Spread the word – Covid isn’t gone.

This story is getting old, but seems like it still needs to be told over and over again. I just admitted a COVID patient who is young (early 30s) and has no medical problems who went from room air to requiring HFNC (remember the equipment I said was running frighteningly LOW in my post last week?!) and is now on the brink of intubation within the 8 hours since I admitted her. This could be you.

So let’s reiterate the points: 1) COVID-19 is not just a “bad flu”, 2) Today I can use an anti-virals, steroids, and other experimental therapies to help COVID-19 patients navigate more safely through their disease course. I didn’t have any of these options 3 months ago. I hope this patient will survive because of these new discoveries. What other tools will we have to fight COVID 3 months from now? Delay getting this disease as long as you can – we will have a better chance to cure you and get you through this terrible disease.

Thanks for listening and spread the word.

Love, Dr. Yang

**Radical art and mural by @austinzart

You’re allowed to be a good person and survive this pandemic.

Every person wants to think they are a good person. But when you willfully defy the good, hard-earned advice from scientists just because you “don’t like” something, you have to question the “good person” goal. People try to bend the rules :“well if I’m outside, talking at the open window-counter inside to the person 2 feet away, it’s ok to not wear a mask right?” People try to have their parties “no matter what,” or because they are simply tired for trying so hard. This is not how it works. We have to follow the evidence. And the evidence says, make no exceptions. Socially distance. Cancel your parties. Wear. A. Damn. Mask.

I can promise you that in no way did your country or anyone else conspire to exacerbate a pandemic just to control you and force you to wear a tiny piece of cloth on your face. Please just wear the mask. If not for you, for all of us. So we can open back up and resume our lives.

Are you a good person? Do you want to be? Prove it. Make the right decision, over and over again. And eventually it will become habit to be kind to others and unselfish in your actions. Habits create lifestyle. And it can be your lifestyle to be a good person AND survive this pandemic.

Love, Dr. Yang

Cartoon by the hilarious @theawkwardyeti

“We’re running low.”

Last week while on service in the hospital, one of the respiratory therapists said: “We are out of High flow nasal cannulas.” This struck fear in my heart. Let me explain what that means and why this is so terrifying. For me, for you, for everyone you know.

In the past 3 weeks, COVID19 admissions in my hospital have risen, and the majority of those patients requiring oxygen, and sometimes intubation, have been between 30-50 years old. For my followers, that’s probably you.

The equipment in which we use to support a person’s oxygenation range from nasal cannula (#1 on the graphic) to intubation (#6). You want to try to avoid #6 at all costs because there are, more often than not, long-term consequences to having a tube placed down your airway for even a few days. And we want to avoid the risk that the tube will never come out at all.

In the graphic, notice that HFNC (high flow nasal cannula) is #4. That means that, because supplies are running low or are out altogether, we are losing one of the most important intermediary steps to supporting patients who cannot breathe without oxygen support. In sum, you are one step closer to intubation and death from COVID-19 without the intermediary step of HFNC.

My hospital has since replenished our stores, but we are still running low. The whole country is running low because we have so many Covid19 patients that are using them. And if infections keep rising at this rate, we may not have one for you or your loved one when you/they are hospitalized, whether with COVID-19 or another illness. This, to someone who wants to be able to save you, is terrifying.

But don’t panic. There is a solution. Save the high flow nasal cannulas. Save your body from being intubated. Wear a mask. Wash your hands. Socially distance!

Thanks for listening and I hope you stay safe and healthy.

Love, Dr. Yang

“Medicine is not a job, it is a calling.”

The other day, I was interviewed by the U.S. News and World report regarding why someone would make the financial decision to become a physician. My best answer was: “You don’t go into medicine to become rich, or famous, and definitely not to be well-rested. You go into medicine because it is a calling.”

12 years ago, I left my law practice to start the long, arduous journey of becoming a physician. Making the decision to leave law (a lucrative path at that!) to pursue medicine was an incredibly difficult one. If I had continued as an IP lawyer, I would be able to retire in the next 5 years, and enjoy a very comfortable retirement. But I would’ve lived only for my own comfort and the accumulation of wealth. But now, I am the person that is there for people on the worst day of their lives, and to me, there is nothing more meaningful.

