Dispatches from the front line of the COVID crisis.
I think, as a physician for nearly 20 years, it is always amazing how fragile life is. -Dr. Joseph Wu, Simon-Williamson Clinic
I think as a physician for nearly 20 years it is always amazing how fragile life is. With COVID I have watched people deteriorate so quickly… be okay one minute and then deteriorate so quickly and not recover. It is mind boggling.
You could be fine one week and dead the next week because of this virus. it makes me appreciate life so much more now. I have had COVID myself back in August. When I had a fever for ten straight days and there was no end in sight, I felt so much despair. I never felt so much despair over being sick before. And so appreciating how fragile, amazing and what a gift being alive is, that’s probably the biggest revelation I have had out of this.
My oldest patient that had COVID is in her 90s and she had the sniffles from it. Now this is someone that all of the experts would say is a high-risk patient who if she got COVID would have a high chance of mortality. And she came through it with flying colors.
Right now I have a patient in the hospital who is in their thirties with COVID pneumonia. Why is somebody that young in the hospital where the 90-year-old did not need to go to a hospital. It doesn’t make a lot of sense in a lot of ways.
I don’t think we know all the answers to this yet. From my standpoint, and looking at the patients I have taken care of as an inpatient and as an outpatient, it is impossible for me to know who is and who is not going to end up in the hospital.
We have patients call up and say they have been diagnosed with COVID and we tell them to do these certain things. And they do fine. And then there are a few of them who call me back a week later and say Doctor Wu I can’t breathe. I need help. And I have had to put some of them in the hospital.
A very healthy lady called and a week later she had low oxygen saturations and we admitted her to a hospital. She is my biggest success story. We needed an intensive care room for her and at the time we did not have one. So she stayed in the hospital two weeks and she made it out alive, but this is someone you would not have thought would get that sick. She was perfectly healthy.
I could not have predicted that when she first called me and said she tested positive. It is absolutely crazy and you know I think there are things I have learned along the way in treating these patients. If you are an older patient and sick enough to end up in an intensive care unit and keep in mind you have to be really really sick to get into intensive care now because beds are so limited.
The nurses on the floor here at Princeton are heroic. They are doing heroic things. They are risking their lives taking care of extremely sick patients. In any other circumstances these kind of low oxygen levels they would be in intensive care but we don’t have the intensive care beds available.
If you are an elderly patient over 80 and you make it to the intensive care unit they are not making it our alive. It is not for lack of trying we are doing everything we can to help these patients.
We don’t have a great way to shut the body’s immune system down and that is why they die. Hearing them say their last words before they get intubated is a sobering experience. It is not easy to hear and witness these things.
We have been doing this since March. I remember sending my first COVID test of a patient to the state back in March and fighting with the state to get them to accept this specimen for COVID testing. It is astronomical how it has soared. The number of calls to the clinic, people in hospital.
It is exhausting. The extra stuff you have to do on top of your day. Patients are coming through the door and are not always truthful about their symptoms. They make it upstairs and we realize they may have COVID. The stress around that is because they could have exposed our employees and staff.
Managing all of this is perplexing. Every day is a puzzle you have to try to solve. When you do that for nine straight months your brain is fried. Then on the clinic side we have to deal with keeping our employees paid and the business going. When we had to shut down for a while in March, April and May, and were not seeing patients. Our revenue went down and we tried to keep our employees paid by making whatever sacrifices we had to make.
It’s been stress beyond anything I can relate to. Then I take the stress home to my family. First thing I do is shower. The fear causes strains in family dynamics. you are worried you will make your family sick.
With numbers going up there is no end in sight. I can’t quit I can’t stop doing this …who would take my place.
You want to see it through but when the job becomes an occupational hazard it makes you think what am I doing here. I love taking care of patients, everyone who knows me knows that.
The paradigm of practicing medicine has changed because of this because you have to protect yourself, your employees and everyone else in the building. It is unreal.
We are just seeing the tip of the iceberg. There will be a lot of people getting together over the holidays
I’ve seen my mom three times this year. She is older and lives in Huntsvillle. When I go to see her we stand outside for a few minutes and that is the extent of my interaction with her because I don’t want to get her sick.
I get the need for families to come together but there will be more infections.
When patients come in COVID positive they stay in the ER until there is a bed for them.
Hard decisions will have to me made by hospitals across the city. Are we going to have to put off elective procedures again?Nobody can predict how this turns out
(Taken from a Facebook update made by Dr. Wu last July)
If a tree falls in a forest and no one is around to hear it, does it make a sound?
In the case of COVID in the US, whole forests are being felled all around us, and yet there are people who still cannot believe it is as serious as it is because it’s a conspiracy, or because no one they know has COVID.
I’ve been a physician for nearly 20 years, with over 15 years in private practice traditional Internal Medicine seeing both inpatients and outpatients. I have a unique perspective that others may not have. I’m seeing tragedy unfold before my eyes in the hospital and talking to and seeing/swabbing patients in clinic every day.
There are the patients with fever and flu-like symptoms for a few days which then resolve. There are patients with fever, significant shortness of breath, cough, GI symptoms, and aching, with normal oxygen saturations who do fine at home but are sick for a week or two and slowly recover.
