Feb. 9, 2021

S1E14: Erik - "A Deployed Doctor Comes Home to Covid"

This week we got to interview Dr. Erik, an anesthesiologist who was deployed in the Middle East when the pandemic broke out last March. His deployment had already come to a close but he was detained for a few more weeks before he was allowed to come back to the States. He's grateful to be reunited with his family again and we spoke and mused about many different topics like healthcare accessibility, Covid bubbles, and the reliability of masks. Because of his medical background, he went into detail about how doctors go through "fit tests" to discover which masks work the best with their face - a protocol we didn't know previously existed! It left us reevaluating the efficacy of the masks we're currently wearing and wondering what we can do to create a tighter seal to prevent this pesky virus from sneaking-up on us again. 


Hi, I'm Caroline Amos. And I'm Raymond mcanally. And we are Fatigued (laughter) Eric, thank you so much for joining us today. How are you doing? I'm doing very well. Thank you for having me. Of course. Could you give us a brief summary of who you are? Okay. I am a Swanee grad. That's how I know Raymond. But afterwards, I went to medical school at the Uniformed Services University, which is a D.O.D. medical school that is kind of the equivalent of the academy like the Air Force, or But it's for medical forces of all four services. After that point, I served as a journey medical officer for a couple of years, and then did a residency in anesthesiology. I've deployed with the Navy to the Middle East, and most recently have transferred to the reserves and now civilian practice in anesthesia. Did you transfer because of the pandemic? No, actually, I had completed my obligated service time and for family reasons, we thought it was a good time to transition over to the civilian side. I was gonna say I was reading in your questionnaire that you were deployed in the Middle East when the pandemic broke out last March? Yeah, that was a very interesting situation. I was deployed before the pandemic started. I deployed with Task Force 515, which is kind of like an emergency response action force in the Middle East. It's a it's a big entity. So by no means were we a major component of it but we were one of their surgical teams to support all of their different operations. And basically, they would fly us out of Bahrain, where we were stationed primarily to wherever we were needed. We went to Iraq for a couple of months, or for about a month or so. And then when we came back, we were about the tail end of our deployment. When the COVID started, it had been going on for a while, but it started to become more and more endemic. across the world. When we first started, it was just in China, we started to kind of see the escalation of phases of quarantining and limitation of life in Bahrain, which is, while it's a Western friendly state, it's still an authoritarian state, like the the ruling party dictates what happens. So things that they said, went, and so we saw this scale up from just mask and sanitation to restaurants closing to pretty much everything shutting down, and you had to have all your food delivered. And because of the nature of our deployment, we were not on the military base, we were out in the community in a in a hotel, because we were highly mobile. So we would come and go, that's where they housed us. So we were kind of isolated from any of the military resources that we had available. So we kind of had to rely on the community has towards the the time when these restrictions really hit we were actually at the end of our deployment, our deployment ended, right around March timeframe, we actually had tickets to fly home, at least kind of emails that we had tickets to come home, when basically all the heavy restrictions hit. And we were stuck there for another, I think three to two to four weeks, because the country was just locked down. What did it look like? being detained for a little bit longer? What were the process? What was the process like getting back into the United States like, well, we were basically constantly on a like, well, it's just gonna be a little bit longer just gonna be a little bit longer. And then at one point, because there the God at large started to halt a whole lot of movements, even though our entity was due to go home at one point they were going considering extending us for an indefinite period of time like they had no end date, because they didn't know when they were going to get other entities to go out there. Oh, wow. But ultimately, that didn't go through. Fortunately for for our team. He was we're ready to come home. Yeah. Yeah, that's gonna be a bit of a shock. You've, you're already in the headspace that you're going to, you're going to see your family soon, you're going to be back stateside. So that definitely wasn't wasn't the highlight of the deployment. I can imagine. Did you encounter anybody that had COVID in your deployment? During my deployment, we didn't do a whole lot of medical care, because we were a contingency force. So we did set up surgical tents in Iraq. And we were ready to receive casualties if they were, but we mainly supported special operations. So they were very good at what they did. And they're very good at not getting hurt. But they also want to know that there's a surgical team within an hour's flight or wherever they're doing whatever they're doing. in Bahrain, we actually don't have a hospital. The military doesn't have a hospital, we have a clinic. So we did have discussions as to, what would we do? If there was a COVID outbreak on the actual base? What sort of services could our team provide? Because we were the only critical care team there, which we kind of had to tell them. We're not really