COVID Beyond the Hepatology Clinic
By Craig Lammert, M.D.
AIHA Executive Director
The first few days of 2021 gave me a different view of medicine than I am accustomed to. My institution asked me to “redeploy” as an internal medicine hospitalist at IU Health University Hospital in Indianapolis. The ongoing novel coronavirus pandemic has placed a huge burden on the inpatient hospital staff, and several hepatologists and I were asked to take on shifts to help relieve our hardworking internal medicine colleagues.
This might appear straightforward since I’m a hepatologist and completed a residency in internal medicine, but it had been 10 years since I worked as a resident and cared for “general” medical patients in the hospital. As a hepatologist, my practice focuses exclusively on caring for patients with liver disease.
In addition, with the pandemic, I didn’t have the luxury of having medical trainees like residents and fellows assist me while working in the hospital as is typical. Everything landed on me. My three-day stint was both exhausting and saddening. I took care of very ill and anxious patients with COVID-19, called their worried family members (who weren’t permitted to be in the hospital with their loved ones), and provided care to other unlucky patients who needed to be hospitalized and worried they would get infected with COVID during their stay.
Reflecting back on my shifts, I have a few observations:
Resources remain low. Many patients I cared for required high concentrations of oxygen to maintain normal blood oxygen levels yet remained on the general medical floor. In the past, these patients would typically be admitted to the intensive care unit or step-down unit. These areas of the hospital are typically used for sicker or more unstable patients in order to provide a higher level of monitoring. With the constraints of space and hospital staff, these patients can now be found all over the hospital.
The different ways COVID-19 affects patients is insane. Even though we understand risk factors for severe disease, there are still young and healthy people in the hospital requiring breathing assistance. Why do some otherwise healthy people get so sick with this disease?
Hospital workers are tired. Many are picking up shifts from sick coworkers or recovering from COVID-19 themselves. This on top of increased patient to nursing ratios, and putting on head to toe protective gear every time they enter a patient’s room and then taking it off when they leave, is contributing to burnout. This is physically and mentally challenging especially for this long duration of time.
The patient volume has strained the outpatient clinics. When patients leave the hospital, they need follow-up care typically pretty quickly. This burdens the work of all medical establishments. For example, my lag time getting back to hepatology patients in my clinic regarding labs or other follow-up has increased.
I am proud to be a medical provider. It was amazing to see that, despite all of these issues, there is still a sense of comradery. I have never seen this level of grit, determination, and connectedness in my workplace.
Every night I would come home, remove my scrubs in my garage, shower, and think over and over: how did we get here, and when will it get better? I only spent three days caring for hospitalized patients, but it gave me a better perspective of the hospitalists, nurses, techs, respiratory therapists, housekeeping, café workers, and others that do this EVERY DAY. I am so grateful to my partners in healthcare working in these COVID-19 trenches.
Despite the development and distribution of successful vaccines, remember that the battle with SARS-CoV-2 is raging and the healthcare system will have to fight for a long time. Unfortunately, many more will be infected and more will still die. Keep doing your part.