Transformational Times, April 24, 2020

Transformational Times

Words of Hope, Character & Resilience from our Virtual Community

Friday, April 24, 2020

In this Issue:

Director's Corner by Adina Kalet, MD: Education Strategies on a Dime
Perspective from Chris Decker, MD: Staying Safe Yet Compassionate
Perspective from Alexandra Harrington, MD: Gratitude for Lab Staff
Reflections: What do you look forward to doing again?
Take 3 from Laura Michaelis, MD, Director of Inpatient Services, Hematology/Oncology; Associate Vice Chair, Dept. of Medicine
GME Leaders of the Week: Brian Gooley (EM1) & Joseph Lawton (EM3)
Announcements | Resources | Ways You Can Help

Director's Corner

Transforming Educational Strategies on a Dime

by Adina Kalet, MD, MPH

The COVID-19 pandemic has hit our economy hard. On our own campuses, saving and protecting lives has caused unprecedented revenue shortfalls within our community, to our hospitals, and to the Medical College of Wisconsin. Ironically, just when health care provision, education, and research are needed most, our work is threatened. Those on the “front line” of the pandemic deserve hazard pay for taking on risks for the rest of us, yet our staff is facing salary reductions and furloughs. Along with many of our peer institutions, MCW is implementing a financial austerity plan. We have hit a very rough patch and more changes are coming. Our futures are uncertain. People are scared. In this context, the Kern Institute is working to be good citizens by aligning emerging needs with our resources.

Perspective

Staying Safe Yet Compassionate in the

COVID-19 Era

by M. Chris Decker, MD

Just over four weeks ago, COVID-19 entered our community. Once merely a news story, this highly contagious virus about which we knew little and for which we had neither treatment nor vaccination, became experiential for all of us. Many of us were pushed to the edge of our coping skills; we all were vulnerable. Family gatherings, holiday celebrations, sporting events, and everyday work became circumstances in which we could become infected.

Like other health care systems, Froedtert Health (FH) cancelled all routine appointments and elective surgeries. In the first few days we cared for patients with the illness, we witnessed colleagues being quarantined after exposures. Some became ill. The precautions that once kept us safe as health care workers weren’t working.

Heroes

Photos from the Front Line

Froedtert Laboratory, 2nd Shift Team

Perspective

Testing, Testing, Testing: Gratitude for our Laboratory Professionals

by Alexandra Harrington, MD

Laboratory testing is in the news these days, and the public has heard the terms “swabs,” “Abbott,” “NAAT,” “RT-PCR,” “reagents,” “RNA,” “antibodies,” and “false negatives” more in the last few weeks than ever before. As our federal and state leaders develop strategies for safely re-opening the country, the news media will bring more and more details on COVID-19 laboratory testing into our living rooms. The data needed to understand our current situation and to plan for the future will emerge from the nation’s testing labs. Let me be the first to welcome you to the laboratory, also affectionately known as the “Black Box!”

Submit a Reflection for Next Week

" We so often spotlight the heroes on the front lines treating the sick, the grocery workers, delivery drivers, law enforcement, etc. Yet with thousands of us working and schooling at home, we shouldn't forget our unsung heroes in IS, nor take for granted "connectivity". Without the hard work of IS professionals, we could not remotely access the files in our desk computers, participate in Webex meetings, get help with an overflowing email inbox, or have reassurance that would-be hackers are kept behind the firewall. We so depend on those who maintain this critical infrastructure! I look forward to thanking them in person!"

Jane Thelaner, Staff - Biophysics

" I look forward to being able to travel again. My family had a special vacation planned - a trip to Iceland (my son has always dreamed of experiencing the northern lights) - which was abruptly cancelled due to the spread of the COVID-19 virus. I know it's very uncertain when we will be able to take our next family vacation, but it's reassuring to know that medical professionals and researchers across the globe are working to develop reliable tests, treatments and a vaccine for COVID-19. When they are successful, we will ALL be able to make plans and do the things we love again, and I'm hopeful I'll finally get to take my son to Iceland (thanks to credits on Icelandic Airlines). Thank you to everyone who is doing their part in fighting this virus!"

Julia Schmitt, Staff - MCW Kern Institute

"I look forward to going to the gym again! It may sound frivolous with all that's going on, but I really miss the stress release of a good workout and feeling fit and healthy."

Anonymous, Resident - Milwaukee

"I'm looking forward to finding a new way forward. Like everyone else, I remember where I was or how I reacted to events during my lifetime. I remember 9/11 because I was in the OR that day. I remember the Challenger explosion because I was living in Houston. I remember the tornadoes in Joplin, MO near where my dad grew up. I remember Hurricane Katrina because of friends who work in New Orleans. I remember Columbine because I had kids in high school. I remember the JFK assassination because I watched it over-and-over on my parents' black and white. television.

Each event stayed with me. I hope each one changed me. I hope I am changed by what we are experiencing now."

Bruce Campbell, Faculty - Otolaryngology

Share a reflection for our next issue:

Next Week's Prompt

From the Front Line

Three Questions for

Laura Michaelis, MD

Director of Inpatient Services, Division of Hematology/Oncology; Associate Vice Chair, Dept. of Medicine, Froedtert Health

1. What has been hardest for you as you balance moving forward with cancer treatment while avoiding risky exposures for patients?