set up to do ICU level care. We're a surgical team. So we were designed to patch people up and then send them to a higher echelon of care, get them to the to the next step. Yeah, exactly. So we kind of internally had discussions about Okay, well, we could intubate people and have them on respirators while we get caught them somewhere else. But even just the amount of medications that you need for keeping someone sedated and comfortable on a on a breathing tube for an extended period of time is not something that we were designed for, you know, they wouldn't basically have to rely on the local hospitals, which they were, they were reasonable hospitals, but we were not going to be able to give them the type of support that they would have liked to if there was a big outbreak in Bahrain. So you get back, you back stateside sometime in in March or early April, beginning of May. So we had like a quarantine period. And that was kind of at the lower timeframe. If you guys kind of recall that Coronavirus seem to get under control. I remember those. Yeah, it was basically exactly that just a couple of weeks. I went back to I was stationed at the time, and they will hospital primary 10. And we started to do cases, kind of more routine cases and they would test people and we would wear all the N95 masks. We kind of had the luxury of not having a lot of the PPE shortages that civilian hospitals faced in the military, because we just had larger stockpiles of it in the different supply chain, given the size of Naval Hospital Bremerton being a smaller facility. It pretty much if you had COVID, you were sent elsewhere, the patient population of that hospital benefits from from youth and health, which is not the case in the civilian world. So most of the people who are there, the average military person is usually between 40s retirees, yes, that can be sicker. But usually, the thing that I've kind of learned more as I've transitioned from the civilian side, or from the military side to the civilian side is access to care makes a huge difference in overall health of an individual. If someone has even if they're an unhealthy individual, they're overweight, they smoke, they kind of don't take care of themselves, if they've had access to consistent and in the military. It's free health care, because it's it's all inclusive in the package. Nice. Yeah, yeah. It's amazing how much healthier an unhealthy individual who's been able to get blood pressure medications from the time they got their diagnosis, get diabetes medications from the time they got diagnosed, lung issues that they get their pulmonary function tests, they get their their pulmonary meds, all of that stuff on a consistent basis. Even as their disease advances, it advances in a much more controlled and a much Slower way than what I've been seeing now more in the civilian side, we have indigent populations who, because they use math, they are homeless, they don't take care of themselves for financial reasons or other reasons, other socio economic reasons. You've got 50 year olds whose hearts are worse than 90 year olds, or sometimes even younger than that, because they've just been kind of ravaged by their diseases. I didn't grow up in a community like that, where I grew up in Tennessee, people went to the doctor to do his reaction. You know, I'm sick, something's horrible. I've got cancer, and this thing is going on. But the only time I see a doctor, and it took me quite a long time in my adult life to to figure out that that was not the way to do it. I remember, I remember my when my dad got cancer. My mom who was a highly educated woman, and you know, she was just speaking from emotion, she said, and we laugh about everything in my Irish family. So preface that for anybody listening. She said, Well, your father went to the doctor, and look what happened to him. And how are you saying that the doctor gave dad cancer? And it hit her what she what she just said? She's like, no, that? Well, it is kind of I think that is what I think we were able to have a conversation about it, because that I mean, my that's the way my family operated. That's the way a lot of people I know still back home. And, and it does have to do with access. Even people who you wouldn't think they drive a nice car, they have a nice house. They can't afford those medical bills with the way they are leveraged either. And so yeah, thank you for bringing that up. Yeah, I mean, speaking as someone that does not have health insurance right now, and didn't have health insurance throughout the duration of my COVID experience. I'm terrified about what's going on inside of me. And I'm only I'm going to turn 28 in two weeks. Like, I shouldn't be worried about what's going on in here. But I am an Am I am I am I gonna go get it checked out? No. Can I afford it? No. So I'm just not going to? Well, you are at least one step ahead of the people who don't worry about what's going on. You're concerned. Well, even Thank you. Even my, my family's big fans of the Marvel Universe. But Chadwick boseman. He recently died of colon cancer. He was from outward appearances in the peak of physical health. Yeah. And just goes to show you that you never know kind of what sort of symptoms he may have been experiencing that he may have been disregarding, or even just had no symptoms. And sometimes, you're dealt crappy cards. If you don't think about it, if health is tertiary, or further down the line, you you might get a nasty surprise one day when you kind of stumble break your leg, and the X ray shows tumors in your bones. And that's why you broke your leg, not because you fell. Going back real quick, because you're the first person with a military background that we've spoken with. Is it just in general, from your experience, whether it be stateside or deployed? Maybe