If you start working as a plumber at 18yo, you will save more for retirement than if you become a doctor. With 12+ years of training, 8 of which you are paying into the system, and another 4+ of residency where you are barely paid enough to cover rent, the numbers don’t add up for doctors. But rationality has little to do with the decision to go into medicine. We make this decision because medicine is a calling. Because you can’t imagine doing anything else other than caring for those who are suffering. Because you have been so close to the human condition that you just want to alleviate other’s suffering. And any other life than that would be unsatisfactory.

I sometimes joke around that if I had stayed in law, I could be relaxing on my yacht on weekends, rather than working extra moonlighting shifts to pay down a mountain of loans. But life isn’t about dying with the most money, it’s about living in alignment with your values with the most meaning. There is a saying: “You may love medicine, but medicine will never love you back.” Whether or not medicine loves me back doesn’t matter to me. Medicine has taught me so much about being a compassionate, selfless, giving, empathetic human. And in that vein, medicine has given me so much than I will ever give to it.

Yes, it’s hard. Yes, it lends meaning to life. Yes, it’s worth it.

“I recognized your voice…it’s the voice of the person who saved my life.”

This week in the hospital, I was caring for a 46yo patient with a bowel obstruction; we’ll call him Edward (changed for privacy). He is strong and brave and never complained.

On my 3rd day on service, I woke up earlier than usual. My patients were especially sick this week, so I got up, put on my scrubs and drove into work as the sun was barely rising. When I got to the hospital, I went straight to Edward’s floor. When I saw him, his abdomen had tripled in size. I immediately called the surgeon, booked an OR, and told him he would need emergent surgery. His bowel was starting to die and if he wasn’t surgically decompressed, he wasn’t going to make it.

After surgery, he was still intubated and transferred to the ICU for recovery. I waited late into the evening for his extubation, but he was still sedated when I left that night.

The next morning, I headed straight for the ICU. I first stopped at his doorway to debrief with his nurse. Edward heard my voice, opened his eyes and lifted his fingers to wave at me. As I entered the room, he picked up his hand for me to hold, with all his tubes attached, and said, “I heard your voice from the door. I knew it was you.”  I responded, “Uh oh. I guess my voice really carries.”

He responded, “No, I’d recognize that voice anywhere. That’s the voice of the person who saved my life.”

After having his abdomen opened and part of his colon cut out, he still made the energy to say thanks. He admitted that he couldn’t have made it much longer. He was thankful I recognized the need to take immediate action.

I don’t often think of myself as someone who saves lives. Most of the time, I help people by diagnosing a serious infection or coordinating surgical, procedural or oncologic care. Often, I’m caring for dying cancer patients, helping to ensure their comfort during transition.

But with Edward, I actually saved his life. I had been thinking about his case all night. He was too brave to admit he was in excruciating pain, but I saw the signs. He thanked me for paying attention, for listening and caring. And that’s all it took. Someone who listened, paid attention and cared.

It is indeed a beautiful day to save a life.

Respect your body and respect others through self-love and compassion

I saw this book on my patient’s bedside table yesterday. She was recently diagnosed with metastatic colorectal cancer. She is 41 years old.

When I pointed out the book, she said that it is helping her accept her circumstances and calm her anxiety. Two months ago, she was living life as usual, and the biggest threat to her life was COVID-19. Now, everything has changed. She has an amazingly positive and compassionate attitude. and all she wants is get out of the hospital and continue her outpatient chemotherapy to give her a few more months to enjoy life with her family.

She is brave and beautiful. And heartbreakingly young. Her presence was an important reminder of how everything can change in a split second. And hopefully gives us a chance to be thankful for our current state of good health and to not take it for granted. Today, you could be fine, tomorrow you could have metastatic cancer or a life-threatening viral illness. Let’s spend our time appreciating what we have in this moment and work towards maintaining it.

She would trade places with you or me in an instant. Let’s respect her and respect the grace with which she is both fighting and accepting her fate by being thankful for our good health and by maintaining it. Respect your body. Wash your hands Respect others. Wear a mask.

It’s the Thich Naht Hanh way of non-harming. Self-love. Compassion.

I’m rooting for her. I hope you are too.
Love, Dr. Yang

Who are you? I’m really asking. Who are you, really?

