Help My Unbelief

(I was asked to lead a devotional in a group of Christian doctors. Here is what I shared.)

One man was telling his friend about his doctor. He said, “my doctor guaranteed that I will be walking in just a week after my big surgery.”

The friend remarked, “Wow, that’s impressive.”

The man added, “Yes. I have to walk now because I have to sell my car to pay my doctor’s bill.”

Most of the times, we doctors guarantee healing. But our story today is about a failed healing.

**********

Our story for our devotional today is found in Mark 9: 17 -27

17 A man in the crowd answered, “Teacher, I brought you my son, who is possessed by a spirit that has robbed him of speech.18 Whenever it seizes him, it throws him to the ground. He foams at the mouth, gnashes his teeth and becomes rigid. I asked your disciples to drive out the spirit, but they could not.”

19 “You unbelieving generation,” Jesus replied, “how long shall I stay with you? How long shall I put up with you? Bring the boy to me.”

20 So they brought him. When the spirit saw Jesus, it immediately threw the boy into a convulsion. He fell to the ground and rolled around, foaming at the mouth.

21 Jesus asked the boy’s father, “How long has he been like this?”

“From childhood,” he answered. 22 “It has often thrown him into fire or water to kill him. But if you can do anything, take pity on us and help us.”

23 “‘If you can’?” said Jesus. “Everything is possible for one who believes.”

24 Immediately the boy’s father exclaimed, “I do believe; help me overcome my unbelief!”

25 When Jesus saw that a crowd was running to the scene, he rebuked the impure spirit. “You deaf and mute spirit,” he said, “I command you, come out of him and never enter him again.”

26 The spirit shrieked, convulsed him violently and came out. The boy looked so much like a corpse that many said, “He’s dead.”27 But Jesus took him by the hand and lifted him to his feet, and he stood up.

The background of the story is that Jesus just came down from the mountain where he had his transfiguration. Though it is really uncertain what mountain, traditionally it is believe to be the Mount Tabor. With him were Peter, James and John. When they got down from the mountain he was met with the rest of his disciples and was told that they failed to heal a boy from his illness.

I want us to view this story from a doctor’s or a healthcare provider’s perspective.

Let’s first examine the boy, the patient, in our story. How old was he? I don’t know, but most likely he is in the pediatric age. Since I am an adult medicine doctor, he will be somebody that will not be brought to me.

What is his illness. If we look at the description of what his illness is, we would say that it is epilepsy with the classic tonic-clonic grand-mal convulsions. The seizures seems to be uncontrolled and frequent that it can come any time, as he would fall in the fire or in the water. Being unable to speak, maybe he also has cerebral palsy with speech impediment.

How long has he been sick? According to his father since his childhood. So for a long time this boy has been suffering. One reason why I did not choose to be a pediatrician, besides I hate placing an IV on a baby is that I cannot stand the sight of suffering children. Especially those sick kids that had poor outcome.

Are there any pediatricians here? I admire you, caring for the most vulnerable among us. May God continue to bless your profession and your ministry.

So if this sick boy was brought to you, what will you give him? Keppra? Carbamazepine? Phenytoin? Or perhaps you will request for CT head, EEG and lumbar puncture first.

But something tells us that this is more than physical illness. Rather, it is an spiritual illness, or more specifically demon-possession. As it was told in the story that Jesus drove the deaf and mute spirit out and ordered it not to come back.

I have witnessed demon-possession when I was still in the Philippines. It happened on an evening prayer meeting and this young lady jumped out of her seat and attacked the speaker. Her voice changed and it took several men in the church to hold her down. It required some intense prayers of the church before the demon was driven out.

Let us examine now the father, the other patient. One thing for sure is this father was desperate. If your child is sick for a long time you will be desperate too. He has been disappointed before, perhaps by other healers that he brought his son to and they tried to heal him, including Jesus’ disciples, but all were unsuccessful. Because this father was let down in the past, he was having trust issues. He has become a skeptic. He told Jesus, “IF you can do something,” (emphasis on the IF), but honestly admitted his doubts by telling Jesus, “I believe. Help my unbelief.”

This father is also suffering. It’s not just the boy, but the father as well. Maybe not much physically, but more on emotionally and mentally. Note on verse 22, he did not say “have compassion on my son,” rather he said to Jesus: “have compassion on us and help us.”

