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A Day in the Life of a Neurologist During COVID-19

This is an unprecedented time. The novel coronavirus 2019 pandemic has become a time that will be recorded in history, similar to the Spanish Flu pandemic of 1918 or the SARS pandemic of 2002- 2004. The Spanish Flu pandemic reportedly caused 500 million infections and over 50 million deaths, worldwide. 

SARS and COVID 19

The SARS pandemic reportedly caused over 8000 infections and 774 deaths globally for a mortality rate of approximately 15 percent.1 This new pandemic of COVID 19 is estimated as infecting over 2.6 million people and causing over 180,000 deaths so far, globally.2 In the USA, as of 4/21/20, there are over 800,000 cases with 44.5 thousand deaths.3 For many of us in healthcare, we have never experienced something of this magnitude.

Daily Life for a Neurologist

As a neurologist covering neurological cases in the hospital, daily life has changed. In the earlier part of this year even, my career was fairly stable and routine. I would wake up early to get ready for work – shower, brush my teeth, get dressed, eat breakfast, kiss my family, and then head to the hospital. 

I would see my neurological inpatients on the hospital floors with my team of students, resident, and physician assistant. This would last about 2 hours. Then I would head to the office to start outpatient clinic until the evening, after which I would head back to the hospital to round on any new consults for the day. It would be rare that I would have to wear a protective gown or mask.

This has all changed with the COVID 19 pandemic. On the surface, it may seem relatively routine. I still round on neurological patients in the hospital and then start my outpatient clinic. However, that’s where the similarities stop. Now, I am wearing a surgical face mask with scrubs all day, frequently changing into an N95 mask with a protective gown and face shield to see COVID positive patients or those being investigated. Rounds take quite some time due to all the preparation needed to even step foot into most of the patient hospital rooms. 

Testing

Testing is limited as the hospital tries to limit contamination around the facility. We are also having our temperatures checked before entering the hospital and as we leave at the end of day. After rounding in the hospital, my physician assistant and I return to the office to start outpatient clinic. Instead of seeing my patients in person, we speak over the phone or via video chat. We get the job done, but not the ideal situation.

Learning about COVID 19

We are learning more and more about this novel coronavirus. It appears to primarily attack the pulmonary system. However, it does appear to affect the neurological system as well. I am being consulted on more and more COVID positive patients every day. The difficulty is figuring out what is directly related to COVID 19 and what is coincidence. 

What I have noticed is that it appears to contribute to global encephalopathy (confusion or altered mental status). These are most of my cases in the hospital. In addition, there is concern that it may contribute to clotting issues which may result in strokes, as well as dizziness or headaches. Unfortunately, we do not know enough yet but hopefully will soon.

On top of the above daily rounding changes, we have had to help out around the hospital in all different capacities. If needed, I may have to help with coverage in the Emergency Department or the Intensive Care Unit. As colleagues get sick and more COVID positive patients get admitted to the hospital, I may be called to help out. 

A Decade of Practicing as a Neurologist

After about a decade of practicing neurology, working in the ED or ICU will obviously be a big change. But in times like this, we have to step out of our comfort zone to help. We are seeing a lot of COVID positive patients and unfortunately, they are sick and unable to leave the hospital quickly, if at all. It is a tragic time in history.

Having heard about conditions in hard hit areas like New York and personally seeing the cases at my hospital, it is clear that I will not be returning to my routine schedule any time soon. We have to be smart about returning to previous activities. 

As we near our peak, social distancing and being smart are what is saving us. If we return too quickly, we may have to fight another peak of this infection. Being in the thick of this pandemic and hearing stories from colleagues about the devastation that this virus has inflicted upon the world, it is not hard to imagine our healthcare workers becoming depressed, anxious, and hopeless at times. These are stressful times for everyone but healthcare workers and all essential workers walk into the thick of it to help our fellow humans. 

For myself, seeing many tragic cases in my hospital does cause grief and anxiety. We do not know what the future holds with this pandemic. Hopefully, with continued social distancing and further research, things will become easier and hopefully life will become more ‘normal’.

Some healthcare workers can develop significant depression and anxiety, potentially to the point of suicidal thoughts and post traumatic stress disorder. I hope they seek help and know that there are people who want to help. One viable treatment option is ketamine infusions. 

There is a plethora of evidence showing successful treatment of treatment-resistant depression and post traumatic stress disorder with ketamine infusions. At StrIVeMD Wellness & Ketamine, we have seen first-hand its successes. 

If you find yourself developing hopelessness, anxiety, or depression, please seek help. Whether it is a friend or a professional psychiatrist or psychologist, there are people who want to help you. Discuss with your psychiatric team if ketamine infusions are the right next step for you.

If we work together, we can get through this pandemic. Continue social distancing. Stay safe. Call StrIVeMD if you have any questions or would like a consultation.

References

  1. https://www.healthline.com/health-news/how-deadly-is-the-coronavirus-compared-to-past-outbreaks#1918-influenza
  2. https://www.worldometers.info/coronavirus/
  3. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

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