There are certain lessons in life that are difficult to forget. Unfortunately, some of these lessons are very costly, and in the medical field the costs is usually counted in human lives. I still remember this day like it was yesterday. The lone house officer on the medical floor on a Saturday morning after a call in Accra, Ghana. We had a lot of admissions and the ward was completely full.
Rounding for me in those days was an ordeal that could be likened to an obstacle course with patient problems of all kinds being the obstacles. I was halfway across the ward when one of the new admission from the previous day started complaining of pain. I skipped a few patients and moved to his bed to address his problem, and resumed my morning round from the prior point.
I was almost beaming with pride at the sheer meticulousness and efficiency of my process. My excitement was however soon to be deflated to total despair when I got to the bed of my patient with advanced cirrhosis and liver failure with varies. On getting to him I realized that the poor guy had bled silently and died whilst all the commotion was going on in the ward. He was a terminal case of advanced cirrhosis who everyone recognized as the sickest patient with enlarged blood vessels deep in his throat and rectum which had risk of bleeding. In a perfect world he should have been in an ICU but those were totally non-existent in my hospital in those days, and electronic patient monitoring was also only available in the ER and post-surgical units.
This was a patient that I had developed a relationship with but failed to say hi to him that morning on account of the clamoring for attention all around me. I learned one important lesson in medicine that day. The patient who screams the loudest is usually not your sickest patient.
I may have digressed from the original reason for telling this story but I believe it is an appropriate one. Today we are all making major changes to our lives and activities to help reduce the spread of SARS-Cov-2. Though I agree we need to do something I cannot completely dispel nagging doubts on the shear unilateral focus of our response. For to me this could be just another case of the loudest patient not being the most critically ill one.
I realize most facilities are making all efforts to reduce non-essential visits as part of our social distancing efforts. There are still many more patients whose access to needed services could be reduced in these days. The question that we need to consider is if we are unknowingly sacrificing some poor silent patients to reduce the spread of COVID-19? If so, are we making the right cost benefit analysis? In a complex world the answers to such questions are never that easy.
I cannot also help but wonder if social distancing is harming some of our mental health patients especially those who may be unable to see their psychotherapist as often as needed as we adhere to social distancing requirements. Hopefully there would be enough virtual and telephone counseling sessions made available to address the needs of such individuals. For those who may not have access to virtual sessions I suggest to call your therapists or use your providers online patient portals to contact them if you have any needs. Most of them would be available to assist as much as possible.
To our health system decision makers, I would encourage you to make sure you include some of your rank and file clinicians in these decision making efforts. Please do not make these Covid-19 decisions with a room full of Infectious Disease Physicians, epidemiologists and administrators. That would be the best recipe for tunnel vision. Always remember that if the non-experts can understand and agree with the rationale for your decisions then you are close to making a good decision. Also please accept that there are no excellent decisions in circumstances such as what we are dealing with today.
I know our Commander in Chief would only want an A+ but those who agree with that only end up revealing the depth of their Bull Shit.
Now some advice and resources for those who may need help with life threatening mental health crisis at any time;
For Maryland State Residents with Addiction Crisis: 1-800-422-0009
Also always remember social distancing does not mean stop all activity. Engage in your normal activities whilst abiding by these rules as well as engaging in good hand washing. Thanks for taking the time to read.
I will need to stop now to go biking, have a wonderful day whilst social distancing. Remember to stay active by getting involved in sports and activities which allows your body to flourish not wither.
Feature photo: A hospital ward in Somalia. “Somaliland, 2012” by Direct_Relief is licensed under CC BY-NC-ND 2.0