0
All Podcasts Following One Shift in the COVID-19 Unit (with ER Dr. Megan Ranney)

Following One Shift in the COVID-19 Unit (with ER Dr. Megan Ranney)

Subscribe to Lemonada Premium for Bonus Content

Description

Dr. Megan Ranney recorded her shift in a COVID-19 ER in Rhode Island the day after Thanksgiving and was kind enough to talk to Andy about it. Though her job is both physically and mentally exhausting, she manages to remain hopeful. This is a rare look inside a hospital’s COVID-19 bubble.

 

For more of Andy’s conversation with Megan, check out In The Bubble’s Patreon page at www.patreon.com/inthebubble.

 

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

 

Follow Megan Ranney on Twitter @meganranney.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at https://lemonadamedia.com/inthebubble/

 

Support the show by checking out our sponsors!

 

  • Livinguard masks have the potential to deactivate COVID-19 based on the testing they have conducted from leading universities such as the University of Arizona and the Free University in Berlin, Germany. Go to shop.livinguard.com and use the code BUBBLE10 for 10% off.

 

Check out these resources from today’s episode: 

 

 

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcription

SPEAKERS

Andy Slavitt, Speaker 5, Dr. Megan Ranney, Speaker 4, Dr. James Tanch

Dr. James Tanch  00:00

So our phone here has been ringing off the hook all day, because family members are just desperate to find out a little bit more information about how their family members are doing. Oftentimes with COVID, they are too sick to reach out to their phone. Their phone numbers on the outside in order to give them updates. So that burden falls on to us. And there’s just not enough people to answer the phones, very to the amount of people who are calling in. So it is vitally important that we continue to be more proactive actually in calling out and reaching ourselves so that we don’t keep getting hammered by calls. But the family members are really, really appreciated. They just have even when you tell them the bad news that they’re family members are COVID positive, they’re still grateful that we reached out to them, gave them the update as soon as possible so that they can start the process for themselves, whether they have to get treated or they have to go get tested.

Andy Slavitt

Welcome IN THE BUBBLE. This is Andy Slavitt. This is our follow shift in COVID Hospital session. And you just heard from James Tanch, who’s a resident at the Brown Emergency Medicine. And he’s talking to Megan Ranney, who’s our guest on our show today. And Megan was kind enough to allow us to follow her on a shift. So you the podcast listener IN THE BUBBLE were in her bubble. She spent a shift in hospital today because we are trying to get a sense for what that feels like. We don’t get a lot of views into what’s going on. I think part of people’s disbelief about what’s happening with COVID-19 is that they aren’t getting the sort of tactile visuals, which you get in hurricane when you could see the storms or the war-torn hospitals, because the cameras aren’t going inside very much. So Megan was kind enough and her hospital was kind enough to allow her to record part of her day. She doesn’t do that in any way that exposes any patient confidential information.

02:03

When she talks about some of the patients she sees, and what she’s experiencing, and what she’s feeling. And she’s a very accomplished person. She is in addition to being an emergency room physician, she is someone who has saw a problem in February and launched an organization called getusppe.org, where she has been locating PPE for medical workers at Brown. She’s the director of the Brown Lifespan Center for Digital Health. And she’s the assistant dean of the Brown Institute for Translational Sciences. So you’re gonna enjoy hearing from her. What you’re gonna hear today is Megan, as the ER doc, Megan, as someone who is experiencing what the day is like, she recorded this a day after Thanksgiving.

Cases are growing, both in Rhode Island where she is, and everywhere else. It’s a dark period with a lot of case growth. But what’s the promising stuff around the corner. And our next few episodes after this, you’re going to hear about how we’re going to get vaccines out to people looks like we have a winner in the presidential race for the 50th time, Joe Biden has won. And I say that because it’s relevant to everybody. This is relevant to your bubble. There’s a whole new set of people coming into town, there’s a whole transition going on. And I can report from everything I’ve heard that it is productive. But there’s a lot to do. And if you want to go back in, you can hear what some of the priorities are from the task force from listening to some of our most recent episodes.

