Residency During The Pandemic

This week’s guest columnist is Dr. Hanh-My Tran, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I recall one elderly patient I took care of in the ICU. He had COVID, which in turn caused multiple organs to fail. Inflammation was killing his kidneys, his liver, and his lung capacity. After two weeks on the ventilator he continued losing ground, and his family agreed to switch from life-saving measures to comfort care for the end. The worst part: I had to tell the family that visitors weren’t allowed. Coronavirus is rampant enough, and no one wants other family to get sick, maybe die, and compound the tragedy. I gowned up in full PPE, took in an iPad, and Facetimed the family. Devastated, the children and grandchildren said their goodbyes, crying in the camera.

This last year of residency was supposed to be seeing more patients, honing procedural skills, and broadening my experience with different diseases. Instead, my fellow residents and I have learned to tackle a pandemic. Early on we were designated for more adult floor and ICU shifts to shore up personnel for that first surge. As the attending doctors and hospitals have gotten more efficient at COVID care, we’ve resumed a mostly normal schedule.  In pediatrics, we’ve not had anything near our usual volume of patients, since with COVID precautions kids have been pretty healthy, not passing colds to each other. But kids have suffered other ways.

As adults, we tend to understand what stressors make us feel overwhelmed, angry, sad, anxious, and depressed. Children learn how to respond to stressors as they grow and develop. COVID has forced them to grow up a little faster this year. Isolation, social distancing, and fear of family and friends getting sick are taking their toll.

Anxiety and depression are rising in children and teens, and counseling services were scarce in the best of times. So besides your own stress, watch your kids for the subtle signs of depression- changes in mood and appetite, unusually defiant behavior, self-isolation. Respond to these sympathetically now, so your kids can learn to cope too.

I have a condition that weakens my immune system, so I follow guidelines on COVID prevention religiously. I’m always masked, wear PPE with patients, and of course wash my hands until they’re red and raw. But COVID-19 is highly contagious and sneaky, and I contracted it nonetheless. My first symptom was fatigue, but since residency is a 60-70 work week, that wasn’t abnormal. I had no fever, cough, or trouble breathing. However, my partner got sick with cough, fever, and aches, and tested positive. He works from home, so he probably got it from me. “What’s mine is yours, what’s yours is mine” didn’t  have that poetic ring when I tested positive too.

The worst part for me was the loss of taste and smell for two months. I l dropped weight, but don’t recommend COVID as a weight-loss plan. No taste or smell takes a lot of fun out of life, and is a major depressor in affected patients. However, both my adults and children in clinic have drastically gained weight since COVID started. Trapped in the house, they’ve increased snacking and eating. Physical activity is also down, with limited school, sports, and outdoor time. Obesity has been escalating globally, and is now an epidemic within the pandemic!

Overweight kids have more trouble looming than just achy feet. Obese kids become obese adults, and have a head start on the attending heart disease and cancer risks. They also get sleep apnea, joint pain, and diabetes. High blood pressure in children, and thus risk of future strokes, is also rising. “Curing” obesity is harder than treating cancer. Medical attempts at weight loss lag behind cancer cure rates.

As we discussed above, more children have depression and anxiety due to the pandemic, and obesity compounds depression. Feeling achy, being bullied, and social isolation are a trifecta of misery. The lessons are clear: keep your kids to routines: three healthy meals daily, limited and healthy snacks, regular bed-times. Get them moving! Less screen time!  Besides masking and distancing, you’ve got to fight Coronavirus at home as well as in public. For our kids’ futures, it’s a battle we must win.

My Big Fat Cajun Wedding

On December 8, 1990, I got married. It was my first trip to Louisiana, and my staid protestant family met my new loud, fun catholic in-laws. Like the movie My Big Fat Greek Wedding, my stiff northeasterners got swallowed up in merry-making, and had a blast. First, the rehearsal dinner speeches started with the restauranteur welcoming everyone with a dirty joke. Wary looks were exchanged, but fortunately none of my family understood his thick Cajun accent (enhanced by a few drinks). Except it had something to do with ducks and condoms.

For our 30th Anniversary this month, there’s no Big Fat Events. COVID in Acadiana’s hospitals is up to apocalyptic volumes, added to our usual winter big numbers of patients. This new bump started with pre-Thanksgiving gatherings. For example, some parents rented party buses for Homecomings, finding the distancing, outdoor events planned by schools too nerdy. Those unmasked teens spread the virus to each other, then on to their families. Then Thanksgiving happened, and it’s a bump on top of a bump.

