SGIM Forum

From the Editor

You Can’t Go Home Again

“When things are at their worst is when you will see the good, the bad, and the ugly. Where people are under pressure you see like the true essence will come out and some people will break your heart, people who you expected to react differently will just break your heart and disappoint you but then other people who you expected nothing from will show you a strength and a resilience that just is an inspiration.”

—Andrew Cuomo, Governor of the State of New York, Daily COVID Briefing, Easter Sunday, April 12, 2020

It’s hard to write my penultimate editorial without mentioning the COVID pandemic. I tried. I just couldn’t get past the first paragraph. It’s all different now. It will not be the same again. Not in three months, not in one year, never. Relationships are different. Roles are different. I am different.

Front line staff have changed. This story has been and always will be about the patients, the healthcare team, and the front line staff—in the EDs, the inpatient wards, ICU, and primary and urgent care. Patients placed their trust in us to support, treat, and, in too many cases, ease their suffering. It’s not like we’ve never felt helpless when we confronted a disease we couldn’t treat or pivoted to the role of palliative care provider. But the heavy toll came when it happened multiple times per day, seven days a week, and in the span of 6-8 weeks. The wave came hard and stayed. We stood our ground. The strength and resilience that the governor referred to on Easter Sunday was in full view these past few months. No one broke my heart. All were an inspiration.

We know more about the virus today than we did when this all started, more than we did last month, more last week, more yesterday but not nearly as much about it as tomorrow. New information came at us like drinking from the proverbial fire hose:

  • Hydroxychloroquine is a game changer!—No, it’s not!
  • Place them prone! Give them zinc! Vitamin C!
  • They clot!! Anti-coagulate them!
  • You want to give them what!!??

How we do research has changed. At Northwell, we stood up clinical trials from concept to recruitment in a matter weeks. We organized the data such that we can perform rapid queries to answer clinically impactful questions for frontline staff to use. We literally ran to the wards to share the latest info so that front line caregivers could change their management. It’s been exhausting but exhilarating.

The banners, lining the halls to the employee health entrance and corridors of my hospital, still call out to the heroes in the ED, the ICUs, and on 9 Monti, 7 Tower, 5 Katz, etc. In the absence of baseball, it is reminiscent of a mid-summer game at Citi Field (we are, of course, in Queens). I wonder which healthcare hero is going to win rookie of the year, MVP, and the most saves? Many have known the heart break of losing. The song Here Comes the Sun by the Beatles is playing more often now when a patient is extubated.

Somewhere between the last month’s and this month’s issues we felt compelled to release an additional SGIM Forum simply referred to as “COVID-19”. People needed to write and express themselves and we felt Forum was the perfect venue in which to do it. I hope you find it to be a source of inspiration, hope, and information.

This month’s issue tries to get back to the work we do as academic internists. Drs. Clark, Sims, Grenn, and Fryoux fittingly provide us with four thoughtful pieces on dealing with death. Dr. Grossniklaus discusses how to teach procedures through medical procedure services integrated into residency electives. SGIM President Dr. Jean Kutner also provides a framework looking toward this uncertain and complex future in her monthly column.

All the best and be safe!


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