Who are you? I’m really asking. Who are you, really? We all want to believe that we will be cool as cucumbers when crisis hits. We think we’ll keep our heads on straight and gently land the plane, Captain Sully style, on the Hudson river and calmly instruct our passengers to disembark while you are the last person off, ensuring every other person’s safety before yours. When crisis hits, we are all tested and show our true colors. So here it is. This is your Captain Sully moment. What are your true colors? Will you rise to the occasion? Or scramble around, screaming and shoving people out of your way?

There is no doubt that we are in a crisis. A viral pandemic that has killed almost 300,000 people (and rising) is the definition of a crisis. Maybe it is quieter and more prolonged than watching the flames of a burning house, but let me tell you, my friends, it’s reach is much more prolific.

So what are you doing during this crisis? Are you helping the old lady stand up who tripped and fell and is about the get trampled by the stampede of people? Or are you shoving everyone out of your way to get to the exit sooner? That’s the question you ask yourself when you decide whether or not you wear a mask next time you go out. That’s the same question you are asking yourself when you decide to go to a bar or the gym without a mask.

Let’s be honest. Everyone loves Sully. Everyone wants to be Sully. You can be Sully too. So next time a friend asks you to meet him at a bar or you want to pick up the phone to make that nail appointment … ask yourself, are you a Sully?  What would Sully do? I have a good feeling Sully would decline those invitations. Be a hero. Socially distance. Be a Sully. Wear the mask.

Do your part. Wear a mask to save lives.

This photo is composed of the countless doctors who died from COVID-19 worldwide.

Zoom in. Look at the individual photos. Look at each face, who had a name, a family, and 12+ years of training, to perform the job that ultimately killed them.

I’ll admit it for the first time publicly. I am scared. I get up and go to work each morning to care for patients fighting a myriad of life-threatening illnesses: from metastatic cancer to disseminated bacterial infections to exsanguinous bleeds… to COVID-19 infections. I have never felt as helpless as I do when treating COVID-19 patients. Helpless in helping them and helpless in keeping myself and the staff safe. But we forge ahead, all of us. We show up, physically, mentally and emotionally for you.

I, and thousands of other physicians, nurses, nurse aids, phlebotomists, Xray techs, physical therapists, laboratory workers and so many more, have spent our lives training to help others. It’s time for you to do the same. Help others.

There is a way. There is a BETTER way.

Do you want to contribute? Do your part. Wear a mask. Wash your hands. Distance. That is the only way.

Thanks for listening.
Love, Dr. Yang

Covid is still here.

We know how to slow the spread of the coronavirus. And it’s not rocket science. It’s just plain old, run-of-the-mill, everyday science.

Just because our communities and restaurants are opening back up, *nothing* has changed about this virus or its lethality. It can still kill you just as much as it could in March. Maybe there is a ventilator for you now, but there may not be in a few weeks. And for those of my patients that have recovered, most of them have some kind of long-term organ damage – not just in their lungs, but also in their kidneys and hearts. The best thing to do is to not get it.
There is a consistent set of lessons, from around the world, about how to reduce the transmission, and thus your risk, of contracting COVID-19.

The biggest lessons? *Wear a mask if you’re going to spend time near anybody who is not part of your household. *You should minimize your time in indoor spaces with multiple people. *You should move as many activities as possible outdoors. You should wash your hands frequently. *And you should stay home, away from even your own family members, if you feel sick.* The past six months have repeatedly shown the value of these steps. Countries and regions that have taken them have either avoided outbreaks or beaten them back.  Over the last few weeks, however, the virus has begun spreading across the southern and western U.S., as well as in some other countries. And there’s no real mystery about why.
The single act of wearing a mask will save lives. Others, and probably yours. And while you’re at it, wash your hands and maintain 6 feet of distance from those not in your household.

Unless you want to end up like one of my patients, who is 33 years old, super healthy, athletic, ran and did yoga every day, and 2 months after recovering from COVID19 (and not even needing to be placed on a ventilator), can still hardly walk 2 blocks without becoming short of breath. Wear a mask for her.  Wear a mask for yourself.
Hope this helps and please feel free to share. Love, Dr. Yang

PS: And thanks to @theawkardyeti for the profoundly real and also tragically funny cartoon.