A day in the life . . .

Models are by their nature subject to constant revision. Two weeks ago, we believed we would now be in the peak of demand on University of Iowa Health Care resources as a result of the COVID-19 pandemic. Recent well-publicized outbreaks in Iowa and other factors have now pushed our peak to around May 8. That said, we have been busy. Our hospital medicine team and ICU colleagues have so far taken care of 101 COVID-19 patients in the hospital, and our home treatment team (HTT) has managed more than 150 patients. The close monitoring of patients at home with timely admission might be contributing to the remarkably good outcomes of patients followed by our HTT, including those that eventually needed hospitalization. In Grand Rounds yesterday describing our collective experience taking care of COVID-19 patients, Dr. Brad Manning commented that the patient care teams on our dedicated inpatient COVID floors and ICU remarked how calm everything is on those floors. “We know what to do,” they told him. I can attest to this. When Dr. Manish Suneja, Dr. Kim Staffey, the Chief Residents, Dr. Joseph Zabner, and I visited the MICU last Tuesday afternoon, we were impressed by the sense of calm, purpose, mission, and enthusiasm exhibited by all members of the ICU staff, our residents, fellows and APPs, and the clean-shaven pulmonary and critical care attending staff.

It is clear that significant effort has gone into executing our hospital’s and department’s response, and it is very gratifying to see how everyone has risen to this challenge. To everyone, from our screeners at the front door to our medical ICU providers to the environmental service members, all performing at the top of their training, I cannot say this enough to you: Thank you. Your professionalism and commitment shine through in countless ways every time you perform a task that depends on you working efficiently and collaboratively. You rely on each other, and others’ reliance on you continues to be rewarded. Take a moment and recognize how far we have come in a little more than a month. (And then Take Five and refresh your memory on best practices.) There is nothing we cannot achieve as we trust in ourselves and in each other to do the right thing. Keep up the amazing work.

Before I begin to cite some more specific examples of recent successes, I want to share a snippet of a story you will be hearing more about in the near future. The story shows the power of teamwork, planning, and being adaptive to changing circumstances. This individual has recently recovered from COVID-19 and shared a note with us about their care, graciously agreeing to let the story be shared with our community. In the letter, they describe moving through our process, from ILI Clinic to Pathology to test results in 24 hours. They also describe receiving excellent care from our innovative HTT and then eventually within our medical ICU. Ultimately, their letter reminds us that each of us has a part to play and that patient by patient, story by story, we will prevail.

Though all of you continue to be exemplary, I want to call attention to one group in particular: our house staff. Working long hours on the front lines, our residents have always borne one of the largest burdens in our hospitals and clinics. But with the additional expectations and requirements, it has been our residents who have been some of the first to leap into the breach. They are the ones who first discover needed adjustments in coverage, reporting up about where staff should be best deployed. It is their boots on the ground that give us the clearest sense of what is working. But their vigilance takes a toll and I am continually impressed at how well our residents take care of each other. They check in, they offer relief, they listen and offer support. Some of this comes from the examples set by our Chief Residents and program director Dr. Suneja, but much of it just springs from who they are. To our residents, I say that it is your creativity and curiosity that sustains our efforts. Not just during this current pandemic, but in general. For many of us senior faculty, it is the opportunity to inspire and be inspired by you that keeps us in academic medicine. This department is grateful for your presence and will not forget what is being asked of you and what you have done these last weeks.

And life goes on . . . Other examples of resilience and nimbleness in our department have occurred that do not necessarily make headlines but are still nonetheless extraordinary. In the gap between the extra-long spring break and the resumption of classes, our educators responded just as decisively and creatively as did our colleagues on the clinical side of the house. Dr. Don Brown has earned his reputation as an unparalleled instructor using little more than an overhead projector and his ability to translate tiny variations in electrocardiographs into memorable lessons for his students. The move to a virtual classroom represented a challenge for Dr. Brown, but he did not shrink from it. Aided by Associate Dean for Education Dr. Amal Shibli-Rahhal, our ever-present ITS group, Kathleen Detert, and Kathleen Steenlage, Dr. Brown’s two-week virtual EKG course went off without a hitch by all reports. Kudos all around on learning some “new tricks”!

Similar nimbleness and innovations in continuing medical education have been mentioned in this space before, but I want to thank Dr. Loreen Herwaldt and Dr. Suneja for their quick adjustments to our Grand Rounds schedule. Almost every week they have provided an additional forum to educate our faculty and staff in a quickly changing COVID environment by offering deeper dives into the disease’s pathophysiology and its clinical manifestations. To date, we have heard from Dr. Stan Perlman, Dr. Jorge Salinas, Dr. Dan Diekema, Dr. Herwaldt herself, Dr. Greg Schmidt, and just yesterday, Dr. Brad Manning. Attendance at our now-virtual Grand Rounds has gone from around 120 in the pre-COVID days to an average exceeding 500 participants each week. Thank you as well to our faculty who have joined the collegiate and hospital leadership in their Monday and Wednesday sessions available for viewing on The Loop. These informative and candid presentations continue to be vital.

Finally, as talk begins of what things will look like “on the other side” of our current phase of this pandemic response, I am proud to share with you that our research mission will barely have lost a step. Our research administrator Lori Bassler prepared the table below listing the new grant awards to our department in just the first few months of 2020. Some two dozen awards totaling almost $25M have already been awarded, and I know that there are more that will be funded and will be announced once those awards become official. This is who we have always been in Internal Medicine, but it should be as heartening to you as it is to me that our status as a beacon for discovery and healing cannot be dimmed.

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