It’s been about a year since COVID-19 patients first flooded intensive care units (ICU) around Indiana. IU School of Medicine Bicentennial Professor W. Graham Carlos, MD, who also serves as the Eskenazi Health Chief of Medicine, spends most of his time in Eskenazi Health’s ICU and has watched several surges during the last few months.
Back in the spring of 2020, Eskenazi Health had to expand ICU capacity by 400%, quadrupling their ICU beds and leveraging the staff they had to help take care of the influx of patients. Eskenazi Health is one of the country’s largest essential health care systems, and Carlos says he was proud to see his staff give world-class care to their patients, proving that a “safety net” hospital could rise to the challenge of maintaining good outcomes during an incredibly hectic time.
“We worked together as a team to address the problems of the day and take care of patient needs,” said Carlos. “We meet many people on the worst day or worst week of their life. I really try to instill humanism in medicine and compassionate care, all the while showing my residents and students how to do the same thing.”
Last spring, most of the patients Carlos saw had COVID-19. While his team kept busy helping those patients, Carlos couldn’t help but wonder about the ones they weren’t seeing. He noticed that people with infected foot ulcers, who had experienced heart attacks or strokes and other non-COVID issues did not come to the hospital. Carlos worried that many of them suffered at home, so he wanted to make sure they could prove hospitals were safe spaces, by implementing policies to make sure each patient could be as protected as possible during a visit.
Carlos and his team seem to have achieved that goal, because he says Eskenazi Health has recently been experiencing a second surge. This second surge is different from what they saw last spring, because it includes COVID patients as well as those who have other afflictions. While not quite to the same level as spring 2020, Carlos says they are still seeing between two and three times the number of patients as they would in non-COVID times.
“We know we’re not through this,” said Carlos. “We know how to navigate these waters, but we’re looking forward to a break and some time on the shore. It’s been a long season of suffering. We see suffering from the bedside, where patients haven’t been able to be with family members because of visitor restrictions. We seem to need to be the bridge between the family and the patient, so we’re taking on a lot of that emotional burden. We’re just doing our best to keep up.”
One way Carlos has been helping his team keep up is instilling positive patterns, which have been proven to improve outcomes for both patients and practitioners.
“Studies have shown that if you can put yourself in a positive mindset, you perform better,” said Carlos. “When I’m rounding the ICU with my team, I try to create a positive learning environment where we encourage and thank one another. When you tell someone they’ve done a good job, you increase their serotonin levels. Serotonin is what we call the pride hormone, which gives you the feeling of doing a good job. Being more positive can help us both at work at the hospital and also at home, by being fully present with our patients, our colleagues and our families.”
Another positivity hormone is oxytocin, which can be created in your body when you give someone a high five or spend time with them. During one study about oxytocin, two groups of people were randomized and one of the groups got to pet a dog for 20 minutes. The other group sat in a room and did nothing for 20 minutes. The group that petted the dog had higher oxytocin levels and interestingly, the dog’s oxytocin levels were higher as well.
On the flip side of that, Carlos says it’s important to try to decrease cortisol, the stress hormone. Cortisol can increase blood pressure, make your hair thin out and raise your blood pressure, as well as other symptoms that can take a major toll. Carlos suggests that to lower cortisol, people can practice deep breathing and try to increase the other positivity hormones.
“When you find your mission and your purpose, you find incredible inspiration, resolve and resiliency,” said Carlos. “When you find you’re doing what you’re passionate about, your calling in life—and for me, that’s medicine—it makes going into work and doing what we do every day have enormous value. When your pursuits have value and you see the results of that, that is encouraging. That is wind in your sails. That gives you strength to move on.”