Six months into his first job after medical residency, 31-year-old Bennett Gladden found himself caring for patients getting sicker, faster than anything he’d seen.
“I happened to have been working some extra shifts,” said Gladden, a hospitalist at Providence Sacred Heart Medical Center, talking about the early days of the coronavirus pandemic in March. “And I worked about two and a half weeks straight taking care of all these patients we were trying to rule out, or rule in, for disease.”
Nine months of battling an illness that has no cure, and speaking directly with patients whose only human contact is a doctor or nurse clad head-to-toe in protective equipment, Gladden has practical experience with a pandemic that is an abstraction for most Americans. It’s seen mostly through the rising numbers of the ill, or the death toll, and in the changes to everyday life that include more video phone calls and donning a mask for necessary trips out in public.
“It really is a tragic illness, and it’s very real for physicians,” said Daniel Getz, chief medical officer at Sacred Heart and Holy Family Hospital. “I think it’s hard for a lot of members of the community, that aren’t based in health care, because to them it’s still very much an invisible threat.”
They’re not seeing the conversations taking place between a severely ill patient and their care providers about whether to start on a ventilator, a decision that for some is final. Aspiring doctors prepare for those conversations, Gladden said, noting his own training at the University of Kansas, near his hometown of Olathe, and in a residency program in Georgia.
But doctors don’t prepare to have them as frequently as they must during a pandemic.
“As a resident, or in medical school, I’d watch the physicians training me have those conversations, and learn how to have them myself,” Gladden said. “But when we’re taking care of the COVID patients, on these teams, these conversations are nearly daily.”
Splitting into teams to intensively treat 15 or 16 patients is just one of the ways care has changed since those early days of the pandemic, Gladden said. Doctors and nurses are also constantly shifting the regimen of drugs, including steroids, they’re giving patients in an effort to treat the inflammation that often appears in the lungs.
Gladden has seen that inflammation in other areas, too, and in patients who shouldn’t have the dire complications that have led to more than a quarter million deaths in America alone since the pandemic began.
“A patient in his 30s showed up to the hospital with a stroke,” Gladden said. “People have strokes. But 30-year-olds typically don’t have strokes.”
Just last week, Gladden noted, the hospital announced another clinical trial for patients to determine whether a different combination of steroids might be better to treat the inflammation that can cause serious blood clots, and death.
“Medicine is something that constantly evolves, and the reason that a lot of people go into it is because of this idea that we’re lifelong learners,” he said. “And I think, with something like this, we’re seeing how much more quickly that learning can be.”
Gladden had to learn quickly himself in the early days of the pandemic, and as a hospitalist saw COVID-19 patients coming through the doors with varying levels of infection. Some needed additional oxygen and treatment for milder symptoms, while others were quickly taken to the intensive care unit for treatment that many times included breathing assistance from a ventilator.
Having a team of younger doctors, including Gladden, who can care for COVID-19 patients is critical to protecting the health of other physicians working at Providence centers, Getz said.
“We have lots of physicians who practice hospital-based medicine, who would be considered high-risk themselves,” Getz said. “To have these younger physicians, that don’t have these classic risk factors including age, put themselves in front of these patients was a really wonderful thing for him to offer up.”
A common experience for coronavirus patients is isolation, Gladden said. Those outside the hospital have been dealing with separation from their loved ones and fewer trips outside the home, but that’s nothing compared to the type of isolation experienced by hospitalized patients.
“It’s very otherworldly,” Gladden said. “Like the isolation tent that people were looking at in the movie ‘E.T.’
“Imagine that you’re stuck alone in a room, and your only human interaction for a couple days, or weeks, or however long you’re sick, is that level of interaction. Your nurses are taking care of four to five other patients, your doctors may be seeing 15 to 16 other patients. They’re not able to be there and sit at the bedside with you the whole time, and give you that human interaction that’s really ingrained in our evolution,” he continued.
Gladden described his job as a bit of a utility man, treating symptoms while providing generalized medical care. A hospitalist is a doctor charged with practicing generalized medicine to those admitted for in-patient care, so Gladden found himself treating respiratory symptoms, blood clots, neurological and gastrointestinal disorders.
Getz called hospitalists “the glue” that holds the hospital together.
“They really are experts in helping patients navigate their way through severe illness back into the community,” he said.
Gladden said he’d trained for this, while many of his medical school colleagues – who’ve found jobs in other parts of the country – have been drafted as COVID fighters, even if that’s not their specialty.
“My old roommate, she’s a plastic surgeon resident in New York City. But she was managing ICUs and ventilators there, because that’s what they needed her to do,” Gladden said.
During the seven days straight that he’s working, the care of patients falls to Gladden for 12 hours, from 7 a.m. to 7 p.m.
Every morning there are checks and tests from overnight to review, to determine which patients his team is assigned to require the most urgent care.
On his days off, Gladden has taken to the outdoors that drew him to the Inland Northwest in the first place. That includes hiking, camping and running.
The doctor had planned to compete in the Boston Marathon for the first time this year but had to settle for the virtual event instead.
“It’s a weight on everybody in society that they can’t do the things they’d like to do and be with the people they want to be with,” said Gladden. “I think a lot of people in the hospital experience that weight, in addition to the weight of caring for these patients that are incredibly sick.”
“It’s not mentally and physically exhausting beyond what we’re used to,” he said. “It’s that emotional tragedy that we’re dealing with. That continued loss of life in certain cases, where we feel like that could have been prevented if we had people taking this a little bit more seriously.”
In order for that weight to lift sooner than later, Gladden encouraged people outside the hospital to continue taking the steps necessary to limit the possibility of infection. Wearing a mask, washing your hands and maintaining distance are key to keeping teams like his capable of caring for incoming patients. While many have called health care workers the front line of defense, Gladden doesn’t see it that way.
“In the hospital, we’re their last line of defense,” said Gladden. “When somebody gets to us, we’re their last line of defense. The first line of defense is really the community doing the right things, for everybody.”
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