COVID-19 Can Cause ARDS, And AFDS

(“ACUTE FINANCIAL DISTRESS SYNDROME”)

Written by Stephanie Wottrich, MS3

The virus SARS-CoV-2 makes daily global headlines and has precipitated a de facto worldwide quarantine. When it began insidiously popping up in the United States, first in Seattle, then Los Angeles and Chicago, I thought, “Ok, this thing is here. We’ll get it under control.” As cases began to exponentially increase, I thought, “Quarantine, ok. It makes sense that to control the spread of this thing, we stay away from each other for a while.”

I never anticipated that, within a month, we would find ourselves in an altered reality in which seemingly benign things like hugging our grandparents or going to a concert would be considered a massive health risk. In these last few weeks, I’ve seen terms like

“social distancing” and “telemedicine” go viral (pun intended), and hashtags like #FlattenTheCurve, #RaiseTheLine, and #LowerTheBaseline sprinkled all over the internet.

Given that I am a second-year medical student, regardless of whether there was a pandemic or not, I would have found myself this season in “study quarantine,” given that my first board exam was scheduled for April 27. Even so, I never could have foreseen that things would become this extreme. Like everyone else, I saw my daily frequents close one by one – first my school, then church, part-time job, and gym. My board exam was pushed to the end of June due to test center closures, then cancelled altogether af- ter being rescheduled five times. Upcoming elective periods no longer may involve direct patient contact. Every student panel and meeting has moved to Zoom, and even my brother’s wedding ceremony scheduled for the end of May was cancelled. Instead, it was live streamed from the courthouse with just the officiant and photographer present!

All the changes, cancellations, precipitated layoffs, and daily updates on the virus left me thinking in circles about the state of my own health and the healthcare system in the United States. I suffered from severe asthma in childhood and had several bouts of pneumonia over the years, so shortness of breath and hospital emergency rooms are very familiar. I was young at that time, so I didn’t think a lot about the fallout, such as the bill. Regardless, I was aware even then that it was expensive to be sick, and my classes in my first year of medical school taught me how facets of our healthcare system favor those who can afford “good” insurance or paying out-of-pocket expenses, often leaving others with lesser care or none at all.

As a broke student with a lot of debt and a part-time job limited to 20 hours per week, I was appalled when I received the bill from my trip to the emergency room earlier this year after collapsing in my bedroom from extreme dehydration secondary to the flu. The number on paper wasn’t unexpected, but it still burned. And I do know that I’m one of the lucky ones; I am on my father’s insurance plan and, thankfully, had enough money from my job to pay the bill and be done with it. This did not change the fact that I felt nauseated thinking about all the folks that need care right now amid layoffs, chaos, and financial insecurity that may not be able to afford it (or at least not without making huge sacrifices).

On top of money issues for patients, doctors are taking hits as well. The overwhelming number of new cases coming into hospitals everyday forces cancellation of elective procedures and extensive use of resources, which burns through budgeting. There are some actions being taken to allocate and extend relief funds, but amid so many healthcare workers doing their jobs even without proper protection due to shortage of resources, there is still talk of pay cuts. One doctor in a recent article I read even described it as a situation of “shooting ourselves in the foot.” In the meantime, medical students like me are being recruited to volunteer to help with childcare, picking up groceries, pet-sitting, etc., for these heroic folks busting their tails every day so that they can’t manage these essentials themselves.

The question thus presents itself: There’s a problem of resource misallocation, but what is the solution? That was rhetorical actually; we know the solution. A deep-rooted problem requires deep-rooted changes. I’m not a politician, but given the infringement of our current system on basic human rights to life, it would seem that adequate access to medical care is not, nor should ever have been, a bipartisan issue.

It is unacceptable that we live in a state in which anyone with enough money can access life-saving medicines, but those who cannot afford it are faced with the decision of trading financial ruin for survival. Implementation of a system that provides healthcare for everyone is absolutely essential.

While the pandemic of this season is nothing short of a catastrophe, the response to and outcomes of it have highlighted this issue of health access disparity arguably more than ever, at least in my experience. There is a very palpable fear of requiring hospitalization, not just from the risk of contracting the virus, but because of the cost to be treated.

And don’t worry, I will not segue here to speak on behalf of or against any one political candidate or figure based on their plans for making this a reality. However, I will urge you to consider the position of those who currently have jurisdiction over maintenance and reformation of the healthcare field, as well as those who may come to have jurisdiction. This extends not just to those in federal seats such as the president, but state and local governing bodies as well. There has never been a more important time to be involved in investing for the future in terms of our everyday actions. That includes washing our hands, not touching our faces, physically distancing, staying home, and staying informed. The future of our local and global community depend on it, so let’s “stay woke,” my friends. 1

Stephanie Wottrich is starting her third year of medical school She holds a bachelor’s degree in Microbiology, Immunology, and Molecular Genetics from the University of California, Los Angeles.