But let’s get to this conversation with Megan because I think when I tried to do I don’t know if I was successful. But what I tried to do was try to bring you up close to see what it feels like to be in a COVID Hospital. At a time when our hospitals are really overrun. They were not built for this. People like Megan were not hired for this. No one was designed for this. And she’s gonna give you a little bit of a feel for what the day was like.

Andy Slavitt  04:17

Megan, welcome.

Dr. Megan Ranney 

Thank you, Andy. It’s a joy to be here with you.

Andy Slavitt

I hope you had a good holiday. So you spent in the ER, and you were kind enough to take us through your day. Tell us a little bit about during Rhode Island. What’s going on in your part of the country with COVID right now and what’s happening at your hospital?

Dr. Megan Ranney

So here in Rhode Island, just like pretty much everywhere across the country right now. We are experiencing a massive increase in the number of people who are being diagnosed with COVID-19. The number of people who are being hospitalized with COVID-19 and the number of people in our intensive care unit with COVID-19. As of tomorrow, December 1, 2020, we will have opened up what is being called our alternative hospital site, otherwise known as a field hospital. Because our hospitals across the state are so full, that there’s just no more beds in a normal system.

Andy Slavitt 

Well, how big is the hospital? How many patients does it hold? How many COVID patients are there now? And how’s that grown?

Dr. Megan Ranney

So our larger hospital system has about 1200 beds. I can’t say the exact numbers that are hospitalized at my system right now. But I can tell you that the numbers have grown exponentially over the past few weeks, and that our ICU beds are pretty much all taken up right now. One of the things that is really tough about this point in the pandemic is that we’re taking care of not just COVID-19 patients, but also all the other folks with all the other diseases and surgical emergencies and traumas that are part of normal hospital life, because we’re not in a full shutdown. And because so many people put off care in March and April, were full of not just COVID, but a lot of other really bad stuff, too.

Andy Slavitt  06:10

So let’s go through your day, since the day after Thanksgiving, maybe you start with your ear at home. When you’re going into the ER in a day like today as an emergency physician. What are you feeling? Are you feeling dread? Are you feeling any fear?  What’s it feel like?

Dr. Megan Ranney

So it feels anxiety provoking, every time I get ready to go into the hospital for a COVID shift, I have to be super careful to make sure I have everything I need to make sure that I’m bringing things that can either stay in my car or are disposable. And I have to get myself mentally prepared for what the day is going to be like it’s really different. On the days when I’m working in our COVID-19 pods or right now just working in the ER in general, compared to normal times. Normally, I’m an environmentally conscious person, I bring a reusable water bottle and coffee cup. Now I don’t do that. I know I’m not going to be able to drink for hours on end because I’m going to be wearing full PPE. And then there’s always that little bit of worry in the back of my head about what if I catch it today?

Andy Slavitt

Right. So what time do you arrive?

Dr. Megan Ranney 

So I arrived at the hospital around 6:45 in the morning, my shift started at seven.

Andy Slavitt

What was in front of you? What was it like when you got there?

Dr. Megan Ranney

I’m at the beginning of my shift and signing in. We are full of patients for COVID. And trying our best to get them rooms upstairs. I’m geared up in full PPE with my resident talking about the upcoming shortage of nitrile gloves, and getting ready to go see some patients as soon as they’re open beds to see them. So right now, when you walk into the hospital, the emergency department is full of patients who are waiting for beds upstairs. Because our hospitals are so full because the nursing homes and the skilled nursing facilities are full. There’s just nowhere to put the admitted patients. And so you have a waiting room of folks that are waiting to be seen you have an ER that’s full of patients that are waiting for beds. And you see the numbers just constantly increasing. As soon as you get a bed for someone upstairs, it gets filled with someone else. And they’re all sick. They’re all really sick. Normally in ER is a mix of not super sick and sick. And it’s different now. There’s not a lot of those lower acuity patients coming in.

Andy Slavitt  08:42

So tell us about some of the patients you saw what kind of symptoms were you seeing? How constant was it?

