The ICU is not what you see on TV.

Sunrise over our local hospital.

But you don’t want to find this out first hand.

I saw a picture of a group of physicians and nurses in the “COVID ICU” on social media today. It was the same intensive care unit I worked in for years as a medical trainee. I recognized it right away with its beige tiled floor, clear glass rooms, and that awful yellowish paneled wood work area. Suddenly a flood of emotions passed over me. Memories unrolling one after another. And I realized something…

After all these years I still feel deeply the pang of the long hours in that ICU spending hour after hour with the sickest of the sick. I still hear the alarm beeps. I smell the cleaner in the air and feel the cold as the temperature drops in the wee hours of the morning only rectified by the overly starched heated hospital blankets. And I still remember the patients.

I can see the cancer patient getting treatment with medications making them so sick they could no longer breath on their own. In the corner I see the young cystic fibrosis patient praying for a miracle transplant. I remember standing in a pool of blood putting giant tubes down throats for patients with massive stomach bleeds on the brink of death. And I will never forget the numerous patients so sick with infections in their blood all their organs were failing them, one after another. I hear the ‘code blue’ alarm ringing and nurses yelling for help. I can feel my stomach drop and my heart race a bit as I run towards the room for CPR. 

Sometimes I was there with you alone at 3am, doing everything possible to save you. And other times your family was at your bedside when the ultimate tragedy struck. Tears could not be stopped on either side of our exchange as they said goodbye.

Seeing that picture I remembered everything so vividly my heart felt heavy in my chest. I realized suddenly very few people know this experience. Very few ever have the emotional experiences attached to seeing that ICU. Most Americans (luckily) have never personally witnessed the wrath an ICU on the delicate human body. Most have not had a loved one suffer through countless procedures or treatments, with lines and tubes sticking in and out of every body part possible. They haven’t seen their beloved spend day after day hooked up to breathing machines and machines mimicking kidneys when their bodies basic systems start to fail. They haven’t seen the trees of pumps with IV medications surging into large veins in the neck and groin, while their loved ones lay paralyzed and asleep in a bed growing more and more swollen from the fluids trying to sustain life. This isn’t the television version of the ICU you have been shown before. It isn’t glamorous. At all. People don’t always survive and there is nothing TV viewable about the actual ICU experience.

I know one thing for certain. Be happy you haven’t been there and don’t know that experience. But more importantly just because you haven’t seen it doesn’t mean it isn’t real. It is real. It is the most tragic existence you’ll never be able to imagine.

Wear a mask. Stay home. Stay distanced when you must go out. Please avoid groups. And keep yourself safe. You don’t want to learn what the ICU is really like, trust me.

What is it like?

What is it like to visit a doctor’s office right now during the pandemic?

Sitting in my office today I realized that given the state of the COVID-19 pandemic there has been increased anxiety in my patients about visiting the doctor.  They just don’t know what to expect and for good reason are worried.  It is intimidating and can be associated with anxiety to begin with, and now with any new protocols or potential increased risks patients are (rightfully) concerned. However, I want to tell you that it is not that much different.  To alleviate some fear, I’ll walk you through the process and discuss what new protocols you can expect when visiting.  

First and foremost, we are here, and we are seeing patients who need us.  There are a couple different ways to visit the doctor right now.  You can definitely come in person to see us as you would normally, or if you feel uncomfortable and worried given either the pandemic or your risk given your personal medical conditions, we are also offering telemedicine visits, which I have talked about before Here! (essentially where a doctor and you can video chat). 

Next when you have decided to make a doctor’s appointment, what changes should you be aware of?  Let’s walk through the process.  You start by calling for an appointment as always, but you will likely notice the first change here with the conversation you have with the scheduler.  Your scheduler will ask you about symptoms for COVID-19 as well as any other risk factors for exposure.  They will inform you about some of the measures in the clinic that we are taking to try to protect our patients.  Once you complete the screen, you make your appointment and are good to go.  Face coverings are mandated in the buildings, so you will be reminded have one for your appointment. And in case you forget, don’t panic!  You will be provided with a mask if you do not have one when you arrive.  Like you, the doctor, nurses, and all staff you meet will also be wearing a mask throughout the visit.  When you arrive at the office you will be asked to fill out a questionnaire about possible symptoms and exposure and have your temperature checked with an infrared forehead thermometer.  If you do not have a fever, or active symptoms you will “pass” this portion.  You may notice that our waiting rooms have been changed to help with social (physical) distancing.  This means chairs have been removed and spaced far apart. In some cases, you may bypass the waiting room altogether and move immediately from check in to your examination room.  This helps keep everyone safely distanced and separated. Heads up, this may mean you sit in the exam room longer than normal while waiting for the doctor, but it helps keep everyone away from each other, which is the goal of social distancing.  

