Nov 17, 2020

TRANSCRIPT

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Scot: Okay. Let's talk about COVID now. Woo!

Troy: Yeah. Love COVID.

Scot: Do you really? If you love it so much, why don't you marry it?

Troy: I pretty much have. I feel like COVID has just moved in here and it's joined the family.

Scot: Just sleeping on your couch, will never go away.

Troy: Sleeping on my couch, yep. Just on the couch, just a guest that just does not take a hint.

Scot: The podcast is called "Who Cares About Men's Health," and around here, we like to think of health as the currency that enables you to do all the things you want to do. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Scot: And today's show, Troy, Dr. Madsen, is an emergency room physician. And of course, all across the United States, we are seeing new stories that this big, huge wave of COVID is coming. I wanted to talk to Dr. Madsen, because you and I don't necessarily talk about this that much, about what you're experiencing in the emergency room when it comes to this pandemic.

So, first of all, are you seeing a lot of COVID in the emergency room, or do you not really see it there?

Troy: We are seeing a lot of COVID in the emergency room. So anyone who has symptoms where they're concerned about COVID, they're coming to us. They're not really going to a primary care doctor because the primary care doctor is going to say, "Hey, if you think you have COVID, go get tested. And then if you're feeling really sick, don't come to clinic." If the clinic is even open. They're saying go to the ER. So we truly are on the frontlines of this.

We have a dedicated respiratory unit, so an area of our emergency department that is set aside for patients who have COVID or potentially have COVID. And I will say that the shifts I've worked there lately, that unit is full, and we have patients waiting to try and get back in there. So there's no doubt we're seeing COVID, and we're seeing a lot of it.

Scot: And what's a typical patient that comes into the ER with COVID? How bad of a sick is it?

Troy: Yeah. Great question. So, first, to break that down, I would say in our respiratory unit I see three different types of patients. Number one is the patient who comes in who has a cough and fever, who you think has COVID, but is well enough to go home. We'll send the COVID test, tell them it's going to take 24 hours to come back, go home, self-isolate.

Then we get the people who come in who know they have COVID, they're one to two weeks into it, and they feel absolutely miserable. Sometimes they're well enough to go home. Sometimes they need to be admitted, because their oxygen level is low.

And then the third type of patient we have come in I see a lot of are the people who are probably a little bit on the older side, have some medical issues, who come in and are really sick. High fever, maybe their blood pressure is low, their heart rate is going fast.

Some cases, I have had people come in with oxygen levels that I have never seen in a living person or someone who is actually able to walk and talk. I've had people come in with oxygen levels on room air, which is breathing room air oxygen, in the 50s and 60s. Just for reference, normal is greater than 95%. This is down at 50% to 60%. It absolutely blows my mind to see this, but I've seen it on several occasions, people who come in with these unbelievably low oxygen levels. We put them on oxygen. We have high-flow oxygen, all these things we're doing for them to get their oxygen level up. They get admitted to the intensive care unit.

Scot: So then, every shift, are you dealing specifically with COVID, or as an emergency room physician, sometimes you work in the regular ER, sometimes you have to go to the respiratory unit where the COVID patients are coming in? How does that work?

Troy: So probably a third of my shifts, third to a half, depending on the month, are in the respiratory unit. The rest are in the main emergency department seeing all the other stuff we see -- abdominal pain, chest pain, heart attacks, strokes. Obviously, none of that stuff has gone away, so we're still seeing all that as well.

Scot: So how are you holding up mentally as a healthcare professional with COVID? Is this truly unlike anything you've seen before? Is it taking a toll on you in a way that the day-to-day that is very stressful in the emergency department not during a pandemic is?

Troy: Yeah, it's interesting, Scot. I try to be fairly objective about things and try not to overstate things or overdramatize things, but this has been a unique situation. It is unlike anything I've experienced before, and I think it's unlike anything anyone working in healthcare right now has experienced before.

