Dr. Valerie Briones-Pryor is the medical director of the hospitalist program of U of L Health. This interview has been edited for length and clarity.
How has COVID-19 changed your life?
“I spend my days on the isolation unit. From the moment I get to the hospital, I go straight to the unit. The only time I leave the unit is to go downstairs to get a cup of coffee, and then I’m right back on the unit. I moved to my office here to the unit. I bring my laptop and work directly here on 6 East in Jewish Hospital. I’m normally in the Heart & Lung building.”
This is a unit where people are COVID positive, but not sick enough for ICU, or they’ve come out of ICU and are getting better on your floor. What kinds of things are you seeing?
“The thing about COVID is, it really has no rhyme or reason. We have seen anywhere from 30-year-olds to 90-year-olds, men and women, folks who have chronic medical problems and folks who have been completely healthy.”
How do you figure out the best treatment when this disease is so new?
“We’re trying of learn from what other countries and states have already done. It’s a case-by-case basis. That’s kind of what medicine is: you tailor it to your patient. ...
“If they’re dehydrated, we give them fluids. If they need oxygen, we give them oxygen. And it’s time. That’s what we’ve really figured out with these patients. Every one of them is on their own timeline.”
Some medicines have gotten a lot of publicity. Does that confuse things? Or because families can’t come to the hospital, are they unlikely to insist you give their mother the latest drug people are talking about?
“It’s frustrating because, before COVID, you knew what to treat patients with. If they had a bacterial pneumonia, you knew what the antibiotics were to give them. If they have heart failure, you know what the treatment is. But COVID, because we don’t know anything about the disease, and things are still experimental, we try something, and then the next day they say, ‘Oh no, we’re going to retract that.’ And it's just so frustrating, because we’re trying to do the right thing for the patient, and we’re trying to give them the best chances, but everything is so experimental. I think maybe a year from now, after we’ve had time to look at what has worked and what didn’t work, then we’ll have a better treatment for COVID. But that’s going to be a year from now, after people have adequately studied it. We are really sometimes flying by the seat of our pants.”
Can you give me an example of a recommendation that you were advised to use, and then a little down the road, they said, don’t use that anymore?
“So, initially they were talking about these Plaquenil (hydroxychloroquine) with azithromycin, and so we did that. There were several studies overseas that showed possible benefit with the use of both Plaquenil and azithromycin. Then all of a sudden they retracted the azithromycin. The people who put the study out about the azithromycin said, ‘Oh, well maybe it didn’t work. Maybe it actually causes more problems.’ And so now we don’t use azithromycin, and unfortunately, then azithromycin went on shortage all over the country. Azithromycin is a great drug that we use for community-acquired pneumonia in the hospital. So we actually ended up putting azithromycin on shortage and having to use other alternatives to treat bacterial pneumonia because we had been using it to try to treat COVID patients.”
I’ve read that a drop in blood oxygen saturation can really be an important sign of trouble.
“That is really the hallmark of what we’ve seen. When they start to deteriorate, it’s usually because of because of the lungs. They start to require a lot of oxygen. They go into acute respiratory distress syndrome. That’s why we’ve really pushed for early intubation on these patients, because the last thing you want to do is intubate them when they’re already doing poorly. ...
“It was amazing when we first opened the unit how quickly some of these patients deteriorated. I think that was the scary part. They would come on the unit, and they looked fine, and then a few hours later you could just see their oxygen requirement increasing, and then suddenly they would crash.”
“The first positive patient we had here at Jewish, he was my age. He was 44 years old. He has no medical problems prior to when he got COVID. He had been in the ICU on a ventilator. When he got off the ventilator and came to us, he would just sit in the bed and try to move his legs to the side of the bed. And on eight liters of oxygen, he would drop his (blood oxygen saturation) into the 70s. (Normal is 95 to 100.) Just from that little movement of his legs — things that we take for granted every day. You know, we shift our legs from side to side and don’t think about it. But when he did that, his oxygen saturation would drop, and he would just have to sit there. And I’m thinking, Oh my gosh! This man is my age. He had no medical problems before this. I mean, this could be me or my husband sitting in this bed doing this. I was so worried about him from day to day. At one point he needed 10 liters of oxygen, but then all of a sudden he just started getting better, and every day we were able to get his oxygen saturation or his oxygen requirement down.”
Has anyone working on your unit contracted Covid?
“As far as my group, nobody in my group has tested positive, and none of the nursing staff that I’ve worked with has. So we’ve been fortunate. I was telling nursing staff, I said, ‘I feel the safest in this unit and the most protected, more than I do outside of this unit.’ And that’s still the case. I feel more protected in the hospital than I do when I go to Kroger.”
Do you take any extra measures to protect your family?
“I have the luxury of showering every day before I leave the hospital. I leave the shoes that I work in all day in my office. I Lysol my office before I walk out of it. They have a can of Lysol sitting outside of my office because that’s the last thing I do before I leave. I share an office with my director. She says this whole room smells like bleach and Lysol.
“I can’t remember the last time I hugged my 6-year-old. It’s probably been four weeks since I’ve touched him, and same with my husband. (Her voice breaks.) And that’s probably, that’s the hardest thing. My husband says that as long as I shower and I don’t touch them, he won’t banish me to another room.
“My husband works for Pepsi. He is completely opposite of me. He used to travel for work, and by the last week of February, Pepsi had already stopped traveling. So he’s been home and he now is the one who teaches our first-grade son every day.
“They’ve got a pretty good routine. One day I was home in the morning a little later I than I usually am. By nine o’clock, my husband had Brandon sitting at the table, he had all of his homework printed out, and had his iPad set up. And my son just went right to it. I’m like, how did you do that? Because that would never happen if that was me. So Matthew and Brandon have a really good routine going, and far be it from me to mess it up.
“In fact, I think they’ve gotten so used to me not being home that that day that I was home until 9:30, I think I messed up their routine.”
What are you most looking forward to when this is all over?
“I would go sit down somewhere and have someone serve me, cause that’s what I need. But honestly, the first thing I’ll do is I’ll go hug my family. I’ll go hug them for a long time. Cause I think we take things like that for granted when you can’t do things like that anymore.
“One patient we had passed away on our unit. Aside from a respiratory therapist that sat with her all night long, she was alone. Her family couldn’t visit. We couldn’t let them visit. And it was heartbreaking, because that’s how she passed away. She had a wonderful family who wanted to be here. I felt for her. It was a Friday afternoon. I knew she was going to pass away over the weekend. I was just standing there with the realization that her family couldn’t come. Her daughter was trying so hard, and I was trying to pull strings as much as I could to get the daughter to be able to come visit, and it wasn’t going to happen. So I had to call the daughter and tell her no. And for me, that was just, that was my breaking point. Because that was when I realized — and it had only been, at the time, two weeks — that I hadn’t hugged my son. I hadn’t hugged my husband. I hadn’t had any physical contact. And one of the nurses came over and hugged me. And that’s what I needed right at that moment. I was crying. All the things we had been preparing for, and all the plans we were creating for a worst-case scenario. And I was spending my nights worrying about what was going to happen on unit. It was just an accumulation of all those feelings in that one moment. And ever since that moment, I feel like I cope with everything better.”
Photo by Mickie Winters
