November 16, 2021 • 29 mins
On the outside, city hospitals look just as they always have: big glass and steel buildings, an ER entrance with ambulances coming and going. But on the inside, Covid has completely transformed the hospital experience for patients, their families -- and for doctors and hospital staff. Once held in high esteem as the place where doctors performed miracles, hospitals have become more sombre places under the staggering weight of illness and death even as communities increasingly view them through the lens of vaccine misinformation and mistrust.
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
What were you doing in there? I'm making sure they
clean don Long's event. I don't want one more person
getting a super bug might be too late for that.
In March, an episode of a Fox Network television show
called The Resident appears about a lethal fungus spreading through
a fictional hospital. The fungus has an ability to attack
people with underlying conditions, such as diabetes. The hospital staff
(00:25):
go to great pains to try to get rid of
the infection without causing panic or revealing their own mistakes.
Canada Horse is highly dangerous and immune coupleized patients. Half
the people will get it die. The coronavirus actually makes
a brief appearance in the episode We're Lucky is not
in irriable, and like the coronavirus, his dad is not
(00:45):
at risk, but the patients could be, but it doesn't
really figure into the plot anyway. One of the writers
behind this episode is named Daniella Lamas, and around the
time of the ears the episode starts to feel like
reality for her. That's be As. In addition to being
a TV show script writer, she's an ICU doctor at
Brighaman Women's Hospital in Boston. Initially, this sort of odd
(01:08):
feeling of truth being stranger than fiction, and and for
feeling slow to kind of realize that this was real.
You know, I have friends who work in New York,
like we saw what was happening there, but even so
it took a little bit of time to to to realize,
oh my gosh, this is this is happening. Reality was
(01:29):
following an alternative script in which a coronavirus was the
arch villain. Swaved in Ppe, Lamas was taking care of
patients with a previously unknown disease COVID. Nineteen hundreds across
Massachusetts became sick, with the disease piling into the hospital
in unforeseen numbers. Brigham Women's has a sixteen floor patient tower,
(01:51):
but across the street there's a newer cardiology building with
a number of rooms with negative airflow that can be
useful for keeping viruses under control. So the cardiology building
became a COVID facility. It was in one of those
rooms that Lamas took care of the patient. She'll never forget.
There's a room that will always be a guy in
his thirties with developmental delay who got COVID in his
(02:13):
group home and who was on a lung bypass machine
to keep him alive. But when it was clear that
that was not going anywhere, and we had to tell
his mother that that he was was going to die,
and she asked us not to take him off the
machine on Mother's Day, which was a Sunday, so we
waited until Monday morning. I was off that Monday morning.
It was no longer my time on service. Normally, interns
(02:36):
and training were generally kept at a distance from COVID
patients because of the risk of catching the disease. But
on the morning that Lamas's patient died, she wasn't in
the hospital. So an intern who had been involved in
his care put on protective gloves, a gown and mask
and went into the room with him, and she held
the phone to his ear, and you know, his family
(02:57):
said goodbye and told him apparently what heaven would be like.
And remember sure he telling her me that that night,
and I felt so short of guilty that she had
been in there and gotten that experience. Um it also
said it was good because she realized she had never
really seen the patient before. Because we kept the interns
from examining, from being in the rooms as possible, you know,
we sort of did the exams as attendings, and so
(03:20):
she's like, I've been caring for him for weeks since
was the first time I saw his face, and so
sort of those moments, I think, you know, are things
that will always be in our minds. Even doctors had
difficulty believing what they were seeing happen in front of
their eyes. COVID was changing everything. But there was a
big difference from Lamas's show, where doctors were trying to
hide the infection in the hospital. Now they were trying
(03:42):
desperately to make clear to the rest of the world
what was really happening within their walls and how COVID
was changing your rules collide Ishmael is a colleague of
Lamas is. We specializes in taking care of lung disorders.
This like a big conspiracy, I know. I think once
we start to hear these things on the out side
and see what's happening on the inside, I mean, I
think that really affected, you know, the way I see things.
(04:06):
And you know, I usually don't post much on on
social media, and I went, actually I had like a
post about people please listen and please follow recommendations for
prevention and PPE and mask and social distancing and all
of that. Now, Lamas and Ismail are both working in
a Brigham clinic where they take care of people with
(04:28):
long COVID, a mysterious syndrome they can affect people months
after they've been infected, even if their cases aren't serious.
Bit by bit, COVID is altering the space where they work.
Hospitals have long occupied a singular place in the community
and in the imagination. There are a place where discoveries
are made, where friends and relatives come to be with
(04:49):
a sick where medical miracles can happen. But that's changing. Increasingly,
hospitals are becoming fortresses that must carefully limit who enters
and who exits, no matter how many gowns and masks
they have. Now, workers are feeling overburdened with caring for
COVID patients who may stay for months needing highly intensive care.
(05:11):
Miracles are getting harder and harder to perform, and many
healthcare workers now feel less trusted than ever before. I'm
John Lawerman, and I'm a journalist with Bloomberg News from
the Prognosis podcast. This is Breakthrough Riemond Women's the hospital
(05:47):
where scriptwriter Danielle Allamas works as a doctor is one
of the most storied in the world. It can trace
its history back almost two years when it was one
of the first American maternity hospitals. Come doctors actually developed
the idea of the intensive care unit in the nineteen fifties.