Fortunately for children, they aren’t getting as sick as adults with Coronavirus. There’s some coughing and fever, maybe a headache, and recovery in a few days. Many fewer children get as gravely ill as adults do.  Unfortunately, Emergency Departments, Intensive Care Units, regular beds, and even ambulances are clogged by the sheer numbers of very sick, even dying, grown-ups.

It doesn’t seem to be the schools’ fault. They’ve been careful with their protocols,  enforcing mask-wearing and distancing. It’s parents not following the basic containment rules: teaching kids to wash hands and wear masks properly (cover BOTH nose and mouth). Their violation of distancing rules in allowing, even arranging, spreader events, has been responsible for the current calamity. Maybe enough of them and their elderly parents have gotten sick now, that we’ve all learned our lesson.

So please, from all of us working at hospitals, please plan a Quiet Christmas: no parties, no big family events. Just you and your kids at home opening presents, virtual church, and grandparents at a distance, preferably on facetime. Thus we can have as merry a Christmas as possible.

Another event during my Big Fat Cajun Wedding 30 years ago was the Thursday Gumbo. My family of stiff protestant Northeasters wondered, what’s “A Gumbo?” A gathering? Brown soup? But they were swept up in the milling, laughter, and noisy chatter, and even calling for seconds on the brown soup. I get misty-eyed watching the video; so many of our parents and family have passed on.

Also when I watch that video, I first wonder “Why is everyone so close together?” Then I remember: oh, that was life before COVID. Hopefully, no one’s planning any Big Fat Events for this Christmas. Too many friends and family have been in the hospital, in ICU, or died, to risk making more Christmas tragedies.

As mentioned above, Coronavirus cases have ramped up since October, with too many kids and adults having big risky gatherings. Acadiana’s hospitals are clogged with cases, adding to the usual winter high volume. Being careful, not succumbing to “COVID fatigue”, is key to survival. It’s a sneaky virus, being so contagious and spreading through asymptomatic kids and adults. We’ve got to cinch up on the mask-wearing, distancing, and hand-washing; to get through the next few months as the vaccine rolls out. Fortunately for us in Louisiana, we get to go back outdoors in February or March. My unlucky Northern family will still be shoveling snow.

As for vaccine safety, I’m not worried; I’ll happily start mine in the next few weeks!  The vaccines have been carefully studied and well-scrutinized. Mythbuster: there’s no microchips in the injection. Nanotechnology is amazing, but just isn’t there yet, so don’t worry that Government will track you through the vaccine. Like they want to watch me anyway: “Hey, look, Scott’s driving to work. Now he’s napping. Wow, he’s mowing the lawn.” If they really wanted such information, it’s much cheaper and doable to spy on us through our phones.

So again, plan a Quiet Christmas. Fewer people, no parties, fewer presents. Just you and your kids at home, and visit other family on-line. That way next Christmas can be a happier one, with no melancholy watching of this year’s videos.

Happiness In The Age of COVID

The Advocate newspaper carries a column on parenting by child psychologist John Rosemond. I’ll herald the latest installment to my wife: “Hey Honey, cranky ol’ Dr. Rosemond is at it again!”  He’s old-school, wherein children-should-be-seen-and-not-heard, hard-work-is-its-own-reward, etc.  While not exactly advocating that kids work 14 hour-shifts in textile mills, he likes to cast doubt on such “modern” diagnoses as ADHD.

He sometimes makes good points. His column “Why Some People Believe That They Are Entitled,” speaks to the erosion of happiness in the age of COVID.  Entitlement is the idea that you deserve happiness, wealth, and success, whether you’ve earned it or not.  According to Rosemond, recent generations have raised kids to think like European Royalty, that they’re more special than everyone else, and thus Entitled.  Even cheating to get what you want is okay, since you’re above the rules meant for commoners.

Many argue that instilling a sense of Entitlement, and generally spoiling children, has led to the rise in depression and suicidality in kids and teens.  When kids don’t get their way in the real world, in school, with other kids or adults, they’re profoundly disappointed, their world-revolves-around-me view shattered.  Now with social distancing, travelling restricted to grocery shopping, and economic free-fall, few adults are getting their way anymore either.

With loss of work and freedom, people are bored, depressed about a life without purpose, and full of anxiety that they or their loved ones will get seriously ill. Many raised in the land of plenty are, like spoiled toddlers, now profoundly disappointed with life.  However, many others, in the search for meaning in this new age, have taken action. They’ve started life-affirming tasks- learning new skills like a new language or cooking; spending more time with their kids (and parents!), making masks and delivering food to health care workers and shut-ins, donating blood.

John Rosemond is right, at least about this aspect of parenting. Kids should learn that being useful, being moral, and working hard, are more important than striving to be happy and successful.  Then strangely enough, the pursuit of character begats happiness anyway.. Especially in the Age of COVID.