And then there are the…
• Elderly COVID patient hospitalized with improvement of his oxygen saturation such that he would not have to go home on oxygen, about to be discharged, up and talking one minute, arresting and dead the next (in front of his wife in the next room, also hospitalized with COVID).
• Middle-aged gentleman without chronic respiratory illness previously, now three weeks on in the hospital, still on significant amounts of oxygen, short of breath walking less than 10 feet to the bathroom, probably will end up going home on oxygen.
•60-year-old female without prior medical problems, contracted COVID at work along with a dozen other people, now deceased.
• Middle aged female with respiratory problems admitted for COVID pneumonia, with good oxygen saturations on her standard home oxygen settings for two days in the hospital, suddenly decompensates, and is now on a ventilator on maximal ventilator settings, still with oxygen saturations in the mid 80s or less – she’s hanging on by a tiny thread.
• Middle-aged previously healthy gentleman, who contracted COVID over a month ago and has since lost 40+ pounds, with persistent debilitating neurologic symptoms of COVID (which are now being recognized) including headaches, tremor, and gait abnormality.
None of this has been made up. I couldn’t make this up if I tried. I saw three of these cases in the hospital this weekend alone, and all five of these are local to the Birmingham area. Does this sound like the flu? Does this sound like anything you or your family want to get, or want to risk getting?
Did we complain this much when there were all the PSAs in the 1980s talking about the drug epidemic—“This is your brain… this is your brain on drugs… any questions?” —and say they were fear mongering? I may not have known anyone who was on drugs at the time, but I respected the information, and I didn’t doubt the validity.
As I’ve written before, as we get more data on disease processes, our recommendations change. Diabetes, heart disease, cancer, stroke, hypertension—management and best practices have changed over and over in my 15 years in practice. I can’t tell you how many hypertension and lipid guidelines there have been.
COVID is new, and recommendations for treatment and prevention are changing at breakneck pace. Let’s stop focusing on what Dr. Fauci and the WHO said in January and February. They have more evidence and data now. I’m certainly not treating COVID the way we did in March, and I expect that I’ll be treating patients with COVID differently 2 months from now. And that’s fine with me.
Everyone talks about freedom and their rights. What do you need to have liberty and the pursuit of happiness? Life, first and foremost. Our problem as a country, in my opinion, is that we’ve stopped caring about everyone else’s lives but our own. We shrug when someone dies because we don’t know them, and go about our business as if they didn’t matter. Today there are 350,000+ lives that have been lost in the US since the start of the pandemic that are now unable to enjoy liberties and rights because we as a country haven’t done what we needed to do to protect those lives.
And sure, some of them may have died from their chronic medical problems anyway. But there are countless others who were previously healthy and have died that should still be here right now, and they aren’t.
Ultimately, this is a failure of our national, state, and local governments to enact and enforce measures that we know can prevent the spread of this illness and to prepare resources for the surge that we knew was coming back in March and April.
And when I see law enforcement officers and government officials say that they aren’t going to enforce mask ordinances, it infuriates me. Do I have that “right” when they come to the hospital or my clinic to say that I’m not going to do my job to take care of them? Am I going to be that callous and reckless with their life as they’re being with the lives of our fellow citizens?
I’m tired. Health care workers are tired. Medicine was hard enough before this, and now we’ve been handed a bowl of shit and asked to make it taste good. And there’s no way to do it. I’m going to do my job if it kills me, but I’m asking any of you who doubt this is going on, or think mask wearing is stupid, to take a second and think about everyone around you, and value them as you would yourself, and then do the right thing. Stop being selfish. It’s not political, and honestly, it’s not that hard. Try wearing a surgical mask over a N95 mask for a couple of hours a day – then you can complain to me. It’s about taking care of each other so that we can get back to some semblance of the lives we were leading before COVID.
Biography: Dr. Joseph Wu
Dr. Wu was born to Taiwanese immigrants in Oklahoma. He lived in Taiwan, Oklahoma, and Kentucky before moving to Huntsville in the early ’90s and came to Birmingham for medical school in 1998. After moving up north for residency, he decided that Birmingham was home, and after moving back and finishing residency at UAB, joined Simon-Williamson Clinic in 2005.
Dr. Wu practices traditional Internal Medicine and sees his own patients at Brookwood Baptist Princeton Hospital in addition to maintaining a busy outpatient practice. He is Board Certified in Internal Medicine (ABIM) and certified by NCQA’s Diabetes Recognition Program. He has held various leadership positions, serving on Princeton’s Medical Executive Committee for 5 years with a short stint as interim Medical Staff President, was SWC’s President from June 2014 to October 2016, and currently serves as Vice President and Managing Partner for Recruiting and Physician Development. He can’t imagine a better place to practice medicine and a better community to be a part of. He believes in spending quality time with patients, educating them about their medical problems and helping them make informed decisions about their health with the goal of improving their long term quality of life. Alex Crumpton, CRNP, is his nurse practitioner, and they work closely together to provide attentive care to their patients.
Dr. Wu is married, has three children, and lives in Homewood. In his free time, he enjoys cycling, hiking, world travel, and landscape photography. He is an avid “foodie” and is always looking for new places to explore. You can follow his adventures at josephwu.smugmug.com.
University: Johns Hopkins University 1994-1998
Medical School: University of Alabama School of Medicine 1998-2002
Residency: University of Michigan 2002-2004; University of Alabama at Birmingham 2004-2005