WEBVTT
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Today is Wednesday, July 8th
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and COVID is still happening in Los Angeles.
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[eerie instrumental music starts]
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The medical ICU is full,
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surgical ICU is full,
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there is not a single ICU bed open in the hospital.
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[eerie instrumental music]
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It is Friday!
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Today, it's Saturday.
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Just another really hard day.
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Holy crap, he comes back to life!
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Heart starts beating, there's a real blood pressure,
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I'm like, "Fuuu..."
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An ICU nurse can only take care of one or two patients.
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We are busy here, we are drowning.
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You know, with California re-opening
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and Los Angeles sort of getting back to regular life,
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but the outbreak, you know,
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being quite far from under control.
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We've sort of gone back to regular modes
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of functioning at the hospital, plus COVID.
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I just sort of never really imagined
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that it would happen in that way.
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We're doing tons and tons of trauma,
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July is a very busy month for traumas.
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For example, I was on-call yesterday
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and had a couple of gunshot patients come in,
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who needed emergency surgery,
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who happened to have COVID.
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So community spread is very common and very prevalent.
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There are tons of asymptomatic people coming to hospital
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for other problems, who happen to have COVID.
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So that's putting a strain on our system,
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because we don't have the specific isolation beds
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that we might need for such a patient.
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I've been sort of surprised by that.
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That's just not what I pictured.
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The ER occasionally, here, will go on diversion,
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except for the most critical of trauma cases.
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And then, just the other night,
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we finished two cases in the middle of the night,
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one was a stab wound to the abdomen,
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one was a gunshot wound through the arm
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and through the belly.
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And this gunshot wound guy had COVID,
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and the other guy did not,
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but neither had an ICU bed available.
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So they had to just, sort of, park in the OR
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for, like, six hours while they waited for a spot.
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So, that's sort of what's going on these days.
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Still got my mask.
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Everybody's hanging in there.
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[mellow guitar music]
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Good morning.
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It's Thursday, July 9th.
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It is 5:50 in the morning,
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and I'm coming into work.
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COVID number's going up,
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and if you look at the curve in Los Angeles,
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we had, just like in the rest of the United States,
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a big spike in April, which just began
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to come down a little bit in May,
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which sort of flattened, but never really went away,
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and now numbers are going back up.
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So the curve in Los Angeles looks
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very similar to the curve in the rest of the United States.
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With the big spike, a little bit of a flattening,
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and then...up.
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It is still Thursday, July 9th.
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It is now 7:30 p.m.
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I am here on my little porch,
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in my little rocking camping chair.
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And meanwhile, my phone is blowing up.
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Trying to get me to move people out of ICU,
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because the ED is so full of ICU patients
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they have nowhere to go.
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So they are trying to push current ICU patients
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out, out, out, out, out!
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As fast as possible.
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You know, when the system stretches,
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everybody suffers, not just COVID players.
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I have a bunch of COVID patients
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who are in the COVID unit
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but have, primarily, trauma and surgical problems,
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and I was asked to move them out of the ICU.
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And I think it's too early,
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because they still have ongoing issues
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and we're, sort of, grasping at straws
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as to which patients will be safest to move.
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Good morning!
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It is Friday, July 10th.
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I got a text last night letting me know that
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our hospital has reached capacity
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for the number of patients who require dialysis.
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So we have no more dialysis machines.
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As you guys probably have heard by now,
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COVID is not a respiratory illness.
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What is actually is,
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is a vascular illness.
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The virus attacks the tiniest little
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blood vessels in the body.
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You know, there happens to be some of those in the lungs
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but there also happens to be a lot of those in the kidneys.
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So, many patients, when they get critically ill,
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go into kidney failure.
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It's gonna be a problem for our trauma patients.
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We've been advised to transfer early,
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if we have patients who we think are gonna need dialysis.
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Which is crazy, like, where are we supposed to send them?
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You know?
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So, we'll see.
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Happy Friday.