The closest analogy I can have for this is H1N1. And when we dealt with that, that I think put everyone's anxiety up a bit and we're all like, "Are we going to catch H1N1? Are we going to get it ourselves?" But this has certainly been a whole other level of that.

Prior to COVID, I had never sent anyone home on oxygen. We'll have people come into the ER and if they're sick and they need oxygen just to be able to breathe, they get admitted to the hospital for it. But now with COVID, our hospital, we're at capacity. The way we've been able to work with that is people who are under 50 and maybe don't have other medical issues, we're sending home on oxygen and telling them, "Use the oxygen. Try and check your oxygen levels. Turn it up if you're having trouble breathing, and if you can't turn it up more, if you max it out at six liters, come back in and we'll have to admit you."

I've never done that before, but that's a contingency we had to put in place initially to be able to deal with the surge of patients and be able to have hospital beds for the people who absolutely need it. It's a strange situation to be in to be doing that. And as I look ahead, I don't know what the next month or two will hold.

There have been some times when I'm in the respiratory unit and it feels a little bit like being in a war zone, where you've got all these people, they're sick, we're taking care of them, let's get them upstairs. We've got three ambulances coming in. We've got no beds for them. It's been interesting.

And all that being said, I think our administration has done everything possible, has done an incredible job of dealing with this and having contingency plans and surge capacity and everything we can do, but at a certain point, those resources max out. And again, I've always worked in busy ERs, and we've always dealt with overcrowding and all that.

But you asked about from a personal standpoint, I think I went through a phase initially over the first three months where I was very, very anxious. I was very anxious. I would go into work, and I'd be like, "Man, I am going to catch this virus, and this is not going to be good." I think I've settled into things now, settled in the routine, and also, in terms of taking care of this new disease, become much more comfortable with that after seeing so many patients with it and so many sick patients.

I've probably tried to compensate for it just by running more. I think we may have talked about this. As of June 1, I increased my weekly mileage by about, I don't know, 30%, 40%. So I have probably tried to just compensate for it just by running more. And partly, that's just to say, "Hey, the best defense against this virus is being in the best shape you can be in."

Scot: Yeah. Having a strong immune system. And also, you've talked about how that's how you deal with things from a mental standpoint, is exercise.

Troy: Oh, yeah.

Scot: I read something that was really . . . actually, somebody told me that I need to get this book. It was fascinating. It talked about if you find yourself in fight or flight mode . . . which I'd imagine COVID does. That's what stress is for any of us. It's a fight or flight mode. That's what stress is. You have these chemical reactions happening in your body. It's dumping cortisol into your system. The way to get around that is you have to do something physical.

And I'd love to get this book and find out if they talked about why, but on the surface, and this is not the scientific explanation, it makes sense, right? Because if you are in this fight or flight mode, then from a physical standpoint, your body is ready to do that. So if you can do that, then you feel better about things.

It's just the difference is it's not a physical threat like it was if it was a saber-toothed tiger. A lot of times now it's mental threats, but still, the way to get over that is to . . . I also heard getting hugs, so get hugs, but to physically just get rid of it, which I find fascinating.

Troy: Something I've done as well is . . . because I just felt like, "Okay. This is a new disease. I've got these sick, sick patients," and that created some anxiety, but I just thought, "I'm going to hit this head-on. I'm going to hit this head-on, and I'm going to be ready for them."

And every day, every day for the past several months, I have practiced physically . . . talking about taking that physical action. I have physically practiced and I have this lo-fi simulator I've created. I physically practice walking through the steps that I will take when someone comes in and they can't breathe.

And it's not just sticking a tube down their throat because we want to avoid that. We want to keep them off the ventilator. You may have heard some of the numbers on that. It's every step along there. "The oxygen. Okay. That's not working. Add on the non-rebreather mask. Okay. High-flow oxygen. Then we go to CPAP. Okay. Let's get ready to intubate." I walk through that every day physically.