maybe more stateside, the duty do these bases have a natural built bubble? And I know that there's there's family interaction that and people have jobs outside of base. But when this when you got back stateside, did you see bubbles being put into place by the military on the basis that might have helped outbreak levels on base. So what they were doing with some of these medical personnel was they were isolating them for two weeks before the workup and usually the workups. It's a certain period of time that they go out to sea. So maybe they'll go out for a week at a time. So they'll isolate them for two weeks before they'll fly him to the ship. Do the workup, fly him back, isolate him for another two weeks. And so now this one week, evolution became a month long isolation period for and it's not like we have a lot of crnas or anesthesiologists or surgeons just kind of laying around to do All the work, if you think about this guy who's been, who's kind of slotted to work in the hospital has just been kind of cut out of the hospital workload for a month, and multiply that by every other deploying unit. It was a huge, huge resource suck, that all of these COVID protocols have, have caused to the military healthcare system as a whole. And I'm not saying that it was unwarranted, but but just to speak to kind of your bubble. It's like, surgeons, this is what they did to them. And, you know, just kind of, and they were faced some pretty strong language of you will stay at home, or else type of language. But they don't have a whole lot of leverage or control over the rest of the family, who still has to go to the store and get food. If the kids are in daycare, or, or if the spouses work, they're still going out. So you've got this kind of Swiss cheese bubble is Yeah, I would say that they're trying to create with, with some with limited efficacy, because as you saw in the news, they were still ships with COVID outbreaks. And this is why because either you had the person decide, for whatever reason be political or health reasons that this COVID stuff isn't as serious. And I'm just getting put on house arrest for two weeks. So I'm still gonna do whatever I want. I've just got two weeks of free leave from the military. I'm curious to know if you encountered pushback for mask wearing within the military. Did anybody push against that? So yes, and now, the nice thing about a military, the military is the guy in charge says something, you do it, you don't do it. You basically violated a lawful order. And there be consequences. Yeah. Are people bitching about it? Kind of half assing? it? Yeah, there was a lot of that. I think the biggest issue that we've kind of had is we've developed public health policy. During a pandemic, we've basically been seeing the scientific method at work. And people who don't understand how the scientific method works. keep on saying, well, a month ago, you told me not to do this. A month ago, you said this didn't work. Now you say it works. And tomorrow, you're going to tell me something different. So I'm just not gonna do any of it. Yeah, the amount of people who heard for example, we we've heard it quite a bit people saying I thought they told us this was only going to last two weeks. And I'm like, I don't have the soundbite with me, but I'm pretty sure they they said, we're gonna do two weeks of this, and then we're gonna reevaluate. Everybody seems to have selective hearing when it comes to what they want to hear. Yeah, yeah. It's amazing how many people on Facebook and Instagram think that they are the experts on this? The amount of times I've heard someone say, Well, my friend on Facebook said, I, I feel like that's a terrible way to start any sentence these days. Well, my friend on Facebook said, I mean, I feel like the second I hear that I'm like, Well, whatever that person said, I'm just gonna count as a lie. That's not true. Until I'm reading it in a factual source of information. I'm not gonna take anything that your friend on Facebook said, Well, we even debate that now that to me, that's one of the saddest and we can agree on what's a valid source? Yeah, what's, uh, what vetting means or research? Well, there's been a, I like to call it a democratization of facts that you put, you put one fact next to another fact, quote, quote, unquote, facts. You put them in equivalent boxes, and one box is a PhD scientists. The other box is some Yahoo, who has a blog somewhere, you put them on the news right next to each other in equivalent sized boxes. And you debate the issue. And you have, by all by all measures you've equivalent, you created an equivalency between their arguments that this is equal to this, but that should never be the case. In your experience, because you you had told us that even with a higher rate of exposure in these hospitals that you've managed to knock on wood, remain COVID free for you and your family because you do have a family. What is the stress of managing both your job and your career? For your family and and what does that been like? And what, what have you done to be able to sit here today with all that exposure and not have COVID? Well, what are the things that I've been lucky in is that, at least, both with my job itself, and the hospital system that I've been practicing in, is that we've been able to maintain a level of PvP that has allowed us to protect ourselves. Right, they've been able to test patients appropriately. We have COVID operating rooms and COVID wards and COVID protocols that I have been had the luxury of kind of walking into just because of the timeframe when I joined the practice, like I wasn't there for like the really bad kind of trying to figure out what do how do we do this sort of thing, they had already started to figure this stuff out by the time I started. So I've