He is undergoing mental agony. Perhaps anxiety and depression. Would you give him Prozac? Or maybe a psychotherapy session? But most likely he just needed his son to be healed and he will be healed as well.

Let’s apply the story to our day to day experiences.

First, have you experienced that you were unable to help your patients, even how hard you try, like the disciples did? You probably tried all the medications and procedures known to you, but still your patient was not getting better. I know I have experienced that, all the time. Being a Critical Care doctor, I have lost many patients, which is part of the specialty I chose, especially in this time of COVID pandemic. How frustrating that has been for us. We felt incompetent. Is our training not enough? Is our knowledge and skills not enough? We felt helpless.

But in our story, Jesus said (verse 19), “Bring the boy to me.” Yes my fellow doctors, we can bring our patients to Jesus. We can bring our frustrations, our incompetence and our helplessness to Him. We can bring our problems to the Lord, not just in our patients, but our own personal failures to Him.

Many times though we are also like the child’s father, we suffer with unbelief. As trained scientists and professional clinicians, we believe more in our medications, or in our surgical skills, in our medical science and technology than in God. Have you felt that way sometimes? I know I felt that way, many times!

When I was sick with a flu last year and I felt so awful, I prayed that God will heal me quickly. But I felt I have more faith in the Tylenol that I took to make me feel better than in God who can really take my illness away.

In this story, when the father told Jesus “If you can do something” Jesus used that same words back to him and said “If you can” believe “everything is possible.” May we also pray that father’s prayer, “Lord, help, my unbelief.”

Lastly when the child was taken to Jesus, it appears that he even got worse. The boy had more violent seizures when the evil-spirit saw Jesus. The original text used a term that meant worse than before. The boy went into a grand-mal status epilepticus, worse than he ever had. After the seizure, the people thought that the child was dead (verse 26)! Did Jesus made the situation worse?

Have we experienced something similar? We prayed to God already, and we call on Him to heal our patients, but they seem to be getting worse, not better. Was God not hearing our prayers? Was He not listening to our pleas?

Then when people thought that the boy was dead, (in verse 27) Jesus took him by the hand and lifted him on his feet and he arose. The healing came in God’s way. The healing came in God’s time.

For us today, when we are struggling in our practice, when we are getting discouraged in the outcome of the patients that were placed under our care, we just have to trust in God’s ways, and we have to trust in God’s timing.

**********

I would like to tell a story that happened to me last year.

It was the height of flu season last year, and this was before COVID, which made this year’s flu season worse. I was working that weekend, and I was in the hospital for 36 hours straight. We had several patients in the hospital that had complications from the flu. There were five on ventilators due to respiratory failure from Influenza A in our ICU. Two of them were on ECMO. 

ECMO is short for extracorporeal membrane oxygen, an extracorporeal life support. It is an intervention to provide adequate amount of gas exchange or perfusion in patients whose heart and lungs have failed to sustain life. It is done by placing a large bore catheter in the patient’s central vein or artery, where the blood was sucked out from the body, then ran through a machine to bathe it with oxygen, then flow it back to the body. We also have used this intervention now for the very severe COVID patients.

Saturday morning, I got a call from another hospital for a woman in her 40’s who had Influenza A and who was rapidly deteriorating. She went into respiratory failure and was placed on ventilator. They want to transfer her to our hospital for possible ECMO.

We rarely have two ECMO patients at the same time in our ICU. Even one patient on ECMO makes us busy, so two was really demanding. But a third one at the same time? That never happened in our hospital before. 

I made some phone calls to verify if we have a machine for a third patient and if we have enough resources and staff to handle a third ECMO. After confirming, I was given the green light to accept the patient.

Additional ICU and ECMO staff were called to come in. I called the interventional cardiologist-on-duty who would assist us to put the Avalon catheter, a dual-lumen catheter half as big as a garden hose that goes from the jugular vein and through the heart. The cardiologist in turn called the cath lab to prepare for the arrival of this patient.

The patient was flown in via helicopter to our hospital and went straight to the cath lab where me, my ICU and ECMO team, as well as the cardiologist and his cath lab team were waiting.

We were ready for the challenge and eager to make it happen. 

While we were doing all this, our patient’s oxygen saturation was only in the 70-80% despite maximum ventilator support, so we knew we needed to work fast.

However problem struck. Working for more than an hour, we had difficulty placing the Avalon catheter in good position. We tried different approaches with different instruments, but cannot get the ECMO flow going.