And you would laugh if you saw the simulator I created. Laura saw it. She's like, "What is this?" I would probably be embarrassed to send a picture, but it's essentially my simulator and just some old equipment I've gathered over the years of just stuff I can physically handle, just like putting the oxygen on this on my simulator and putting the non-rebreather mask just so I feel like I'm physically doing this every day. And then, when I've had these patients come in, it's just like that muscle memory is there.

So I think partly, yeah, there's the physical running. There's that part I've done to deal with it, and that I think helps process a lot of things. But just being able to physically walk through this every day and just be like, "Hey, I want to be ready for this, and I feel ready for it," I think that's helped a lot with that anxiety piece as well.

Scot: You are one of the people that I just admire so much because I know that this virus is taking its toll on healthcare systems and healthcare workers all over the place working tremendously long hours, the stress that comes along with it, but you always seem to manage to maintain a pretty good attitude. How do you do that?

Troy: I don't know, Scot. Sometimes I feel like my attitude is not very good. Thank you. Great question. Maybe that is my coping mechanism, to put more of a positive spin on things.

But emergency medicine is inherently stressful, and that's one thing I've accepted over the years, and it inherently has a lot that you take home with you. And I always say emergency medicine keeps you up at night. It keeps you up at night because you work night shifts and it keeps you up at night because you take a lot of it home with you and you think about it.

COVID, I think, has compounded the stress of emergency medicine several times, many times. Just that sense of sometimes feeling overwhelmed. And seeing those cases multiplied many times of . . . the cases that you used to see here and there and that you'd think about a lot, but to see that many times over.

To have someone come in the ER who's about your same age and you're doing CPR on that person and you don't get them back has been a lot of what has been challenging for me over 15 years of practice compressed into about nine months of . . .

Scot: Wow.

Troy: Yeah, just in terms of really tough cases. Tough cases meaning cases where you have cared for people who didn't make it. It's been a lot more of seeing that over this period of time than I've seen in my career prior to this. So that's tough.

I think you're right. I'm probably downplaying things a bit and focusing on the positive, because there is a lot of positive too. I don't want to say there's not, but I think just the teamwork aspect, the way our team has come together to deal with this in spite of their personal challenges and professional challenges, the way our administration has responded has been very positive.

And then to see these people who come in really sick and to be able to care for them at this time is a positive thing, in spite of the challenges. At least you're able to offer something. I can't offer a cure. The treatments we can offer are not great. At best maybe some evidence behind it, but not great, but at least to be able to offer that during such an uncertain and difficult time for them. I think that it's difficult, but it's also empowering.

And while I think so many of us feel like we're stuck at home and there's nothing we can do, at least I do have that where I can feel like, "Hey, I'm doing something. I'm trying to help."

I'm doing some research with COVID too, which hopefully has a bigger impact on understanding COVID and the disease process. So I think at least that gives you a little bit more sense of empowerment, and I am grateful for that, that I do have that.

I think certainly distractions of health. I like listening to these Great Courses. I don't know if you ever listen to The Great Courses on audiobook, but I love listening to that kind of stuff. A lot of science stuff. Some stuff that has nothing to do with my job. I just love listening to that.

And it's funny. I'm actually listening to a book on stoicism right now on philosophy, on the stoics, and certainly relevant to our time. I think that helps as well.

It helps being able to come home to a supportive spouse with Laura, who's very supportive, and I think certainly has faced her challenges with work and with adjusting to working from home as well, but in spite of that, obviously, has a great attitude and is a very positive person.

And coming home to 17 kittens. If that doesn't brighten your day, I don't know what will. We don't have 17 kittens right now. At one point this summer we did have 17 kittens, but we have four little kittens right now that are the cutest little things you will ever see. And when you come home grumpy and you see those little faces, honestly, it's hard not to feel good about things when you see that.

Scot: So COVID is real? It's a real thing?

