How CommonSpirit is using AI-powered text messaging to drive care coordination and holistic patient care
How CommonSpirit is using AI-powered text messaging to drive care coordination and holistic patient care
How CommonSpirit is using AI-powered text messaging to drive care coordination and holistic patient care
CommonSpirit partners with Concert Health to create a new primary care model that better addresses depression and anxiety
My message today is a little different. Generally, my comments are directed to the Baylor Community, and I hope they may have broader applicability. Today’s message is squarely directed outside of Baylor. Please share it widely, and share it today.
You do not need me to tell you the SARS-CoV-2 situation has substantially worsened over the past week – every media outlet in the nation is covering that story. We are in the midst of a major surge. Our affiliate hospitals are working hard to make sure there will be beds available to meet the demand, staffed by qualified healthcare providers. We are prepared, but clearly are in for a challenging couple of weeks. As we manage increasing volumes of patients, and especially as we enter the holiday weekend, the most important thing we can do is work to slow the spread of COVID-19. That is why I think the story of Frank and his family is so important.
Note: I changed the name of the main person in this story to Frank Wilson and left out some details, not at his request, but to allow this story to be told without intruding on the privacy of anyone involved in this story. The story is real, the people are real, the impact on their lives is real.
Frank Wilson and his extended family have lived in the same town for more than 40 years – three generations. They are a close-knit family in a close-knit community. They enjoy a pace of life that is at least a half step slower than a city like Houston. This is the story of SARS-CoV-2 in a place far removed from the intensity and complexity of the Texas Medical Center. It is a story of good people in a safe place.
The Wilsons planned to spend their Memorial Day the way they spend most holidays and many weekends – enjoying a family gathering at their favorite picnic spot. This celebration took on a little more significance, as they were coming out of the coronavirus induced lock-down. As regional leaders mandated a partial shutdown of the economy, they suffered along with the rest of the state and the country – lost shifts at work, cancelled family events. Now public officials were reopening the economy, and life was trying to regain its normal rhythm. There was nothing more normal for Frank than a family picnic.
What did he think of all the coronavirus warnings? “I thought it was all a big hoax – the government trying to take control of things”. He knew people in other parts of the country had the virus, but he did not personally know anyone who had it. He didn’t even know anyone who knew anyone who had it. The response of media and civic leaders seemed overblown. “It was a big nothing.” Thankfully, it seemed now it was behind us. We were opening back up. We had beaten the virus.
This Memorial Day was like countless other similar holidays – an opportunity to unwind and relax with family. It would become a day – that would lead to a week – that would change their lives forever.
The first warning sign. Frank’s mother became short of breath. Her symptoms were severe enough they felt compelled to get her checked at a local emergency room. She was evaluated and told that she was suffering from a “broken heart.” She was still mourning the recent death of her husband – Frank’s father – and it seemed reasonable that her symptoms were anxiety related. All were relieved it was not the virus.
Memorial Day was Monday, May 25. Tuesday passed and was uneventful.
Wednesday, Frank went to help a friend tune up the engine of his car. Towards the end of the day he didn’t feel well. That night his temperature went up and he called his boss to say he would not be at work. He went to the hospital and got the COVID-19 test. Results the next day – positive. He had the virus.
Thursday, Frank’s wife developed similar symptoms. She went to the hospital, and was sick enough to be admitted.
Also on Thursday, Frank’s mother-in-law became ill. In retrospect, she had not felt right since mid-May, but had already had a negative test for COVID-19. She went to the hospital, and was admitted.
Friday, Frank’s sister became ill. Like his wife, she went to the hospital and was admitted.
By Friday evening, his mother’s condition had worsened to the point he sat at her bedside all night. He did not realize it at the time, but this would prove to be the last night she would spend in her home. On Saturday, he took her to the hospital, and she was admitted.
Thus ended a week from which the family is still struggling to recover.
Frank was lucky. He did not need to spend time in the hospital. However, he tells me it was the worst thing he has ever had. “It was ten times worse than the worst flu. I had terrible stomach pain, and couldn’t get my breath. It felt like a bomb was going off in my chest.”
His wife’s condition was severe enough that it looked like she would need to go on a ventilator. Fortunately, with a combination of regular proning (face-down positioning that improves air exchange in COVID-19 patients) and high levels of supplemental oxygen, she avoided the ventilator and was discharged after about a week.
His mother-in-law’s condition deteriorated, resulting in a prolonged ICU stay. She is profoundly weak and continues to undergo intensive rehabilitation.