benefited from that. The other thing that I've benefited of is the lower volume of actual COVID positive cases that we've been doing. Like we've been with our good testing, we've cancelled elective cases that can be delayed until the patients are COVID, negative, like all of the more minor procedures, and it's not just to protect us but all of these patients and to incur a great deal of risk by going under anesthesia and having procedures done. If they have COVID. So it's it's both for their benefit and ours. And then that just kind of reduces things down to the cases that have to go. And in those situations, we do have the higher order of the positive pressure, the peppers and the cappers, which are positive pressure, filtration devices that we wear on our heads. And most of us also like to wear that and then 95, and then kind of the extra gowns on top. And that's the first time I've heard those terms of the cappers. And so the capper is a device, it looks like a football helmet. And it's a, it has a face shield, and then they have like a plastic membrane that covers you and seals up around here. And it draws air from the top and blows it out the back through a big hood. That's a filtration device. And then the hopper has the added kind of shoulder drape. So it connects from the helmet here. And it actually drapes and it covers you around here. And it trips around, and then you would wear your mount, either on top or below that. I think ideally, it's supposed to go on top. But a lot of times it's just worn. However you end up putting it on, you're prepared to walk on the moon with that kind of gear on you. Yeah, so that's, that's basically what is the recommended care for COVID positive patients. So for COVID unknown patients, usually it's the end 95, which is the the mask. And one of the ironies about this whole pandemic is back since I've been at several different hospitals in the military beforehand. And part of your intake to every hospital in the past was a respiratory fit test. So that's where they would put lots of different and 95 level masks on you. And they would spray like a little sugar packet around you. And then if you could smell or taste the sugar packet, it wasn't making a good seal. So like this is a huge deal and lots of different types of masks for us and they have like five or six different varieties of masks to help Can you find out what's the best mask for correct for your face? Because everyone's face is a little bit different. Yeah, well that's out the window. So like, which makes me wonder is like so if we cared that much to get because everyone's face is different, that we had to go through this huge process of figuring out which mask works for you. And now we don't even bother like it's like if there's one in the corner like you make that one fit. How protective are these masks on us? Even if it's an N 95 I've never heard any other discussion About that sense, but just the whole. So we used to fit test people. Now it's just whichever one's available? Are we actually getting the benefit from the 95? That we think we are? And are some of these people who get sick in spite of the end? 95? Is it because they weren't fit tested, and it was a face mask that wasn't making a good seal? I just have had a lot of frustration with the things becoming so political over a public health issue, that there's so much so many people are upset about what the government is doing to me. And there's very little of what are we doing to each other? By not engaging in these Public Safety's? That Yes, it's a it's a infringement or, or inconvenience to our lives to do this, and some for some people where their life is getting affected? Yeah, it's definitely more so than just an inconvenience, but it seems like we're getting lost into this mimimi culture, where it's how is this affecting me, but how is what we're doing affecting all the people that we not even necessarily our friends, but like the person down the road, who, or the, in your case, the person who used the restroom before you. It wasn't his intention to give you COVID or her intention to give you COVID it was completely inconsequential. But the impact that it had on on your life was real. If you kind of take it to an a completely academic exercise. If everyone would have just gone inside their house, and hunker down for four weeks, and not done anything else, the pandemic would have ended in four weeks. Yeah. And it would have had a had a far less economic impact. Yeah. But we chose not to. And I'm not saying that that was a viable option at the time, but kind of as a purely academic argument like that would have caused pain. And that would have been inconvenient. But is put it have been less painful and less inconvenient than what we've experienced since I, I could not agree with you more. And that was really well said, I've been trying to articulate versions of this myself. Most recently, I was trying to find a way to encapsulate the feeling that you know, in our cultural narrative, as Americans, we're very, we like to talk about individual sacrifice for our own personal gain, right. So, for example, I've picked myself up by my own bootstraps and created a company from scratch. We we love those narratives, yet. We're not into individual sacrifice for collective gain, apparently, yeah. And it's always an expensive lesson to learn when we learned it the hard way. A good example of that was the fact that all the deregulation that happened in California with the energy that ended up costing everyone in California, tons of money, because the deregulation of the energy market led to all of these private companies profiting off of increasing, decreasing supply of energy and increasing the cost per unit. And in the end, they they hung the governor out to dry for it, but it was not a democratic