Loss and resilience

Make no mistake, we have been facing a lot of hard days. Recent losses of faculty members, losses by department colleagues of parents, and even the loss of children have reminded us all of our fragility and the quickness with which our whole world can change. But in our grief, we are reminded of the importance of community as we have offered each other and those left behind sustained comfort now and importantly in the difficult moments that may lay ahead. These losses have compounded an already challenging year and particularly this month, in which daily new cases of COVID-19 in our state have surpassed their peak in January. We are a few months away from the two-year anniversary of when we began preparing for and fighting the then-“novel” coronavirus. For nearly two years we have watched it wreak havoc on our neighbors, our family and friends, our social structures, disrupting many aspects of our lives and importantly upending normal life across the planet. Two years. That is a hard number to face as we look at the data such as current test positivity rates, inadequate vaccination rates, our current MICU and pediatrics ICU censuses, and of course a national death toll that now exceeds that of the influenza pandemic a century ago. It is OK to feel that weight. You should not dismiss it. When so much wants to tear away your empathy and your compassion, whether out of self-protection or simple aversion to pain, we should be reminded that those feelings can motivate us and remind us why we entered this field in the first place. We wanted to alleviate others’ suffering and we have, and we will continue to hold this as our first priority. But we must also be mindful that many are tired, and it is important for us to look after each other even as we plow ahead in our respective missions.

The medical director of our MICU, Dr. Kevin Doerschug, is one of many of us who has not had the luxury of turning away at any point in this pandemic. He eloquently articulated in a recent conversation the difference from last year to this one. He reflected on a shift in the outside world from one of solidarity with and between those on the frontlines to one now in which many health care workers feel, frankly, betrayed. They feel abandoned at times by those who prioritized personal freedoms over playing an active role in ending this. As the pandemic has stretched on, the stress and fatigue everyone working in the MICU endures can feel like the personal toll that this takes on our frontline colleagues does not matter. I share Dr. Doerschug’s concerns, particularly for our APPs, whose only responsibility is to keep showing up in the MICU each day. Unlike faculty, fellows, or residents who may have other rotations, research or teaching opportunities, our APPs have had little reprieve, and in fact have taken on more shifts, more burden. I am here to tell each of you—the APPs, the respiratory therapists, the nurses, the nutritionists, the fellows, the residents, the environmental services staff, all of you—your work matters. Your sacrifices have mattered to countless patients, their families, and most important, to us, your colleagues, who see what you have endured. Your professionalism and commitment to serving everyone who comes through our doors is inspiring. You keep showing up, we see you, and although words might not be enough, we thank and appreciate you.

Dr. Doerschug and our Pulmonary and Critical Care Fellowship Director Dr. Alicia Gerke both report that despite the exhaustion, despite those moments of feeling abandoned, there are also moments of inspiration. The trainees, residents and fellows alike, have an eagerness and an energy to learn critical care that has sustained faculty members and others around them. In fact, the entire unit, Dr. Gerke says, has found solace and resilience in their shared experience and support for each other. Their ability to work as a team has been crucial to maintaining the same level of intensity and compassion for their patients that they have shown since this all began. They know that they know what to do and that those who stand at their shoulder also know what to do. Inside each patient’s room, thoughts of how the rest of the world thinks or behaves do not factor in their ability to provide the best care, world-class care, to every human who needs it. Our community will never be able to thank you enough.

What happens inside our MICU is only the center of many ripples that affect the rest of UI Health Care. Our primary care providers at Iowa River Landing and elsewhere continue to see high volumes of patients seeking help for multiple health needs, while remaining vigilant for COVID infections, which members of our Home Treatment Team and those working in the ILI Clinics have been working overtime to manage. Our residents have also been heroes. They rotate throughout the institution gaining experience and education, providing top-notch care, but importantly relief for each other, which for those not in the know would not necessarily recognize as we have not missed a beat. The Chief Residents report that despite the challenges of shuffling schedules and activating the tier system for substitution, the residents have supported each other with flexibility and an understanding that the support they give today will come back to them if they should need it. Kudos to the Chiefs and to the residents for maintaining an equitable system and for finding ways to publicly recognize those who make sacrifices. The active Wellness and Humanities Committee has some planned activities as autumn arrives that recognize the importance of increasing the bonds of community and collegiality and to have a little fun.

Two final thoughts in this long and heavier-than-usual post. First, an anecdote: This week the Carver College of Medicine hosted a recognition for the recipients of the 2020 Distinguished Alumni Awards. I had a chance to speak with one of them, Ohio State pulmonologist and Medicine Chair, Dr. Rama Mallampalli. He told me that in his brief time revisiting Iowa, he was impressed by the unique and observable esprit de corps that exists among our department’s members that he has not seen at any other institution. It is easy for us to take it for granted when we are surrounded by it, so take the word of an outside observer and feel proud of the way you treat others and are treated.

Second, remember that you are not alone. Formal resources such as the COPE Team exist solely to let you know that what you may be feeling is natural and manageable. If you are in distress, please do not suffer in silence. Your friends, loved ones, and your patients need you to be well. Less formal, but still crucial are affinity groups like the Women in Medicine Group launched last year by our Associate Chair for Diversity Dr. Nicole Nisly and Vice Chair for Clinical Programs Dr. Kim Staffey. The support and education the women in this group provide each other through their email contact list and their regular meetings is one of many ways our department is doing what it can to counteract generations of systematic sexism that has existed in our profession. We have detailed some of the recent successes of women in our department in recognition of September as Women in Medicine Month, but are keenly aware of all the ways in which we still have so much more work to do.

About E. Dale Abel, MD, PhD

E. Dale Abel, MD PhD Francois M. Abboud Chair in Internal Medicine John B. Stokes III Chair in Diabetes Research Chair, Department of Internal Medicine Director, Fraternal Order of Eagles Diabetes Research Center Director, Division of Endocrinology and Metabolism Professor of Medicine, Biochemistry and Biomedical Engineering

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