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One sort of interesting thing that has happened
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over the last couple of weeks,
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is patients who initially tested negative for COVID
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on the way in the door of the trauma bay
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have become positive later in their hospital stay.
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As they're literally rolling in the door,
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somebody jabs a Q-tip in their nose
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and sends it off to the lab.
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We test every single patient
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who gets admitted to the hospital.
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Before they go out to rehab or something,
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the rehab place will ask for another
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confirmatory negative test,
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and we'll send it, and it will be positive.
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Some of those folks are asymptomatic,
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but I have another patient who developed
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fevers, a cough, and a funny-looking chest x-ray.
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We actually, luckily, are not bursting at the seams
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anymore in the ICU.
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We do have beds available
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but we are still on diversion,
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meaning ambulances are still
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not bringing us patients, except for trauma,
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because we actually don't have
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enough respiratory therapists.
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In addition to needing physical space for patients,
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we need enough staff.
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An ICU nurse can only take care of one or two patients.
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A respiratory therapist,
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who is the person who runs the ventilators,
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they can only have, I think it's five or six here.
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So our hospital's not full,
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but we still are not taking new patients for that reason.
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Hey, everyone.
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It is Monday, July 13th.
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It's 8:00 p.m., just got home and showered.
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Just another really hard day.
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We just had this young girl in her thirties
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just die of a massive, overwhelming,
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soft tissue infection of the arm.
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There was nothing we could do,
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and it went from zero to 90 in, like,
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just a couple of hours.
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She was impacted by the COVID outbreak
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'cause her family couldn't really be with her
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in her last moments.
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And that's unfair.
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And so much of this is unfair.
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One aspect that people probably
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have heard about in the press
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is the disproportionate effect that
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the COVID pandemic is having on patients of color.
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You know, in Los Angeles county it's something like
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a third of the population is Hispanic,
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but they represent 70% of all hospitalized patients.
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There's a lot of reasons,
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and some of them include the fact that
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most of those people are working front-line jobs,
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where they can't work from home,
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and they are the people that are keeping the economy going.
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Working in deliveries, working in the restaurants,
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working in the service industry.
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These folks are not able to self-isolate
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and protect themselves.
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In Los Angeles county,
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two percent of all in-patient admissions for COVID
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have been white people.
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Which is, obviously, vastly underrepresented
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of how many white people there are in Los Angeles county.
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So...
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That's unfair.
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Right?
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And decisions and policies that open the economy too early
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are racist policies, because they will have
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a disproportionate effect on the health
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and life of people of color.
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Our government has just, kind of, wished this virus away,
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and it's still here, and we're opening.
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And, actually, today Los Angeles...
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And California, Governor Newsom said that
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we're taking a step back in opening.
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So I'm proud of that policy,
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people are at their wits' end at the hospital.
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So that's where we are today.
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Hey, everyone.
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Today is Tuesday, it's two o'clock in the afternoon.
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We had our quality improvement meeting today,
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in which we go over our numbers for the trauma center.
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Our volume, our outcomes, our mortality, that sort of thing.
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Our overall trauma numbers were much lower,
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but our overall penetrating numbers were much higher.
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Usually, our percentage of penetrating trauma
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is somewhere around 20%.
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But for the months of April and May,
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it was significantly higher, and more like 25%.
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It's, you know, hard to know if that's
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a blip in the statistics,
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or if that's a real phenomenon,
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that more people were shooting and stabbing each other,
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despite the overall drop in trauma volumes.
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It's July 15th, Wednesday, 7:30 p.m.
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The news today is that the federal government
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has decided that the hospitals
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and local public health authorities
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should now be reporting their COVID data
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to a centralized database run by the White House,
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and not to the CDC.
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This is concerning because of
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transparency issues, and data-sharing issues,
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and accountability issues, and privacy issues.
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I wanna take care of patients,
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and operate on sick people,
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and do my job, and do it well.
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We are busy here, we are drowning.
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We are stressed out.
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It is incredibly frustrating
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to be, pardon my French, balls deep in taking care
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of a lot of sick patients, and have the government types
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not be able to deal with this effectively.