You're in Boston um and at the Brigham. Yes, we
(06:08):
definitely have critically ill, unvaccinated patients, but not to the
extent that there are in other places in the country.
In our vaccine rights are good here in Massachusetts, and
there's some outlying hospitals who have been a lot more
hit than we are. My father is a doctor in Miami,
and so the hospital he works at is just full
of one vaccinated, super sick on vaccinated COVID and and
I think, you know, there's a different tone to it.
(06:31):
The pandemic is making health workers feel like they're on
an island. On the outside, the hospital looks pretty much
the same as it always did, banners, the glass and steel,
the emergency room, parking lot. On the inside, it's become
a very different place, one of constant stress and worry
and feeling like there's no way out. Late this summer,
(06:53):
Idaho was overrun with COVID cases. At one point there
were more than six people hospitalized. That about more than
in December, when COVID was running rampant across the US
and vaccines weren't yet available. Staffing shortages were limiting hospital's
ability to provide good standards of care. Even today, only
(07:16):
Idaho residents are fully vaccinated. Washington's Governor j Insley appealed
to Idaho residence to wear masks because the Idaho crisis
was spreading west into his state. Jim Susa is a
pulmonologist at St. Luke's Hospital and catch him Idaho. He
says it's difficult to find enough beds and to keep
(07:36):
them staffed, where we're just experiencing an unprecedented wave of
acute illness, and that acute illness is all COVID and
it is almost exclusively in unvaccinated individuals. They checked the
statistic right before our interview today, and of our intensive
(08:02):
care unit patients who are in the hospital with COVID,
of them are unvaccinated. There's a small handful that are vaccinated,
including organ transplant patient, cancer patient and and so on.
On the zoom call, Jim looks tired. He talks about
(08:25):
constantly dawning and daffing personal protective equipment as he and
his team go from one SAG room to the next.
Jim also says the actual interior of the hospital has
had to change to accommodate more COVID patients. Just like
Briggerman Women's. This wave has has caused us to change
where we're providing care. So we've opened up surge units.
(08:48):
We had one surge unit which was a cardiac observation
unit that we turned into a nine bed intensive care unit.
We filled it today, but still more COVID patients come
into doo Are and today is this day is probably
going to be the day that we spill over into
our next surge unit, which is a telemetry unit. And
(09:12):
you know, for those who know something about this, intensive
care unit rooms are specifically designed to meet the needs
of those patients. Very large rooms to accommodate all of
the machinery, equipment, monitoring, etcetera that's needed, all of the
people that might need to be in the room to
care for a patient. A telemetry room is not designed
(09:34):
for that, but we're gonna We're gonna do our best.
Adding to all this, though, is the open hostility that
he and other workers encounter some patients tell them that
COVID is a hoax, and they demand that the word
be kept out of their relatives death certificates. Many of
these people have been getting their information about COVID from
different sources, Jim says. So they come with a different
(09:57):
mental model about this disease ease, and they come with
a different belief system about this disease. And as they
do that, they're coming with a bit more hostility, which,
which I got to say, is a really unique thing
in healthcare. We are very used to taking care of
(10:22):
all comers. I mean we right, we take care of
We take care of lots of folks who have chronic
problems that they've decided not to manage. Doctors don't resent
patients for their beliefs about COVID, Jim says. We take
care of, you know, prisoners, We take care of good people,
bad people. We just take care of people. That's our job.
(10:45):
And what what helps you have that sort of um
cool indifference to the um the individual characteristics of the
patient you're caring for is the fact that almost all
of the time, what you get back from the patient
is an overwhelming sense of appreciation for the efforts being
(11:08):
applied to try to return them to health. So to
be met with hostility is unusual. And I don't want
you to think that that is pervasive, but even when
in small doses it it does take a toll. And
then there are the meetings of the school board. We
were invited by the school board and the request was
(11:29):
to speak about the wisdom of a mask requirement as
they started school, um whether we should or shouldn't do that,
and we shared our pros and cons and we were
not going to share an opinion unless they asked for it,
and they did ask for it, and you know the
the it's just jeers, booze. Those jeers and booze came
(11:54):
after Jim and as Kylie recommended the use of masks
in schools. Jim wasn't able to actually see the audience,
but his wife is at the meeting in person and
told him afterwards what she'd seen. The moderator did an
excellent job, by the way it was she was trying
to mitigate that and what the way she did that.
(12:14):
And my wife's a school teacher, so she had she
admired this technique. She said it was a very school
teacher type thing to do. She said, Look, I know
people are going to have different opinions about what our
experts are saying. You know, if if you don't like it,
you can kind of do this. Jim is waving his hands.
If you like it, you can do this. Now he's
(12:35):
giving a thumbs up. So apparently while we were talking,
there was all kinds of crazy gesticulation happening in the audience.
You know, that sense of disconnectedness between hospitals and the
communities they care for has perhaps never been so strong
or uncomfortable. It's making the job of working in hospital
harder all the time, and this means healthcare workers are
(12:57):
starting to burn out and leave. That threatens to create
an entirely new crisis in hospital understaffing. Wendy Dean is
the co founder of a group called Moral Injury of Healthcare.
