A Doctor’s Diary: The daily routine in an ever-changing Covid-19 ICU

(The ninth installment of a special Efe series featuring the first-hand account of pediatric surgeon Colleen Fitzpatrick, who offered her support to an ICU for adults at a community hospital outside New York City, the global epicenter of the coronavirus)

New York, May 13 (efe-epa).- At the end of each day in the unit, I remove my personal protective equipment and change out of my scrubs so they can be laundered at the hospital.

As soon as I get home, I wipe down the inside of my car and my clothes and I go in the shower. Most of us who work in the unit have similar routines, though that’s probably the only part of my daily routine that happens consistently.

Normally, I arrive at work in the morning at the Covid-19 unit of Syosset Hospital in Long Island and get sign-out from the person who was covering the unit overnight.

Early in the pandemic, when the number of critically ill patients exceeded the capacity of the normal ICU, the operating room recovery unit, which was a larger, open space, was converted into the COVID-19 unit.

We typically have around 15 patients in the unit, most of them on ventilators. Several of the patients are sick, and days in the unit are very busy.

As soon as I arrive, I print out a patient list and walk around the unit making a note of the current ventilator settings. This is followed by reviewing the patients’ medications, laboratory studies and X-ray findings.

I try to have this done in time for rounds, which typically include the pulmonologist covering the hospital, members of the hospitalist team, a telemedicine ICU doctor present on a portable computer and other team members who call in by phone, usually a dietitian, social worker and pharmacist.

(Under normal circumstances, these team members would be physically present for rounds, but to help limit unnecessary exposure to the COVID-19 unit, they call in remotely.)

After rounds, I follow-up on any new plans, make adjustments to the ventilators if feasible and go through the charts again looking for recommendations left by consulting doctors.

Somewhere in the middle of this I eat lunch and in the late afternoon the pulmonologist and I go through the unit again, making adjustments to the ventilators. I then try to have things organized to pass off to the night person.

This sounds very straightforward, but it rarely works out that way. Because this is an ICU with sick patients, it’s a very dynamic environment.

A patient might acutely desaturate – suffer a dramatic reduction in oxygen levels in the blood -, a breathing tube could become dislodged or a patient might suddenly have low blood pressure or a high heart rate. Each scenario requires immediate attention.

And there are lots of phone calls – from the laboratory with critical lab values and from the pharmacy to discuss medication orders. And of course calls come from families looking for updates.

Additionally, I respond to rapid response codes called in other parts of the hospital. This happens when a patient on the regular floor acutely decompensates and often results in them being transferred to the unit. Many of these patients end up on ventilators.

These codes have become less frequent as the number of cases has started to slow down.

Needless to say, there are many interruptions to my “normal” routine and it’s a rare day when I don’t have leftover tasks to pass on to the person covering at night, which, honestly never feels good. EFE-EPA


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