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I'm just like, "Guys, figure this out!"
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Today is Thursday, July 16th.
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And there's been two situations in this last week
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that have been sort of, like,
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"Hmm, that's kind of interesting."
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One is a lady who has a really terrible,
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and difficult, and complex abdominal wall hernia.
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And normally, between operations, we would be
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removing the breathing tube and putting it back in.
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Just for surgery.
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But because she has COVID,
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and reintubating and extubating is just
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such a massive exposure for the doctor who's intubating,
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the anesthesiologist who's intubating,
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the nurse and the respiratory therapist
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who would be extubating,
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this lady who otherwise would be awake and walkie-talkie,
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just with this abdominal problem,
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has been intubated this entire time.
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And then, another patient that's been sort of
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different because she has COVID,
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is this lady that we admitted overnight.
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She's a young lady,
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who was witnessed to be assaulted by three different people.
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She was getting kicked, and punched,
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and all these other things.
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She has this massive fever.
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So, is that from an intestinal perforation
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that we don't know about,
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or is that from her COVID?
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All other things being equal,
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she probably would have earned herself
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an abdominal operation to go in and check on things.
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But right now we're just chalking that fever up to COVID.
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So we'll have to see,
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she's sort of a mystery at the moment,
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so we'll follow her closely and see
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sort of how she plays out.
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And we are being asked to recycle our N95s.
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PPE seems adequate here,
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but next to every COVID or negative pressure room
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there is a bin to recycle the N95s.
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It's Friday, July 17th.
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6:10 in the morning, I slept in a little bit.
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I got a bunch of frantic text messages
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from the on-call trauma team last night,
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'cause there was not a single ICU bed in the entire house,
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and they needed me to move somebody.
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And we had to pick and choose.
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These are people who, under normal circumstances,
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would probably take another day or two
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of observation in the intensive care unit.
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But, you know, with the crunch for beds
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we had to sort of boot them out a day early.
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So, I think they'll be fine,
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00:11:37.201 --> 00:11:39.383
but it was just...
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It was a very surreal conversation
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that I was having last night, so...
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I just realized that, on this day,
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two weeks from now,
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I will be walking out of the doors of this hospital
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for the last time.
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I will finish my year of critical care fellowship,
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and that will complete 10 years of medical training.
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And I'll be done.
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00:12:03.910 --> 00:12:05.920
So, two more days running in the ICU,
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then a few trauma calls in the last two weeks,
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and I am out of here!
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Our center is also participating
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00:12:13.543 --> 00:12:15.890
in a couple of clinical trials for COVID,
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which is pretty exciting.
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One trial that we're involved in
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is looking at mesenchymal stem cells,
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00:12:21.300 --> 00:12:23.690
which are just stem cells naturally found in the body
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that have the potential to become
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anti-inflammatory type cells.
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Doctor Baudisch is coming around,
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and keeping tabs in all the patients,
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collecting various data points
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and seeing whether it's helping.
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Good morning!
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It's Saturday, July 18th.
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I'm heading into the hospital
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for my last day ever rounding the ICU at county.
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The fellowship has 12 days left in it,
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so one more day rounding the unit
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and then four 24-hour trauma calls in 11 days.
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That doesn't sound like that much, but that's a lot.
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But it's good.
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It'll be good.
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It's a good strong way to finish this year.
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Okay, well, it's Saturday, July 18th.
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I'm finished rounding.
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The overnight trauma team was very busy,
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we have many new patients, many very sick new patients.
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And a lot of them have COVID.
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00:13:16.540 --> 00:13:18.723
So just another day at the office.
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00:13:20.810 --> 00:13:23.650
Because our hospital is cohorting the COVID patients
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and so strict about that,
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00:13:25.130 --> 00:13:28.770
meaning the COVID patients can only go to certain units,
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a lot of our trauma patients
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are ending up in the medical ICU.
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These medical ICU nurses are now being asked
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to take care of trauma patients
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with hemorrhaged, you know,
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ridiculous amount of blood volume,
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or have bad head injuries.
