When I walked into the micro lab this morning to go to huddle Amy was tallying some numbers - she wearily asked me if it was huddle time already, staying concentrated on her task. I asked her what she was doing and she told me she was tallying up the number of Covid tests we did over the weekend. Over 500 Friday, Saturday and Sunday. She showed me a big number - over 96,600. She perked up. See that? When we get to 100,000 Paula promised us a pizza party. We thought we wouldn't make it, but with this new Delta variant I think we are going to get there. In a few days, by the looks of it, I thought.
A rather morbid benchmark, I communicated. She said, hey, we will take what we can get. We earned this. Not denying that, I said - if Paula reneges on her promise I'll buy everyone pizza. Reminded me of residency, when the VA gave a pizza party to the medicine team that got the most consents for autopsy every month. Autopsies are fine once or twice a year but when you are on the rotation in residency five or six a week (seven or eight if you are super unlucky) will have you cursing the pizza party promise.
Clean up today was busy - I went to get a redeye after lunch to get me through the afternoon. I bumped into Zach, who is a super sweet nurse who took care of my dad in the CVICU and always asks after him and the rest of my family. I asked him how many of the ECMO patients have Covid. All of them. We are full to capacity. This isn't what we were seeing in January. I've got a 20 year old college football player. A forty year old who was at the pinnacle of health. So, I wondered, how many of these patients get off ECMO and make it? I know the odds are grim. My dad, who was on ECMO then weaned off then placed on it again, is nothing short of a miracle. The 15 years younger doctor who was placed on ECMO at the same time he was did not make it. Dad was the first survivor in the history of Baptist to make it off of the external right ventricular assist device - Bhama brought it from Ohio - and that was freaking ECMO step down. Zach said even if they make it off of ECMO a lot of them die of pneumonia or sepsis.
Kathy Parnell - I've talked about her before - bubbly platinum blonde hospitalist with a wonderful personality called me about a liver core I got over the weekend. I told her what Zach told me. She said yeah, that 20 year old is my patient. I got back from vacation July 10, and I have admitted many Covid patients, most of whom are unvaccinated. A few are partially vaccinated. The vaccinated do fine. I have successfully treated and discharged one unvaccinated patient. The rest are critical or dying or dead. But this guy, he is Covid free! What do you think about the liver? I was kicking myself today wondering if I should have consulted Sosnoff over the weekend to scope him and save time, but it just doesn't seem like colon cancer. You are absolutely right, I told her, not colon at all three of us have looked at it number one differential is well diff hepatocellular. Which it was, and she called Melody's sister Rhonda when I texted her to get an oncologist on the case.
Speaking of Melody, poor thing is recovering from a nasty sore throat and cough (we swabbed her and threw it on the turnaround 1 hour Panther last week and when she came into my office with a negative result we both almost wept in relief). I told her the ECMO story, and she said so that's what that ECMO class is about in the hall. I recalled seeing an ECMO class sign on a door and lots of employees heading in. Of course. Staff is stretched to the limit they need to train more people to help out.
I watched another inservice today while triaging morning cases - new information on Delta from Novack and Dillaha and Keller and someone else I'm blanking on it was over an hour. It felt like Groundhog Day. Someone who is closer to Mandee than me told me she took June off to recover from the pandemic. Now here we are again at square negative one. But life goes on. Happy Monday, much love, Elizabeth