Stories from a Frontline Hospitalist: Reports from My Kid

By  |  June 18, 2020 | 

The kids are navigating the crisis with maturity and aplomb and way too much “Clash Royale.” Online school somehow went through the wash and has shrunk to 3 hours, including lunch. They continue to seek ways to fill up the day. We’ve tried to set some clear goals, pulled out the QI toolkit and made them write some SMART aims. My youngest decided that maybe this is the time to learn about journalism and do some interviews, particularly around coronavirus. (Of course, she loves a field that was struggling before the pandemic.) And as we remain desperate for good journalism during the pandemic, layoffs are occurring at sites with some of the best COVID journalism.

Murtaza Cassoobhoy, MD works as both a hospitalist and Director of Palliative Medicine at Northside Gwinnett Hospital in Georgia

This paradox runs rampant. In the middle of a health care crisis, hospitals and practices are contemplating closing. As families struggle for food, farms throw it away. Scientists should be front and center and are tossed to the back of the line. Masks that may save lives are not worn, while drugs with potential harm are touted.

Back to journalism. My youngest wanted to interview doctors or nurses initially and has now planned out questions for other frontline workers, or anyone who will sit down to talk about their experience. She’s been journaling daily as well. A budding Daniel Defoe in addition to a journalist.

I asked her why she wanted to do this interview.

I’m curious, I like to ask questions. Wouldn’t you agree? Why do you ask? What is a doctor? Why is this virus here? Where do we come from? Can animals feel?

They were rapid-fire like that since 5. As she ages, she at least lets the answers wash over her a little. When my wife and I are most exhausted, at the end of the night seems to be the best time to tackle life’s thorniest problems. For the endless questions this month, I thought I’d sic Lyla on one of my good buddies. Of course, she could have asked me her litany of coronavirus questions. However, I’ve discovered that too many fart jokes and tickle fights cause me to lose any of my medical cache around the house.

Therefore, a couple of weeks ago, she talked to Murtaza Cassobhoy, MD. We ZOOMed in on a day off. He’s a hospitalist and palliative care doc in Atlanta and an all-around great guy. We worked together at Emory for a few years at Grady Memorial Hospital. For the last 14 years, he’s been at Northside Gwinnett Hospital. They discussed some of the basics of the coronavirus, what the future may bring, and how it’s impacting him at home and the hospital. I appreciated her perspective, as she asked a wide range of questions, from the basics, to those filled with empathy, curiosity and others to simply understand the facts on the ground. The responses were perfect for the audience, catering to the 11-year-old trying to look for some answers to explain a world upside down and where answers may not exist yet. She may not become a journalist but is learning a lot on this maddening journey. Some of this may be simpler than you’d want, but I think she uncovered some great nuggets and some insights into the hospitalist world. At least as it existed in early May.

This has been edited and condensed for the blog.

Lyla Messler (LM): Can you briefly explain what the coronavirus is?

Murtaza Cassobhoy (MC): There are many different types of viruses. Coronavirus is just one type of virus. Corona means crown and if you look at this under an electron microscope it looks like there are spikes on it like a crown. That’s why any type of virus that has those spikes could come under the family of the coronavirus. Many of them cause the common cold type of infection, and many of them can cause severe illnesses. If you’ve heard of SARS, which was an infection that was very serious about 15 years ago, that was a coronavirus. There was another called MERS, middle eastern respiratory syndrome. That was also a coronavirus, and now we have this type SARS-COV2, which is causing the COVID-19 infection.

LM: What is the difference between coronavirus and COVID-19?

MC: Coronavirus is a big family of viruses. This type is called SARS-CoV-2. The illness it causes is called COVID-19. CO is ‘corona,’ V is ‘virus,’ D is ‘disease.’ 19 is because it was discovered in 2019.

LM: Why is the coronavirus spreading so quickly?

MC: Unfortunately, viruses mutate. That’s how they change and cause infections. First, it’s very contagious, so its easily spread. It can spread from droplets from a cough or sneeze. Secondly, because it’s a new virus, a “novel” virus, no one is immune to it. Thirdly, we don’t have any treatment or vaccine for it, so people can get very sick, and we can’t do a whole lot for them. Lastly, people can spread the virus even before they’re sick.

LM: What are the symptoms of COVID-19?

MC: The main ones are cough, shortness of breath and fever. But there are others also. Body aches, chills, headaches… even symptoms you wouldn’t think about, like pink eye, diarrhea, rashes.

LM: There has been an increase in people buying antibacterial hand soap. Will it kill more germs than regular soap? [Lyla also recommends Gloria Gaynor’s “I Will Survive” as well as this Hamster delivering great advice.]