(13:20):
The group focuses on healthcare workers, who they say are
forced to work under conditions that violate their sense of
right and wrong. She says COVID has pushed that to
a boiling point, and hospitals are the focus. It is
a much less comfortable space. That's what I'm hearing from
across the country. I'm hearing more more clinicians now who
(13:43):
say I cried all the way to work. I didn't
want to get up this morning. I love my job,
I usually love my job. I don't want to go
to work. It's too hard. It's too much watching thirty
year old on thenolators that you know of chance for
(14:03):
a chance of not getting off. That is excruciating, and
we don't just leave it when we walk out of
the hospital. One of the key points of frustration is vaccination.
Many people about those coming to the hospital with COVID
have refused to get shots. Doctors and nurses still feel
(14:26):
compassion for them, but the frustration is extreme. There are
all kinds of reasons why patients can't get the vaccine
or don't have access to it, but at the same time,
it's frustrating to us that we can't make it more
available and that we can't no matter how how much
we encourage people to get it or ask them to
(14:48):
come with us, come to us with questions that it's
that turning that corner so that there's there's less vaccine
hesitancy has been really hard, and I think that is
that's becoming more frustrating for healthcare workers. Doctors are often
(15:09):
at pains to help people understand that COVID isn't a fantasy,
that it can be life altering or even lethal, and
that it's threatening their lives every day. Katie Muro Johnson
is an infectious disease doctor in Denver, where hospitals have
also been hit hard. She says she recently bumped into
a neighbor on the street whose friend was sick with
(15:30):
COVID and on a ventilator. The neighbor asked Johnson how
she thought her friend might do and I looked at her.
I said he's probably gonna die. I said, there's there's
very low chance he's going to survive. Johnson says her
neighbor's face went white. I felt bad walking away from
that that I was so honest, But I said, she
(15:51):
asked what was what what I thought? Because I think
people are asking what do you think about this? And
if I say something such as that they're gonna die,
you know, um, it scares people and they don't know
how to grasp that that's a possibility, and that's hard.
(16:12):
The neighbor's friend was only in his forties and with
no underlying medical problems. But there's often little that can
be done by the time someone is on a ventil latter,
and I don't want to be that person. It feels
hard to uh, um, for them to look at me
in the same way, you know, with saying things like that. UM.
(16:37):
But when you're around it every day, UM, I don't,
you know, I don't feel it is that gravity that
they do. It's a strange feeling for doctors not being
able to be heard. They're used to being the voice
of authority, the last word on medical issues and experts
(16:58):
on life and death. But this is how it is
in the time of COVID. One reality inside the hospital
and one outside and not enough communication in between. And
I think you know, going forward, UM, there is a
disconnect still with UM. There's a substantial amount of people
(17:20):
getting admitted with these long sixty day hospital admissions, unvaccinated,
and we are using our highest resources possible to keep
them alive. And and it's hard, UM, it's hard, UM.
(17:42):
Venolatory support you know, ivy medicines daily and some of
them taking a flight for life plane from other you know,
other states even to come here, which is you know, um,
which is desperate, which is uh yeah, that's kind of
what we're what we're dealing with now. Just a few
(18:04):
months ago, it looked like the pandemic would fade, at
least in the US as vaccines rolled out. So far,
that hasn't happened. In the states where vaccine uptake is low,
unvaccinated people, particularly those with chronic illnesses, are still getting sick.
Kate says there's still a lack of good treatments to
(18:25):
take care of people who get really sick. I think,
from the health care provider standpoint, UM, we want this
to be over UM just as much as everyone else does. UM.
And UM. I do think that if we can increase
vaccination worldwide, which is the goal, is the only way
(18:47):
we're going to bring us to an end, UM and
protect all of our most vulnerable people UM in the
US M from continually to be you know, coming to
the hospital, be sick and and ultimately die. UM and
so UM I think from our standpoint, we were giving
treatments that we have high quality evidence for but are
(19:11):
not willing to risk using other things that UM have
low quality evidence or or are negative have negative studies
behind them. And UM, I think that UM, if there
was something that we thought would cure someone, we would
be giving it. Drugs with poor quality evidence behind them
(19:32):
include ivermectin and hydroxy chloroquine. Hydroxy Chloroquine is a drug
from malaria that was touted by former President Donald Trump
as a cure for COVID early in the pandemic, when
there were even fewer options than there are now. Studies
have shown it doesn't work, but there's still a large
segment of the population that puts its trust in the drug.
(19:56):
Ivermectin is another drug for parasites that hasn't shown effectiveness.
Many patients in their families come into hospitals demanding it.
Katie says the controversies over COVID treatment are eroding trust
in hospitals and health professionals. I still think that we
are used as a way to take care of acute
(20:18):
illness and hopefully turn it around. But I do think people,
certainly a certain certain um subtype or our subpopulation of
folks are not coming to the hospital because they're worried
that somehow the hospital is going to make them worse. Now,
(20:38):
doctors sometimes have hard time treating patients because of mistrust
no matter where they're cared for. Patients who do get sick,
are very worried and often mistrustful. What we have is
(21:01):
an invisible war, uh and where the war is being
conducted is on the insides of the hospitals and in
our clinics. Those places are on fire right now with
sick patients. The rest of the community doesn't see that.