policy that that they were trying to push. It was a compromise policy. And they learned the hard way that perhaps sometimes regulations are good. Yeah. Well, that instinct to hang somebody something to dry. I think we're dealing with that right now with COVID. Like you, like you artfully said earlier. And then we've heard in a number of different interviews is that when you look at this from a rational standpoint, it can be simultaneously horrible for the economy horrible for for individual interests, and the right thing to do to shut things down. Yet we were going to blame ourselves. Politicians you said it would have happened in the Seattle area, depending on who you talk to the mask. And social distancing mandates locked down mandate to be there been too severe or not enough. We like to point that finger. When really we're dealing with a non sentient virus it is doing what viruses do. Yeah. It doesn't care what our intentions are, it doesn't care what our politics are, it's gonna do its thing. And so we're combating something, but trying to put some sort of human logic to it that does not exist. And I think it comes from that instinct of needing a scapegoat. Well, even going beyond this pandemic, the bigger question that I think we should start to broach as we crawl out of this pandemic, is, this isn't going to be the last pandemic, that's going to happen. You know, we've been a little lucky in Yes, this has been kind of deadly, but it's been kind of deadly. It could very easily if you go back to kind of the classic movies, the medical movies, outbreak, contagion, all those movies that have now started to get a little bit more. Yeah, they're really. But you get a really bad flu, you get a hemorrhagic fever. And it'll get it'll get really ugly. And if we don't learn the lessons of how, what has worked now and what has not worked now, it's, we're not going to Farewell, because we're not faring great. In a slightly pathogenetic virus. Imagine how we're gonna fare in a very pathogenetic vices virus. I know. Yeah, we have a lot of work to do. And I'm thanks to travel convenience, and, and everything we're, we're whether we want to admit it or not, we're global society, especially in terms of health. This is a prime example that I really hope we learned that from. So I know we're we're kind of at the end and a no Caroline wants to ask her off, wrap up question. I you know, I just I love anything on a positive note, as positive as we can get in a deadly pandemic discussion. And my question for you is what gives you hope right now? Well, the vaccines definitely give me hope. I was lucky in that I was able to get the vaccine very early on Congrats. Yeah, you've had both doses him I've had both doses, our health care system was very good. And that was in one of the top tiers given my specialty. As more virus vaccines, options become available, the Johnson and Johnson one now on top of the Madonna, in the other mRNA one, and I think there's one other one that's in phase three trials, that isn't quite there yet. But the more that we are able to develop these, even if there are strains that escape, it's it's definitely a starting point at being able to get us back to some degree of normalcy. Hopefully, people will take the vaccine. I know there's, that's becoming a new issue to people trusting the vaccine. But if nothing else, reducing the amount of people that will have life threatening responses to the vaccine, I'm sorry, to the virus with the vaccine is great. My kids just restarted school, in person or Yeah. So that's seeing them how excited they are to interact with other kids is giving me hope, because I know how much they've they've missed having other individuals their own age with their own with similar interests available to them aside from their sisters. So that gives me hope, and that at least in our district, they're being very serious as to how they're approaching the reduction of density of classrooms and how they're approaching cleaning and sanitation and the social distancing. My hope is that as the political climate hopefully starts to change to a more science based one on a national level, that the state won't be hung out to dry. And they will get the resources that they that they are able to, to continue these sort of trends because I know At least my school district is is reasonably affluent. There are lots of other places that are less so. And I imagine they're starting out at a at a much higher disadvantage than our schools are. But they're still going to have to fight the same fight. Yeah, my heart goes out to the administrators who who know what needs to be done, who see what, how the school could reopen, and just simply are not funded well enough to do it at all. Well, I hope that I can see you sometime soon. And, you know, hang out in person so we can celebrate being on the other side of this. Yeah. Erica said it's so nice to meet you. Thank you so much for sharing all that you shared with us today. Yeah, thank you for having me. It's been fun. Yeah. Hey, this is Caroline and Raymond. We wanted to say thank you for listening to this episode, and let you know that there will be more every week from now until we get fatigued by it. We're building out this podcast as we go. So stay tuned for improvements on our website, our graphics and video clips and just everything else. The time was now to tell our stories. So we're learning as we go. We really do appreciate your interest in support we truly hope and the personal stories that come out in each episode can help build a better understanding of COVID-19 how it spreads and how it affects us. If you have a story or a question that you'd like us to address in an episode. please email us at fatigued podcast@gmail.com that's fa t igpu ed podcast@gmail.com. Thanks for listening. Bye