After deliberation, we decided that we cannot sustain this patient on ECMO. Perhaps it was her vascular anatomy, or perhaps there was a big clot in her vein. Whatever the reason, we could not proceed.

I went out to the cath lab’s waiting room, and gave the sad news to the patient’s family that we couldn’t do the ECMO. All I could say was that we tried and gave our best, but it was unsuccessful.

I felt that we betrayed this patient and her family. After I thought I moved heaven and earth to get this patient to our hospital, only to end up like this was really deflating.

The worse part was, I knew that without ECMO, this patient had little to no chance of surviving and possibly could be dead in a few hours.

We transferred the patient to the ICU, but we left the big neck catheter in place even though it was not hooked to the machine. We have to wait for the heparin we gave when we attempted to start the ECMO, to wear off before we can pull the catheter out.

After about half an hour in the ICU, I was informed that the blood test showed that the heparin had worn off and I can remove the catheter with less risk of bleeding.

When I pulled the Avalon catheter out, I applied direct pressure in the patient’s neck to control the bleeding. I did this for 30 minutes. I was alone in the room with the patient most of that time, with the nurse intermittently coming in and out of the room to adjust the IV pumps or to check on the patient.

All along while I was holding pressure, I was watching the monitor which showed that the patient’s oxygen saturation was staying in the high 70’s to low 80%. I thought death was imminent.

During the time when I was alone with the patient, I felt helpless and defeated. I failed her. We failed her. 

Then a thought came to me: I don’t save lives. It was not up to me. Only a higher power determines who will live or die. That’s when I reached out for the Higher Power.

As a doctor, many times, I put more faith to the medical intervention than God’s healing.

With my hands on the patient’s jugular holding pressure, I turned my thoughts to heaven: “God I am nothing, but an instrument of Your healing hand. I failed. But You never fail. I don’t know this patient personally, but I am personally praying for her. Please heal her in my behalf, and let me witness Your awesome power. Amen.”

After 30 minutes of holding pressure the bleeding stopped. I left the room and went to see other patients, especially the new ICU admission, a young man in his 20’s who had a bad asthma attack, so bad we had to place him on a ventilator.

As I was busy attending to other patients, I was just waiting to be called back to that particular patient if she goes to cardiac arrest or expires.

More than an hour later, I went back to the room of our failed ECMO patient. I looked at the monitor and her oxygen saturation was 100%. I was amazed! The respiratory therapist told me that she even titrated down the oxygen level on the ventilator to almost half as the patient was really doing good.

What happened? I had no other explanation but one: God heard my prayer.

I went down to my call room to be alone. With tears welling in my eyes, I uttered a prayer of thanks. Never would I doubt the power of God again. 

My friends, God healed my unbelief.

May God heal us all with our unbelief, this is my prayer.

On This Together

I was again on-call this last weekend, and to say that it was busy is an understatement. We have not seen this many COVID patients in the hospital right now, ever since this pandemic started early this year. The health-care system is really stretched out thin.

There are members of the medical staff that had contracted the virus, and I know some of our hospitalists had come down with the illness, most likely getting it from the very patients that we care for. There was even a colleague that got so sick and he became our patient in the ICU. Scary times indeed.

But I have a few days off since my last weekend call. I have sufficient time to unwind and recover. We need to take care of ourselves first so we can take care of others, right?

This morning, as I was out for my 3-mile run around our neighborhood, taking advantage of the out-of-season relatively warm weather, I happened to see this (photo below):

I don’t know who Parker is, nor what illness he has. But it put a smile in my face to know that even in these times that we cannot be physically there for somebody due to this pandemic and the mandate of social distancing, yet we can still show in one way or another that we care. We are all in this together.

Stay safe everyone!

Halloween Full Moon

Even though I am off this Monday I came to the clinic to do some light work. No, I’m not workaholic. It’s just that I procrastinated to read last week’s sleep studies and now they have piled up on my to-do list. It is my day off as I worked this past weekend.

As I entered and sat on my desk, one partner of mine who was sitting at the other end of the room greeted me and said, “Bad weekend call, huh?”