That's Ted Epperley, a doctor and CEO of residency program
(21:21):
based in Boise. When we talked, Idaho had the second
lowest vaccination rate of any state, and residents were just
starting to return to events like state fairs and football games,
most of them unmasked. I was a family medicine physician
of the physician in the Army for twenty one years.
I've been in a war and the first Golf War,
(21:42):
and did a lot of work in the Gulf War
at a mash hospital with emergencies, UM and UM. The
analogy I like to use for this is that if
tanks were rumbling down the streets here and there are
bombs going off, planes flying over in helicopters, smoke fire,
everybody would get it, and everybody would be appropriately concerned
(22:05):
and pulling together as a team. That's not happening. That
says the invisibility and isolation of hospitals. Plate is particularly
deep and some very rural, very conservative communities, people are
kind of uh, you know, stacking up like logwood, like
cordwood in the UH in their waiting areas. They've had
(22:27):
fairly significant amounts of bad cases that are right in
front of them that they can't do much for. And
what that leads to is a sense of both isolation,
fear and loneliness. Um, they feel like they're out on
an island trying to manage all of this and with
(22:50):
all the resources the United States has to offer around them,
but not being able to get anything accomplished. So it's
that that's sense of disillusionment that the whole system is
kind of shutting down and breaking that. I think it's
part of the dynamic and the tragedy of this that
(23:12):
we're going through in Idaho right now. Ted says he
thinks this could be the case for a long time.
I think this could go on for quite a while.
And what I mean for quite a while maybe or
forty years um. And I know that sounds almost like
you gotta be kidding. That just sounds unbearable. But Ted
studies pandemics and says some have lasted from forty to
(23:35):
a hundred years. Now, science and technology wasn't like it
was back in those times. But we currently have another
pandemic simultaneously ongoing that's been ongoing for forty years already simultaneously.
That's the HIV epidemic pandemic. We've not resolved that, and
the reason we haven't is that we haven't developed a
(23:57):
vaccine for it. Um. What could happen in this scenario
because we only have about three to four percent of
the world that's been vaccinated, A key problem is the
lack of access to vaccination in many parts of the
world in resistance to it in the US it's a
very low percent. Is that this continues to reverberate in
(24:22):
populations of people with low vaccination rates, and new variants
UM get spun off of that reverberation, so that different
variants continue to slam populations. We have one, as you
well known now called the new variant that's coming out
of South America that has immune of Asian properties, which
(24:44):
means that the vaccines and the plasma of the serum
plasma that we have right now may be ineffective against
this variant, meaning that we go through another whole cycle
of infection and illness only to spawn another AUNT that
kicks off from the process. So um, the optimist in me,
(25:05):
and I tend to be an optimist, would like to
see this resolve and the team months to twenty four months.
The potential realist in me, h really says that this
could be forty year experience that we all just learned
to manage. Jim Susa, the Idaho pulman ologist, has been
(25:31):
trying to get local politicians to come to St. Luke's
and see what's really happening. He says many have had
their eyes opened and gone back out to the community
to talk about the desperate situation and hospitals. But another thing,
he wants them to talk about his vaccination and its benefits,
because that's the only way he and his colleagues see
(25:52):
out of this situation. I'd like them to talk about
the fact that this is real. I mean, there's all
this stuff on social media that our hospitals are filled
with patients who have gotten the vaccine and gotten COVID
from that, and that's why I'm like, people are pulling
that this stuff out. I'm talking thin air here, so
(26:15):
talk about it's real, talk about your own vaccine. That
separation between what people say outside the hospital and what
actually happens inside, between beliefs and scientific facts, remains a
huge challenge to hospitals and the workers. At the end
of Daniello Llamas's Resident episode, the vital information about the
(26:40):
deadly fungus gets out, people start to take precautions, and
things go back to normal more or less. That's what
Lamas would like to see happen with COVID, but it
may take a long time. It ended and tied with
a boat though, So that's the difference between fiction and reality. Said,
when you're tired of a plotline, you can say, let's
(27:01):
put that one to bed, let's just move on. And
here we are unable to do that. Caring for deathly ill,
contagious patients with a poorly understood disease is always a
difficult job. An absence of trust makes it even harder.
COVID is not only doing damage to patients, it could
poison the atmosphere of many hospitals for years to come.
(27:46):
Next week, on Breakthrough, we're going to look at how
COVID revolutionized medicine with the development of the m r
and A vaccines. We'll meet Catline Carrico, Hungarian biochemist. Two
decades of early work, sometimes making two dollar an hour,
paved the way for vaccines that could go from idea
to immunization in just a year. This was incredible. Yeah,
(28:09):
this boss just wait taking and in this moment we understood, Hey,
there's a vaccine for mankind and corna is a problem
that can be soft. That's next time on Breakthrough. This
(28:34):
episode of Prognosis. Breakthrough was written and reported by me
John Lowerman over four is our senior producer. Carl Kevin
Robinson Jr. Is our associate producer. Our theme music was
composed and performed by Hannas Brown. Rick Shine is our editor.