Bravery Is Being An Ally To People Of Color

Written by Dr. Niran Al-Agba

Over Memorial Day weekend 13 years ago, my younger brother, Laith, died in an accident. He was 26 years old. Losing young people in their mid-20’s is particularly devastating because they are embarking on adulthood and their futures hold limitless hopes, dreams, and possibilities. For the survivors, no holiday brings the same joy as it did before. Someone is not there, and never will be.

Wanda Cooper-Jones, the mother of Ahmaud Arbery, has endured unbearable pain. Gregory and Trevor McMichaels shot and killed her son while he was running down the road. They were not arrested and charged with a crime until 74 days later. A third man, William Bryan, stood by and recorded the murder of Ahmaud Arbery on his cellphone for more than 4 minutes. 74 days passed before he was charged with committing a crime. The gruesome facts of this story have enraged me because I know a little something about the unrelenting grief associated with unexpected death.

My brother’s death was accidental, which made me incredibly sad. Wanda Cooper-Jones’ son was ruthlessly lynched and then this week George Floyd was killed in broad daylight by a police officer in Minneapolis, both of which make me unspeakably angry.

Enough is enough. This nation must stop tolerating lynching of black men and women. While racism is difficult to discuss, it is also necessary, valuable, and essential in order to bring about change. My previous column addressed white privilege and ever since, readers have been asking, “What now?”

Now, we need to become allies to people and communities of color.

But what does it mean exactly to be an ally?

First, we can listen more and talk less. There is no path to understanding without listening. If a person of color trusts you enough to share how discrimination and prejudice impacts them, stop talking. Listen. Watch. Learn. Tackling any problem requires awareness before action. White privilege can be a powerful tool for an ally to fight racial oppression. We must acknowledge privilege without asking for absolution of our guilt about having it. If these conversations make you uncomfortable, own those feelings. Be careful not to lend support just to make yourself feel good — this is not about you or me.

As allies, we can acknowledge the history of institutional racism in America: a system of structural advantage favoring whites over non-whites in social, political, health, and economic arenas. In truth, these are abuses of power artfully disguised as acceptable social constructs. This racial hierarchy was built and reinforced over many generations, making inequality based on race, gender, or ethnicity, profoundly systemic. Dismantling them requires invalidating arbitrary biases each of us hold about those who are different from us.

Reject pervasive stereotypes which do harm. Allies look for connections between racism, economics, and other forms of injustice, but poverty is not a defining characteristic of being black in America. The notion that racial disparity begins and ends with smaller black pocketbooks is incorrect. In fact, ample education and wealth cannot insulate black people against the harms of systemic racism.

Do your own work. Asking people of color to teach you more about racial discrimination burdens those in need of support. Educate yourself. It relieves people of color who are exhausted by fighting oppression alone.

Advancing the opinions and ideas of others is a way to contribute without taking up space. The role of an effective ally is not to speak for others, rather to remove impediments which prevent those who are marginalized from speaking for themselves.

Become comfortable with being uncomfortable in the pursuit of equity and justice. Talking about race can be challenging, but isn’t that the point? No amount of white discomfort can match the danger of being black in America. Remember that. Talk about racism, but resist the urge to take action on behalf of people of color without knowing what they need. Guard against being a savior to swoop in and fix communities of color. Their communities do not need fixing. Instead, amplify voices of color. Better yet, listen first and then amplify.

Endorsing racial equality often means taking a stand against injustice. Call out friends or colleagues on their racial bias, even when no one is watching. It can be disconcerting to do this, yet it is our moral obligation as citizens of a free and equitable society. Take the risk. Never let the sun set on the endorsement of racism by someone you know.

Never deny, minimize or justify racism. Whitesplaining — or advising a person of color on how to deal with oppression — is not helpful. Offering suggestions places the onus on those who are marginalized, as if they have not already worked to overcome racial injustice. Instead, ask how you can support the safety and health of people of color.

Finally, let us admit we all see color. Ignoring color is not the solution because seeing color isn’t the problem. The real issue is our conscious or subconscious action when we see color. Mellody Hobson, CEO of Ariel Investments, gave an inspiring TED talk about being color brave instead of color blind. She said, “We cannot afford to be color blind.” She is right.

Racism is the most divisive issue facing this country. The mere fact that 74 days elapsed between the lynching of Ahmaud Arbery and the arrest of the men who murdered him demonstrates how tightly racial discrimination is woven into the fabric of America. Whites becoming allies to communities and people of color is the way we can change the heart of our nation.

It is time for all of us to become color brave. 1

Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular column for the Kitsap Sun. Contact her at niranalagba@gmail.com.

This article https://www.kitsapsun.com/story/ opinion/columnists/2020/05/29/niran-alagba-being-ally-people-color/5278238002/, first appeared in the 5/29/20 issue of the Kitsap Sun, four days after George Floyd was killed by asphyxiation in Minnesota beneath the knee of a white police officer.