Another pillar of happiness is being connected with others.  While we just discussed that hard work and a meaningful life lead to happiness, social interaction helps too.  Before the invention of telephones in 1876, people communicated from afar by written letter. Also in those days, early death was a constant.  About one quarter of infants died before their first birthday, and almost half of children died before puberty.  The average adult was lucky to live past 40.  Thus letters between distant family members often started with “I hope this letter finds you well,” followed by a summary of the health of those at home.

That was the snail pace of life, death, and communication in the Age of Enlightenment. Thanks to the internet, with email, twitter, instagram, and facebook, the above sentiments are transmitted instantly.  I’ve gotten scads of electronic messages from near and far asking me if I’m okay on the “front lines” in the Emergency Department. At home we’ve been spending lots of facetime with my daughter in Seattle and my son in New Orleans, COVID hot spots.

Though it’s a good time for the internet, with it keeping us connected and informed, the net’s also a two-edged sword in these respects. Hateful and divisive posts on facebook or twitter come at us instantly as well. Nothing gets people fired up, and not in a good way, like a skewed political post claiming the other side is criminal or incompetent.

Misinformation spreads quickly too, For example, there’s many posts about how influenza, the plain old flu, has caused many more deaths than COVID, and yet we never tanked the economy by closing schools and businesses during flu season. What they don’t mention is that COVID threatens to cause even more deaths than influenza, since it’s more deadly to individual patients, may be even more contagious, and has no vaccine or anti-viral medication to check its spread. The only way to stop it and save lives- closures and social distancing.

So for information on keeping you and your kids safe, and your futures, please use expert sources without political or social agendas: the Centers for Disease Control (CDC) and the American Academy of Pediatrics ( These places will give you the straight scoop as it becomes known, without an extra helping of anger to dampen your happiness.

School’s Out For….Spring?

This week’s guest columnists are Drs. Mark Carreras and Jacob Sellers, Family Practice residents at the University Hospital and Clinics here in Lafayette.

When I was a kid, the last day of class would end with a final bell, and we’d blast Alice Cooper’s “School’s Out For Summer.”  We were free, thrilled we’d “survived” another year, as if we’d reached high ground just ahead of a tsunami. With schools closed probably for the rest of the year, many kids celebrated pretty early.

For parents this is NOT a fun, exciting time (their lyrics: “Well I tried to make it Sunday, but I got so damn depressed”).  School’s definitely not out yet for summer, and while parents are used to kids’ summers off, this is very different.  There’s no more family vacation, with many household budgets taking a hit and vacation spots closed. Working parents must find babysitting and activities for their kids way before they were ready.  And there’s school work still to be done. At home.

Unless you’re a professional educator, schooling and teaching are tough. Who remembers what they learned in history, much less technical subjects like trigonometry?  While schools are transitioning to on-line teaching and assignments, parents must do their share to keep their kids from falling behind.  More on this below.

Doctoring must be done at home too. Offices and clinics have shortened hours, and visits are more time-consuming.  Many practices have parents wait in their cars, and staff call them when it’s their turn to come in.  Emergency Departments are COVID war zones, with really sick and contagious patients; not places you want to be with your child.

This blog’s a place to go for advice if your kid is sick.  If you’re reading this in the Advocate, note the blog address below.  Stock up on ibuprofen, tylenol, and benadryl. Make sure asthma medicine is refilled, as COVID can make trouble for wheezers. And don’t panic. Many kids are still getting cold and fever viruses, and parents worry it’s COVID.  Rest assured that in most kids, COVID is benign, and soon gotten over.  Only go to the ER if kids are short of breath, too sleepy to drink enough, or vomiting continually.

As a new parent, one of the most shocking realizations for me has been the power of the screen.  My 2 year-old is typically unreserved, energetic, and sociable. All at once.  He’ll hold a conversation with you while leaping from couch to chair.  However, a flip of the television switch turns him into an expressionless, drooling zombie.  I wouldn’t be surprised if he started moaning “..brains….brains….”

Limiting screen time may be the biggest challenge for parents during this extended school break, or school-at-home-for-the-rest-of-the-year.  But this battle is worth fighting, as increased screen time is linked with worse childhood obesity, depression, poor diet and constipation, and worse sleep.  In other words, an overall tanking of quality of life.  As Dean Wormer said in the movie Animal House, “Fat, drunk, and stupid is no way to go through life, son.”

