This pulmonary physician has a message for you [PODCAST]

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“To the people who say that wearing a mask perpetuates the conspiracy:

Tell that to the health care workers who have put their lives at risk to face firsthand an unknown disease. Tell that to the families of frontline workers who have contracted and succumbed to COVID-19 while their loved ones save everyone else.

To the people who say that COVID-19 does not exist; that COVID-19 is just another cold or flu:

Tell that to the families who did not have the opportunity to hold the hands of their loved ones as they passed; the families that had to say goodbye to their loved ones through a video chat or a phone call; the families who never dreamed that when they dropped their mothers, fathers, spouses, and siblings off at the ER, the next time they’d see them would be in a casket.”

Fady Youssef is a pulmonary and critical care physician.

He shares his story and discusses his KevinMD article, “A frontline physician has a message for you.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Fady Youssef. He is a pulmonary and critical care physician, and he wrote the KevinMD article “A frontline physician has a message for you.” Fady, welcome to the show.

Fady Youssef: Thanks so much for having me, Kevin.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Fady Youssef: Yeah, absolutely. I grew up in Egypt. My father was a pediatrician, so medicine was always a big part of me growing up. I actually got critically ill once in high school, and that kind of sealed my fate into pursuing a career in medicine. I started medical school in Egypt, and my parents decided to make the difficult decision of uprooting myself and my sister and moving to the United States. I re-pursued my passion for medicine: undergrad, medical school. I recently finished my pulmonary critical care fellowship two or three years ago, and I currently practice in Southern California in a large teaching community hospital.

Kevin Pho: So we’re speaking in the middle of September currently. How has the pandemic affected you and your practice?

Fady Youssef: In multiple, multiple ways. I was just looking back at the article. When I submitted it, it was back in July, and it feels like it was ages and ages ago. I think time has been going by very, very fast. Currently the numbers are going down, so things are somewhat normalizing, giving us a little bit of time to get ready for the flu season and a likely resurgence of COVID.

Kevin Pho: So let’s talk about your article, “A frontline physician has a message for you.” For those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Fady Youssef: Yeah, absolutely. I think it was kind of a cathartic experience for me, going through the pandemic and seeing how things are being portrayed in the media. It felt like there were two different experiences being had: one that physicians, nurses, respiratory therapists, and all the health care workers are experiencing, and one that’s being portrayed in the media. And so I wanted to express my views to those who likely disagree with me. I normally keep my opinions to myself. I don’t like to engage in unnecessary political debate or such, but my goal is just to share how the pandemic is being felt from the belly of the beast.

My experience centered around being in the intensive care unit as the pandemic was unfolding, and there were two big points that I wanted to express. One is one of the difficulties and the differences in this pandemic. In critical care, we’re used to seeing patients usually when they’re very, very sick, and the interactions are short and intense. With COVID, what we’re experiencing is that we have patients in the ICU sometimes for weeks, and you get to know them, know their families, and know their stories, and it makes the loss that much harder because you’ve invested a lot of time. I have a lot of respect for our oncologists, because they do this on a daily basis. In critical care, we are usually shielded from it just by the nature of critical illness, but COVID is a little different.

So one of the things I thought about is the families of patients that we lost and how they would feel when they would turn on the TV and listen to somebody talking about the pandemic as a hoax or just another cold. I think that adds insult to injury. There is a significant amount of human suffering that this pandemic has exacted on its victims, and its victims are not just the patients in the hospitals but those around them. One of the difficulties that we encounter is when you have somebody in the hospital for three, four, or five weeks, and we have limited visitation policies, these patients are isolated from their families, friends, and loved ones. In some cases, they unfortunately succumb to their disease, and they never get to see their loved ones again. And so that’s very difficult.

I think the other point that inspired me, and I may be in the minority on this: Around the time the pandemic was picking up, signs around hospitals all around me started calling health care workers heroes. I think it’s a nice sentiment, but my take on it is that I think of a hero as somebody who walks into a burning building and walks out unscathed. I don’t think in medicine we’re that. I think we are scathed by what we do, emotionally and physically. My feeling and sentiment is, if you think we’re heroes, I think physicians, nurses, and respiratory therapists were heroes before the pandemic and will be after, because we encounter many, many of those difficulties on a daily basis, but now it’s just under the microscope because of the pandemic.

And the other thing that I thought was that this energy would be much better if it was applied toward ensuring that health care workers have appropriate PPE and making sure they feel safe and comfortable, so they can provide for their families, go home, and keep their families safe. And if you think a health care worker is a hero, then strictly adhere to public guidance, even if it doesn’t fit with what you think should be done.

Kevin Pho: Sure, that’s well said. So have you ever actually engaged with someone who thought that the pandemic was a hoax, whether in real life or on social media? And if you did, what was your reaction, and how did you engage them?

