keep clean for Dr's to share experience and information.

Sorry it won't let me post a link, for some reason my count has been stuck on 5 posts for about a year.
Old 04-22-2020, 03:35 PM
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Thank you. I know it is not pretty out there. God bless him
Old 04-22-2020, 05:01 PM
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Originally Posted by TexasBryan View Post
It's a COVID Forum on a site called Texags. Like other on-line forums, some of the forums are just political rants, but they have one forum that they have tried to keep clean for Dr's to share experience and information.

Sorry it won't let me post a link, for some reason my count has been stuck on 5 posts for about a year.
Posts in Dockside do not count towards your total. You need to post in boating-related forums for them to count. The change was made probably a year ago now.
Old 04-22-2020, 05:19 PM
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Damn. That's some good technical data and not a lot of fluff. Thanks for posting.
Old 04-22-2020, 05:30 PM
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I’m a pulmonary and critical care physician in south Florida and his post is 100% accurate.
Old 04-22-2020, 05:50 PM
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Thanks for your post. Very good read.
Old 04-22-2020, 09:06 PM
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Great read. Sobering. I'm curious as to why this Dr (God bless him) has been in two hot spots New Orleans and New York??
Old 04-22-2020, 09:10 PM
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Thanks for sharing.
Old 04-23-2020, 11:27 AM
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Scary - read an article from NY that reported that only 20% of pts on ventilators survive. Micro blood clots are a major problem.
Old 04-23-2020, 11:30 AM
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How do we know this isn’t Chinese misinformation?
Old 04-23-2020, 11:43 AM
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Almost in b4 "its fake news, or the doctor is just looking for future revenues"
Old 04-23-2020, 12:58 PM
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Originally Posted by jeremiah2360 View Post
Great read. Sobering. I'm curious as to why this Dr (God bless him) has been in two hot spots New Orleans and New York??
New York was paying Doc’s to fly in and help. My father in law’s group in Texas was conctacted also to see if anyone wanted to come to New York to help. Some jumped on board, some said heck no.
Old 04-23-2020, 02:36 PM
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Originally Posted by Danny33486 View Post
How do we know this isn’t Chinese misinformation?
We don't. Is it? Your opinion.
Old 04-23-2020, 04:56 PM
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I can say I know because I have confidence in the Doc who passed it on so I could post it.
You don't know him so I understand.

Old 04-23-2020, 04:59 PM
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Originally Posted by jeremiah2360 View Post
Great read. Sobering. I'm curious as to why this Dr (God bless him) has been in two hot spots New Orleans and New York??
because it is probably bullshit

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