“OK, Let’s roll…and hey! let’s be careful out there.”
-Sgt. Phil Esterhaus, played by Michael Conrad, Hill Street Blues

At the morning roll call, Sgt Phil outlined the priorities for the next shift. He was briefing a group of police officers in the fictional Hill Street precinct on the challenges they would face. Like a coach, he fired them up, and like a benevolent parent, he reminded them to take care of themselves and each other.

The last few months have given all of us the opportunity to both encourage and protect our colleagues. Health care providers that choose to be in direct patient care do so with the understanding that they are provided an incredible opportunity to touch and heal their fellow human. At the same time, the closeness can be dangerous, both physically and emotionally.

How do we look to the past to gain understanding going forward? How do we protect our workers while meeting our moral obligation to our patients? How do we grow comfortable with the concept that the world will never be risk-free?

I was a Surgery resident during the 1980s, newly married, and with a child on the way. We were seeing increasing numbers of IV drug abusers and young gay men with a puzzling array of symptoms, including atypical lung findings. Open lung biopsy was the standard of care. I had already been exposed to Hepatitis from a needle stick, and at that point, we didn’t know HIV was transmitted. But we adapted – we limited the use of blades, employed staplers instead of sutures, and developed clear cut protocols for how instruments were passed. We recognized that with the privilege of caring for patients, we accepted and, in fact, embraced the management of risk. Patient care improved because we took that challenge.

COVID-19 feels strangely similar and yet also quite different. Early on, we didn’t fully understand transmission, optimal treatment, or slope of the curve. We responded based on the horrors we saw in New York City, moving rapidly to remote work, throttling back on elective surgeries, and appropriately protecting the payroll of employees. We paid whatever was necessary to have basic levels of PPE. Sadly, early on, some of our colleagues contracted the disease and died.

But we didn’t stop caring for our patients.

Over time, and with understanding, we realized that masking, social distancing and rational judicious use of testing would allow us to open services to all in need. The nosocomial transmission was rare. We saw that deferring care for non-COVID-19 patients led to the progression of the disease and poorer outcomes. We needed to bring the staff back and help them feel safe.

Transparency, along with frequent communication of new data and protocols are vital. While our colleagues can be given the option to work from home when possible, they must also be required to come to work when it is safe, and their skills are needed on site. As leaders, we should be seen walking the floors, shoulder to shoulder with our staff. We need to get out the message and demonstrate with our behavior that risk can be managed, even if never eliminated. Living with risk is living life.

“It is not because things are difficult that we dare not to venture. It’s because we dare not to venture that they are difficult.” -Seneca

Be safe – but don’t be scared.

 

Harry C. Sax, MD, FACHE
Regent for California – Southern
harry.sax@cshs.org

 

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