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What are you doing to not go nuts? (part 1)

May 4, 2020


My friend, who is a psychiatrist (the one who wrote the riff last week about what we are feeling now), had an idea to write a follow-up riff on what we can do about the feelings she described. I was reminded about this when I read this article about how doctors that are seeing a lot of the death related to COVID (primarily in NY and New Jersey) are hurting and need help. As of last week, those two states have about:

  • 40% of the total number of cases in the US and 13% of the entire world. 

  • 50% of the total number of deaths in the US and 13% of the entire world.

I really can’t imagine what my colleagues are going through. Or what Dr. Lorna Breen went through. 

Then I heard this story about a doctor who was cross-trained to help out the overburdened ICU docs. By 9 am of his first ICU shift, 4 of his patients had died. He got home that night and started to cry in the driveway. It’s 5 min listen and provides a great perspective. The story is on a podcast I found called TWiV (This Week in Virology). They go deep. I struggle to keep up sometimes, but they are fascinating to listen to. The doc then spends about 10 min describing his observations on why doctors, in general, have thrown so many untested therapeutics at this disease and why we need to get back to evidence-based medicine (a different letter for a different day). 

I have two other takeaways from this 3 min story. One, doctors are going to need more psychiatric help than normal. Yes, doctors deal with mental health and drug and alcohol abuse like everyone else.  Much of the time they are bad patients and have worse outcomes

Every doc that works in a hospital has been around death. Certainly, our ICU colleagues see more than most. But this situation is unique. Docs are seeing an unprecedented volume of death that is caused by a disease that didn’t even exist until a few months ago. It is truly mind-boggling and will result in an unprecedented need for physician mental health.  

Two, when listening to this story, I finally realized why I started writing these letters. When the pandemic started, I felt anxious and completely impotent to do anything. It stressed me out. I have learned that getting sh*t done is my positive coping mechanism to stress. While I couldn’t go anywhere to help, I have a family, a software company, and an ER job all in Austin, I could educate the people that I know. They hopefully are aware that I have no agenda, I care, I will try to be thoughtful, and I enjoy explaining complex concepts to folks. Hopefully, you find value in this. I trust if you are this far into this muse, you do. 

So, there you have it, these letters are one of the things I am doing to address my unsettled psychological state during this time. Tomorrow I’m going to share what an expert on mental health recommends. Until then…

Stay emotionally connected and physically distant,


PS: An interesting take on veterans. I include this as I mentioned in a prior postscript that the number of COVID deaths surpassed the American deaths in the Vietnam war when we crossed 60k deaths. 

PPS: A followup on the COVID + plan letter. I haven’t heard much about the need for family members to talk about what will happen if and when they get COVID. But, one of the regulars on TWiV randomly talks about his COVID (+) plan on this episode

PPPS: Here is an analysis of the two Remdesivir papers. The bottom line… we need multi-center double-blinded placebo control trails to give us the answers we seek. I hope we didn’t jump the gun here. 

PPPPS: Two guys on your head discuss moral injury.