Francesca Levie is the head of Bloomberg Podcasts. Be sure
(28:57):
to subscribe if you haven't already, and if you liked
this episode, please leave us a review. It helps others
find out about the show. Thanks for listening.
What were you doing in there? I'm making sure they
clean don Long's event. I don't want one more person
getting a super bug might be too late for that.
In March, an episode of a Fox Network television show
called The Resident appears about a lethal fungus spreading through
a fictional hospital. The fungus has an ability to attack
people with underlying conditions, such as diabetes. The hospital staff
(00:25):
go to great pains to try to get rid of
the infection without causing panic or revealing their own mistakes.
Canada Horse is highly dangerous and immune coupleized patients. Half
the people will get it die. The coronavirus actually makes
a brief appearance in the episode We're Lucky is not
in irriable, and like the coronavirus, his dad is not
(00:45):
at risk, but the patients could be, but it doesn't
really figure into the plot anyway. One of the writers
behind this episode is named Daniella Lamas, and around the
time of the ears the episode starts to feel like
reality for her. That's be As. In addition to being
a TV show script writer, she's an ICU doctor at
Brighaman Women's Hospital in Boston. Initially, this sort of odd
(01:08):
feeling of truth being stranger than fiction, and and for
feeling slow to kind of realize that this was real.
You know, I have friends who work in New York,
like we saw what was happening there, but even so
it took a little bit of time to to to realize,
oh my gosh, this is this is happening. Reality was
(01:29):
following an alternative script in which a coronavirus was the
arch villain. Swaved in Ppe, Lamas was taking care of
patients with a previously unknown disease COVID. Nineteen hundreds across
Massachusetts became sick, with the disease piling into the hospital
in unforeseen numbers. Brigham Women's has a sixteen floor patient tower,
(01:51):
but across the street there's a newer cardiology building with
a number of rooms with negative airflow that can be
useful for keeping viruses under control. So the cardiology building
became a COVID facility. It was in one of those
rooms that Lamas took care of the patient. She'll never forget.
There's a room that will always be a guy in
his thirties with developmental delay who got COVID in his
(02:13):
group home and who was on a lung bypass machine
to keep him alive. But when it was clear that
that was not going anywhere, and we had to tell
his mother that that he was was going to die,
and she asked us not to take him off the
machine on Mother's Day, which was a Sunday, so we
waited until Monday morning. I was off that Monday morning.
It was no longer my time on service. Normally, interns
(02:36):
and training were generally kept at a distance from COVID
patients because of the risk of catching the disease. But
on the morning that Lamas's patient died, she wasn't in
the hospital. So an intern who had been involved in
his care put on protective gloves, a gown and mask
and went into the room with him, and she held
the phone to his ear, and you know, his family
(02:57):
said goodbye and told him apparently what heaven would be like.
And remember sure he telling her me that that night,
and I felt so short of guilty that she had
been in there and gotten that experience. Um it also
said it was good because she realized she had never
really seen the patient before. Because we kept the interns
from examining, from being in the rooms as possible, you know,
we sort of did the exams as attendings, and so
(03:20):
she's like, I've been caring for him for weeks since
was the first time I saw his face, and so
sort of those moments, I think, you know, are things
that will always be in our minds. Even doctors had
difficulty believing what they were seeing happen in front of
their eyes. COVID was changing everything. But there was a
big difference from Lamas's show, where doctors were trying to
hide the infection in the hospital. Now they were trying
(03:42):
desperately to make clear to the rest of the world
what was really happening within their walls and how COVID
was changing your rules collide Ishmael is a colleague of
Lamas is. We specializes in taking care of lung disorders.
This like a big conspiracy, I know. I think once
we start to hear these things on the out side
and see what's happening on the inside, I mean, I
think that really affected, you know, the way I see things.
(04:06):
And you know, I usually don't post much on on
social media, and I went, actually I had like a
post about people please listen and please follow recommendations for
prevention and PPE and mask and social distancing and all
of that. Now, Lamas and Ismail are both working in
a Brigham clinic where they take care of people with
(04:28):
long COVID, a mysterious syndrome they can affect people months
after they've been infected, even if their cases aren't serious.
Bit by bit, COVID is altering the space where they work.
Hospitals have long occupied a singular place in the community
and in the imagination. There are a place where discoveries
are made, where friends and relatives come to be with
(04:49):
a sick where medical miracles can happen. But that's changing. Increasingly,
hospitals are becoming fortresses that must carefully limit who enters
and who exits, no matter how many gowns and masks
they have. Now, workers are feeling overburdened with caring for
COVID patients who may stay for months needing highly intensive care.
(05:11):
Miracles are getting harder and harder to perform, and many
healthcare workers now feel less trusted than ever before. I'm
John Lawerman, and I'm a journalist with Bloomberg News from
the Prognosis podcast. This is Breakthrough Riemond Women's the hospital
(05:47):
where scriptwriter Danielle Allamas works as a doctor is one
of the most storied in the world. It can trace
its history back almost two years when it was one
of the first American maternity hospitals. Come doctors actually developed
the idea of the intensive care unit in the nineteen fifties.
You're in Boston um and at the Brigham. Yes, we
(06:08):
definitely have critically ill, unvaccinated patients, but not to the
extent that there are in other places in the country.