Dr. Megan Ranney 

So at this point in that pandemic, you can kind of look at someone and have a pretty good guess as to whether they have COVID-19 or not, assuming that it’s a typical COVID-19 symptom. So someone tells me they’ve lost smell and taste. They tell me they have fever and a cough. And I know, you know, My bet is that it’s COVID every once in a while though I still get surprised. I’ll take care of patients who come in the symptoms that I think are heart failure or a heart attack. And it turns out it was actually COVID that was causing it. So it is a wily virus and can cause all kinds of strange symptoms. People at this point are generally staying away from the ER with the milder symptoms. We have pretty good testing in my state so you can go and get tested as an outpatient. For someone to decide they really need to come into the ER it means that they’re feeling sicker, they’re having more trouble breathing, they’re coughing more, or again, they have those other symptoms that COVID-19 can cause like blood clots or heart problems or stroke symptoms.

Andy Slavitt

So you’re going to protect the privacy obviously of all of the patients that came in. Did you admit anybody over the morning on Friday?

Dr. Megan Ranney 

Oh gosh, yeah, I admitted just about every patient I saw on Friday, honestly.

Andy Slavitt 

How many patients did you admit?

Dr. Megan Ranney  10:02

Tough to tell for sure I don’t keep track of the exact number. But usually on an average shift, I take care of somewhere between 16 and 30 patients. And I’ll say in non-COVID times, usually I admit about a quarter of the patients I see. But this time really it was more like 80%.

Andy Slavitt 

Wow. So were there an age profile? Were they older? Were there some that were younger? What was the what was the mix?

Dr. Megan Ranney 

So that’s one of the really tough things about COVID, Andy. Is that, yes, older folks are higher risk. And so if I’m taking care of someone who’s 60, or 70, or 80, and their COVID-19 positive, chances are really high that they’re going to end up being admitted, because they just don’t have the reserves, that those of us that are younger have. But one of the scary things about COVID, for me as someone in my mid 40s, is that I take care of a lot of folks who are in their 30s and 40s, who don’t have preexisting conditions, who would seem perfectly healthy to you. But for whatever reason, didn’t do well with COVID and ended up needing to be admitted. So yeah, more of the folks that are getting admitted are older, but you’re not immune from the bad effects just because you’re otherwise young and healthy.

Andy Slavitt

If there’s something that you’re looking for when you’re deciding to admit these patients?

Dr. Megan Ranney 

I look at a bunch of things. So oxygen is one of the biggest and most obvious ones. Cardio or fast heart rate can be a factor, their kidney function, their measures of inflammation in their blood, also are factors in the decision to admit them.

Andy Slavitt 

So you’ve got to run some labs on people. And the hours are super busy. So how long does it take for you to get, you know, someone comes in, they’re waiting, then you see them. You order some labs done?. How long is that taking? Are they backed up?

Dr. Megan Ranney

So my lab is not backed up, my lab and my electronic health records are still tremendously efficient, if someone is low risk, and I’m going to be able to send them home from the moment that I personally set eyes on them, until I get lab work, chest X ray, etc back, usually a couple of hours start to finish. But you know, there’s that wait until they actually get seen by me. We’ve tried things like putting physicians out in triage. But again in COVID times, that’s not super safe, because we want to keep our patients separated from each other as much as possible, so that they don’t accidentally infect each other. So our whole workflow has shifted with this disease.

Andy Slavitt  12:30

You admitted patients of what was the youngest? Roughly speaking, what was the youngest patient that got admitted?

Dr. Megan Ranney 

Friday was, you know, a mix of folks ranging from 30s and 40s, right up through the 90s. Some people came in knowing they had COVID. And knowing that they’d been exposed, others came in having no idea that I was going to diagnose them. I think one of the really tough things was taking care of people who had known they were exposed and went and did normal stuff in the community anyhow, knowing that they were then potentially putting other people at risk. One of the things that I’m hearing a lot is fatigue and confusion about the public health recommendations. The other thing that I heard a lot was fear and anxiety from families. Remember, this was the day after Thanksgiving. So a lot of folks that I had taken care of seeing their families the day before. And that too, is really difficult as a physician who’s working, where our health system is already on the edge. And knowing that we’re looking at a cascade of, you know, hundreds and hundreds of new infections. We’ve had a million people in my state, a lot of them were at family gatherings on Thursday.