Yes it was a horribly busy weekend. I rounded on more than 50 patients in the hospital, almost half of them are COVID cases. I am not superstitious but I cannot help but think that it was due to the Halloween combined with a full moon. In fact, October 31st was a Blue Moon too. A Blue Moon is when it is the second full moon in one calendar month. According to information from NASA Earth and the Old Farmer’s Almanac, the last time a full moon fell on Halloween was in 1944.

Photo by Pixabay on Pexels.com

It did not help too that it was Daylight Savings time change, so we fell back one hour. That meant an additional one hour of work for me. And boy, that night was really long, both figuratively and literally. The non-stop activities in the ER and in the ICU put me on skates. Needless to say, I barely slept that night.

After staying 34+1 (Daylight Savings Fall back) hours in the hospital, I came home last evening really exhausted. Right after eating dinner, I went to bed and slept for more than 10 hours. Home-cooked meals and comfortable home bed are life’s luxury. When I woke up this morning I felt refreshed and recuperated. I even felt good enough that I went out for a 3-mile morning run.

So back to the comment of my partner about my bad weekend call. How did she know? I did not tell her about my weekend. Was I still haggard-looking? Did I look ghoulish from the Halloween?

Then she told me that she have noticed that our secretary printed some forms and placed it on top of my desk for me to sign. Based on those, she figured out that I had a rough weekend. What were the forms waiting on my desk?

Eight death certificates. All of them from this weekend.

Dearly Departed

I was standing in a small countryside cemetery. With me were seven other people, and we were hovering around a newly covered grave. It did not even have a tombstone or a headstone yet, just a temporary marker placed on its foot end.

It was a beautiful, warm summer day. Nice day to be out, though I’m not sure if there’s really a good day to visit a grave site. Near the cemetery was a small country church. Surrounding the graveyard which was on top of a small hill were endless fields of corn whose stalks were swaying gently with the breeze. Once in a while a car or a truck would whiz by the country road where the cemetery was located.

IMG_3674

Buried in the grave we were visiting was a work partner of mine. He was a little past the traditional retirement age but chose to continue working, although in a slower pace. Yes, he was working until the time of his sudden death.

Due to this age of COVID pandemic and physical distancing, we were not able to attend his wake nor his funeral, as his funeral was a family-only affair. Visiting his grave was the closest way to say goodbye to him formally.

I know he chose this small country cemetery which was off the beaten path because not too far from here was a farm that he bought. But instead of making it into an agricultural farm he planted trees and turned it into a little forest. He even had his colonies of honey bees in that patch of land. This is were he escaped to, which was about 45 minutes drive from the city, when he was not doing doctor duties.

He had a brilliant mind, and he delved into different interests. Besides being an arboculturist (forestry expert) and a bee keeper, he was also a certified scuba diver. These were among other endeavors that he had dabbled into. But most of all, he was a diligent and dedicated physician. His patients vouched for his passionate work and many of them claimed that they were literally “saved” by him when their lives were on the line. He was a great teacher too. He encouraged me to pursue my certification in Sleep Medicine.

He and I were the only Board-certified sleep experts in our group of 10 Pulmonary and Critical Care doctors. Perhaps we just love to sleep so we were both fascinated with the science of it. Now I am left to carry on.

We are missing him not just because we have become more busy and we’re down one body. It does not help that this COVID-19 is still running amok. In fact a week ago we were in the news as Iowa was the number one hotspot in the whole USA with the highest infection rate. We are missing him for his wisdom and advices from years of experience which we could use in this difficult time.

As I stood in that cemetery, I was thinking of my own mortality. What do I want to be remembered when I am gone? A bungling pianist? A slow but persistent runner? An amateurish writer? Or an OK (just OK) physician? Maybe a good father, I hope? Or a loving husband? Or a trust-worthy friend? How much time do I have to direct this narrative?

When I moved to Iowa and joined this group 16 years ago, I remember my first day at work. I was in the office and I finished early as I don’t have any established patients yet to see. I hang around in the clinic as in the last group I was a part of in Florida, they frown upon and make you feel guilty if you leave early, especially if the senior partner still have patients to see. So most of the time I would not go home until after 6 PM or even later.

But it was different in this new group that I joined. It was only about 2 o’clock in the afternoon, but I have nothing else to do on my first day. That’s when this partner found me still hanging around. He asked me if there’s any other patients I need to see. When I said no, he told me to go home and rest, and that I should spend time with my family.

My departed partner, it is my turn now to tell you that you can go home. Rest, and have a peaceful long night sleep.