The visit with the doctor should feel pretty normal overall.  Sure, we are limiting handshakes, but the doctor will still examine and treat you in our normal way.  There is lots of handwashing for us these days! But honestly not much different from how we normally operate. Hand washing has long been a part of our infection control practices in hospitals. 

What happens next?  Once you see the doctor if we need an MRI or another test it is absolutely still available.  In some cases, there may be a bit longer wait given those facilities are also implementing procedures for social distancing and cleaning, which may mean more time between appointments.  But overall, tests, medical procedures and surgeries are being done as they were before this pandemic with a little additional caution. 

After visits with my patients, I am asking folks to stay in the room, and once the coast is clear from other patients in the common areas, my staff review any needed next steps with you directly and help you exit seamlessly and as socially distant as possible.  Once you exit our building our staff does a diligent job in cleaning the rooms before we move on to our next patient.

Bottom line:  there are some small changes to protocols to try to keep patients safe, but no other large ones you should worry about. You need to be mindful of local stay-at-home orders and the pandemic is absolutely still out there. But, we are here for you, and we are all doing the best we can in this challenging time.  Stay safe!

I miss sports…

April 30. 

The fiancé and I took a long run tonight around our neighborhood.  I have been trying to get into the swing of exercise during the pandemic. But if you read my last post (linked here!) it hasn’t always been easy.  So, when offered a leisurely paced (aka Morgan’s pace, not his pace) tonight after dinner, I took him up on the offer.  When we were about 1.5 miles out, we happened upon the local high school sports fields.  Immediately I felt the need to reach out my hand towards the gate.  There was a pit in the bottom of my stomach.  Seeing that football field I was struck with so many emotions.  I really miss sports. 

My job sometimes isn’t easy, and it often weighs on me.  As an emotive person the weight of everyone’s pains and injuries can build up. The expectations of seeing volumes of patients, doing paperwork, and managing a staff can weigh on my sensitive being.   And when you have games to cover on countless weekends and evenings it can start to feel like a chore.  But that day I felt such a strong longing to stand on the sidelines on a fall Saturday covering a football game.  I could feel the cool breeze in the air, hear the fans cheering in the stadium, and see our team playing on the field.  I long for the day we are able to play sports again.  But this longing is mixed with the fear I have for the safety of our athletes. COVID-19 has changed everything, including my perspective.   

May 3.

My fiancé and I have jumped on the bandwagon and are watching The Last Dance on ESPN (ESPN Story linked here).  The story for those that don’t know is about the Chicago Bulls in the era of the great Michael Jordan.  And you know what, I’ll say it again, I really miss sports. While watching I couldn’t help but think about why I feel so strongly about it.  I am not just a fan.  There is something more to the desire I feel.  

You’ve have heard the saying, “if you can’t be an athlete be an athletic supporter?” Well I think we as team docs are the ULTIMATE athlete supporter.  Let’s be honest again, I am not larger than life. I will never be.  But these athletes are.  And when they stand in victory we stand on the sidelines or in the very far background.  The feeling that we helped, even in a just small amount, contribute something towards whatever it was that allowed them to get there… WOW. Even if we didn’t directly contribute anything aside from being there in case, even when we are just there to watch it from behind the scenes while it is all happening…. Same feeling. Still Wow. 

The energy of being around sports is irreplaceable.  I don’t have a championship ring, but I know what it is like to watch that end being achieved. Maybe that is in part why we do our jobs;  it isn’t for the ring itself in our case but to be a part of something greater than ourselves, to help the best of the best achieve her or his best, to help those larger than life characters to be the gladiators of today. 

Team doctors are always there.  Winning seasons or losing ones. Pandemic or not.  There is no real credit and most of us don’t care. All we want to be there to help the best achieve greatness. We want the gladiators of our time to shine. We want those who are larger than life to make magic.   