Andy Slavitt 

And now for something we like to call advertising.

Andy Slavitt

So how are you doing at this time? I mean, you’re admitting patients, you’re in full PPE. And maybe you can describe for the listeners, what full PPE is and what it feels like to be wearing full PPE for several hours. As you’re going about that business?

Dr. Megan Ranney  14:14

It’s a great question because I think it is one of those things that kind of opaque to the average person. So I’ll first heard about PPE, honestly, back during SARS and H1N1 and then we all trained in it during the Ebola epidemic. So our hospital system was one of the northeastern centers for treating Ebola. So we all practice this process of donning and doffing, and we’re using the same stuff for COVID that we use to prepare for Ebola. So basically, what you do is you put on first an N95 masks, which is this specially manufactured mask that filters out particles down to that I’m gonna mess up exactly the words but basically filters that really, really teeny particles down to kind of 95 microns to protect you and fits really well that you’ve had tested to make sure that it actually filters out what you’re trying to filter.

Then you put on a surgical mask over that to protect the N95. Because you have to use  N95 over and over. And so you want to try to keep them as clean as you can, then you put on a face shield over that, because we know that COVID-19 can be transmitted not just through the nose and mouth, but also through the eyes. So you have a face shield that you reuse for days or weeks on end, then you go into your warm zone, and you put on an isolation gown. In olden times before COVID we used to have disposable isolation gowns, but those are one of the first things that hospitals across the country ran out of. So now we’re using reusable or washable gowns, which sound really great, but sometimes they don’t tie right or they’re knotted, sometimes they fall off and they make it a little more complex in terms of getting them off safely. After you put on your gown, you then put on a pair of nitriles tight fitting gloves that you wear for the entire day.

16:00

And each time you go into a patient room, you then put on a second pair of gloves over that first pair of nitrile gloves. So you’ve got like six different layers on you. Basically the entire shift, and then kind of flex up as needed. The other piece that will sometimes add is if we’re going into a room of a patient with an aerosol generating procedure, particularly an intubation if someone’s really sick and needs to be put into a medical coma and have a breathing to put down their throat. We’ll put on something called a Packer, which is a personal air purifying device, which is a helmet that goes over your head and has a little motor to purify the air for you as well.

Andy Slavitt 

All of this stuff on it sounds. When you visualize it, it sounds like a lot. It sounds you could be confining.

Dr. Megan Ranney 

It is a lot. It’s tough to hear is one thing I’ll face so patients can’t hear me. I can’t hear my nurses. It’s tough to talk on the phone, a lot of us are actually getting fitted for reusable elastomeric masks instead of those N95. And those are even tougher to hear. It’s heavy, your head starts to hurt I wear glasses, the elastic from the two different masks and the face shield compresses my glasses causes sores behind my ears sores on my face, you can’t drink, your sweaty, it is physically exhausting.

Alright, at this point in the shift, I’m feeling sweaty and thirsty, wearing an N95 for hours on end. In addition to gown, gloves, and face shield does not make for good hydration status. At the same time, I continue to be concerned about my patients and trying my best to take care of them.

I sometimes joke that it reminds me of those rubber suits that people used to wear to try to lose weight. Before, I remember I had friends that were wrestlers back in high school. And that’s what it feels like, for an entire day. It is mentally exhausting, because you can’t see people’s faces and physically exhausting as well.

Andy Slavitt  18:07

So, forgive this question. But you go to the restroom before you leave the home? Does that the smartest play?

Dr. Megan Ranney 

Exactly. Yep, you go. Well, before you leave home, you go right when you get to the hospital, and then you’ll take usually one break in the middle of the day. And then at the end. Yeah, because you don’t want to have to on down and take all this stuff off to go pee.

Dr. Megan Ranney 

The noise you hear behind me is the sound of ambulances lined up to bring patients in. I’m outside for a quick lunch and water break. It’s not really safe to eat inside the break rooms. Because we don’t want to unintentionally expose each other to COVID. And the spaces in the hospital are full.

