DOCTORS' LOUNGE
(continued from page 31)
for him: such truck drivers who had sex at truck stops were among
the earliest group of AIDS sufferers nearly 40 years ago.)
We worry that, unlike the flu, we as physicians will be exposed
and quarantined, and who then will see sick people? There are few
enough of us as it is. In the 2008 pandemic flu, we worked despite
our fevers, because the entire city was sick. It came down to who
was ambulatory, not who was well.
We worry that we cannot protect the vulnerable old from the
working young, who have no sick leave and must feed their children
and will work till they drop. The nurses’ aides, cleaning staff and
bedside nurses in hospitals and nursing homes are scared. The EMS
turns no one away; they will pick you up wearing only gloves, since
when you appear to be dying, it takes too long to put on full hazmat
gear (that is, if you have enough to go around).
We worry that we have no clear guidelines, as yet, for treatment
other than “supportive care,” unless remdesivir turns out to work
better than hoped and can be supplied en masse. We can hydrate,
treat the pneumonia and supply oxygen and vent support. We have,
of course, the proverbial thoughts and prayers.
We worry that the White House stance on muzzling the experts
and having all data filtered through the Vice President will succeed
only in tormenting the country with a frenzy of fear. Scientific
evidence may be chillingly correct, but at least it contains what is
believed by experts to be true. Statements manipulated for political
purposes have no value whatsoever. Jonathan Quick, writing in the
Wall Street Journal Sunday Review about the parallels between the
1918 influenza and today’s viral pandemic, said, “In 1918, the print
media served as an essential ally of the public health community.”
Twitter accounts from scientists help keep us up to date. Despite
the ban, on Feb. 25 Dr. Nancy Messonnier at the CDC sounded the
alarm in conference calls with the press. Newspaper reporters and
network talking heads are asking solid questions and keeping track
of case reports and death tolls. The March 5 New England Medical
Journal of Medicine (NEJM) had a long case report of a Chinese
man, highly instructive, with a detailed timeline of symptoms and
progress.
Mr. Quick produced comparative data from flu epidemics: in
2009, the swine flu killed the young, and school closures in Texas
reduced acute respiratory illness by more than 45%. Yet in a just-pub-
lished online article from March 6 in Science magazine entitled “The
Effect of Travel Restrictions on the 2019 COVID -19 Outbreak,”
lead author Matteo Chinazzi reported that his model showed that
by mid-February, the Chinese efforts led to major reductions in
cases in other nations. However, once the virus takes hold in other
nations, the success of travel bans and closures will vary widely.
But there is a balloon of hope rising in the West. The Bill and
Melinda Gates Foundation may save us all. They are funding a
project for self-testing at home with results reported to local health
officials. And that is not a hoax.
Dr. Barry is working at various Norton CMA offices as a “float/fill-in” only position.
She is a clinical associate professor at the University of Louisville School of Medicine,
Department of Medicine.
LIFELONG LEARNER
T
AUTHOR Nicholas Chen
hroughout my time in medical
school, I’ve often heard the phrase
“lifelong learner” used to describe
medical students, and it’s an identity
with which I’ve struggled. Of course,
we are all driven in some part by a
desire to learn, stirred by a curios-
ity about the human body and the intricate
secrets it holds. We learn the machinations that drive our bodies
through life, the diseases that bring them to a painful halt, and the
extraordinary measures we take to compel them back to motion.
The existing knowledge of medicine we use to help our patients
is beautifully complex, yet exceedingly vast, so a natural question
32
LOUISVILLE MEDICINE
becomes: “What information is most important to learn during my
time as a student?”
Coming into medical school, I knew that classes were pass/fail,
so I was excited by the prospect of learning for learning’s sake. It
made sense; medical students should be studying for their patients,
not their grades. Then somewhere along the way, I began to hear
about Step 1 and its deterministic nature. It didn’t seem particularly
different from other tests I’ve taken; after all, medical students go
through the SAT, ACT and MCAT, along with other high-stakes
college examinations. But despite its relatively innocuous origins,
the test has largely outgrown its intended design to simply act as a
licensing tool for “safe and competent practice of medicine.”
In recent years, there has been a clear correlation between scor-