Bottom line, I am honored to go behind the scenes and play my very small role in the greater world of sports.  It is absolutely my honor to have stood in every tunnel in which I have been placed. It is my honor to walk into a locker room and help an athlete in need.  

I often joke that it is like going behind the curtain of the Wizard of Oz at times. You know what is back there now, and some of the spectacle of it all changes.  But what an honor it is to know the greatest of the greats. 

Dang, I miss it. 

40 days.

April 20. 

Monday. I think its Monday. Yes, I checked, definitely Monday.  Forty days since the NBA announced they were postponing the season. We have been in “social distancing” since March 19th.  Life has happened since then in some ways: I have gotten engaged, moved, started telemedicine.  Amidst it all we as a society still are trying to plan a future.  I see it for me as we are forging ahead planning our wedding (not for the faint of heart doing a pandemic I might add).  We dream of our perfect honeymoon and hope we can go somewhere amazing. But as it looks now, that may not be in the cards with the regulations on foreign travel in the short-term. 

But life has also stopped. Hard stop. In some ways life hasn’t happened at all.  No sports to cover.  No concerts to attend or dinners out to be had.  People’s most joyous life events usually celebrated on a grand scale like birthdays and baby showers have turned in to drive by affairs. Vacations have been postponed.  And let me be honest with you, it has not been easy.  It seems petty to complain about not having a Friday cocktail out on the town, but we’re missing out on celebrating life’s milestones in the way we’re used to. We are social creatures. And when you take away the social part, even the most introverted souls are rippled.  

So now, we are all suddenly given this block of time without socialization or events to attend.  A full block of protected time spent at home.  Yet, somehow, I am personally struggling to know exactly what to do with it. And you know what, I have decided that is okay.  

There is so much pressure around us to do something productive at all times, especially during this social quarantine.  Social media is full of daily workouts, everyone is baking banana bread or reading novels or cleaning their closets or doing 73 step skin care routines nightly.  And sure, I have upped my home cooking (mostly out of necessity), but honestly some mornings I am simply proud that I have gotten out of bed.  There have been no home projects completed.  My closet is still a mess, and my at home workout routine has not been as strong or structured as my workout routine was pre-COVID-19.  I have been reading about how part of your brain- whether you realize it or not – is focused on this whole pandemic. Part of your brain is literally in panic mode wondering about your safety and survival, even if you aren’t consciously thinking about it. When I read that, my internal feelings made sense for the first time.  Sure, I want to be running every day and planning this wedding and dreaming of my fall sports seasons, but the future is so nebulous right now and my brain is at least in part in fear of the world around me.  It makes it nearly impossible to plan ahead, to dream, to have any sort of existence outside of waiting. 

And the waiting is hard. We don’t know how long this will last. Luckily for us, California has done an excellent job at social distancing so far, and our number of cases has been what most would call fair.  Under the leadership of our governor we are appearing to use science and testing and planning all appropriately.  But, no one knows when we will return to “normal.” And what is the definition of normal going to be?  For someone like myself that tends towards the worrier type, I am in a constant state of heightened fear. And even in the moments of joy and comfort I am in the background playing the movie reel of “what if it’s not okay.”

I admit this because I want you, or anyone who might read this, to know that it its okay.  It is okay not to know. It is okay to be worried and fearful and not feel like learning French or refinishing your wood floors is high priority right now even if you’ve always wanted to.  Just because you have the time, doesn’t mean now is the time.  Sometimes we just need to let ourselves survive anyway we can. Give yourself grace today. We all need it.

A new day.

“Courage is not the absence of fear, but rather the assessment that something else is more important than fear.” FDR

March 12. 

Today I awoke to find that indeed things are changing.  The NHL and many other leagues as expected followed suit to postpone seasons. It literally, and figuratively, changed overnight.  (NYPost article-sports in hybernation)  My eerie feeling of the night before was confirmed, and suddenly an onslaught of cancelations and postponements are being sent.  Changes to all of our prescheduled clinical meetings, social engagements, and all life events are happening in rapid succession.  Officially all social gatherings were limited to less than 50 people shortly thereafter. A national emergency is declared, and further global limits in other countries are reported. Just like that my, just like many others, day to day existence was unsettled.  And although my work continues it feels very different. As I stand in clinic seeing patients, it feels wrong.  Every patient I talk to shares the same fears as I.  We don’t know what we don’t know about this virus, and what we do know is very scary.  We try to be cautious with handwashing and limiting close interactions, but that feels supplemental to a bigger ominous production at hand.  It’s like watching something awful slowly unfold in front of you and knowing it needs to stop but not having the power to stop it, like seeing an impending car accident just seconds before you know the crash sound will be heard or like the moment of stillness in the air where time tics by more slowly than it should when I see a bad tackle on the football field, the kind that makes me hold my breath in anticipation of how it all ends. 