One recipe for success during this COVID outbreak is maintaining a routine.  Filling kids’ days, making them adhere to school work and stay off the computer/phone/tablet/TV sounds tortuous.  However, mapping out a daily schedule can actually save time and make things easier.  Start with wake-up time, three meals, snacks, and bedtime. Then insert school work, indoor play time, outdoor playtime, chores, and family activity. There can be some fluidity in that schedule, but keep in mind that kids are happier and better behaved when kept to a routine. The wake-up, mealtimes, and lights-out should be reasonably enforced.

One daily activity that can’t be discounted is reading.  Study after study shows that reading with children improves brain development, social-emotional skills, language, and of course literacy.  Your schedule should absolutely include reading to your child, or them reading independently.  When they read on their own, make time to discuss with them what they’ve read.  One of the best opportunities to read to your child is bed-time. This should ALWAYS be part of the nightly ritual.

How you manage this challenging time will make a difference about how your children grow up.  Do you want them to be successful and happy?  Kids thrive on structure and reading.  Reinforcing these makes the difference between your kid being strong and independent, or being a screen-addicted zombie, depending on others for…..their brains!

Don’t Touch Your Face?

When we visited my 89 year-old mother-in-law last week, we met on the patio. Staying on the swings far from her chair, we couldn’t pass her the COVID virus if we were carriers.  My wife brought her own bottle of wine.  Later Nana went into the kitchen to refill her glass, and through the window we saw her pick up my wife’s bottle, examining the label, while we both slapped our foreheads: “Nana, go wash your hands!”

Staying safe from the COVID-19 virus, aka Coronavirus, is like playing “invisible force field,” where any surface (counters, door knobs, wine bottles) is potentially contaminated, and you need to wash your hands before you touch your face or food.  That’s how COVID, or any cold/flu virus, gets into your system.  You inhale it when someone coughs or sneezes near you, or you put it in your mouth, nose, or eyes with your fingers.

The good news is that so far, COVID doesn’t seem bad for children.  They get a cough, runny nose, and maybe fever, but many fewer kids are hospitalized for breathing trouble than adults. Like any other cold and fever virus, kids get by with ibuprofen or Tylenol for fever and pain, and plenty of fluids.

The bad news, and the main reason why schools and daycares close, is that kids spread infection around.  They cough and sneeze without covering their mouths, letting fly with virus-laden droplets.  They wipe their nose and mouths with their hands, and smear infectious drool onto every thing they touch.  Kids shed virus into the environment worse than adults, because they’re, well, gross.  So we close schools so kids don’t pass the virus from family to family, sending it into households with vulnerable family members- the elderly, cancer patients, or those with certain medical conditions.

Some kids get seriously sick from COVID.  The Chinese experienced some pediatric hospitalizations, with some critically ill. Kids with asthma might get it worse, or kids with heart conditions, or infants.  If your child has a potentially dangerous condition, be extra vigilant about who they contact, where they go, and what they touch.  And don’t touch your face!  More on that below.

Three weeks ago my wife and I were on vacation.  We weren’t in China or Italy; we were in the snowy woods of Quebec, away from crowds, cross-country skiing.  However, we flew home through Newark airport, part of New York City’s transportation network, with lots of international travelers milling about.  In the Customs line a kid next to us kept sneezing without covering his mouth, his parents oblivious. Great.

We haven’t gotten sick, so the little turkey apparently hasn’t given us COVID, but it’s  now revealing itself in Acadiana.  As you keep hearing, the best defense against catching the virus is good hygiene. Cough and sneeze into your elbow to avoid spreading the virus.  Don’t get close to anyone since they might be shedding it.  Wash hands frequently, in case you’ve inadvertently touched a contaminated surface. And don’t touch your face?

As we mentioned above, the virus gets into you through your mouth, eyes, and nose.  You can pick up the virus from a doorknob, a handshake, a handrail, and then when you touch your face, you pass it into those portals.  It’s remarkable how many times people touch their faces- on average several times per hour.  After all, faces are sensitive, and need scratching.  Noses need picking, thumbs need licking..

Telling people to stop touching their faces is like telling them to lose weight or stop smoking.  Eating badly, smoking, and rubbing your nose are all near-impossible habits to break.  Hence the draconian steps of closing schools, restaurants, and anywhere else people mingle. The virus spreads too easily, and people pick it up too easily as well.  And try teaching kids not to touch their faces!

That’s also why we’re advised to wash hands so much.  When we do touch our faces, we’re safer with clean hands.  Frequent hand-washing is easy for me, washing them over forty times per day at work anyway, before and after touching each patient.  But not everyone has that habit.

The CDC has warned that wearing a face mask doesn’t really stop the spread of infectious droplets. But maybe wearing the mask will keep you from getting your fingers into your mouth, nose, or eyes.  Maybe people should wear mittens instead.  And definitely, for the next few months, stay away from Nana.