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Merit Health Natchez chief of staff gives update on hospital

On Jan.1 I assumed my role as chief of the general medical staff at Merit Health Natchez.

COVID 19, the disease caused by the virus SARS-CoV-2, was just breaking the headlines, but back then, it was a disease being battled far away.

I attended the CHS Chiefs of Staff conference in Nashville on March 5 and the overwhelming talk between sessions was about the devastating tornadoes that had ravaged downtown Nashville. Shortly thereafter we started to receive reports from Italy and then Spain and then Washington state. But it wasn’t here and possibly would never come.

It was at the Medical Executive Committee meeting on March 16 that several physicians and administrators started to discuss the crisis that we may be facing. Several preparatory forces were already in the works then, but it was at that moment that the truly Herculean effort of hospital transformation and preparation began in earnest.

The hospital instituted evolving policies to protect staff and patients and began to segregate the hospital into COVID areas and non-COVID areas. The list of transformative actions at the hospital are too numerous to list, but within days the entire Telemetry and ICU units were transformed into the COVID 19 ward and the majority of rooms transformed into much-needed negative pressure environments. Makeshift “ante” rooms were constructed virtually overnight at the entry point to those isolation rooms.

The hospital visitation policy was drastically altered. Access sites into and out of the hospital were severely restricted and anyone entering was screened.

All elective cases were suspended at the recommendation of the Mississippi Department of Health on March 19 as it was thought that delaying non-essential procedures would preserve essential material and personnel, as well as limit patient and staff exposure.

A COVID 19 Operating Room was constructed in an isolated area of the hospital in order to safely segregate patients, protect staff and maintain our readiness in the normal OR for non-COVID 19 emergencies while at the same time prepare us to safely care for the surgical needs of COVID 19 confirmed and COVID 19 patients under investigation.

We instituted daily multidisciplinary critical care rounds including representatives from the areas of infectious disease, surgery, critical care and internal medicine. We hired a respiratory consultant who has been invaluable to the management of the most complex ventilated patients. We instituted evidence based critical care treatment strategies that mirror those being implemented in the largest cities in the country.

We wrote what seems like hundreds of pages of recommendations ranging from proper use of personal protective equipment to summaries of what is known about this virus’ basic structure and its epidemiology. Most of these documents have been shared with other hospitals. We learned early on that there was no available playbook to go from, so we constructed our own with the invaluable resources coming out of China, Italy and Singapore.

We developed surge plans for the rapid mobilization of person power, from both the nursing and physician standpoints. We even drilled our protocols for intubation and surgery on COVID 19 patients.

We developed a COVID 19 Intubation and Vascular Access Rapid Response Team and instituted a vital rapid link from patient intubation to critical care administration.

We were not only prepared when we started seeing our first COVID 19 patients, we were dug in and ready to fight. We have seen brilliant acts of ingenuity, like the development of our rapidly deployed intubation drape to the development of filtered nebulizer devices to developing methods to multiply limited COVID 19 testing kits. We have witnessed acts of compassion and love beyond what can be described here.

And we have never backed down from our solemn oath of rendering aid and comfort to the sick. I have intentionally left out names of individuals who have gone well above and beyond the call of duty during this unprecedented crisis. They do not want to be glorified. I have intentionally used “we” when referring to our efforts because it takes everyone.

The administration has given us all of the resources needed to care for the sick. Every director and leader in the hospital has worked tirelessly and nearly around the clock during the last three weeks. Facilities management has virtually transformed the hospital to facilitate the safe care of all patients and the protection of staff. Environmental services has dealt with our mess and have “terminally” cleaned more rooms than I would like to admit. Food services has kept us fueled. Information technology has altered order sets to deal with the unique nature of this disease. Pharmacy has kept the essential medication pipeline open and has been instrumental in offering alternatives when we used up some first choice agents. There are even people pulling night shifts sitting outside the ER in the cold and rain to screen patients who enter the hospital.

And then there are the people who don their PPE and directly care for their COVID patients and never question the very real danger they are putting themselves in. Some heroes enter burning buildings when others are exiting. These heroes enter a room to care for a patient afflicted with an invisible enemy who does not discriminate when dealing out its evil disease.

Nurses, laboratory technicians, respiratory technicians, radiology technicians, therapists and physicians — not one has shied away from their duty. This is a different type of bravery, because it’s silent and unassuming. These professionals just want to do the best job that they were trained to do, care compassionately for those afflicted with any illness, and go home to their families who they work so hard to support. And regrettably, many of us have chosen to isolate ourselves from our families, just in case. These people are silent heroes, and yes, heroes do wear masks. We have had some good days and we have had some very, very, bad days. But it has made us all more resilient and more dedicated, not less.

I want everyone to know a couple of things: It is safe to come to the hospital. If you are sick, whether it is possibly related to this virus or it’s totally different, do not hesitate to come to the hospital. We are totally prepared to take care or you safely. It is dangerous not to seek emergency medical care when needed.

We are all working very hard and will continue to do so. Although everyone has had their world turned upside down, social distancing is working and we have seen the curve flatten. We are seeing better days. So please be patient and keep up the good work.

The incredible outpouring of support from the community has truly been humbling. From food to donations to kind words to homemade masks to signs of encouragement to car horn honking rallies; you will never know the effect that all of this has had on our collective morale, and we thank you.

I have truly never been more proud to say that I work at Merit Health Natchez and that I work alongside some of the finest most dedicated healthcare professionals on the planet. And I truly have never been more proud to say that I have been blessed to serve this very special community.

Geoffrey J. Flattmann, MD, FACS, is Chief of the General Medical Staff at Merit Health Natchez.