In our vaccine rights are good here in Massachusetts, and
there's some outlying hospitals who have been a lot more
hit than we are. My father is a doctor in Miami,
and so the hospital he works at is just full
of one vaccinated, super sick on vaccinated COVID and and
I think, you know, there's a different tone to it.
(06:31):
The pandemic is making health workers feel like they're on
an island. On the outside, the hospital looks pretty much
the same as it always did, banners, the glass and steel,
the emergency room, parking lot. On the inside, it's become
a very different place, one of constant stress and worry
and feeling like there's no way out. Late this summer,
(06:53):
Idaho was overrun with COVID cases. At one point there
were more than six people hospitalized. That about more than
in December, when COVID was running rampant across the US
and vaccines weren't yet available. Staffing shortages were limiting hospital's
ability to provide good standards of care. Even today, only
(07:16):
Idaho residents are fully vaccinated. Washington's Governor j Insley appealed
to Idaho residence to wear masks because the Idaho crisis
was spreading west into his state. Jim Susa is a
pulmonologist at St. Luke's Hospital and catch him Idaho. He
says it's difficult to find enough beds and to keep
(07:36):
them staffed, where we're just experiencing an unprecedented wave of
acute illness, and that acute illness is all COVID and
it is almost exclusively in unvaccinated individuals. They checked the
statistic right before our interview today, and of our intensive
(08:02):
care unit patients who are in the hospital with COVID,
of them are unvaccinated. There's a small handful that are vaccinated,
including organ transplant patient, cancer patient and and so on.
On the zoom call, Jim looks tired. He talks about
(08:25):
constantly dawning and daffing personal protective equipment as he and
his team go from one SAG room to the next.
Jim also says the actual interior of the hospital has
had to change to accommodate more COVID patients. Just like
Briggerman Women's. This wave has has caused us to change
where we're providing care. So we've opened up surge units.
(08:48):
We had one surge unit which was a cardiac observation
unit that we turned into a nine bed intensive care unit.
We filled it today, but still more COVID patients come
into doo Are and today is this day is probably
going to be the day that we spill over into
our next surge unit, which is a telemetry unit. And
(09:12):
you know, for those who know something about this, intensive
care unit rooms are specifically designed to meet the needs
of those patients. Very large rooms to accommodate all of
the machinery, equipment, monitoring, etcetera that's needed, all of the
people that might need to be in the room to
care for a patient. A telemetry room is not designed
(09:34):
for that, but we're gonna We're gonna do our best.
Adding to all this, though, is the open hostility that
he and other workers encounter some patients tell them that
COVID is a hoax, and they demand that the word
be kept out of their relatives death certificates. Many of
these people have been getting their information about COVID from
different sources, Jim says. So they come with a different
(09:57):
mental model about this disease ease, and they come with
a different belief system about this disease. And as they
do that, they're coming with a bit more hostility, which,
which I got to say, is a really unique thing
in healthcare. We are very used to taking care of
(10:22):
all comers. I mean we right, we take care of
We take care of lots of folks who have chronic
problems that they've decided not to manage. Doctors don't resent
patients for their beliefs about COVID, Jim says. We take
care of, you know, prisoners, We take care of good people,
bad people. We just take care of people. That's our job.
(10:45):
And what what helps you have that sort of um
cool indifference to the um the individual characteristics of the
patient you're caring for is the fact that almost all
of the time, what you get back from the patient
is an overwhelming sense of appreciation for the efforts being
(11:08):
applied to try to return them to health. So to
be met with hostility is unusual. And I don't want
you to think that that is pervasive, but even when
in small doses it it does take a toll. And
then there are the meetings of the school board. We
were invited by the school board and the request was
(11:29):
to speak about the wisdom of a mask requirement as
they started school, um whether we should or shouldn't do that,
and we shared our pros and cons and we were
not going to share an opinion unless they asked for it,
and they did ask for it, and you know the
the it's just jeers, booze. Those jeers and booze came
(11:54):
after Jim and as Kylie recommended the use of masks
in schools. Jim wasn't able to actually see the audience,
but his wife is at the meeting in person and
told him afterwards what she'd seen. The moderator did an
excellent job, by the way it was she was trying
to mitigate that and what the way she did that.
(12:14):
And my wife's a school teacher, so she had she
admired this technique. She said it was a very school
teacher type thing to do. She said, Look, I know
people are going to have different opinions about what our
experts are saying. You know, if if you don't like it,
you can kind of do this. Jim is waving his hands.
If you like it, you can do this. Now he's
(12:35):
giving a thumbs up. So apparently while we were talking,
there was all kinds of crazy gesticulation happening in the audience.
You know, that sense of disconnectedness between hospitals and the
communities they care for has perhaps never been so strong
or uncomfortable. It's making the job of working in hospital
harder all the time, and this means healthcare workers are
(12:57):
starting to burn out and leave. That threatens to create
an entirely new crisis in hospital understaffing. Wendy Dean is
the co founder of a group called Moral Injury of Healthcare.