March 15.

March and April were supposed to very busy months for me.  There were games to cover every weekend and travel intermixed with other obligations. Instead, everything is on hold. This weekend, instead of being filled with back to back work responsibilities suddenly has a slower tune.  There is still that eerie sense of this new reality in the air, but we are oddly used to the feeling that these changes are imminent regardless of how we react.  Discomfort and uncertainty are becoming normal already.  

Amidst all of this, this (Sunday) morning my boyfriend has a spark of energy suggesting we go out for an adventure.  Little did I know he had been planning this day for over a month. Painstakingly he had been ring shopping while I was away covering sporting events or at work. And now, he is planning to propose.  I can’t say I didn’t know something was up because something just felt different.  But I wasn’t sure.  We went for a drive in his car and stopped to hike at the same place we first hiked as friends 11 months prior. It wasn’t going to be easy for him today though; with the COVID pandemic, most locals have taken to the hiking trails.  In order to find a more secluded spot, he decided to call an audible to strike off the beaten path, which led to a slightly more adventurous climb up the hill between the rows of switchback paths.  Muddy climbing through the bushes laughing that he is trying to kill me seems oddly apropos for how we should do this, right?  We happened on a small clearing that overlooked the coast from Catalina Island to Malibu.  He gets down on one knee and asks me to marry him.  I say yes as I reach to hug him as fast as I can. 

I had learned in my life before that grief and joy can coexist. It is today that I learned that fear and love can do the same.  Love is the most valuable thing we do as humans, and even in the time of pandemic we must choose to love. We must choose to fight for a love and a life that can spread this ultimate joy to others. 

March 19.  

I am cooking curry in the kitchen when the Mayor announces the first stay home order for LA.  (LA Mayor – safer at home).  He said, “We are all safer at home. Staying in our residences, being aggressive about hygiene, and practicing safe social distancing are the most effective ways to protect ourselves, the people we love, and everyone in our community.  Each one of us is a first-responder in this crisis, and Angelenos understand that we have to make big sacrifices right now to save lives. This isn’t forever — and we’ll get through it together.”

This week has been different. I have still been going to work and seeing patients that need to be seen. But now we have talked about a transition to telemedicine. 

What is telemedicine?  Basically, we as doctors can now treat patients by using a computer or phone.  Your face pops up on my screen and mine on yours.  We talk shop, I make my recommendations, do any orders for treatments you need, and document our visit. There are some rules and regulations:  the main one being I have to have a medical license in the state you are located… but it’s honestly that simple.  Why haven’t we done something like this sooner, right?!

(EVISIT article- how telemedicine works)

We have been discussing this type of care for years. A way for doctors to do medical care remotely. Some have started it but on small scale.  I have been reluctant to do so for several reasons.  First, I don’t do surgery (I discussed this more here… sportsdrmorgan article- what is a SM doc?), and most hospitals have started with doing these sorts of visits for visits after a surgery. Why? A couple of reasons. One, it is usually a quick visit to say look at a wound, and that is easy.  We feel bad when patients drive for hours, sit in waiting rooms and then spend 2 minutes with us saying ‘yep looks great! See you in a month!’ Two, we don’t get paid for these visits. It is complicated, but when you have surgery, the first few post-operative visits are included with the price of the surgery.  So, the insurance companies pay for them as a package deal.  We don’t charge separately for those visits. And guess what, we also don’t (or didn’t… more on that later) get paid by insurances for telemedicine visits. So, if we aren’t getting paid for seeing you in real life, there’s mutual benefit to see each other on the computer. We can save you the strife of the whole painful coming to the doctor process. And for us, we can do these encounters at odd hours like after clinic normal clinic times or during lunch breaks. This way, we get more patients seen during daylight hours. Three, the final reason why I never loved the idea of telemedicine, there is the possibility of more work after hours when I want to be home off the clock.

