by Elizabeth Hofheinz, M.P.H., M.Ed., March 25, 2020
The surgical profession confers many joys and benefits, one of which is to feel a sense of control in your daily life. That control has been stripped away from most of them, including one orthopedic spine surgeon in California. This is the very personal story that Dr. Greg Mundis, who works at Scripps Clinic in San Diego, is living.
“My dad, who lives in Missouri, started feeling ill on Thursday, March 12. He felt a lot of malaise and aches and on Friday he saw his PCP. At that point Scripps clinic was already considering canceling elective surgery. He tested negative for the flu, spiked fevers on Saturday, but was still told by his doctors in Missouri to stay home. By Monday morning my mom said he was not making sense and couldn’t put his thoughts together. He did a drive through COVID19 test that day and by the time they got home the ambulance basically met them there and took him to the ER. He arrived at the ward around 3 and was transferred to the ICU and on a ventilator by 4:00.”
Two days later Dr. Mundis’ mother spiked a fever.
“She was tested for COVID19 on the 11th and was started on hydroxychloroquine. On Friday the 13th the test returned positive and was admitted into the hospital Friday night secondary to increased symptoms and EKG changes (which can happen with hydroxychloroquine). As of today, March 25, she has been discharged home with continued mild symptoms.”
Describing the complexity of caring for a patient with COVID19, he states, “It takes the nurse 5 to 7 minutes to put on all their PPE before they enter the room with my dad. They usually remain with him from about 30-40 minutes in an attempt to get as much as possible done during one visit. He has to be kept hydrated with IVs, there is a feeding tube, he has to be moved left to right to avoid bed ulcers, his endotracheal tube has to be managed to make sure his airway is secured, urine output must be tracked, he must be bathed, and his meds must be administered.”
“The other nurse must stand watch outside the room to ensure that the nurse inside the room is alright. If/when the inside nurse needs additional supplies there has to be a sterile exchange. It is critical that we protect our nursing staff and respiratory therapists.”
“You can just imagine the stress for everyone. Family members are trying to get information on their loved ones while the nurse, who has just emerged from the room, has to now chart the notes, etc. I could understand how they wouldn’t have as much time to talk to family members.”
“The hospital has been gracious. I flew in on Monday the 16th and was able to visit my parents until Thursday when the hospital administration said that I could no longer come there.”
Asked how he is changing, Dr. Mundis stated, “I am blessed to possess a lot of medical knowledge because I can handle the roller coaster. I am not affected when my dad requires more oxygen or when he had to go on dialysis. I am firmly grounded in my time in a hospital where I have seen these things on a routine basis. I am concerned that my parents are in isolation, and that there is a lack of information overall. It is a perfect storm for heartache, fear, exhaustion, abandonment, guilt and shame.”
“My father, the first COVID19 patient at his hospital, had incredibly professional and compassionate care. Whenever I brought something up, they had already thought about it. But it is noteworthy to realize that for the first few days my dad was told not to come in…and then he ended up on a ventilator.”
“My mom’s experience was 180 degrees different. Things got crazy very quickly and the element of fear was evident. PCPs are fielding thousands of calls, triaging and deciding who should come to the hospital. Unfortunately, when they sent my mother home the first time she went to the hospital…they were not learning from the Washington state experience and are not paying sufficient attention to what is happening in New York, Italy, Korea.”
“It is heartbreaking to see my mother in this vulnerable state. She cannot care for herself properly, yet she is being discharged. She will be alone, scared, and confused in her home and thinking of her husband lying alone in a hospital bed…not knowing if he will live or die. My sister lives out of the country and I have to return to my family in San Diego. And who is going to do home health for a COVID19 positive patient?”
Asked where he thinks we will be in 30 days, Greg Mundis says, “If people would just do what they are being asked to do, i.e., STAY HOME, that would make a huge difference. There are still 200 cars in the parking lot at the local Walmart and 50 in the parking lot of Michaels craft store! People are assuming that it’s not going to affect them, but the problem is that there is always going to be a 10-14 day delay from the time you were good about staying home. So if everyone had listened when the authorities first said to stay home then I think it would only have taken 4-6 weeks from that day until we were on the other side of this. Look at China…their first case appeared on December 1 and only in the past few days did they record no new cases.”
At this point Dr. Mundis cannot speak to his father in person, but he is talking to his mother. “We are having some deep philosophical conversations such as, ‘What does it mean to have fear? What is sadness? We have determined that sadness is a choice, as is fear. We are choosing love. We are choosing hope.”