(*photo is of a nearby cemetery where I live, not the site where my departed partner was buried)

A Room with a View

Our planned trip to Canada this summer went kaput. Because of this COVID-19 pandemic, the northern border is still not open for tourists. Instead of giving back the vacation days that I already took, we scrambled to look for an alternate local getaway.

As we were booking for a hotel or a lodge, we were looking to have a room with a view. I for one is really particular of having a view. Even if I spend the whole day doing nothing, as long as I enjoy looking outside the window, that’s more than enough for me. Thus on many of our trips we hunt for a room with a view. And if we checked in to the hotel and we’re given a room that was different than what we imagined, we would request to be moved and not settle until we get the room that we wanted.

Who wouldn’t like a room with a view?

I don’t know if this can be applied when being hospitalized. First of all you cannot really pick your hospital room. Second, most hospitals don’t have a view. And lastly, if you do have a beautiful hospital window view then you may not want to leave at all, which is counterproductive.

I am not saying that hospitals should not have a good view if they can provide it. After all I believe a serene setting or view could be in itself therapeutic to patients. In our hospital we have a central garden with pretty flowers and some rooms overlook this garden. While a few of the rooms have a view of our city’s skyline. While many rooms in our hospital have brick walls for their view.

Recently, one patient of ours told me that he was surely glad that he was referred to our hospital. He was transferred from a small regional hospital to our tertiary medical center for further management of worsening respiratory status from COVID-19. He told me that besides the advance medical care we can provide in our facility, the view from his window at the regional hospital where he came from was not “reassuring.” In fact he said it was downright depressing.

A couple of years back, we started going to that regional hospital once a month, which is an hour and 45 minutes drive from our main office, as part of our outreach clinic, so I fully understand the comments of that patient. Across the street of the regional hospital is a very “serene” park, though it is probably not what you want to see when you are sick. The said hospital, believe it or not, is overlooking the town’s cemetery. That could be depressing. Though it could be an incentive to get better too, or else you end up across the street.

I remember a story* I read years ago about two hospitalized men who were sharing a hospital room. Both of them were suffering from serious illnesses. One patient was by the window and the other one was across the room. The one far from the window was unable to get out of bed, so everyday he would ask his room mate what he sees in the window. Every time the patient who was lying by the window would tell the other one the beautiful view outside. Like how the sun was shining in the sky, or the children playing at the park, or the pretty flowers blooming in the garden, or the ducks swimming at the pond. This lifted the spirit of the other patient and gave him encouragement to get well so he could go outside and see for himself the beautiful view.

Then one day the patient who was by the window died. The one across the room felt very sad for his room mate, yet he felt good at the prospect that he could transfer to the bed by the window.

When he finally got transferred to the bed by the window, he was terribly disappointed. Why? The window of their hospital room was facing a brick wall. No view of a park, nor of a beautiful garden, nor a pond.

He realized that his former room mate made it all up to inspire him and to keep his hopes alive. That hope that sustained him through his illness and pain.

The next day, there came a new patient who was laid in the bed far from the window. This new room mate ask him what he sees outside their window. To this he replied, “Oh, there were children merrily picking flowers……”

**********

(*Original short story is by Harry Buschman, “The Man by the Window.” I added the last twist.)

A New Normal

I have been going to work now with a mask and a shield. No, I did not become Captain America, nor did I become an Avenger. What I meant is I’m going to work with a medical face mask and a face shield. This has become the new normal for me.

If I am going to do a procedure that is at risk of aerosolizing the virus, like putting an endotracheal tube or doing a bronchoscopy on a known or suspected COVID-19 patient, then I even use my “powered suit.” Not a powered suit like that of Iron Man, but it is a battery powered air-purifying respirator or also known as PAPR.

I rarely take my temperature before. Now, it is taken at least once a day and sometimes more. This daily temperature probe is not to determine if I’m ovulating or not, for the last time I checked I am a male. For your information, the “temperature method” is a family planning method that takes the woman’s daily basal temperature to determine if she is in her fertile or infertile periods of the menstrual cycle.

I am having my temperature taken whenever I enter the hospital, with additional screening questions of “Do you have fever, cough or shortness of breath?” If from the hospital I would go to the outpatient clinic building, I would get my temperature checked again and have the same screening questions, with an additional inquiry of “Were you exposed to a person with known COVID-19?” The last question is tricky to answer, for if I say yes, then they might not let me enter the building. But how else could I answer that question if I have just seen patients with confirmed corona virus in the hospital? Lie, if we must.