Dr. Megan Ranney 

It just keeps going. Patients keep coming in. As soon as we get a few of them better to leave. The beds fell right back up.

Andy Slavitt  19:13

So here you are in break. What are you thinking as you’re seeing that fresh air outdoors.

Dr. Megan Ranney 

Oh my god, it’s so wonderful. So the nice thing about the shift where I recorded for you is that it was a daytime shift. So I was able to go outside it was not rainy or too cold. I could spend a few minutes outdoors just in my scrubs with my surgical mask and enjoy the air. It’s good to be away from the noises it’s good to be able to drink. You get really thirsty. And it’s good. Just have a moment to clear your head. The tough thing is that you know most of us in emergency medicine and in the hospitals in general. We don’t just work day shifts and it’s not always a decent day outside and sometimes you don’t get the chance to go outside and take that breath of fresh air. Sometimes it’s snowing or it’s darker, it’s raining. And then you have to make do in other ways.

Andy Slavitt

So were there any of the patients that you saw in the morning, that you were still thinking about that was still running through your head. When you were outside taking a break?

Dr. Megan Ranney

Andy, and my patients are constantly running through my head. I actually tweeted the night before the shift about how I couldn’t fall asleep, because I was running through patients from earlier in the week.

Andy Slavitt

Who was somebody you were thinking about? And what were you thinking?

Dr. Megan Ranney  20:34

Yeah, there were a couple of patients in the morning that stayed with me kind of throughout the day, I had one kind of middle-aged patient and one older patient who were quite sick. One of them the older patient, I was worried, not just about how they were doing right at that moment, but also, honestly, whether they would be able to see their family again, we frequently have family, bring patients into the emergency department, and then we tap to tell them that they can’t stay because of COVID. And so I spent a lot of time on the phone, with a family of one of my older patients, trying to explain what was happening, what would happen next. But knowing that the likely outcome was not good. And unfortunately, given the course of illness that this patient was, there just wasn’t a lot to do. It really is kind of one of those things where we give them fluids and oxygen, and maybe put them on some extra support to try to avoid intubation, and then you just hope that what you’re doing is going to be enough. And it’s the course of the disease that determines whether they’re going to make it through or not.

Andy Slavitt

And if they’re not, are there choices that you or some of the doctors or nurses in the ICU are able to make that lessen the pain of the experience of dying for them.

Dr. Megan Ranney

Yeah, so as an ER doc, I’ve been had at least some training in palliative care. And we’ve done a lot of work over the past few years with our colleagues both in emergency medicine and the ICU about how to have discussions about end of life and how to lessen pain and suffering at those moments. We have medications we give to take away air hunger, and to keep someone from feeling pain. We have treatment so that  our patients don’t feel anxiety and fear. And we try to get people on the phone or on an iPad to say goodbye to their family. If we have time. One of the things that I’ve learned to do is whenever I admit a patient now with COVID-19, I talked to them about their wishes, would they want to be intubated to have a breathing to put down? Would they want to go on a machine? Those are important questions to have early because I like every doctor and nurse that’s taken care of COVID-19 patients have had patients that go south really quickly. This disease causes not just pneumonia, but also blood clots in the heart and the lungs that can kill people very quickly. So we try to have those discussions in advance.

Andy Slavitt

So maybe just answer a question about the communities that are hit hard. Rhode Island is an interesting state because while it’s the northeastern state, it has very, as a working class, certainly a large working-class element to it. Not the Vanderbilt’s necessarily, but you know, the rest of the folks that aren’t that aren’t at the Vanderbilt mansion. And well, it’s a blue state. I think I’m right in saying that, that has a spectrum like anywhere else. And it’s fairly urban. And there’s a lot of people that are just working class, but from what I recall, poor, there’s some pretty depressed areas of the state. Give us a sense and really races, income levels, at least thing you can help us understand about who’s being disproportionately affected.

