Shenzhen Second People's Hospital. Image source: official website of Shenzhen Second People's Hospital
Faced with the peak of the epidemic, many hospitals are integrating their resources, either by forming a new Crown Admission Zone or by deploying doctors from other departments to support the emergency department and the intensive care medicine department.
According to Surfing Technology, on December 23, 2022, the Second People's Hospital of Shenzhen City deployed doctors from different departments to form a "special ward" dedicated to treating patients with new crowns, mainly critically ill patients. At present, the hospital's special ward*** has nearly 40 beds and more than 10 doctors, who come from the hospital's respiratory and critical care department, Chinese medicine, endocrinology and so on. The following are two doctors in the special ward in their own words.
Oralist: Li Zhongkang, 28, Department of Traditional Chinese Medicine, attending physician
The night before I was interviewed by you, I had just finished my night shift and ended my overnight work. Last night a critically ill patient in his 80s passed away after being resuscitated. The patient's own heart function was not very good, and the new crown induced heart failure.
This is my daily duty routine, first round by round, and then focus on asking the critically ill patient's condition and medication. If we find a critically ill patient in a critical condition, we immediately form a 4-5 person resuscitation team, with a senior respiratory physician as the lead, directing the resuscitation, another 1-2 physicians performing operations such as chest compressions, another nurse administering medication, and usually a note taker documenting the entire process.
I was transferred to the special ward on December 28th, and now our ward mainly gathers patients with relatively mild pneumonia and critically ill patients with serious conditions, most of whom are over 40 years old, and the critically ill are mainly elderly people. I have been working in the Chinese medicine department before, and the main reason for transferring to this side is that before the liberalization, we were sent to the hotel to take care of the foreign importers, including nucleic acid collection, answering everyone's questions, and treating positive cases, etc., so we still have some experience in this area. The Chinese medicine department of the Shenzhen Second People's Hospital usually focuses on chronic non-communicable diseases such as hypertension, diabetes and coronary heart disease, and although I don't come from a respiratory background, I'm quite familiar with the relevant treatments.
For the new crown, there is no antiviral drug that has a very significant effect, and the drugs that have been introduced have very strict indications, and some patients are not suitable for them. At this point we will use a combination of Chinese and Western medicine to help promote lung function recovery by analyzing the disease and prescribing some Chinese medicines after seeing and hearing the disease.
As to whether the transfer of Chinese medicine to the special ward will be "incompatible", in fact, it will not be. Because the big basics we all know, it is only the operation of the degree of familiarity is different. Nowadays, the Chinese medicine doctor's work routine is not like everyone imagines that it is just to look and smell, pulse and acupuncture. Western medicine knowledge is also necessary to master, we will standardize the study of the pathological process of disease, diagnosis and treatment and other knowledge. The only thing is that you may not be familiar with the respiratory medicine, and the operation of the ventilator, for example.
On our first day of transfer, the ward director led the entire department to conduct a unified training, including the use of the ventilator, and how to deal with any situation. The training is also conducted during the visit, for example, whether a patient needs to use the ventilator in a certain situation, and how to use the ventilator, are all explained while operating on the patient, which makes it easier for everyone to understand.
In addition to the unified training, we are divided into different medical groups, led by senior respiratory physicians, usually associate chief physicians. They would lead our room visits as well as develop treatment plans.
I received at least three training sessions in the four days after I was transferred to the special ward. In addition to the use of the ventilator, the main content of the training included the treatment process of respiratory specialties and the precautions of respiratory medication. For example, in the respiratory specialty, because patients are different and have different mental states, we always consult with our supervisors about whether a certain antiviral can be used and whether the dosage needs to be reduced.
The pressure on our medical resources is still quite great. When we first came here, there were often cases where we did not have enough ventilators, or we managed to borrow a ventilator but found that we did not have the right tubing, and when we did have the tubing, we did not have a mask, and so on. We are also actively striving for emergency purchases from the hospital or emergency borrowing from departments such as the Department of Intensive Care Medicine and the Department of Respiratory Medicine. The whole hospital is now fully integrated, and some departments are already fully engaged in assisting with treatment in the new crown ward, so the problem is still being solved very quickly.
The next step in the program is to supplement our knowledge of respiratory medicine. We also have a 10-plus day online training that has already begun. It is divided into several modules, such as the use of the ventilator, which was just mentioned, the differentiation between diseases such as neocoronary pneumonia and respiratory failure, and so on. The lecturers are divided into two categories, one is a specialist from our hospital, and the other is an authoritative foreign expert. At the end of the training, there will be a relevant examination, which we are also required to pass, and a supplementary examination is also set. So the pressure to learn is also relatively high, I listened to the course introducing the difference between acute respiratory distress syndrome and severe pneumonia today, which was very carefully explained.
Oralist: Su Weixin, 33, Respiratory and Critical Care Medicine, Resident
I was transferred to the special ward as soon as it was established, and three doctors were transferred to the respiratory department I***. The purpose of forming this ward is to triage for the Emergency Department and ICU. When it was first established, we had to admit about 12 patients per day, and currently our ward beds are all full. I am in charge of the beds, and my daily routine is to check the room and keep an eye on the patient's condition.
The doctors in our special ward come from different departments, but they all have similar professional backgrounds. We are first and foremost doctors who have undergone rigorous training and professional medical exams, so at best we are not too familiar with some of the machine operations or specialized knowledge, but basically there is no such thing as a complete ignorance of the "knowledge blind spot". Whether it is in the rescue, or in the daily work, colleagues from other departments are very helpful. And there is another advantage of bringing doctors from different departments together, which is that it is very convenient to consult with patients when they have other complications, for example, if some patients' blood sugar control is not good, they can directly let the endocrinology doctor take a look, unlike the usual situation, where it is still necessary to call and invite for consultation, and we also communicate with each other to learn the knowledge of different departments, which is very pleasant to work with everyone in general, and also a process of letting me grow my knowledge. I'm not sure if I'm going to be able to do that.
Of course, since the special ward was set up on a temporary basis, a lot of the medical equipment is not yet complete, so we need to borrow equipment from the hospital or other departments in a timely manner. Unlike ICUs and emergency rooms, which are not fully enclosed, sometimes some patients have a weak tolerance, and when we give them medical equipment, their families will raise objections, which we also understand, after all, we don't want our loved ones to suffer. This time we will explain the pros and cons to the patient, put forward a compromise proposal, on the whole, or to respect the views of patients and their families.
The patients are still very optimistic. I have a deep impression of a patient whose condition was actually quite serious, with respiratory failure worsening dramatically within three days, and pneumonia worsening on lung imaging, but this patient was very optimistic, and his family was optimistic as well, and actively participated in the treatment with great hope, and very much hoped to be able to be discharged from the hospital.