Photo by Ketut Subiyanto on Pexels.com

I don’t know if we have flattened the curve in our community. I am not talking about the bulge around the waist, for that has definitely ballooned more in many people with the stay-at-home order and the uncontrolled eating, plus with the gyms being closed. I guess a mask can help with this, as it is impossible to eat when you’re wearing a mask. But I digress.

We still have lots of COVID-19 patients in the hospital, though it maybe less compared to two weeks ago. Yet I still saw 15 COVID patients in the ICU this weekend, and many of them were on ventilators. I say it’s less, for at one point we had more than 20 COVID patients in the ICU and had a steady admission of 1 to 3 more a day. Good thing was many recovered fast, although some also died. There was also a time that we registered close to 50 admitted COVID patients in our hospital, both in the ICU and wards. So are we really flattening the curve?

Even though it is terrifying, we as physicians, have gained lots of knowledge and experience taking care of the critically ill COVID-19 patients. One thing we learned is that not all COVID patients with severe hypoxia needed to be on ventilators. Placing them on humidified high flow (pressurized) oxygen via nasal cannula can prevent intubation, and in fact they have faster recovery and less complications with this. Of course there are still patients that would require ventilator as a last resort, but we probably avoided more than half of our COVID patients from getting on a machine. Our experience in our hospital was extremely good that it was even featured in the local news. We might be publishing a paper on a medical journal about this experience in the near future.

Our hospital has also gained so much experience in placing patients on prone position if their oxygenation is failing. Never have I seen so many ICU patients on their belly. If the patient is awake and not on mechanical ventilator, we instruct them to lay not on their back if able. If they are sedated and on ventilator, we avail a team to flip them on their belly. And based on our experience, this really improves their respiratory status – belly down prevents them from going “belly-up.”

Photo by Miguel Á. Padriñán on Pexels.com

There are also interventions that have rapidly fallen out of favor, at least from our experience. Like giving hydroxychloroquine, the anti-malaria medicine, which we initially give to all our infected patients at the onset of the pandemic, but stop doing so. I don’t want to be political, but there is currently no robust data supporting it. We are also part of the on-going study of giving convalescent plasma to our patients, that is transfusing blood from a person that has recovered from COVID-19 and thus has presumed antibodies. We are also giving other drugs like Remdesivir and Tocilizumab, agents that are still under investigation. We are even conducting our own small trials using other novel drugs. At this time, no one really knows which medicine works. It might turn out that all of these medications are worthless.

As we open our communities more and more, I am anxious that we would see a second wave of infection. Yet I have to accept the fact that we cannot keep the world close indefinitely, for that is not considered living either. We just need to embrace the new reality.

For simple recommendations, first, we need to keep a distance from each other. At least 6 feet they said. But is that distance scientifically sound when we know that a sneeze or a cough particle can travel much farther than that? That is why wearing mask is helpful, for it protects us from each other if we cannot keep a safe distance.

So another new normal is that we need to wear a mask when going out. I know it is a barrier for communication as we cannot see the facial expressions when we talk to people. It is really bad for the deaf or for those who read lips. Probably good for people with bad breath, for they can be accepted back to the society. And perhaps sad for many, as we cannot see anymore each other’s beautiful smile.

Photo by cottonbro on Pexels.com

Lastly, no more handshakes. This act of shaking hands evolved from an era when nobody was trusting anyone, that people have to approach each other with an open hand to show that they were not holding a dagger as they meet. This developed into the custom of a handshake. Maybe now we need to greet each other with a bow, like some Asian cultures do. Or maybe a curtsy. That would be cute. Or perhaps some kind of a salute. Just not the “Italian salute.”

Stay safe everyone.

A Beautiful Night

I did two overnight in-hospital ICU call in a span of three days lately. This has obviously derailed my circadian rhythm. Normally in our group of intensivists, a doctor only do 24-hour duty once a week or less. But this is not normal times.

So on the day I was off after my back to back calls, I woke up in the middle of the night and cannot sleep anymore. My body was fatigued yet my mind was awake. Instead of tossing and turning in bed, I got up and went to another room so not to disturb my wife who was fast asleep.