Dr. Megan Ranney  24:00

Yeah, so Rhode Island is a fascinating and lovely place to live. Although we are a blue state, we’re really kind of more purple. We’re a very religious state, we have a high number of Catholics and our state kind of divide pack in half and how it votes, East votes blue, the rest of the West votes red. Our core cities are quite poor. We have a tremendous number of kids in our public schools who are on school lunches, free school lunches, and we have a lot of multi-generational housing. And that’s been one of our challenges with COVID-19. We have a large immigrant community, a lot of Spanish speaking Portuguese speaking and Cape Verdean immigrants. And we’re seeing this virus spread disproportionately among those multi-generational households, and among our non-English speaking community, who often don’t have the choice to stay home, and who don’t have the choice to socially distance, it is a disease that is certainly anyone is at risk no matter who they are or what their background is. But I will tell you that it is just rife within equity, who it affects. And I have seen a disproportionate number of Hispanic and other immigrant patients who’ve come in with COVID-19, who had done everything they physically could to avoid it. But were exposed because of the type of work that they do. And that makes me sad and angry on their behalf.

Andy Slavitt 

Yes, it should, yes, it does. So a lot of people listening. So the old kind of fishing communities, the Portuguese communities are they being particularly hit hard, like in some states, where you’ve got communities like that, where you’re just basically in very close quarters, doing a lot of manual labor?

Dr. Megan Ranney

So we’re definitely finding that our manual laborers, our house cleaners, the folks that work in our jewelry, you know, the few manufacturing plants that are left in Rhode Island, but folks working in jewelry, and in our other manufacturing plants are getting hit hard. It really is kind of the folks in the cities where we’re seeing the highest spread right now. But one of the interesting things about this point in the pandemic, Andy is that it is everywhere in the state, it is in our high-income suburbs, as well as our low-income suburbs. It is spreading through social activities, through churches, through sports league, as well as through those regular kinds of everyday things that that folks don’t have the choice about. And it is, you know, as I care for patients, I think that one of the tough things is to hear people who’ve made choices, thinking, well, it’s open, so therefore it must be safe. And then knowing that was the thing that that got them sick, you know, going to a restaurant or to a wedding or something like that.

Andy Slavitt 

Don’t go anywhere, we’ve got to go earn some money to donate to charity.

Andy Slavitt 

So, let’s finish up the day, what do you see in the afternoon, anything different than what you saw in the morning?

Dr. Megan Ranney

So that’s one of the tough things about this period is that it feels an awful lot like Groundhog Day. It’s the same thing over and over. It’s like, here’s another patient with COVID-19, who’s got wideouts on their lungs, and his oxygen saturation is in the 70s. Or here’s another patient with COVID-19 whose kidneys are failing, because they’ve got little micro clots, and we don’t have anything to do to treat it other than to give them some fluids and hope there’s a dialysis bed available. Sometimes it stays tough to stay mentally sharp, because it feels like it’s the same thing again and again. And you just don’t see it, Andy. And I think that’s one of the toughest parts of it.

Andy Slavitt  28:04

Did you get a chance to check in with any of the patients who came in during the day? See how they were doing?

Dr. Megan Ranney

I did, I make a practice of doing walk rounds through my unit regularly across the day. And again, I’ll tell you one of the sad things about COVID-19 is I don’t see quick turnaround. It’s not like I give someone a liter of fluids and they’re suddenly feeling better. They’re still sitting there hacking. They’re still feeling lightheaded or delirious. I rarely see those miracles right now that I love about emergency medicine.

Andy Slavitt 

How did it work out for the patients that you were seeing, that you were worried about during lunch?

Dr. Megan Ranney

I didn’t end up intubating anyone in the afternoon. So that was a good thing. We’ve tried to move away from intubation in general, because we know that it often dooms people, so we avoided as much as we can. But I sent a couple patients to the intensive care unit or stepped down or kind of intermediate care, and I followed up on them and none of them have died yet. So that’s a good thing.

Dr. Megan Ranney 

I have not heard that music played in a while it means that we just discharged a COVID nation from our inpatient setting. There’s going to be a lot more with well over 150 patients admitted at our hospital system right now.

