April 19th, 2020

Gratitude Before, During, and After Rounding on COVID-19 Service

April in Boston … sigh.

It snowed in Boston yesterday morning — heavy, wet flakes covered the daffodils and tulips that just started coming up — but this brief return to winter didn’t make my red, itchy eyes from spring pollen feel any better.

The flowers didn’t look too happy either. Oh well.

But just as the annual misery of a typical Boston April started to bug me, the work at the hospital provided plenty of distraction — in a good way. Because even in the midst of this terrible pandemic, there are many reasons for gratitude, some big and some small.

Today’s theme — appreciation for people doing an astounding job under truly difficult circumstances. This is hardly a comprehensive list, but just the things that came to my attention during rounds yesterday.

1. Enter the hospital. In US hospitals now, patients and staff must enter through different doors; at the staff entrance we show our ID badges, then our electronic COVID PASS attesting we’re healthy enough to work, and then we pick up our daily surgical mask. Sounds like a huge pain, right? In fact, the people working at these entrances exemplify kindness and efficiency. Not only that — masks with elastic loops (rather than loose ties) showed up this week back in stock, making life so much easier. Thank you.

2. Pick up your scrubs. Most people caring for patients with COVID-19 wear scrubs, and of course this increased demand strains the scrub distribution system. But so far it’s working out mostly ok, with machines dispensing clean sets in your designated size without much difficulty. I haven’t worn scrubs since residency — a long time ago, yikes — and my amazement at this automated system brought to mind George Bush, Sr.’s clueless response to supermarket price scanners in 1992. In my defense, my last time wearing scrubs was even before this date! Regardless, to the people washing the scrubs and stocking these machines — thank you.

3. Put on your PPE. Even after you’ve done it a bunch of times, it’s not easy putting on this personal protective gear — so many places you can go wrong. Fortunately, observers stationed outside of each room guide us through every step. Marie, Diego, Tommy, Danielle, Lucy (to list 5 of many) — all have been extraordinarily helpful, patient, and responsive, even though this isn’t even close to what they usually do in their actual jobs. They’ve been reassigned from the OR, the emergency room, the surgical floors, or the radiology suites to provide this important service. Thank you.

4. Work in a clean, comfortable place. Hospitals need to be clean, but that’s no easy task. Ever see what the resident work or call rooms look like after lunch? Eek. As we’re cogitating over CRPs and D-dimers and ferritins, the people responsible for keeping our patient floors clean work hard and mostly silently, invariably in the background but very much appreciated. Thank you.

5. Get the update from the nurses. In our “SPU’s” — that’s “Special Pathogen Units”, name not chosen by me — the nurses on the floors have been simply amazing, providing remarkable care under very challenging circumstances. A key thing every ID doctor learns early in his or her training is that if you want the complete picture of how someone is doing, ask the patient’s nurse. They’re the ones in the rooms the most, a reality more true now than ever given the need to preserve PPE and other barriers to patient visits. Thank you.

6. Work with dedicated medical trainees. Medical interns and residents. Surgical versions of the same. ID fellows, dermatology trainees, and budding oncologists. Future cardiologists and invasive gastroenterologists and thoracic surgeons-to-be. One thing you can confidently say about all of them — NONE EXPECTED TO BE DOING THIS RIGHT NOW. (All caps, italicized, and bolded for emphasis.) None signed up for this — not even the ID fellows! All of their planned training has been completely sidelined by a few pangolins (maybe) and SARS-CoV-2. Regardless, the trainees’ sustained calm and pleasant demeanor, their competence, and the compassion with which they approach patient care in the COVID-19 era cannot be overstated. Plus, they want to learn about this scary new disease — no running away, they have genuine interest. Just amazed and impressed. Thank you.

7. Get breakfast, lunch or dinner. By my quick calculations, I estimate that I have eaten 8,423 meals either in our hospital’s cafeteria or the coffee place in the lobby. COVID-19 changed how we get and consume food, but both the cafeteria and coffee place still open daily for business — and all the people working there smile (you can tell by looking at their eyes above their masks), and the food is still fine. And good value! Thank you.

No, things aren’t perfect. The lines for scrubs right before shift changes stretch out into the hallway (6-foot separation!), our elevators in our oldest patient tower still could … be … faster …, there’s no salad bar, and I’ve already complained about the masks with the tricky ties (doing it behind your head is so tough for fumble-fingered non-surgeons).

But boy, things could be worse.

Hey, it reached 60 degrees today! Thanks for that, too.

Mabel and Olive, go at it.

12 Responses to “Gratitude Before, During, and After Rounding on COVID-19 Service”

  1. Philip Joseph Bolduc says:

    Thanks Paul for the shout-out to these fine people and to you for keeping us abreast of the latest COVID news..

  2. Jeanne Marrazzo says:

    Beautifully written and felt, Paul–thanks for YOU!

  3. Will Onyia says:

    Thanks for the piece. I love “Cogitating over CRP, D-dimers and Ferritin”. These markers have always been important, but no one would have predicted how outsized they are proving to be.

  4. Cathy Hamel says:

    Someone print/share for the various groups mentioned! Bravo to them –

  5. Jeff Virant says:

    An attitude of gratitude. Thank you Dr. Sax.

  6. Michael Rosenberg says:

    What wonderful, heartfelt sentiments
    The gift of language heals many…
    thank you

  7. Eileen Mullard says:

    Well done you included everyone!
    Thanks for this lovely positive feeling of having gratitude amidst organised chaos, new ways of being and life! Much to be grateful for….for certain Merci!

  8. Rohini Sharma says:

    So very well written and reflects the real world today !
    Thanks Dr Sax

  9. carolyn goldstein says:

    thank you for that story. where I work the staff is just as nice.

  10. Dean Winslow says:

    Nice piece, Paul. I feel the same way here at Stanford. My good friend, Gen Jim Mattis, emailed us a couple of weeks ago: “You two stay safe, but I know you were bred for this brawl!”

  11. Brenda Crabtree-Ramirez says:

    Beautiful written… Thank you too!

  12. Spencer Ryce says:

    Nice Article, it is helping to understand the situation of this covid-19 scenario.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.