I pulled up a chair and sat by the side of the window and stared outside. The night was still and the moon was halfway through the horizon in the sky. The warm glow of the moonlight bathes the whole surrounding and it was quite enchanting. It was after all the super pink moon – the biggest and brightest full moon of this year 2020.

Ah, year 2020. Who could have predicted that this year would be this challenging? At my work we have more than 30 ICU beds, but with the predicted patients surge from COVID-19, our hospital has a contingency plan that we could convert other parts of the hospital into temporary ICUs and that we could potentially take care of 90 critically-ill patients on ventilators. The good thing is we have not seen that kind of surge like what is happening in New York City and New Orleans. At least not yet. I hope we never will.

We do have several confirmed COVID-19 patients on ventilators though, and they are pretty sick. But they are getting better, and the truth is many of them are getting off ventilators after a few days. Even our first ever confirmed COVID-19 patient that ended up on mechanical ventilator improved and got off of it after almost three weeks.

There were deaths though from this virus, even in our ICU and we cannot deny that. In fact the other night that I was on call, there was one patient that was a COVID-19 suspect and I placed him on a ventilator that night. Of course I had my full protective gear when I intubated him. Yet despite of our best efforts he died. But testing came back later that it was not the novel corona virus, but he had positive blood culture for a bacteria and he died from an overwhelming sepsis. People die from other causes as well, not just COVID-19.

As I gazed outside the window, I uttered a prayer for strength and protection not just for me, but for all the healthcare workers that continue to fight this battle. I also prayed for my family and all the families of frontliners who are at continued risk of contracting this disease from us when we come home. More importantly I prayed for the patients and their families that are going through such a woeful and difficult time.

The saddest part of this pandemic is that patients in hospitals are going through their ordeal alone, as family and friends are not allowed to visit them. And for those people who succumbed from this COVID-19, they die alone with nobody to hold their hands even in their last dying breath. It is really heartbreaking.

I looked at the radiant full moon and it was glorious. I observed that the light of the moon cast long shadows on the lawn from the trees. I was unaware on how the trees around us had gone so big and tall now. The evergreens that stayed lush and strong through the cold months and had survived many bitter winters. The deciduous trees that were currently barren but the leaf buds were beginning to appear for it is spring time after all, reminding us that life begins again. I also noticed that there were faint stars in the sky, though their light were subdued by the bright moon, yet they were twinkling whether we see them or not.

All in all, it was a beautiful night.

Photo by David Besh on Pexels.com

Then a thought came to me as if God was answering me. Even if we are going through the night, if we don’t dwell on the shadows and focus on the light, there is still beauty around us. Many times darkness heightens our senses to appreciate the light and other lovely things that we may have taken for granted. Yet the most reassuring thought is that even how dark the night is, morning is surely coming and a new day will emerge.

Yes, we may have lost many in the night and we should remember them, but for most of us, we are going to be alright. Have a blessed and meaningful Easter everyone.

Coming to the Dark Side

Because of this COVID-19 pandemic, as a defense it is now advised that everybody wears a mask when going out. However, there is a shortage of masks available and other personal protective equiptment in many hospitals. Dark times indeed.

Thus, I’m wearing my own respirator mask to work.

“You are unwise to lower your defenses.” – Darth Vader

(*Warning: not a true protective mask. Rest assured for I am donning an officially prescribed PPE when dealing with patients.)

To Immunity and Beyond

(I was asked to do a 5-minute health talk for our local congregation. Of course our church is doing virtual service now, so it was on-line using Zoom platform. Here’s what I presented.)

In this time of pandemic scare, we can wear a mask to prevent the virus from entering our system. In the hospital where we have confirmed or suspected cases of COVID-19, besides mask, we also don gown, eye goggles, and gloves. But what happen if the virus breaks through these barriers and invades our body? Since we really don’t have good medicine to fight the virus, we have to rely on our immune system to fight it.

How can we then boost our immune system? Here are some basic recommendations that we all can do. Let’s talk about the NEWSTART.

N– nutrition. That means eating the right kind of foods. Scientific and medical studies have supported that eating vegetables and fruits can improve our immune system and of course our health in general.

The more colorful the fruit and vegetables – like red, purple, yellow, green -the better, which means they have more anti-oxidants. Antioxidants help repair damaged cells and tissues. Vitamins are antioxidants.