" We always assess risk before administering chemotherapy to patients with cancer, and routinely use tools like comorbidity indices or geriatrics assessments to try and predict the toxicity of our treatments. Now, though, we have this additional layer of risk – one that we don’t know how to estimate or control. But the process isn’t that different: we imagine the various ways things could go wrong, estimate the worse possible outcomes, and then try to weigh the risks and benefits. Many times, in our field at least, the consequences of not treating are dire, and so any planning we do is about mitigating the risks rather than avoiding them.

When I discuss therapy, I try to be as transparent as possible. I tell patients we always worry about viruses when people have low blood counts. I discuss the data from China that showed patients with hematologic malignancies were less likely to survive if they developed a coronavirus infection. I discuss what we can control and what we can’t, and I try and reassure them that others are struggling with similar decisions. I serve on a committee for the American Society of Hematology which has pulled together some great recommendations on cancer management during the pandemic, and I think it’s therapeutic for patients when I pull these up and we walk through national guidance.

The most heartbreaking issue for cancer patients is the need to restrict visitors. When we put these requirements in place, we were thinking seriously – and rationally – about the safety of our entire hospital environment. However, the crushing sadness of going through serious illness – COVID-related or not – without your loved ones nearby, is so difficult. It seems to violate what it feels to be a doctor, nurse, or APP. My hope is that as this evolves, we find ways to alter these restrictions to restore visitation to our inpatients."

2. What do you hope we all learn from this experience?

" I’m sure there are a million lessons, big and small, to take from this – and I hope the trauma of the current time doesn’t mean we forget them when the time comes to cement new processes in place.

When all is said and done, we will probably learn a lot about workforce planning and deployment. This has been highly instructive about our supply-chain dependences and hospital system interdependence. I just heard the other day that we can’t restart many surgeries (a financially critical part of our mission) without adequate PPE, for example. And then there are lessons in room planning and layout – for instance, I have thought about all those patients whose IV pumps are outside of the room to minimize PPE use among nurses. One of the downstream effects of that may be a decrease in the nighttime alarms that wake patients up. What if the next time we outfit a hospital floor, we think about ways to build in remote IV poles somehow?

But the biggest lessons, I imagine, will be more transcendental. Each of us will likely come out of this time having reflected on our mortality, on our biologic vulnerabilities, and on the critical role of community in our lives. I hope that those lessons persist. My grandmother was a girl during the great depression, her father died of the Spanish flu and her mother ran a boarding house. For the remaining years of her life – all 103 years – my grandmother was diligent at saving and reusing every scrap of food. Nothing went to waste, not a vegetable scrap, not a butter wrapper, not a bit of powdered milk. What if those of us who emerge from this are as diligent about treasuring human contact and face-to-face warmth and communion for the rest of our lives?"

3. What has surprised you?

" I think I’d forgotten how gratifying and satisfying it is to work for a common purpose. One of the things I’ve been most proud of is the work of the advanced practice professionals of our Hematology/Oncology inpatient service. At the beginning of all this, we asked them to come together to brainstorm ways we could re-configure our processes to keep our patients – and one another – safe. It was so inspiring to see the ideas that came in and to witness that innovation and mission work. I am so proud of our team, in our division and throughout MCW. This wasn’t a surprise, of course, but it’s good to be reminded of how lucky we are to work in this institution and with one another."

The COVID-19 pandemic has been accompanied by many selfless acts and, without a doubt, our residents have risen to the challenge. Many are giving their all, day in and day out, tirelessly caring for patients, “donning and doffing” their personal protective equipment (PPE) with each encounter, wondering who is COVID-positive and who is not, worrying about their families, and trying to keep up-to-date with online lectures and web-based discussions.

Given the uncertainty and heightened anxiety this pandemic has created, we will highlight a leader or leaders each week from among our MCWAH residents; someone who goes above-and-beyond while demonstrating character and caring without being asked. We invite others in our GME community to nominate trainees. We would love to highlight them in these virtual pages so that we can all gain strength from their initiative, perseverance, resilience, and resolve.

This week, we celebrate a stand-out leadership team that includes Emergency Medicine residents Doctors Brian Gooley (EM1) and Joseph Lawton (EM3) . The Emergency Department’s Observation Unit was rapidly transformed into a Respiratory Care Unit (RCU), creating an urgent need for unit orientation, education on proper Powered Air Purifying Respirator (PAPR) use, and training in proper doffing and donning of PPE. Realizing that their faculty members were already at capacity, Brian and Joe volunteered to prepare their thirty resident colleagues and several of the faculty to provide the safest possible care. Fantastic work!

"Thinking about what’s going on with patients is hard while you also try to concentrate on your every gesture. What did you touch? Did you wash your hands? Don’t scratch your nose. Don’t play with your goggles even if they dig into your face and rub that tender spot above your ears."

by Jay Baruch, MD

Associate Professor of Emergency Medicine; Director of the Medical Humanities and Bioethics Scholarly Concentration

Alpert Medical School of Brown University

"You Are Waiting for the Surge"

STAT News, April 21, 2020