Troy: Yeah, it's real. It's legit. Yeah, it is real. It is such a weird disease process unlike anything I've seen. When you look at chest X-rays of people who come in with COVID, the best analogy I can come up with would be . . . If you have an X-ray of someone's lungs, on an X-ray, healthy lungs are black. They're dark with some little thin white streaks on it. The chest X-rays of people with COVID look like you took a black piece of paper, put it against a wall, and shot it with a white paintball gun, little white paintballs. There are little splotches all over it. Just really unlike anything I've seen before.

It's just such a bizarre process and just to see the full range of how sick people are . . . yeah, it's legit. It's real. It's a crazy disease. It's challenging to deal with. We're seeing really sick people. The hospital is full. The best thing you can do is the simple stuff: wear a mask, wash your hands, avoid social gatherings, social distance, all the stuff health officials are telling you.

Again, it's something we hear again and again and again, and I don't want to get on my soapbox about it, but as a healthcare system, we certainly appreciate the help and support people are offering.

And a thank you goes a long way. I'll say that as well. It's been funny. We got a lot of thank-yous in the ER. Back in April and May, when we were really not that busy. It was like, "Well, you're welcome."

Scot: Compared to now, right? It's a lot worse.

Troy: I know. Tell your healthcare worker thank you. We're nine months into this. We could use a hug, a socially distanced hug. Pat on the back, a thank you, whatever it is, I think we're all feeling that and we appreciate it when people offer that.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health, or it could be something completely random that we just feel compelled to talk about. Troy, do you want to start with "Just Going To Leave This Here"?

Troy: Scot, I'm just going to leave this here. We just talked about COVID and talked everything about COVID. And obviously, COVID and 2020 have become synonymous. Although it's COVID-19, but it's 2020 that's . . .

Scot: We're on a first-name basis with this thing now.

Troy: Yeah. We don't call it COVID-19. It's just COVID. So I know you have seen me many times pull out my little black planner, and you have harassed me for pulling this thing out.

Scot: You don't use electronic means to keep track of your schedule like the rest of the world. You still have a little black planner that you keep in your shirt pocket.

Troy: Yeah. I am still stuck in the '90s. I have a little black planner I pull out. I just bought my 2021 planner. It has November and December of 2020 in it, and it was such a relief to take that 2020 planner and throw it away and start using this one that says 2021 on it. It filled me with a sense of hope that maybe we're moving into something better.

Scot: Did you burn it? Did you throw it out in the yard and stomp on it?

Troy: Yeah, I should have held some sort of ceremony.

Scot: Just going to leave this here. This might also bring some light to your life. I don't know if you like eating raw cookie dough. So I like eating raw cookie dough. My wife hates it. I don't know where you're at on it.

Troy: I don't know. The raw egg piece of it is kind of . . .

Scot: See, that's the thing.

Troy: There's that.

Scot: There's the safety element. Eating raw cookie dough can be dangerous because you've got the raw eggs, so they tell you not to do it, although that never stopped me. I bought some cookie dough the other day that on the outside it says, "Safe to eat raw." So, apparently, technology has finally given us cookie dough. Somehow, and I don't know how they've done it and I ain't asking questions, they are marketing and put on the package "safe to eat raw."

So, in this time of a pandemic, now at least if you're eating cookie dough, you're not worrying about salmonella. So there you go.

Time to say the things that you say at the end of podcasts, because we are at the end of ours. Troy Madsen, go.

Troy: Check us out on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. You can reach us at hello@thescoperadio.com or you can call us at . . . Scot, what's that number?

Scot: Oh, that's a good question. 801-55SCOPE?

Troy: 601-55SCOPE. Don't confuse it for the 801, Scot. This is 601-55SCOPE in Quitman, Mississippi.

Scot: Also, we would love it if you would subscribe to the podcast on the podcatcher of your choice. And thank you for listening and thank you for caring about men's health.

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