Dr. Megan Ranney 

So back in the spring, when Rhode Island was one of the early epicenters of this pandemic, my hospital did something really nice, which was to choose a short clip from Rocky to play whenever a patient with COVID-19 was being discharged from the hospital. And we hadn’t heard it in a while because our numbers had been low. And that song, I can’t say I’ll ever watch Rocky again because I’m kind of it has a whole different connotation for me now, but it gives me a little bit of hope because it means someone’s walking or being wheeled out. And I think we’re gonna see a lot more of those, we are doing better at saving people, not perfect, but better. And our hospitals are full of those patients. So here’s to hearing a lot more Rocky. And someday by being able to go back to Philly again and run up those museum steps.

Andy Slavitt  30:24

Do people just freeze in their tracks. When they hear it? Do people clap, do they stop what they’re doing? Is it emotional?

Dr. Megan Ranney 

Early on, it was quite emotional, everyone would stop and listen. Now it has become part of the backdrop of our practice. COVID has become part of the bread and butter of what we do.

Andy Slavitt 

So at the end of the day, what time was your shift over?

Dr. Megan Ranney 

So the shift was officially over three, but I left probably around 4:30 or so.

Andy Slavitt 

Because?

Dr. Megan Ranney 

Oh, cuz there’s always stuff to do you want to talk to families, you want to say goodbye to your patients, you have to handoff care to the next doctor, you have one more admitting phone call or one more note to write, there’s always more to do.

Dr. James Tanch 

So our phone here has been ringing off the hook all day because family members are just desperate to find out a little bit more information about how other family members are doing. Oftentimes with COVID, they are too sick to reach out to their phone numbers on the outside in order to give them updates. So that burden falls onto us. And there’s just not enough people to answer the phones. The amount of people who are calling in so it is vitally important that we continue to be more proactive actually in calling out and reaching ourselves so that we don’t be getting hammered by calls. But the family members are really appreciated. They just have even when you tell them about it is that their family members are COVID positive they’re still grateful that we reached out to them and gave them the update as soon as possible so that they can start the process for themselves. Whether they have to get treated or they have to go get tested.

Dr. Megan Ranney  32:02

And James were saying to me how you like take the time to really explain because we forget that they have no idea what to do when they find out their family members positive.

Dr. James Tanch 

Right, right. So there’s just so many sources of information that we have outside of the hospital never hear from like all different media and the CDC and our guidance is difficult. So to hear it from, like a physician firsthand. Has it I’ve just noticed it’s provided them a lot of relief and comfort and care directly for me.

Dr. Megan Ranney 

They’re lucky to have you calling them.

Dr. James Tanch 

Thank you.

Andy Slavitt  32:35

So you just mentioned family. And it sounds like the only connection that people have to their loved one is through this makeshift switchboard that people have to man and woman and just try to create a connection and convey some sort of understanding of what’s going on. It feels like it has such specific import because it’s substitutes for so many things that people are losing.

Dr. Megan Ranney

That’s such a beautiful and sad way to put it, Andy, it is a substitute for so many things that people are losing. I think it’s particularly tough for the family members of my elderly patients who may be deaf or have had prior strokes and who the family members know can’t adequately communicate for themselves. But it’s tough for everyone who wants to be there with a loved one. You know, one of my colleagues developed a system where we can have iPads to allow patients to FaceTime or Skype with their families from afar. But for most of the shift, it’s about trying to answer the phone calls. And I will tell you, the phones are ringing off the hook, used to be that you could just walk in the room and update the family.

Dr. Megan Ranney

And now that’s not an option. And the families know how sick their loved one was when they were brought in. And they’re confused and scared, because the news is confusing and scary. And so few folks are, you know, behind the doors of the ER with me that it has become an added part of our job, when it’s sometimes tough to keep up with when you’re in the moment and trying to just take care of that patient and save their life. But in some ways, perhaps the most important thing we can do.

Andy Slavitt  34:28

It’s got to zap you in a whole entirely another way to hear those voices that are no doubt praying for good news when you don’t always have that to offer.