Frank’s sister also wound up in the ICU, and required extracorporeal membrane oxygenation (ECMO). This is used in patients whose lungs are so badly involved that they cannot effectively exchange oxygen between the airways of the lungs and blood, which is much like slowly drowning. The patient’s blood is drained out of the body, infused with oxygen and replaced. Thankfully, she recently improved to the point that she is off ECMO, although she remains hospitalized.
Frank’s mother was the most critical of all. She was admitted to the ICU and received the best and most aggressive treatment possible, at the finest medical center in the world. She participated in the convalescent serum trial, receiving antibodies from another patient who had recovered from COVID-19. Despite heroic efforts, she passed away.
This is a true story, as told to me by Frank – real people, real events. After seeing the devastation the virus brought to people he loves, his instinct is to do all he can to help others. He wants to donate his plasma so someone might benefit from his antibodies. Most importantly, he wants people to know the threat is real, and that everyone must act responsibly to protect each other – to protect people like his wife and sister and mother.
Our most important weapon to control the viral invader is our own safe behavior. Mask when in public places and when exposed to others. Practice physical distancing all of the time. If you have any symptoms, do not go to work or places where you could infect others. Assume everyone you meet has the virus and is infectious, even if they had a negative test.
Importantly, for the upcoming July 4th holiday, celebrate with your immediate household – not with your extended family, and certainly not as part of a public crowd. Celebrate at home if at all possible.
Please share this message broadly. The following link can be used in any social media posting: https://bit.ly/2Zoadec. The Wilson story is tragic, but will at least have some meaning if others learn from it.
I wish you all a safe, happy and healthy July 4th holiday.
Thank you all.
James McDeavitt, M.D.
SVP and Dean of Clinical Affairs
Incident Command Center Commander
Dear Members of the Baylor College of Medicine Community,
This week’s message may be slightly longer than usual, but I hope you will read it to the end. As the viral dynamics continue to improve in and around Houston, I want to pause to recognize a group that has borne a disproportionate brunt of pandemic-induced pain – our front-line health care providers (HCPs). Theirs is a compelling story.
Before I proceed, I will very briefly mention this week’s data. Our “R(t)” value is less than one (so we are winning). Hospital COVID-19 related census levels continue to drop steadily. The rate of new community cases is declining, albeit more slowly than anyone would like. The percentage of people with positive tests is declining. This is all favorable news. If you are not familiar with some of these terms or concepts, please refer to last week’s message for more details.
Things are looking up, but I must revisit a persistent theme in these messages: We must remain vigilant; we cannot become complacent. Mask, distance, and avoid crowds. Settle in for the long haul because we will need to live cautiously for months if we are going to be able to open up schools and maintain something that approximates our pre-COVID life. Again, refer to last week’s message for more details.
Now, on to front-line HCPs.
Every one of us has suffered, to varying degrees, during this pandemic. I have two new granddaughters, one born in September, and the other in June. I consider them both pandemic babies, born in a strange time. My younger granddaughter is named after her great-great aunt, who was an Army nurse, and part of the mobile medical response team that landed with the D-Day invasion in World War II. She has since passed away, but in all the years I knew her, I never heard her talk of her experience. I suspect it was horrific. Everyone in the United States suffered during WWII. There was fear of a mainland invasion, rationing of food, coffee and fuel, and shortages of rubber directed to the war effort. However, given that during D-Day almost 3,000 Americans died, and four times that number were wounded, most would agree that the suffering of the many back home did not compare with the experience of those who stormed the beaches.
Have I suffered during the pandemic? The honest answer is “yes, but…”
Yes. I have worked a little harder than normal. In welcoming our pandemic babies to the family, we have cancelled baby showers and missed a large family gathering for a baptism. We have not been able to jump on a plane for a quick visit. Everything is a little more complicated, and a little less convenient. To be sure, we feel fortunate that we have not suffered loss of livelihood, or health, or life – as many have.
So we have suffered, but not to the extent of our front-line HCPs. In this SARS-COV-2 war, they are the soldiers, and our ICUs are the beaches of Normandy.
In preparation for this piece, I spoke to about a dozen inpatient front-line HCPs in several Baylor affiliates: Baylor St Luke’s Medical Center, Ben Taub Hospital, and Texas Children’s hospital. I spoke to intensivists and hospitalists; nurses and residents. I wish I could have spoken to them all, as they all had an important story to tell. What follows are a few of my questions to them. The responses are their words, not mine.
We have been dealing with this crisis now for six months. Tell me about your hardest day during that time, and what made it hard?