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It's not, sort of, in their wheelhouse
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the way it's in the wheelhouse of the nurses up on five.
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You know, it just takes a little bit more communication,
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it takes a little bit more patience,
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it's for the greater good of the hospital,
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and the staff, and the patients,
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that we sort of cohort all these
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COVID positive folks together.
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00:13:57.270 --> 00:13:58.360
So we just have to, kind of,
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do what we have to do and adapt, in that sense.
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00:14:01.700 --> 00:14:04.470
It's July 20th, it's 9:20 p.m.
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Little bit past halfway done
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00:14:05.910 --> 00:14:07.730
with this 24-hour trauma shift.
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00:14:07.730 --> 00:14:09.880
I would say these last 12 days have been
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00:14:10.780 --> 00:14:13.670
sort of, less of a whirlwind than
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the first surge of COVID back in March and April.
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00:14:16.670 --> 00:14:18.600
When LA was still shut down,
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00:14:18.600 --> 00:14:21.140
all we could do was focus on taking care of COVID patients,
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00:14:21.140 --> 00:14:22.280
and that's what we were doing.
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00:14:22.280 --> 00:14:25.800
But now, since LA is open, and we have this second surge,
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00:14:25.800 --> 00:14:29.283
we are just doing a little bit of both at the same time.
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00:14:30.365 --> 00:14:32.990
Operating on a COVID patient is, like, real slow.
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00:14:32.990 --> 00:14:34.670
Everything that usually takes a long time
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00:14:34.670 --> 00:14:35.880
takes 10 times longer.
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00:14:35.880 --> 00:14:37.510
From anesthesia getting all set up
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00:14:37.510 --> 00:14:39.280
with their very special space helmets,
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00:14:39.280 --> 00:14:42.080
to intubating safely and clearing out the room
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00:14:42.080 --> 00:14:43.970
for 30 minutes with negative pressure.
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00:14:43.970 --> 00:14:46.446
It's been so up and down, and a rollercoaster,
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00:14:46.446 --> 00:14:48.950
and nothing surprises me anymore.
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00:14:48.950 --> 00:14:52.200
Like, my life four weeks ago was really different
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00:14:52.200 --> 00:14:54.290
from my life four weeks before that,
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00:14:54.290 --> 00:14:56.980
was different from my life four weeks before that.
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00:14:56.980 --> 00:14:59.310
So when there's new policies, or new developments,
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00:14:59.310 --> 00:15:00.946
or new steps we have to take,
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00:15:00.946 --> 00:15:02.815
or new interesting twists on
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00:15:02.815 --> 00:15:05.151
the way COVID and trauma can mix up,
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00:15:05.151 --> 00:15:07.025
it's made me more dynamic,
377
00:15:07.025 --> 00:15:09.140
and it's made our nurses more dynamic,
378
00:15:09.140 --> 00:15:10.480
and our staff more dynamic.
379
00:15:10.480 --> 00:15:12.140
You just have to roll with the punches,
380
00:15:12.140 --> 00:15:13.960
'cause the punches are non-stop.
381
00:15:13.960 --> 00:15:15.000
It's been crazy.
382
00:15:15.000 --> 00:15:15.980
But we're used to it.
383
00:15:15.980 --> 00:15:17.280
We're used to crazy around here.
384
00:15:17.280 --> 00:15:19.280
It's what we do, we specialize in crazy.
385
00:15:22.160 --> 00:15:23.440
Oh my good Lord.
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00:15:23.440 --> 00:15:25.270
So now I'm finishing my 24-hour shift.
387
00:15:25.270 --> 00:15:27.390
Last night was, like, one of the craziest nights
388
00:15:27.390 --> 00:15:28.520
I've ever had here.
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00:15:28.520 --> 00:15:30.330
One of these young kids, 28 years old,
390
00:15:30.330 --> 00:15:32.160
he was very unstable, very sick.
391
00:15:32.160 --> 00:15:33.480
Meanwhile, while that's going on,
392
00:15:33.480 --> 00:15:36.290
I get the trauma page that a gunshot wound is coming in.
