A Day in Clinic During a Pandemic

So, here I am in the office, which all but closed in mid-March. While we do have a skeleton crew on site seeing non-COVID-19 urgent care (like abrasions and UTI’s and joint pain), most our ongoing outpatient work is via telehealth. I’m going to talk more about that below.

But first, I had an ulterior motive for coming in to the office today. It’s our longtime superstar nurse Maureen’s last day of work, ever! She is retiring after 44 years on clinical duty, much of it here in our office, but also on the floors, and in home hospice. We’re all devastated that she’s moving on to retirement, but she totally deserves a break, and we’re thrilled for her.

She also deserves some sort of lifetime achievement award for being such a rockstar RN. When I say that Maureen ROCKS, I mean it, and no one would argue with that! There have been so many office emergencies where she just took charge and made things better. My patient having an MI in front of our eyes? She magically produced a wheelchair, oxygen tank, and an aspirin, and in less than a minute she’d maneuvered the patient into the chair, hooked up the oxygen tank and nasal cannula, and made them chew the aspirin. “Just write your note, doc,” she called out as she zoomed away towards the emergency room.

She has a special way of being really nice and funny, yet also unapologetically and almost scarily firm at the same time (a great clinical skill BTW). How many times have I heard her on the phone with a patient, with a genuine smile and cheer in her voice as she reads them the riot act: “I know, I know, this isn’t the exact advice you’d like to hear, but you got the old battle-axe nurse on the line who’s seen a few things in her life, so, let me tell you how this needs to go, in order for you to get better…” Of course the patients laugh and, put at ease, they listen to her, and get better.

We couldn’t throw the wild and crazy retirement party we wanted to because of COVID-19, but we can damn sure recognize Maureen’s awesomeness! (Cheers, catcalls, whistles…)

So even though it’s Maureen’s last day, and people have been popping in to drop off gifts and gab and fawn, she also did a lot of work! A LOT of work. Since we’re basically closed, we’re being slammed with phone calls and messages, and our RNs are on the front lines of all of it (THANKS GUYS!).

And that is largely what telehealth is, managing patient’s medical issues over the phone, using video platforms, or even via “email” (HIPAA-compliant messaging through the electronic medical record). Insurance companies never reimbursed for telehealth before, so we didn’t have systems in place to do this. It took a week of COVID-19 outpatient office closures for the powers-that-be to jump through all the logistical hoops, and us to figure out the technical aspects. Now, we could easily spend ALL day on the phone/ computer managing our patients’ issues.

How it works is: A patient writes us or calls and communicates with the nurse, and if it’s not super-straightforward, or if they request, or if they’re really overdue for a visit, they’re offered a telehealth visit.

Telehealth is not easy. I’ll be honest. I find it exhausting, trying to sort out the details that I can’t see for myself, that I can’t auscultate or palpate or even smell. And I have had to create my own boundaries so that telehealth doesn’t take over my entire life. One effective strategy is to schedule telehealth calls for when I would normally be in clinic, and then actually make the calls from clinic, which solves the problem of my children dropping in on patient calls. Which they do, alot.

So today was a telehealth morning, first call scheduled at 7:30 a.m. I dutifully denied all potential viral symptoms and signed in to work:

I spent the whole morning on telehealth (with one long break to deliver a bottle of wine to Maureen, and gossip, from six feet away and with a mask on, of course), and then I ran up to the inpatient unit to retrieve my precious PPE!

So, we’ve been very lucky here at my hospital that we have enough PPE, but this is in large part because we’re recycling our N95 masks. We have to write our name and unit code/ location across the front in black sharpie, and at the end of a shift, the masks are all collected and decontaminated using this fancy process involving hydrogen peroxide. Then, they get packaged into these hamburger boxes, and delivered back to the floor. Except that there’s so many of them being delivered back to the floor that they’re running out of room to store them, so we got an email today telling us to go get our PPE, if we want to keep it.

Welp, no self-respecting healthcare worker is going to let a perfectly good N95 mask go in the trash, and I have another inpatient block coming up, so I ran up there and rescued mine:

The rest of the afternoon was spent… on telehealth! Yes, many messages and phone calls later, I’m thinking of heading out. Hubby is struggling with the whole homeschooling thing today. Look at the sky! It’s no wonder the kids can’t focus on web-based learning. I’m outta here folks, and hope the reality of a day in the clinic during a pandemic met your expectations!