Feature: Behind the Mask

Q I Feature

Behind the Mask Dispatches from our members face-to-face with COVID-19 every day

Dale Criner, MD, MBA, FAAFP MMS Board Member Chairman, Department of Emergency Medicine Emergency Department Medical Director, St. Francis Hospital-Bartlett Affiliate Asst. Professor of Medicine, UTHSC, Department Of Medicine, Memphis, TN

In his own words

One would think a global pandemic would mean a near unmanageable increase in Emergency Department patient volume. Certainly, that is exactly what many of us expected as we prepared for the worst. Fortunately, that has not happened in our facilities. Hopefully, it never will. What did occur was an extreme drop in patients seeking Emergency Medical Care. This has been one of the most impactful aspects of COVID-19 in our practice.

We strive to improve our time of recognition and treatment of time-sensitive medical emergencies, such as heart attacks, strokes, and sepsis. As the weeks of the pandemic unfolded, we realized many of these patients, who previously presented “within the window” for the time-sensitive treatments were simply staying at home until it was too late. It is heartbreaking to know that if your patient had simply called 911 at the onset of their symptoms, it is very possible they would have been successfully treated with a full recovery. However, EMS professionals relayed to us an increase in calls at patient’s homes where it was too late. The patient had already died. Fortunately, this trend has improved. However, there are still many barriers to overcome to reach as many patients as possible in time to make a meaningful difference.

One of the greatest challenges for both patients and healthcare providers has been the necessary restrictions on hospital visitation. Imagine not being able to see your nursing home bound mother for months and then receiving a call from an unknown Emergency Physician telling you that she is doing very poorly, and likely will not survive her current medical condition. Then add to that the fact you will not be able to hold her hand as she passes. This is heartbreaking for the patient, the family, and the healthcare providers. This scenario plays out every day. In my opinion, this is the most impactful and under reported aspect of practicing medicine during the COVID-19 pandemic.

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Q I Feature

When we speak of physician wellness, I know some of the “right” answers are more exercise, ensure proper rest, meditation/relaxation, unplug and recharge. I wish I could say I’ve been able to accomplish those goals. That would simply not be true. Oh…I’ve tried at times. However, there always seems to be another aspect of this uncharted healthcare territory that keeps the stress level much higher than healthy. As a leader, I try to ensure my team is taking care of themselves. I give great advice on wellness. However, I am not quite as vigilant at taking care of myself. I apologize for written honesty that does not set the best example, but it’s an area I know needs a lot of improvement.

Specific to Memphis, it has been concerning to see how politically polarizing COVID-19 has been even within the medical community. A lot of physicians think they know all the right answers and are quick to criticize other physicians who may not share their same viewpoint. The bottom line…we are all figuring this out as we go. It is quite disheartening when one physician criticizes another for admitting a patient with COVID-19 that “isn’t sick enough to be in the hospital” and another physician criticizes the same physician for sending a patient home who got worse and then needed hospitalization. I personally do not believe a single physician wakes up in the morning with the goal of providing poor care. Certainly, we can all learn and improve our practice. Collegial support and teamwork will accomplish that goal.

We need to support each other…not tear each other down. I so greatly appreciate when physicians with different perspectives and experience can work together with a common goal of better Medicine.

Lastly, and most importantly, I have seen great examples of compassion throughout Memphis and Shelby County. The love poured upon the healthcare workers from the public and business community has been uplifting. Cards and posters crafted with love showing support for of healthcare workers and meals delivered to fatigued hospital staff are wonderful examples of the best of the Mid-South. We are truly blessed to practice Medicine in Memphis!

Elizabeth Gilless, M.D. Hospitalist, Methodist Le Bonheur Healthcare-Germantown

a Q&A

What has been the biggest change in your practice that COVID-19 has brought?

I trained and have always practiced in the era of evidence-based medicine. The practice of medicine is not a cookbook, it is nuanced and individualized for patients, but I have always practiced under the guiding principles of evidence-based medicine. COVID-19 did not come with an instruction manual. For the first few months, we really had no qualityevidence guiding treatment. For instance, in March steroids were specifically recommended against, then in May, we learned that they provided mortality

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Q I Feature

benefit. It is a whole new challenge to practice without the confidence that the therapies you are using are proven to help.

What do you think are the largest impacts on your patients that COVID-19 has brought?

Definitely the most difficult part of being a patient in the time of COVID-19 is the isolation. For the safety of the patients and the staff at Methodist, visitors are not currently allowed, unless the patient qualifies for a handful of exceptions. It takes a whole new level of trust on the part of the patients and their families to drop off their loved ones and trust our team to care for them without an advocate present. We don’t take that responsibility lightly.

What experience are you having, or have you had, that we are not seeing in the news every day?

It’s hard to appreciate the fight that patients with severe COVID-19 have to endure. For most infections in the hospital, like bacterial infections, patients usually come in very sick, are treated aggressively with fluids and antibiotics, and if they survive the first few days, tend to improve from there. COVID-19 works differently. When patients began to feel badly, it is often days or longer until the peak of their illness. We watch them decompensate slowly and are limited in our tools to stop the decline. At Methodist Germantown, we recently celebrated when a young mother who survived the virus was discharged after 70+ days in the hospital. She was pregnant with and delivered her baby while on the ventilator being treated for COVID-19. She will have lifelong health issues as a result of her infection but what a celebration it was when she was able to leave the hospital. These lengthy hospital stays are common for patients who survive severe COVID-19, and we definitely get to know those patients well. Everyone at our hospital was rooting for her.

What have you noticed, or possibly changed, in your own self-care/wellness habits and routines during the pandemic?

There were times, especially early on during the pandemic, when COVID-19 was all I could think about. If I wasn’t working, I was reading about COVID-19, and if I wasn’t reading about it, I was talking about it. I had to learn to turn it off some. Our CEO sends a daily email with information about our bed capacity, PPE availability, and COVID-19 numbers, and I found myself obsessively checking my email every afternoon looking for it. It wasn’t good for my mental health, and I’ve had to discipline myself not to read and to think about COVID-19 all the time. My kids deserve my undivided attention occasionally.

What have you seen personally or professionally unique to Memphis that you would like to highlight?

What other city had a drive-thru testing site in the tailgaiting area of their college football stadium? Staffed, initially, by medical students!

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