393
00:15:36.290 --> 00:15:37.710
So, run downstairs to see that.
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00:15:37.710 --> 00:15:40.250
It's a lady who got shot through the arm,
395
00:15:40.250 --> 00:15:42.460
into the right upper quadrant,
396
00:15:42.460 --> 00:15:44.960
and it went sort of all the way across her abdomen
397
00:15:44.960 --> 00:15:46.400
and caused a bunch of trouble.
398
00:15:46.400 --> 00:15:47.980
And the pager was off again.
399
00:15:47.980 --> 00:15:49.950
It's a stab wound to the chest.
400
00:15:49.950 --> 00:15:52.710
So, there's a two-centimeter little laceration
401
00:15:52.710 --> 00:15:53.600
in the front of the heart.
402
00:15:53.600 --> 00:15:54.510
So I said, "Okay."
403
00:15:54.510 --> 00:15:56.050
So I put a little stitch in that.
404
00:15:56.050 --> 00:15:58.360
And holy crap, he comes back to life!
405
00:15:58.360 --> 00:16:00.480
Heart starts beating, there's a real blood pressure,
406
00:16:00.480 --> 00:16:01.540
I'm like, "Fuu..."
407
00:16:01.540 --> 00:16:05.150
Meanwhile, my other team is working on this gunshot wound,
408
00:16:05.150 --> 00:16:07.293
who obviously also has COVID, of course.
409
00:16:07.293 --> 00:16:09.120
My stab wound guy did not.
410
00:16:09.120 --> 00:16:11.080
Luckily, everybody was wearing their spacesuits
411
00:16:11.080 --> 00:16:12.270
and their special masks,
412
00:16:12.270 --> 00:16:13.750
because, like I said before,
413
00:16:13.750 --> 00:16:15.390
we treat everybody when they're coming in
414
00:16:15.390 --> 00:16:16.510
like they do have COVID.
415
00:16:16.510 --> 00:16:17.690
And, you know, thank God we do,
416
00:16:17.690 --> 00:16:20.883
because 50% of our patients last night had COVID.
417
00:16:21.720 --> 00:16:26.420
So yeah, I'm pretty jazzed right now, pretty amped up.
418
00:16:26.420 --> 00:16:29.170
Thank God everyone this morning is doing much better
419
00:16:29.170 --> 00:16:30.500
than they were last night.
420
00:16:30.500 --> 00:16:34.083
So, all in all, a very positive but very busy night.
421
00:16:35.090 --> 00:16:37.400
I have full faith in the staff that remains here
422
00:16:37.400 --> 00:16:38.840
to keep doing what they do,
423
00:16:38.840 --> 00:16:41.760
which is work really hard and care really deeply,
424
00:16:41.760 --> 00:16:43.420
and take care of each other,
425
00:16:43.420 --> 00:16:44.560
and take care of patients.
426
00:16:44.560 --> 00:16:46.550
We really should never forget,
427
00:16:46.550 --> 00:16:49.550
a lot of people in the world have lost family members.
428
00:16:49.550 --> 00:16:51.310
Their moms, and their dads, and their kids,
429
00:16:51.310 --> 00:16:52.900
and their brothers, and their sisters.
430
00:16:52.900 --> 00:16:55.760
That sort of puts everything to a little bit of perspective.
431
00:16:55.760 --> 00:16:57.961
And a little bit of inconvenience here and there,
432
00:16:57.961 --> 00:17:02.961
or a little bit of a need for ingenuity and adaptability,
433
00:17:03.140 --> 00:17:05.500
I think that's just a small price to pay.
434
00:17:05.500 --> 00:17:07.470
So, I think that's it for me.
435
00:17:07.470 --> 00:17:10.610
I'm signing off, it's been great talking to you guys
436
00:17:10.610 --> 00:17:14.090
and sort of keeping this time as a little time capsule.
437
00:17:14.090 --> 00:17:15.313
All right, peace out!