But with COVID-19 that all changed…  And it changed rapidly.  We can get paid for these visits now due to the pandemic emergency state.  In the pre-COVID days one needed to pay cash.  Now insurances are allowing doctors to bill for telemedicine visits like the way we do for regular office visits.  And the hospitals responded just as quickly.  Massive undertakings by our IT departments were achieved. Full telemedicine apps were developed. And for those that didn’t get that far, ZOOM has become our new best friend.  To be clear, I had never heard of a ZOOM anything until now. But it works! We don’t know how it will all shake out in the end… we don’t know the details of how we will get paid and how much. And if you have ever dealt with insurance companies you know it can be ridiculously painful. But for now, we are rolling it out all over the place. 

With the launch of telemedicine for my clinic the uncomfortable clinic visits I was having (and knowing that people should be staying home) disappeared. I can now see my patients and give medical advice via telemedicine from the safety of my home.  Elective surgeries were postponed next, and all meetings are now video calls. Even rotations for residents and staff on important services were changed to decrease the contact and overlap we have with each other. It all happened very quickly.  We are now truly trying to socially distance even in healthcare. And I cannot stress enough what an amazing feat that has been for most. While alongside of us, other frontline workers have pushed hard ahead to try to save lives.  

This next week proves more and more that adapting to change is the new normal.  Come to find out, emergent services do include vet visits. I call to confirm as my dog, Francis, needs an immunization.  I am scared to take him. Does this really need to happen?  I would’ve canceled, but it was a timed injection.  They confirmed they are open, but I find out even the vets have new special protocols in place to limit contact. We park in the parking lot, call them, and they come out to fetch (pun intended) the dog. We pay over the phone. I can see the front desk from my car window, and I wave thank you.  We are all acclimating to a new way of doing things. And we are surviving. 

March 20. 

We have been looking for a new place to live for over a month.  Our current landlord is selling our condo, and although he was kind enough to let us have some leeway regarding the lease end, I really wanted to find a new home since we were in a position of limbo.  Fortunately, or maybe unfortunately, it happened today.  Good news… We found a place to rent! Super exciting considering several other places we looked at were either not suitable for our needs or not available…  LA is a tough rental market.  Bad news… we now need to move. During the COVID-19 pandemic. If you are reading this in the future, and during another pandemic, I do not recommend a move.  We had one week to pack everything, find movers, and go. Somehow my fiancé found movers who would come (@affordable_movingllc), and they wore masks, and we sanitized everything. But my aforementioned fears and desire to lock myself in the bathroom recurred.  We needed to do this. But I am absolutely worse for wear. 

More of the same has continued with work including telemedicine visits for my patients and being as productive as possible in other areas.  The talks of reallocation of staff continue. My fiancé is back on cycle next week where he will be in the hospital doing emergency things.  I am scared for his safety, and I am scared for mine.  And I wait. I am grateful to be safe at home and hoping others feel the same.  But suddenly my little cocoon of safety will be opened up back to the outside world when he returns.  LA still hasn’t been hit hard yet, and our hospital is holding steady.  It feels like we are waiting, circling. In a holding pattern and on the brink of something very scary, the edge of the bubbling fear I felt outside the night of the Kings game before the season was canceled.  It is still bubbling up and I am waiting.    

March 30.

It has been 3 weeks.  In 3 weeks, we are here. We are at home now.  Some of us are safe. Some of us around the world and still in NYC are in a fight for their lives.  (CBSnews article)  In 21 days, we have changed our entire culture and social construct as a human race.  I pray it ends soon. I pray that the pot never bubbles over locally and we did enough social distancing fast enough to prevent the onslaught of cases that are predicted.  And if mercifully it does subside, I cannot help but think about what the future holds.  How will we react when the bans are lifted?  Will this time of social isolation have an effect on how we choose to live future forward?  I know it will for me.  I will be much more mindful of how positive the sharing of life is with others.  I will be grateful for the interactions I have with my friends and loved ones. I will be grateful for a hug.  I will smile more at strangers and cheer for everyone I can in this life.  Can we all just agree now to do better?  Let’s slow down, be mindful, enjoy life. Human relationships should never be taken for granted again. 

The field of medicine will also undoubtably change.  We now are proficient at telemedicine… the infrastructure of how we treat patients moving forward can be different.  The precipice of a new era in healthcare is upon us.