Fady Youssef: Yeah, I stay away from social media, because I’m more of an observer rather than a participant in social media. But I have friends and close family who did not share my views about the pandemic, and I tried to share my experience and what we see in the hospital. One of the reasons I ended up writing the piece is that a lot of people did not grasp the magnitude of suffering that hundreds of thousands of people have had to deal with because of the pandemic. And I found that when we interact on a human level, rather than debating and arguing (some people are talking about case fatality rates who did not know what case fatality rates were a couple of weeks ago, and so debating and arguing about those minutiae did not lead anywhere), talking about the human suffering that’s happening right then and there seemed to go further.

Kevin Pho: So why don’t you paint a picture for us? Because there may be some people listening to this podcast who may not be taking the pandemic as seriously as they should. Can you paint a picture for us and tell me why they should be worried?

Fady Youssef: Absolutely. It’s by virtue of what I do. I’m a critical care physician, a pulmonologist, so I usually see cases that are severe. And one of the things that I think is puzzling to a lot of us is knowing who’s going to get severe COVID, and we don’t know. So I’ll give you an example of an average patient and how they progress. A middle-aged individual, fairly healthy, but maybe a little bit obese, maybe a little bit of diabetes, comes to the hospital short of breath. He’s in the hospital for a couple of days, then he goes home, and then a couple of days later his symptoms come back and worsen. So he gets readmitted, but this time his symptoms are worse than they were before, and he comes to the ICU.

What we’re seeing with COVID is that patients have a significant degree of hypoxia, where their oxygen levels are very low, but they look OK. And so we’re able to give them enough oxygen to keep them alive and interactive. At some point, something happens where we’re no longer able to accommodate them, and so they go from the stage where they’re just on oxygen, watching TV, eating, and talking to their family, to a time where they go on life support and a medically induced coma, with multiple, multiple interventions that we have to do. Unfortunately, our success in getting those patients out of that state is not as high as we would like it to be. I think with appropriate medical therapy we’re able to have a lot of patients recover, but we do lose a good number of patients.

And the other component of what we don’t know is, when those patients recover, what kind of morbidity, what kind of health state they’re going to be in two, three, four, or five years from now. We still don’t know that. So if you look at the example that I painted, somebody who’s fairly healthy, an active member of society, working, taking care of family, then suddenly gets COVID from a social event or a gathering that they did not think too much about. Then four or five weeks in a hospital, alone by themselves. Interaction is mainly with nurses and physicians who are behind masks, goggles, PAPRs, and gowns and wearing gloves. Family is on FaceTime. And then they go into the critical illness, where they’re no longer interacting with their loved ones.

One of the things that I think I put in the chart and in my write-up was that I’ve had this interaction with several family members. When we call them and let them know that unfortunately their loved one passed away and there’s nothing else that we could do, they share, “The last time I saw them was X number of weeks ago, because I tried to quarantine to protect them and protect myself, and I didn’t get a chance to say goodbye.” And I don’t know how many of us who are just learning about the pandemic from watching the news are getting the degree of how severe this is and how catastrophic it is to those families that go through it.

Kevin Pho: Now, what are some of the long-term morbidity effects that you’re seeing from COVID?

Fady Youssef: It’s not well delineated so far, but I can tell you what we’re seeing right now already is that patients who survive have some degree of lung damage. So a lot of patients, healthy people who did not need any oxygen and were not taking any inhalers, survived COVID, and now they’re requiring oxygen. Some of my patients call asking, “How long am I going to be on oxygen?” Your friends ask, “How long is my loved one going to be on oxygen?” And we’re not sure. The imaging usually lags behind the clinical state, and the imaging is showing some degree of destruction of the lung tissue. And so they have that degree of hypoxia, or lack of oxygen, coughing, and then a lot of fatigue and tiredness. For young, healthy individuals that I know, friends and patients who survived it, it takes them weeks to get back to their baseline. And so if you think of somebody who’s a little older and may have some comorbidities, it takes even longer.

Kevin Pho: We’re talking to Fady Youssef. He’s a pulmonary and critical care physician, and he wrote the KevinMD article “A frontline physician has a message for you.” Fady, I know that with critically ill patients with COVID, we have remdesivir, and we have dexamethasone. But what about the patients who have mild symptoms? Do we have any treatments for outpatient cases of COVID?

Fady Youssef: Not currently, as far as standard-of-care therapies. There are some agents that are in clinical trials to assess those who are not too sick to come into the hospital and get the treatment on an outpatient basis, but nothing that’s recommended as of now. It’s just still in the clinical trial phase.

Kevin Pho: Sure. And from a pulmonary standpoint, do you have any advice that you could give to your primary care clinician colleagues who may be listening to this podcast?

Fady Youssef: I think one of the biggest things that I know we’re all caring about is just making sure we and our teams are safe, and making sure, if you’re in a clinic, that the staff is appropriately protected and patients are appropriately protected. Because that’s one of the difficult things: If somebody’s coming in with COVID-like symptoms, how do you ensure that other patients who may be in the clinic and other staff members who have taken care of them are safe? Sitting and devising a plan to make sure all of us are safe, I think, goes a long way.

Kevin Pho: Sure. And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Fady Youssef: I just hope that as a society we come together and everybody adheres to the strict guidance by our public health advisors, and hopefully we get past this.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Fady Youssef: Thanks so much, Kevin. I appreciate it.

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