MC: Antibacterial soap hasn’t been proven to help this viral infection specifically. More important is the amount of lather you can get. You want to use either a nickel or quarter-sized amount and really rub it in your hands and get a good lather. It’s the amount of time you use it on your hands, under your nails, and over your hands. Scrub for 20 seconds. That’s more important than the type of soap you use.

LM: Why is the coronavirus just now spreading? Haven’t humans been around bats for years?

MC:  Bats can harbor different coronaviruses just like many animals can. Depending on the structure of the virus, it may or may not affect humans exposed to it. Even though humans have been around bats for years, this particular corona virus unfortunately mutated to such a strain that allowed it to pass from bats into humans, The mutations are also why it’s very contagious and can cause severe illness.

LM: Do you think we need to quarantine until we have a vaccine?

MC: I think people need to try and stay at home as much as possible right now. I don’t know about quarantining until a vaccine because that’s still many months away. If we see a surge, we’ll definitely have to go back to quarantining ourselves more strictly, and we may have to close some of these businesses that we’ve started opening up. But if we continue to see a flattening of the curve, which we’ve done so far, we may not have to go back to the strict measures we’ve had in place. Yes, the vaccine is one potential end in sight, but that’s at least 6-12 months down the road.

LM: Why can’t animals get it? And which animals are most likely to get it if they can?

MC: Animals can get it, but it doesn’t seem to cause severe illness in them. Cats, guinea pigs and even a tiger in the zoo have tested positive. It’s unclear if they can transmit it to humans. (See CDC guidelines.) It’s definitely recommended to socially distance yourself from your pet if you have it in your home. If someone is symptomatic and quarantining themselves from their family, they should do the same thing with their pets. They should try not to touch them, snuggle with them or let them lick them because potentially, you could give it to your pet as well – just like you could give it to humans. Dogs, in general, we haven’t seen clear infections in, but cats definitely can get it

LM: Should our dog stay 6 feet apart from others if we are taking our dog for a walk? [We have a 2-year-old West Highland White Terrier, and we’ve been thinking about our dog as a possible carrier, vector.]

MC: Yes, they should follow the same social distancing. Even though cats are more likely than dogs, you should because the dog could get it on its fur, and you could get it then or If someone else pets your dog and has it. Pets should follow the same social distance guidelines as people right now.

LM: How is this sad time going to bring benefits to the future?

MC: I think that it’s an unprecedented event in our history. The whole world is in it together, and I hope that we come together as different countries and learn from this and try to put better systems in place and have more organization, so we can react faster and so we don’t have the scare and stress factor that was very pronounced earlier on as people started to see infections. There wasn’t the type of organization that could have been there. So, I think hopefully we’ve all learned from this as a world. Nobody was spared and nobody has been spared so I hope we come together more because everybody has an incentive not to let this happen to their area, country, community again.

LM: How are you dealing with this personally? What precautions are you taking at home and the hospital?

MC: We are doing what most people are doing. Like you, kids are taking classes from home and trying to stay indoors. Except going for walks, we are not really socializing outside the home. What’s different for us is with me having to go into the hospital, since we started to see cases of COVID-19 in late March, and I was in the hospital, I felt like I was exposed. Even though I’ve never had symptoms, I moved to a different part of the house.

I stay in our guest room, and I use one bathroom that nobody else uses in the house. I have a separate area that I can do work from that no one else comes into. I’ve also stayed out of the kitchen, so that’s been kind of nice for me. I don’t have to load the dishwasher and wash the dishes.

I don’t go into the common spaces, so that way if I’m asymptomatic and I’ve brought it in from the hospital, I’m trying to minimize the risk to my family. It’s hard because my kids want to hug, and we can’t. We haven’t hugged each other in 5 weeks. I’m trying to be very careful at home. A lot of my colleagues in healthcare who are taking care of these patients- nurses, doctors, environmental staff, lab techs- all come into contact with patients, I think all of them are making adjustments at home, so they don’t expose their families.

LM: What equipment are you wearing in the hospital?

MC: One big change at the hospital is we try and change into scrubs as soon as we get there. I used to wear a white coat during work, but I’ve stopped wearing my white coat. I change into scrubs as soon as I get into the hospital. They get washed in the hospital, so I don’t have to bring them home. In the hospital, some people are wearing covers over their shoes. Some people are wearing head coverings. We do have to wear a mask all the time now, which is good advice for many people leaving their houses, even when you go to the grocery store. If you’re taking care of patients with COVID-19, we have to take even more extra precautions. We wear a gown if we go into their room and are checking on them directly. Then we wear gloves and either goggles or a face mask.

