They prepared an infectious containment unit within days. Providers and other employees worked with people from all parts of the hospital, with all the usual divides knocked down for the sake of expediency and finding the best way to treat people, right here, right now, and without a moment to spare.
Medicine at Michigan tells some of their stories in its latest issue, including Anesthesiology's Ross Blank, M.D., assistant professor and a co-director of the RICU, and Andrew Rosenberg, M.D. (Fellowship 2000, Residency 2002), associate professor of anesthesiology and chief information officer for Michigan Medicine.
Jake McSparron, M.D., and Ross Blank, M.D.
“I had not met Ross before this. Then we began working side by side. A lot of people who would normally be in separate silos came together, and we came up with best practices. You don’t want anyone but the most experienced operators intubating these patients or handling tracheostomies. If we had an airway emergency, we were literally sitting next to an anesthesiologist, and if a team wanted to review chest imaging or discuss pulmonary pathophysiology, our pulmonary intensivists were right there. Nephrology, Infectious Disease, Palliative Care, ENT, and so many more teams were all part of this effort. This has worked extremely well, and I hope that this ability to be nimble and work together more easily is one lasting result.”
—Jake McSparron, M.D., assistant professor of internal medicine with a focus on pulmonary and critical care medicine. He co-directed the RICU with Ross Blank, M.D., assistant professor of anesthesiology.
“We had 50 COVID patients at our max in the RICU. Most ICUs are typically 20 to 24 patients on a floor, so having 50 is unprecedented. The only way to take care of all of these patients was to bring in a lot of intensivists — anesthesia intensivists, surgeon intensivists, neurology intensivists, and others as well. We had this multi-departmental team all working side by side to take care of the patients. It worked because it was an emergency situation, and Jake and I were able to quickly get along very easily and be practical about making a functional team. I have really been impressed by the relative seamlessness of people from different units working together on teams. I would like to think that is something that will be continued into the future.”
—Ross Blank, M.D., assistant professor of anesthesiology and a co-director of the RICU
“THE HUMAN STORY”
Andrew Rosenberg, M.D. (Fellowship 2000, Residency 2002)
“I would never have thought about talking about withdrawing critical care with a family over the phone. Now we are doing it with FaceTime when they can’t come into the ICU. One of the things that makes this time so different, so special, that is seared in my memory, are the human stories. We withdrew on two patients today. At least today, the families could be here.
“An adult son and his wife huddled next to each other, holding their hands, looking down at their laps, with their n95 masks that they brought in from home, with his mother, on a ventilator with a new trach tube in place. Her eyes were closed, and she was comfortable. She was 62, and she died today. Other patients, on ventilators, on nitric oxide, who can only barely be oxygenated lying prone (on their stomach). Those are the images of COVID for me.
“There is a sense of isolation in the RICU [Regional Infectious Containment Unit] now. The patients are isolated from their loved ones. The caregivers are isolated from the patient and their family. The caregivers are isolated from each other. This is isolation that goes on. I decided to self-quarantine at home. I sleep downstairs and my family and I eat at different ends of the dining room table.
“We are having to use leather restraints with some patients. The security team came with leather restraints. We have a young guy and he can’t be adequately sedated. He’s on five separate drips, each of which would be enough to sedate a normal patient. He is 27. We never use leather restraints in the ICU. There is some incredibly tough delirium that can come from COVID.
“Those of us who worked in the RICU, we’re all from different parts of Michigan Medicine. We had teams being formed that have never worked together. We opened up new spaces. If there is one thing that I think will be enduring, it’s how to create these multidisciplinary teams. People are exchanging ideas with each other. It’s extraordinary, what we can accomplish together.”