Dr. Megan Ranney

You don’t always have anything to offer. And some of them would like to stay on the phone with me the whole time and keep hearing updates. And unfortunately that’s not an option because I’ve got a unit of 16 or 20 patients that I have to look after. And that’s one of the toughest things is telling them that I have to get off the phone now, when they just want to keep hearing that their loved one is going to be okay.

Andy Slavitt 

Well, thank you, Megan, for I think as much as anything being in the spot where our country’s placed the most pressure. And given the least preparation and resources. And where you and your colleagues have had to call on wells of resilience that were far beyond, I imagine what you thought you were being trained for, both physically and emotionally. And that I know that well, reserve doesn’t run forever. The country can’t take it for granted. But it seems to me that it’s in that depth, that all of our other shortcomings, the fact that we can’t scale testing, or PPE, or prevent this thing from growing exponentially. That’s where our great victories are. And maybe just to close on some positive, more positive news compared to the spring. How many patients are surviving COVID-19 today versus when things begin?

Dr. Megan Ranney 

So early on, by the time folks came into the hospital, we were seeing 40%, 50% even 60% of them die. And now we’re down to a much lower death rate for hospitalized patients, it’s closer to around 10% to 20%, depending on where you are in the country. That’s partly because of treatments. It’s partly because we have space. But I am hopeful.

Dr. Megan Ranney  36:58

So now I’m at the end of my shift, and I’m doffing. I’m taking it off, first I’m gonna clean my hand with hand sanitizer that those are my nitrile gloves. Then I take off my face shield, and I wipe it down with a bleach white. You’re gonna hear me do wiping it off, putting it onto a pain shop. Next, I throw away the bleached white, I clean my hands again. I have had someone else at the beginning I should have said unsign my gown to take off. That’s always the first step. So I’ve got my face shields cleaned, I’m down off my first set of gloves off and cleaning my hands again.

Dr. Megan Ranney

Tell me what you were just saying.

Speaker 4  38:01

I wear my N95 for a full 8-12-hour shift.

Dr. Megan Ranney 

And I am so excited to take it off right?

Speaker 4 

Yes. More than excited.

Speaker 5 

Oh, I usually go in my office, take everything off, take a breather. Then I can do my work.

Andy Slavitt

Thank you to Megan and Brown University for allowing us to snoop. I like to snoop. I like to snoop for you. Snooping into their bubble, tell you what’s going on. And that is I found that conversation had all kinds of emotional highs and lows to it. You know, you don’t get to see this thing on Zoom. Like I do. And I you know we’re talking which really helps. But I think what comes through is someone who is in the face of all this. Just shockingly optimistic, willing to do whatever it takes. I don’t know where she got that from. But she is just so focused on making a difference and setting an example and not just complaining but doing stuff. And I think that’s very admirable. Let me tell you what’s coming up in our coming episodes Monday. We have a very important episode that you’re gonna want to hear. It’s about vaccine distribution, how the vaccine distribution decisions are getting made, where they’re getting made, how they’re getting made. We’re going to be talking with people who are actually doing the distribution as well as someone who is bringing the scientific and clinical approach to the process and we’re answering your questions at the TOOLKIT on vaccine distributions.

Andy Slavitt  40:29

Then on Wednesday, Laurie Garrett, very excited that she’s agreed to come on our show. She’s a pistol. You’re gonna love her. She’s a Pulitzer Prize winning author that have been writing about pandemics, very smart, no shortage of opinions. Then the following Monday, another TOOLKIT for you on how to build your bubble. That’s right. How to Build your bubble because we’ve not been building good bubbles. We’ve been building bubbles with giant gaping holes in them. Giant gaping holes. Got a good bubble. All right. Thank you guys. Have a great rest of the week. I hope you stay safe and healthy. Thanks for sticking with me to talk to you Monday.

CREDIT

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still brew our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @lemonadamedia. And you can find me at @aslavitt on Twitter or at @andyslavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell him at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

Spoil Your Inbox

Pods, news, special deals… oh my.

Join Us

See Open Positions

Discounts

Get Discount Codes

Lemonada Media. 2024 © All rights reserved. Site by AC.