LM: How many people do you work with?

MC: We are about a 400-bed hospital and have 35 doctors.

LM: I heard some doctors are not eating well in New York, because they are always at the hospital. Are you eating ok? What are you eating?

MC: I’m eating fine. We’ve had to make some changes in the hospital. We used to have an area in the hospital for the doctors to get food from a buffet setting, and so immediately they changed that so we wouldn’t expose ourselves and stand in line at a buffet. They’ve changed the way they serve us food. They have a couple of people who stand behind the counter and we make sure we are 6 feet apart and they give us to-go containers.

We also aren’t eating together like we used to. We try to eat separately from each other because that’s when we have to take our masks off. We’ve had to change our eating habits and how and where we eat. Our hospital has done a very good job and the community has done an amazing job in our area in providing meals for the nurses and staff. Some companies, restaurants and private organizations have been really nice about bringing food for the nurses and stuff. I think that’s a real nice way of showing their appreciation for all the people working in the hospital.

LM; How do you guys in the hospital practice social distancing? What other ways have you needed to change in terms of accessing computers or gathering? How do you social distance in the hospital? Is that even possible?

MC: Getting together at the nurses’ station no longer happens. The doctors used to use those computers on the floor, but now, the nurse’s station is really a nurses’ station. The doctors are not using those computers for their charting. At least for the hospitalists we have our own cubbies with our own computers. Everyone is sticking to their one computer to avoid touching other phones and other computers.

People are pre-rounding at their office space instead of on the floor. Then going up to the floor to see the patents and then coming back to use the same computer. In the office, we are wearing masks except when we are eating. Some of the tables have been adjusted, so instead of the people sitting across from each other, they’ll put 2 chairs at the end of a table so people can eat together. If you want to eat with someone, we sit at the ends of the tables instead of across.

In elevators, if there is a stretcher in the elevator, nobody will get on except the person transporting. Even when I get on an elevator, most people try to take the corners. I try to push the buttons with my elbows, but I’m not usually very successful.

I’ve tried to drink my drink with my mask on. Spilled a little. You forget initially. At the hospital, it’s really been amazing how people have adapted from the first couple of weeks. The stress level was just palpable in late March, early April when I did my shift. Everybody was freaking out because it was so new, and protocols weren’t in place. PPE rules were changing every day. Testing was taking many days to come back.

And now, when I did my last shift last week, it was very different. Tests were back in an hour; you know when you’re admitting a patient if they have it or not. The hospital is less full than it used to be, and the nurses have fewer patents that they’re taking care of, so we can focus our energy on the sicker patients.

LM: Are there a lot of hospitals around you with COVID-19 patients?

MC: Yes, pretty much in the Atlanta area everyone experience is similar to ours. I know some hospitals have more than ours, but no hospital has exceeded their capacity which is very fortunate and

LM: In Florida, where I live, they are opening up beaches, opening up businesses. How do you feel about that?

MC: I think communities are deciding for themselves to do what they think is best. But people need to decide for themselves to stay at home or if they can safely go out to places like beaches. And if they do, they wear a mask if possible and honor the 6-ft. distance. Use hand sanitizer and wash their hands frequently. I think they have to change how they interact at those places. It can’t be like it was before this outbreak. I think that’s going to be the norm as other places open up.

LM: Thank you so much for doing this. It was pretty cool.

MC: You’re welcome. It’s pretty cool that you’re doing this as a 6th grader. It’s great. I’m proud of you. You had great questions. You are very thoughtful at such a young age, you’re doing great work.

LM: It’s nice to get your opinions and thoughts.

MC: I’ll be very curious about how it all comes together. Thank you so much for thinking of me. This was awesome.

Thanks to Dr. Cassobhoy for taking part of this interview. Thanks to Lyla for helping uncover some of the front line’s stories. She thanks all our colleagues and health care workers on the front lines. Stay safe.

One Comment

  1. Avatar
    Janet Nagamine June 28, 2020 at 11:42 am - Reply

    Very impressive and nicely done!

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About the Author: Jordan Messler

Jordan Messler
Jordan Messler, MD is the Executive Director, Quality Initiatives at Glytec and works as a hospitalist at Morton Plant Hospitalist group in Clearwater, Florida. He is also serves as the Physician Blog Editor of The Hospital Leader blog. He previously chaired SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, including Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa and completed his residency at Emory University. He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca and requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality. But inevitably, he will have his daughter dumping sand on him and then has to explain to his wife why their daughter is buried up to her neck.


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