My hardest day was when I worked my first shift in a newly-designated “all-COVID” unit. All the patients were incredibly sick. There were multiple codes. I couldn’t leave one patient’s bedside long enough to attend to the next one. I went home and cried. I had to let it out. It was one of the worse days of my life.
Watching a young patient deteriorate before my eyes; seeing families devastated by the disease affecting multiple people.
We are a people called to care. In the early days, there was nothing we could do that seemed to help. It is hard when you can’t see a path forward.
I always try and take care of my people. I couldn’t help them.
I was worried about my family – that they would contract the disease.
It was physically grueling work. At any given time, 70% of our ICU patients were on a proning protocol.
It is very hard to take care of sick kids when both parents can’t visit, they can’t see my face though my mask, and I can’t sit on the edge of the bed.
What single word best describes your feeling on that day?
What did your team of health care providers do well?
We had a shared spirit, and collaborated broadly. It was one of the most rewarding experiences of my life.
I was proud of our new faculty. They were fearless.
Everyone was committed. Everyone sacrificed family responsibilities, vacation time. We all worked long hours.
We really rose to support each other. I was incredibly impressed and proud. Teamwork.
We adapted rapidly, and learned quickly. We became masters of data-driven micro-innovation. We are better for this experience.
Even though everyone was already incredibly busy, we held frequent Zoom meetings with regional hospitals to review cases and treatment protocols. We felt an obligation to help build capacity and improve quality across the region, just not in our hospital.
Imagine a time when COVID-19 is truly behind us. What is the single biggest lesson we should have learned from this experience?
Our health care community is incredibly valuable.
I cannot function without a great team around me. I have an overwhelming sense of humility, and gratitude for my colleagues.
We need to be ready next time.
Stockpile PPE.
Enhance our public health systems – earlier control, more effective contact tracing.
We have a leadership responsibility for the region.
Life is precious, but uncertain and fragile.
Putting others first is the best way to take care of yourself.
I hope we learn these lessons. I hope our front-line health care providers differ from the survivors of the Normandy invasion in one important way – I hope we continue to talk about these experiences. Experiences that have been incredibly hard, but at the same time affirming and formative. As one person commented, “talking about this has been very therapeutic.”
In closing, I want to express my admiration and gratitude to everyone in our professional community who has been on the front lines sacrificing to provide extraordinary care in extraordinary times to our families, friends and neighbors. May we never forget.
What would you like to communicate to a front-line health care provider? Using exactly five words, post to Twitter using the hashtag #COVIDThanksBCM, or send your five words to svpclinical@bcm.edu, and I will post some of your responses. Also, as many have asked, feel free to share this message broadly. You can copy and paste this link to email messages or social media: https://bit.ly/3277mrt.
So what are your five words of thanks? I will start, with apologies to Winston Churchill:
This was their finest hour.
James McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs
I want to share a story about a man who met and fought with COVID-19.
He was born into simple farming family, strong Swedish stock, speaking his native tongue growing up in Minnesota. He knew the value of hard work, love for family, treating others with respect and decency, always with a positive attitude and never a complaint. He knew and loved his God and served Him faithfully.
He was a patriot, serving in the navy in WW II, aboard an aircraft carrier, barely surviving a Kamikaze attack. He later received a letter of commendation from a US President. He loved our country and the flag.
He loved his family, married for a total of 72years, having survived his first wife, he remarried for another 18 years with a strong family and many grandchildren and great grandchildren.
He loved life and lived with vigor, spent his career in sales and knew the challenges of success and failure. He was always open to an adventure and was found water skiing and riding the zip line into his 90s. Even then, he would be the one to help the elderly, younger than himself, and meet their needs and serve freely. Age and time would take its toll and his strength would wane and begin to fail and would be well cared for by loving nurses.
One day, though he was protected, he was found by a virus. He did not understand what this COVID -19 was, a disease no one even knew of a few short months before. He was positive; "I am doing fine" was his reply. Yet, it took its due and his life. He passed away peacefully on July 27, 2020. He was 97. He was my dad.
What we do as healthcare givers and leaders matter. We labor to understand and make hard decisions in times of great uncertainty and anxiety, as we fight this disease and others. We seek to protect our own caregivers, our patients, our families, and our community, with evidence which evolves as fast as lightning. Yet we strive, and we must. Every one of the over 150,000 souls who have passed on, just in the U.S., was loved as a parent, a child, brother or sister or a beloved spouse.
What you do every day makes a difference and is a role unique to you. By Gods grace, you are called to serve and you are called to lead. Take heart and know that, without you in this ministry, there would be less light, less joy, and that much less hope for a bright tomorrow for those we care for.
God Bless.
Greg Anderson MD Lexington, KY
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