Make it to the Mat

From the 5/29/2020 newsletter

Make it to the Mat


Katie Recka, MD - Palliative Care Medicine



It was March 31, 2020. I was happily isolated in my VA office, attending a WebEx meeting. My phone vibrated. It was Mom. Probably a misdial. She only calls in emergencies. Couldn’t she just
text?


I was already grabbing my coat and keys before the voicemail was done. Something was wrong. It was Dad. Stomach pain, coded in the emergency room, now in the ICU. Or was it surgery?


That night we huddled together in my childhood home, just two blocks from Bellin Hospital in Green Bay. We were so close to him, but we may as well have all been in Texas for the good it did us. All we could do was stare at the pictures flashing by on the television and wait for the calls. It was Netflix, and the show was an episode of the docuseries, Cheer, and my father was dying.


He’s out of surgery.He’s on three pressors.This doesn’t look good.We have certain visitor exceptions; would one of you like to visit?


All the with the sunny inanity of the television in the background, its face-to- face intensity now archaic. There are no masks in the cheerleader pyramid, no social distancing.


Now I was the one who was spinning and disoriented. My father didn’t have COVID-19, but the presence of the virus in the community would keep all of us out of the hospital, my second home. Now I was (gasp-double flip-will she make it?) a patient’s family member, not a doctor. I wasn’t an insider. I was a helpless daughter, the annoying daughter who kept calling, the daughter born forty years ago in the same building where Dad was intubated, sedated, alone.


We build our own pyramids within our health systems, vibrant and wholesome when they work well, but precarious when they don’t. The days ticked by. At first, Dad was too delirious to use the phone in the ICU, he didn’t remember why he was there, but he was desperate to get out. Then he was in acute care, and he was terrified knowing he might never get back to his family and to his home that were so close, we were almost visible from the window of his room. Finally, he was in sub-acute rehab that we promised would be better but wasn’t. Each step was filled with well-meaning experts who couldn’t accommodate the one thing my father needed, the reassuring voice of a loved one unfiltered by electronics.


We built layers of help. Homecare promised light and fresh air, but with facemasks and eye shields, would we even recognize his home nurse if we saw him in the grocery store? The gear protected everyone from an invisible virus but isolated us. How do you bond with the strangers in your own home when they are faceless?


The whole goal in Cheer is to “make it to the mat.” The athletes practice until they collapse. They run, jump, and flip to the finals despite both physical and spiritual injuries. We watched Dad move painfully from bed to chair. Then he could walk, then take on stairs. A high-five from everyone when he ate at the kitchen table and support when he kept his game face on during the complicated reality of closing the law office he had opened ten years before I was born.


I can and will slip back into my comfortable role, but what do I do now as an insider? The provider with a new normal? We keep going until we get it right.


Our well-trodden path to the conference room is now the well-worn keyboard on our computer. It’s WebEx, Zoom, Skype, FaceTime, Facebook, Instagram, text, and phone. We attack this new normal like athletes do. We need to do it again, and do it again, and do it again so that constantly making connections becomes our normal. We nail that mental backflip until we believe that sheltering apart is sheltering together. If we don’t believe that masks and eye shields and gloves facilitate contact instead of separate, what patient is going to believe us when we look through a layer of scratched Lexan and say things we don’t believe ourselves?


Keep going. Do it again. Make it to the finals. Somewhere, there is another father coding and another family out there spinning and disoriented. We need to be there to catch them. We need to stick this landing hard and leave it all on the mat.



Katherine A. Recka, MD is an Assistant Professor of Medicine in the Division of Hematology and Oncology - Medicine at MCW. Her practice focuses on Palliative Care.

Social Narrowing

From the 5/1/2020 newsletter


Social Narrowing


by Laura Mark, PA-C, MPH


Social distancing. Two words that have become universally used (although somewhat less universally practiced). We cover our faces and our hands, we pretend to know exactly how far six feet is, and we Zoom like there’s no tomorrow. We – the people on the streets and in the grocery stores and on video chats – are the socially distanced. And there are very real mental, emotional, and physical consequences to social distancing, some of which we likely won’t recognize until long after the practice ends.

But one group has remained quiet in the dialogue of distancing: patients within the walls of our hospitals. The day that visitation was temporarily suspended was filled with frantic phone calls, goodbyes, and pleas to reconsider. Our patients, particularly those with prolonged admissions, provide the ultimate example of what it means to be socially distanced. And I’d argue that theirdistancing predates this pandemic. Hospital admission removes patients from their contexts – their homes, health, jobs, and social networks. Then, patients must not only cope with the unknown but do so without their normal tools and support systems.

Under normal conditions, patients can hold on to some level of normalcy through their visitors. Studies increasingly recognize the positive influence of family presence on patient outcomes. It takes only minutes at the bedside to see why. Family members become therapy aides, cheerleaders, advocates, and even physical voices for patients. If you are a patient, your loved ones push the wheelchair behind you as you take your first steps. They ask questions so that you don’t have to, and they hold your hand as you listen to answers you may not want to hear.

When the ban on bedside visitors went into effect, a patient’s spouse – who had been at his bedside for months – sobbed that she feared her husband would “give up” without her physical presence. A small part of me wondered the same.

The patient didn’t “give up” in the way that his partner had worried. But the distancing patients face has grown. Patients assigned to certain rooms can look out their windows at miniature family members waving from three floors below. Others rely exclusively on virtual contact – no time like the present to become tech-savvy! Others are limited to listening through a phone held to their ear by a masked caregiver, their breathing tube preventing any verbal response.

Clinicians and staff fill whatever gaps they can in an endeavor I’d best describe as social narrowing. And that narrowing deserves to be celebrated. Even before SARS-CoV-2 crossed the species line, medical teams were addressing the social distancing of their patients. Despite a tremendous work burden, nurses make time to play cards with their patients (and no, this does not corroborate a certain senator’s claim of underworked, poker-playing RNs). Between assisting with intubations and running to codes, respiratory therapists listen to stories and share their own. Technicians learn what meals, music, and bed positioning a patient prefers. There are haircuts and pedicures and birthday parties and trips outside, even while on life support. This – this – is the revolutionary work of social narrowing.

The distance that remains is filled by yet another group: the patients themselves. When faced with unimaginable challenges, patients continue onward. They stand, even if they need three sets of hands to lift them. They practice breathing exercises, even if no one is watching. They wake up every day and find ways to hope.

The burdens of social distancing that non-patients carry are both real and serious. But let us not forget those who will remain distanced long after the curve has flattened. They deserve to be honored, along with those doing the daily work of social narrowing.


Laura Mark, PA-C, MPH is a Physician Assistant in Critical Care Anesthesia at the Medical College of Wisconsin. She works in the Froedtert Hospital Cardiovascular Intensive Care Unit.