March 31, 2020

by drplasticpicker

Dr. Plastic Picker knows a lot more about cortisol than the average outpatient pediatrician. I did two years of pediatric endocrine fellowship, and here is the blogpost that explains why I left in good standing https://drplasticpicker.com/covid-19-social-distancing-is-like-bedrest-dr-plastic-picker-understands-but-this-time-you-stay-home-and-i-get-to-do-something/. Cortisol is a stress hormone and is often referred to as almost how doctors in the 1700s would speak about “humours” that would float in the body. This is before we knew about germ theory. It’s somewhat accurate though, because we refer to cortisol in general but to actually get an accurate cortisol level is very difficult. It fluctuates through the day, and to really get an accurate level of one’s cortisol level one has to admit a patient short-term to do an ACTH stimulation test. The cortisol or “stress humors” are running rampant in your body right now if you are in healthcare. In the end of the day, Dr. Plastic Picker is still a middle manager and I’m hearing all about it. I’m calling in the Great Freak Out. Yes, you are all freaking out about COVID-19.

Look at the graph above. It’s one of many COVID-19 epidemiology calculators that are out there. University of Washington, Johns Hopkins, all our armchair epidemiologist have one. Even our own organization has a COVID-19 dashboard where you can look at the spread of COVID-19 in real-time and the county website updates with totals at 4pm everyday.

I feel I’m just about three days ahead of everyone, not that it makes much of a difference. There is one post where I detailed our COVID-19 response as a family. We’ve been social distancing and self quaratining since March 3 https://drplasticpicker.com/covid-19-exhausted-from-trying-to-flattenthecurve-now-i-am-grateful-for-the-rain-and-planted-62-trees/ I have been trying to deploy public health messages when I can. I was freaking out when the projections were 2 million dead. Right now 100,000 to 200,000 does not sound that bad. Morbid humour to get us through the dark times, I know. The graph below does look like that for California, the curve is flattening more in southern california than other regions. We will all watch anxiously over the next few weeks. No matter what it is going to be bad, but not as bad as 2 million dead humans. At this point I am fairly confident that I will not be called in to intubate anyone, especially since the last time I intubated anyone was more than 14 years ago during my medical school anesthesia rotation. So please continue to #stayhome, #flattenthecurve, wash your hands, and I would personally wear a mask in the grocery store. Trust me, there is a funny meme about #stayhome if you don’t want a gynecoloist to intubate you. You definitely don’t want an outpatient pediatrician to intubate you. I can bag-mask very well though!

But the collateral damage has been the emormous amounts of cortisol, those “stress humors,” that are circulating around your body. This is not good. Cortisol and generally stress increases your risk for cardiovascular disease and osteoporosis/bone density. Even lapsed endocrine fellows always think about your bone density. But the collateral of the collateral damage is that as doctors and nurses while we are having our Great Freak Out, we are freaking out all those that we supervise and our patients. It’s like what the airline stewardess tells you, put on your own oxygen first and then you can help others breathe.

I understand everyone’s Great Freak Out, because I already had my Freak Out. I have three anesthesia masks and 10 viral/bacterial filters that make a pretty good reusable respirator. I’m glad I have it, but actually it is fairly difficult to breath with. I tried to wear it in the house and felt like I wanted to pass out. I also have 25 reusable washable fabric facemasks, that have carbon filters in it. My amazing sister sewed them for me https://www.lifeatanchor.com/, when I was in my second iteration of the Great Freak Out. They are more breathable than the anesthesia mask respirators, but still hot to wear. I also ordered 500 surgical masks from a pediatrician friend for our staff just in case. And on and on and on. If I told you all the PPE I’m been trying to get due to the Great Freak Out, I would be embarassed to continue in detail. But anyway, that stage is done. It’s important to be prepared, but let’s refocus on our mental health.

Oh, wait – let’s do a fun paragraph. Let me tell you how your friendly outpatient pediatric office that is doing mostly telephone appointments is freaking out. Please keep in mind, we are not on the front-lines. I have anesthesia friends and adult ED friends, that are at high risk for COVID-19 due to their line of work. We are sitting at empty outpatient pedaitric clinics. Dr. Plastic Picker closed our lunchroom and coffee pot in our office. I love communal eating, but it’s a fomite risk. Than Dr. Dear Friend brought in Costco muffins in an common plastic clamshell container. You remember Dr. Dear Friend? She is the best clinic buddy ever and been through this Dr. Plastic Picker journey with me https://drplasticpicker.com/drplasticpicker-goes-to-the-aap-national-conference-in-new-orleans-and-tries-to-use-less-plastic/ I saw those muffins mostly uneaten because the staff knew I closed down the lunchroom, and I said semi-accusingly to her, “Did you bring those muffins??!!! I told you the lunchroom is closed!” Her big puppy eyes looked so sad. I felt really bad afterwards. She was trying to feed the staff as her way of caring for them, but I just imagined COVID-19 going down their gullets because there is some thought of COVID-19 fecal-oral transmission. We had our mutual freak-out. Then there is another pediatrician friend who is visible losing weight from all this stress, and someone else who is reporting every single kid with a runny nose to management. How in the world did this possible COVID-19 kid get through? After being in management for almost 3 years, there is no way to make fail-proof work flows. They will get through. And they are patients and we just do the best we can.