(13:20):
The group focuses on healthcare workers, who they say are
forced to work under conditions that violate their sense of
right and wrong. She says COVID has pushed that to
a boiling point, and hospitals are the focus. It is
a much less comfortable space. That's what I'm hearing from
across the country. I'm hearing more more clinicians now who
(13:43):
say I cried all the way to work. I didn't
want to get up this morning. I love my job,
I usually love my job. I don't want to go
to work. It's too hard. It's too much watching thirty
year old on thenolators that you know of chance for
(14:03):
a chance of not getting off. That is excruciating, and
we don't just leave it when we walk out of
the hospital. One of the key points of frustration is vaccination.
Many people about those coming to the hospital with COVID
have refused to get shots. Doctors and nurses still feel
(14:26):
compassion for them, but the frustration is extreme. There are
all kinds of reasons why patients can't get the vaccine
or don't have access to it, but at the same time,
it's frustrating to us that we can't make it more
available and that we can't no matter how how much
we encourage people to get it or ask them to
(14:48):
come with us, come to us with questions that it's
that turning that corner so that there's there's less vaccine
hesitancy has been really hard, and I think that is
that's becoming more frustrating for healthcare workers. Doctors are often
(15:09):
at pains to help people understand that COVID isn't a fantasy,
that it can be life altering or even lethal, and
that it's threatening their lives every day. Katie Muro Johnson
is an infectious disease doctor in Denver, where hospitals have
also been hit hard. She says she recently bumped into
a neighbor on the street whose friend was sick with
(15:30):
COVID and on a ventilator. The neighbor asked Johnson how
she thought her friend might do and I looked at her.
I said he's probably gonna die. I said, there's there's
very low chance he's going to survive. Johnson says her
neighbor's face went white. I felt bad walking away from
that that I was so honest, But I said, she
(15:51):
asked what was what what I thought? Because I think
people are asking what do you think about this? And
if I say something such as that they're gonna die,
you know, um, it scares people and they don't know
how to grasp that that's a possibility, and that's hard.
(16:12):
The neighbor's friend was only in his forties and with
no underlying medical problems. But there's often little that can
be done by the time someone is on a ventil latter,
and I don't want to be that person. It feels
hard to uh, um, for them to look at me
in the same way, you know, with saying things like that. UM.
(16:37):
But when you're around it every day, UM, I don't,
you know, I don't feel it is that gravity that
they do. It's a strange feeling for doctors not being
able to be heard. They're used to being the voice
of authority, the last word on medical issues and experts
(16:58):
on life and death. But this is how it is
in the time of COVID. One reality inside the hospital
and one outside and not enough communication in between. And
I think you know, going forward, UM, there is a
disconnect still with UM. There's a substantial amount of people
(17:20):
getting admitted with these long sixty day hospital admissions, unvaccinated,
and we are using our highest resources possible to keep
them alive. And and it's hard, UM, it's hard, UM.
(17:42):
Venolatory support you know, ivy medicines daily and some of
them taking a flight for life plane from other you know,
other states even to come here, which is you know, um,
which is desperate, which is uh yeah, that's kind of
what we're what we're dealing with now. Just a few
(18:04):
months ago, it looked like the pandemic would fade, at
least in the US as vaccines rolled out. So far,
that hasn't happened. In the states where vaccine uptake is low,
unvaccinated people, particularly those with chronic illnesses, are still getting sick.
Kate says there's still a lack of good treatments to
(18:25):
take care of people who get really sick. I think,
from the health care provider standpoint, UM, we want this
to be over UM just as much as everyone else does. UM.
And UM. I do think that if we can increase
vaccination worldwide, which is the goal, is the only way
(18:47):
we're going to bring us to an end, UM and
protect all of our most vulnerable people UM in the
US M from continually to be you know, coming to
the hospital, be sick and and ultimately die. UM and
so UM I think from our standpoint, we were giving
treatments that we have high quality evidence for but are
(19:11):
not willing to risk using other things that UM have
low quality evidence or or are negative have negative studies
behind them. And UM, I think that UM, if there
was something that we thought would cure someone, we would
be giving it. Drugs with poor quality evidence behind them
(19:32):
include ivermectin and hydroxy chloroquine. Hydroxy Chloroquine is a drug
from malaria that was touted by former President Donald Trump
as a cure for COVID early in the pandemic, when
there were even fewer options than there are now. Studies
have shown it doesn't work, but there's still a large
segment of the population that puts its trust in the drug.
(19:56):
Ivermectin is another drug for parasites that hasn't shown effectiveness.
Many patients in their families come into hospitals demanding it.
Katie says the controversies over COVID treatment are eroding trust
in hospitals and health professionals. I still think that we
are used as a way to take care of acute
(20:18):
illness and hopefully turn it around. But I do think people,
certainly a certain certain um subtype or our subpopulation of
folks are not coming to the hospital because they're worried
that somehow the hospital is going to make them worse. Now,
(20:38):
doctors sometimes have hard time treating patients because of mistrust
no matter where they're cared for. Patients who do get sick,
are very worried and often mistrustful. What we have is
(21:01):
an invisible war, uh and where the war is being
conducted is on the insides of the hospitals and in
our clinics. Those places are on fire right now with
sick patients. The rest of the community doesn't see that.
That's Ted Epperley, a doctor and CEO of residency program
(21:21):
based in Boise. When we talked, Idaho had the second
lowest vaccination rate of any state, and residents were just
starting to return to events like state fairs and football games,
most of them unmasked. I was a family medicine physician
of the physician in the Army for twenty one years.