There’s some pilot studies that they are giving mega-doses of Vit. C intravenously in COVID-19 patients. For us, we don’t need Vit. C intravenously, just eat the whole orange or some strawberries. That will taste better too.

There’s also some data that N-acetylcysteine (NAC) helps boost our immune system. NAC is needed for our body to manufacture gluthathione which is a premier antioxidant. NAC is found in legumes, like lentils, beans and peas. You can get NAC supplement in stores too.

E– exercise. Now that it is not too cold outside, go for a walk. Use common sense though and follow the recommended social distancing. Still practice the 6 feet distance from the crowd or don’t walk in a crowded area. But we are in Iowa, we have lots of open fields to exercise. 30-60 minutes of moderate vigorous exercise can release extra immune cells into the system. Exercise will make you look good too.

W– water. The best and the only hydrating fluid you really need. Our body is about 60% water. The brain 70% water. So if they call you airhead, that’s bad. Waterhead? That’s fine. We constantly lose water in our sweat, urine, even through our breath. We lose more water when we have a fever. When we fight an infection, we need to be properly hydrated. Many of our systems needs adequate water to be functioning properly, including our immune system. It is recommended to drink 2 liters of water a day, roughly 8 of 8-ounce glass of water.

S– sunshine. The sun rays can boost our immune system. Besides helping us produce Vit. D, the sunshine can also kill germs. That’s why we place that stinky shoes under the sun to kill the germs and the smell. OK, you don’t have to give that look to your family member, just tell them nicely – how about let’s go out in the sun.

T– temperance. In other words self control. I don’t have to tell you that smoking and alcoholic drinks can be detrimental to our health. As you can surmise, smokers are more susceptible to lung infection.

A– air. Fresh air. Stale air has more CO2 content. We need to replenish the stale air inside our home. Go ahead open the windows. Or go outside and breathe in fresh Iowa air. I hope you’re not near a cattle or pig farm. Or not near somebody who is coughing. Oxygen which in air of course is essential not only for the immune system but for us to live. Practice taking deep breaths. Better yet exercise and so you’ll breathe deeply.

R– rest. We need to have adequate rest or sleep. It is recommended that an adult person sleeps 7-8 hours a night. I know many of us are not getting that. Teenagers who think they don’t need sleep, actually needs 8-9 hours of sleep. Younger kids even need longer hours. Sleep deprivation can weaken our immune system.

T– trust in God. Many scientific studies have shown that people who believe in a higher power, recover faster when they are sick. But we don’t need medical or scientific studies to tell us that. We know that our God is bigger than our world’s problem.

There’s a story in the news about an atheist Italian doctor, and with what’s going on in Italy, he became a believer in God. As the saying goes, there’s no atheist in a fox hole. It’s important that in times like these that we put our trust to the One who is still in control.

Stay safe and healthy everyone.

**********

PS: To get a glimpse of how our immune system fights a virus, you can read my previous post, “A Battle Within,” (read here).

(*image from astroyard.com)

Fearless

I am fearless. But that’s not true. It’s not that I’m scared of spiders or cockroaches. It’s more than that.

I think we all know that we are in a middle of a war. The casualties from this COVID-19 pandemic continues to rise and it is devastating. More devastating are the news that healthcare frontliners are becoming casualties themselves. The news of doctors – from China, Italy, France, Indonesia, Philippines and more – dying from getting infected with the novel corona virus from patients they are trying to save, sends shivers to my spine.

I know there are risks from my chosen profession. From being overworked and being sleep deprived to being cursed by patients and being sued, that goes with the territory of our duties. I can live with that. But to risk your own life from contracting a possible deadly disease and even worse, to endanger your own family from passing on the illness at home makes me afraid. Very afraid.

For those people who are not taking this pandemic seriously and continues to party or not follow the recommended social distancing and community quarantine, or for those who think they are strong and invincible, please think again. If it’s not you who would be severely affected, it may be someone that you love that could suffer, because of your foolish actions.

Today, I came face to face with only my mask in between, with this deadly disease in our ICU. As I place an endotracheal tube to the patient’s passageways to hook her to a ventilator, I can only pray that my personal protective gear will be enough shield from this invisible enemy. Though I pray even more that heaven’s hand will be my shield.

I know this is only the beginning of my daily battle and confrontation with this foe. And it is expected that the worse is yet to come.

Fearless or not, I swore an oath to do this job. So help me God.

(*photo taken at Jardin du Palais Royal)