When Did We Become Our Own Worst Enemy?

Written by Dr. Daniel Waters

Editor note: The problems facing medicine today need physician-led solutions. How will you lead? How will you take back medicine?

Over the last few weeks I have been coming across a new term. Maybe you have seen it. “Vital Exhaustion”.

It appears that if orange is the new black, then vital exhaustion is the new burnout. Which means we somehow allowed ourselves to get burned out by, you guessed it, burnout. It’s OK – burnout was never really a great descriptor for what modern — and especially cor- porate — medicine is doing to good doctors and other health professionals. In the mind’s eye it conjures up a smoking hulk or a charred shell of something barely recognizable like, as a famous New Jersey songwriter put it, the skeleton frames of burned out Chevrolets. And think about what we now know about the effects of this Vital Exhaustion on ourselves – increased rates of depression, suicide, substance abuse, even MVAs — a Litany of Sorrows that gets even worse if you’re a woman. Forget the slings and arrows of outrageous fortune; these are stone-cold killers we’re talking about. And our indoctrinated response for so long has been, “Thank you, Sir. May I have another?”

Why did we let this happen? To quote Walt Kelley’s “Pogo”: “We have met the enemy and he is us.” Perhaps not “us” in the usual sense, but those things within us that drive us to pursue healing as a calling and a career in the first place. Overachievement, altruism, kindness, a genuine desire to do good, and a willingness to sacrifice just to have the chance to improve the lives of others and feel the satisfaction that it brings. And let’s be honest, to make a good living and provide for our families. But I’d make the case that the dedicated physician also makes the perfect patsy. Programmed to never say no, encouraged (you know it’s true) to work beyond normal limits and capa- bilities and chastised for complaining; to be too often embarrassed and not infrequently resented for the fact that we’re paid well for a job exquisitely few people can do and responsibilities even fewer would be willing to shoulder. So when did we become our own worst enemy?

When we failed to start saying, “That’s enough.” That’s enough call; that’s enough cases; that’s enough patients scheduled in one day; that’s enough of our time wasted on EMR; enough taking orders from people with far less education, expertise, and experience; enough Dashboard Reports on our “performance” from CMOs whose career goals involve being as far away from patients as possible; enough being treated as though “we are what we RVU;” and enough being told we’re merely providers.

Enough.

In a long career, I came across only a handful of colleagues who I was certain didn’t like medicine, didn’t like patients, and pretty much didn’t like people in general. But only a handful. The hundreds of others I trained with, worked with, and taught all had the spark, the drive, the heart, and the will to be wonderful and caring physicians. So how does it still manage to suck the life out of so many us? How does it exhaust our vitality? How does the thing we love to do end up hurting us? After all, it’s not exactly BASE jumping or Himalayan mountaineering.

Medicine is not really a business but it certainly has a business component. A successful business model always mirrors its product. Except in health care. Practitioners have been shunted aside by swarms of specialized accountants to whom patients are an abstract, a financial pro forma, and who lack any experience in actual patient care. Is it any wonder things function so poorly? Imagine an auto company run by executives who’ve never driven a car or an airplane designed by MBAs with no grasp of aerodynamics. Welcome to health care.

It is interesting to consider that there is not a naturally occurring straight line or even a true right angle to be found anywhere in the human body. Yet look at what administrators send you every day – org charts, performance reviews, care pathways and the dreaded multi-page spreadsheets – nothing but straight lines and right angles, rows and columns, squares and grids, plusses and minuses, profits and losses, all of it strictly two-dimensional. Realize that this reflects their view of the world, their education, their training, and their thought process. We are the ones trained to analyze the articulations, compensate for the curvatures, and suss out the synergies. And we don’t even need special lenses to see it in 3D.

Imagine an auto company run by executives who’ve never driven a car or an airplane designed by MBAs with no grasp of aerodynamics. Welcome to health care.

Physicians are better at health care leadership because they are better at health care. We need practicing physicians involved and leading at every level, especially the corporate. Do we need professionals with business education and acumen to help us navigate the intricacies of finance and reimbursement? Of course we do. But the leadership culture of so many health care organizations today often seems more suited to a bank, an investment firm, or maybe even a hedge fund.

Want to start fixing health care and put a speed bump on the road to Vital Exhaustion? First – say “enough.” Then get involved. Run for office. Make some noise. Irritate some higher-ups. Serve or encourage your respected physician peers to serve as true clinical leaders and patient advocates, not corporate lackeys. Demand that C-Suite administrators come from the practicing ranks of your institution and that their qualifications extend beyond a willingness to tow the line and cash the check. Let’s be shepherds instead of sheep. We don’t need every physician at once to make it happen. We just need enough. 1

Original article featured in Op-Med, a collection of original articles contributed by Doximity members, February 24, 2020. Illustration by April Brust for Doximity’s Op-Med.