My dear friend RN Plasticpicker gets the brunt of this, because she is true management. She has been there for all of our office beach cleanups with her two children https://drplasticpicker.com/feb-office-beach-clean-up-final-results/. She gets to hear everyone freaking out to her, and then people who are freaking out when they see doctors freaking out. I asked her how she was doing. At home her son is climbing into a large cardboard box and isolating himself in this semi-fort due to COVID-19. He was already a germophobe and now this has skyrocketed his anxiety. How was RN Plasticpicker dealing with this? “This weekend I really tried to center myself because I can’t think clearly if I am stressed out. It’s my daily goal to stay calm.” I originally told her I was going to write a post to help her, but really she is the one who can help us. Remember her words, you can’t think clearly if you are stressed out. Stay calm. It’s a different way for everyone. Here are some resources I did want to provide.

1. Free Headspace Subscription: “Free Headspace subscriptions to US healthcare providers working in public health settings. Our healthcare system is facing immense pressure amid the COVID-19 outbreak, and we’re seeing incredible stress, anxiety and burnout among healthcare workers, who are on the front lines of this crisis. If you work in healthcare or know someone that does, please visit or share this link with instructions on how to claim your free subscription through the end of 2020.” https://www.linkedin.com/pulse/weathering-storm-helping-world-curb-rising-stress-anxiety-pierson/?trackingId=oSdFEhDwQSK0UnDr11UPUA%3D%3D&fbclid=IwAR3zpZN3u8uC5MiAfhFjoFPclviwdrJ14m1jH10MAK9JS22zOKWI7FyYcF4
2. Fantastic Article About the COVID-19 Anxiety as an Expression of Grief. “Yes, we’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level. ” https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief?fbclid=IwAR2NpMe5VtEb1v0XuVmWZkXCiMSIvHeUsInZlKbaStDzEb6PlM3sXUEiHKs
3. Distracting Oneself: I’ve written mutliple times about having been on bedrest twice and this has similarities to COVID-19 social distancing. Distracting oneself is a real way to get through this. I think I watched multiple seasons of Law and Order during bedrest. Right now I’m binge watching Star Trek. It’s really really good and so distracting. You can distract yourself by trying to help the environment, check out this past blogpost “Covid-19: Five Things You Can Do for the Environment Whiel You are Social Distancing Staying Home.” https://drplasticpicker.com/covid-19-five-things-you-can-do-for-the-environment-while-you-are-social-distancing-staying-home/
4. Keeping A Schedule and Having Something To Look Forward to at the End of the Day: I am blogging at home and just asked our middle school daughter her suggestions. She is much wiser than her actual age. Her suggestion is to get dressed every day, and to keep a schedule. Also to have something to look forward to every night. For us it has been a family game night, where we do a short card game, pictionary or even scrabble. It’s a time to focus on each other.
5. Resources for Your Kids: This is from one of my psychiatrist friends. Skip the introduction where the child-therapist is going through her own Freak-out and at the end of the webpage she lists 20 Free, Low Prep, and Minimal Supply Activities for Telmental Health With Children. Great with links for activities. https://www.meehanmentalhealth.com/the-playful-therapist-blog/telemental-health-and-children-20-free-minimal-supply-activities?fbclid=IwAR0ObNyhso50JyzysLZjyasPe5kZ9Z9BGxZOcvIWqsf4Q6y9hb2yqfxDJOw I also wrote a post a few weeks back with some resources for kids. Here it is again https://drplasticpicker.com/3-18-2020-five-reasons-to-be-hopeful-this-wednesday/
6. Dr. Dear Friend’s Suggestion: I just talked to Dr. Dear Friend and she has wise words for our readership. She is trying to focus on other people. Trying to exercise and walk more. She is limited her news to 1 hour a day. And after our funny lunch-room Costco muffin episode, she will try to support our nurses nutritionally and emotionally through single-wrapped packaged protein bars. Right now we are not focusing on plastic reduction due to COVID-19.

Well I hope this will help you lower your cortisol, your stress humour. Perhaps you even found this blog about the stress humor, humorous? COVID-19 is your ACTH stimulation stress test to see how high your cortisol can go. Honestly a few of us especially MDs are Cushingnoid these days, and have some steroid induced psychosis. This blog has helped me dampen my stress since blogging and being Dr. Plastic Picker is a huge distraction right now. I definitely do not have steroid induced psychosis nor racing thoughts. Send me any suggestions that you have of how to reduce the Great Freak Out, and help our friends! We will get through this. And remember RN Plasticpicker’s words, try to center yourself. “I can’t think clearly if I am stressed out. It’s my daily goal to stay calm.” That should be all our goal as well to avoid collateral damage to our staff, children and patients. We will call some of our counselors to come talk to the staff soon so people can talk about their feelings, virtually of course and more than six feet away.