Apr 21, 2020
In today's podcast we talk with Zara Cooper, Rachelle Bernacki, and Ricky Leiter about the state of COVID at the Brigham and Women's hospital and Dana Farber Cancer Center in Boston. While they have flattened the curve somewhat in Boston, they're still seeing huge numbers of seriously ill Covid patients in Massachusetts. They have 143 out of their ~1000 bed hospital filled with COVID19 patients, including 78 Covid patients in ICU, many of which are followed by palliative care. This has resulted in the need to drastically restructure the palliative care team, including: - Embedding palliative care in the ED. They quickly found that if they waited for consults, they got not calls, and had to proactively go out and find consults in the ED. By demonstrating their usefulness, acceptance has increased. - Embedding palliative care in the ICU. These experiences are hard. Zara Cooper, who works as an intensivist in the ICU (as well as surgeon, as well as palliative care doc, as well as researcher, as well as superwoman) relates the ethical dilemmas and moral distress associated with providing care in the ICU. Ricky Leiter talks about how hard it is emotionally for the palliative care teams, how the cadence of our usually palliative care consult becomes compressed in these cases, and how their teams are dealing with the challenges of prognostic uncertainty, video meetings, and not being able to see patients in person. - Their first instinct was to protect the fellows from COVID19 patients. The fellows rebelled. They wanted to be involved, and now they are, and are functioning as an integral part of the response. All of this and more, including forgiving yourself if due to these extreme circumstances you can't give "gold star" palliative care, but maybe "bronze star" is enough? For links to the Pallicovid.app, Covid Protocols, and the Ariadne Labs COVID Response Toolkit, please visit our Covid page at https://www.geripal.org/p/covid.html or our website at GeriPal.org. -@AlexSmithMD