Eerily Quiet

Periodically I donate platelets, being CMV negative.  My previous donation occurred right before the coronavirus.  I delayed the followup a little, partly due to Passover which would keep me out of the post-donation snack canteen and partly because I wasn't feeling my best.  But achiness stabilized, diet resumed at baseline and I made the next donation.

Our regional donation center sits across the street from the Christiana campus of the Christiana Care Health System, the state's largest single employer.  Around the corner lies the regional megamall which predates the medical complex by quite a few years and across lies Delaware Park, a venerable racetrack with more recently added casino.  A smaller shopping center is also across the street and the main branch of the community college has a campus at the highway exit that people take to reach the medical complex.  Typically at 8AM, a lot of traffic accumulates, though not this time.  Surrounding hotels have been ordered closed by the Governor except for a few people involved in the nearby medical care.  The medical complex itself has active employees but also a lot of inactivated employees.  Retail has all but disappeared. At the racetrack, the horses need to be fed, the slot machines don't.  Our mini-metropolis looked virtually abandoned.

Inside the donor center, only modest adaptations were made.  Everyone, staff and donors, wore protective face coverings but social distancing is not realistic when nurses need to take blood pressures, measure hemoglobins, insert IV access and tend to machines.  The post-donation canteen still operated fairly normally. 

The number of donors seemed a little less than usual for an early midweek morning, maybe a little younger crowd now that these time slots are not currently prime work hours.  They are participating in an experiment to harvest post-convalescent Coronavirus plasma for transfusion to critically infected patients but it was not possible for a casual visitor to identify those donors.  Mostly business as usual, fewer people and a new video system to keep the donors from getting too disengaged while they bleed out. 

I leave my cell phone in the car during donations.  When I returned, I opened email to find a note from a friend who departed for NY a few months ago to take a job as radiologist.  I just assumed as a center of coronavirus pandemic he would be inundated with chest images to report.  He noted that it really did not play out that way.  There were coronavirus related images but not excessive.  Offsetting that was a drastic decline in other imaging as most non-urgent care has gone into hibernation.  Financially, that's a net loss for his department and a reduction in assignments for him personally. 

Coronavirus has stressed medical capacity at its peak, though more selectively than I would have imagined.  Those working can be overworked but everyone else lives amid suspended activities.

Suspending Burnout

As I read comments from active physicians immersed in Coronavirus care, Burnout has virtually disappeared from the conversation.  Physical exhaustion occurs and there are skirmishes with the management, though less so.  People have found meaning in what they do.  The EHR with its irritations has become secondary.  Hierarchies seem to have flattened.  Meetings have been cancelled.  In some settings those pesky middlemen have been furloughed.

It would be interesting to administer those Maslach Burnout Inventory profiles to see if a change of focus changes the score.  Viktor Frankl's belief that finding life's meaning as the ultimate satisfaction may express itself that way.

Pink Slips

As people and institutions adapt to coronavirus disruptions, hospitals cannot be displaced as essential points of care.  Yet not everyone within a hospital building or network really contributes to immediate care or to planning essential for restoring normalcy.  A report came to my inbox announcing layoffs at a number of regional centers, with the one from which I retired appearing at the top of the list.  There may be no greater demonstration of institutional values than selecting who plays and who warms the bench.  The ICU people and the hospitalists have to stay.  I presume residents do as well, though electives other than Infectious Disease or Radiology may need to be reconsidered.  My own position as endocrinologist would be useful to surgeons, hospital teams and the like, though maybe expendable to bill payers as the hospital has plodded along in my absence without replacement.  Since residents are now needed both for labor and education, I would expect the director of the residency program who herds this collection of cats to remain on payroll.

How badly do we need dieticians?  Well, diabetes and heart disease patients occupy beds as they did before.  Sanitation crew?  We have the same amount of floor space.  Those people who maintain statistics to report Meaningful Use?  We could have argued whether this blight on medicine should even exist.  As office encounters give way to remote visits, the folks who take weights and blood pressure might be expendable, though they often take the intake history as well and may be the only people on site who know how to troubleshoot the malevolent EHR when it impedes medical care.  And there is always a layer of management that impedes medical care.  They should be more recognizable in that capacity.  Nobody wants to impede medical care right now.  Layoffs for them, though not permanent.  It is a chance to really think about the value of what the many contributors do.  Whether it adds to the learning curve of how to best provide medical care to the public without padding the bill with non-contributory payroll remains to be seen.

Resident Reappears

Some residents are just more memorable than others.  There is a barely definable bell of knowledge, insight, and social grace that lumps most into this big ball.  A progression from novice to experienced occurs, the certificates get signed and onward they move to their next destination.  A few remain colleagues, some fill military or visa obligations, a few appear in print later on.

An article by a former resident, one of the most unique, came my way.  Nicest fellow, the type you would do anything to help advance.  And it took quite a lot.  He did not finish our program but transferred to a different specialty which now puts him face to face with the difficulties of the corona pandemic.  I remember most how appreciative he was of any assistance he received from faculty and other residents.  He remains appreciative for the people who assist him at the front lines of coronavirus.

There is no better gratification than learning that a former resident has been trained in the best way possible.