I've been in a war and the first Golf War,
(21:42):
and did a lot of work in the Gulf War
at a mash hospital with emergencies, UM and UM. The
analogy I like to use for this is that if
tanks were rumbling down the streets here and there are
bombs going off, planes flying over in helicopters, smoke fire,
everybody would get it, and everybody would be appropriately concerned
(22:05):
and pulling together as a team. That's not happening. That
says the invisibility and isolation of hospitals. Plate is particularly
deep and some very rural, very conservative communities, people are
kind of uh, you know, stacking up like logwood, like
cordwood in the UH in their waiting areas. They've had
(22:27):
fairly significant amounts of bad cases that are right in
front of them that they can't do much for. And
what that leads to is a sense of both isolation,
fear and loneliness. Um, they feel like they're out on
an island trying to manage all of this and with
(22:50):
all the resources the United States has to offer around them,
but not being able to get anything accomplished. So it's
that that's sense of disillusionment that the whole system is
kind of shutting down and breaking that. I think it's
part of the dynamic and the tragedy of this that
(23:12):
we're going through in Idaho right now. Ted says he
thinks this could be the case for a long time.
I think this could go on for quite a while.
And what I mean for quite a while maybe or
forty years um. And I know that sounds almost like
you gotta be kidding. That just sounds unbearable. But Ted
studies pandemics and says some have lasted from forty to
(23:35):
a hundred years. Now, science and technology wasn't like it
was back in those times. But we currently have another
pandemic simultaneously ongoing that's been ongoing for forty years already simultaneously.
That's the HIV epidemic pandemic. We've not resolved that, and
the reason we haven't is that we haven't developed a
(23:57):
vaccine for it. Um. What could happen in this scenario
because we only have about three to four percent of
the world that's been vaccinated, A key problem is the
lack of access to vaccination in many parts of the
world in resistance to it in the US it's a
very low percent. Is that this continues to reverberate in
(24:22):
populations of people with low vaccination rates, and new variants
UM get spun off of that reverberation, so that different
variants continue to slam populations. We have one, as you
well known now called the new variant that's coming out
of South America that has immune of Asian properties, which
(24:44):
means that the vaccines and the plasma of the serum
plasma that we have right now may be ineffective against
this variant, meaning that we go through another whole cycle
of infection and illness only to spawn another AUNT that
kicks off from the process. So um, the optimist in me,
(25:05):
and I tend to be an optimist, would like to
see this resolve and the team months to twenty four months.
The potential realist in me, h really says that this
could be forty year experience that we all just learned
to manage. Jim Susa, the Idaho pulman ologist, has been
(25:31):
trying to get local politicians to come to St. Luke's
and see what's really happening. He says many have had
their eyes opened and gone back out to the community
to talk about the desperate situation and hospitals. But another thing,
he wants them to talk about his vaccination and its benefits,
because that's the only way he and his colleagues see
(25:52):
out of this situation. I'd like them to talk about
the fact that this is real. I mean, there's all
this stuff on social media that our hospitals are filled
with patients who have gotten the vaccine and gotten COVID
from that, and that's why I'm like, people are pulling
that this stuff out. I'm talking thin air here, so
(26:15):
talk about it's real, talk about your own vaccine. That
separation between what people say outside the hospital and what
actually happens inside, between beliefs and scientific facts, remains a
huge challenge to hospitals and the workers. At the end
of Daniello Llamas's Resident episode, the vital information about the
(26:40):
deadly fungus gets out, people start to take precautions, and
things go back to normal more or less. That's what
Lamas would like to see happen with COVID, but it
may take a long time. It ended and tied with
a boat though, So that's the difference between fiction and reality. Said,
when you're tired of a plotline, you can say, let's
(27:01):
put that one to bed, let's just move on. And
here we are unable to do that. Caring for deathly ill,
contagious patients with a poorly understood disease is always a
difficult job. An absence of trust makes it even harder.
COVID is not only doing damage to patients, it could
poison the atmosphere of many hospitals for years to come.
(27:46):
Next week, on Breakthrough, we're going to look at how
COVID revolutionized medicine with the development of the m r
and A vaccines. We'll meet Catline Carrico, Hungarian biochemist. Two
decades of early work, sometimes making two dollar an hour,
paved the way for vaccines that could go from idea
to immunization in just a year. This was incredible. Yeah,
(28:09):
this boss just wait taking and in this moment we understood, Hey,
there's a vaccine for mankind and corna is a problem
that can be soft. That's next time on Breakthrough. This
(28:34):
episode of Prognosis. Breakthrough was written and reported by me
John Lowerman over four is our senior producer. Carl Kevin
Robinson Jr. Is our associate producer. Our theme music was
composed and performed by Hannas Brown. Rick Shine is our editor.
Francesca Levie is the head of Bloomberg Podcasts. Be sure
(28:57):
to subscribe if you haven't already, and if you liked
this episode, please leave us a review. It helps others
find out about the show. Thanks for listening.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations.
The Nikki Glaser Podcast
Every week comedian and infamous roaster Nikki Glaser provides a fun, fast-paced, and brutally honest look into current pop-culture and her own personal life.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.