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Michigan doctors prepare for tough conversations and choices as COVID-19 surge begins

hospital room
Dan Stevens
As cases of coronavirus rise in Michigan, healthcare workers face tough decisions about how to serve their patients.

With a surge of COVID-19 patients beginning at some hospitals here in Michigan, healthcare workers on the front lines of the outbreak may soon have to make some tough decisions about serving their patients, and protecting their co-workers, families, and themselves.

Dr. Rana Awdish is a pulmonologist at Henry Ford Health System in Detroit. She's also the author of In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.

Awdish says monitoring the outbreaks elsewhere has helped hospitals in Michigan.

"People saw what was coming in other cities and countries and really prepared. So, we we have deferred any non-time-sensitive procedures. We have cleared entire wards to make room for COVID-19 positive and COVID rule-out patients," Awdish told Michigan Radio. "I feel very prepared. Although I don't think this is something you can ever be completely prepared for."

Preparing for a surge in coronavirus cases goes beyond more typical emergency-response planning. In part because there are fears that hospitals will run out of potentially life-saving ventilators, the medical community is also thinking about the ethical dilemmas that doctors could face. One scenario is rationing ventilators and making life-or-death choices about who gets them.

"This is what I signed up for. I became a physician because I want to help people." - Dr. Megan Bonnani

"There's a recognition that these decisions can't be improvised," Awdish said. "So groups of people are coming together – clinical ethicists, palliative care physicians, ER physicians, ICU physicians,  administrators – to write guidelines. The New England Journal of Medicine published theirs for [resource] allocation. And it's really coming from an understanding that individual physicians should not be left alone to make decisions in a resource-constrained environment, that there has to be guidance."

Dr. Megan Bonanni says whenever she thought about working on a large-scale health crisis, her thoughts turned to mass casualties on a local level. She says that comes with her training. Bonanni is an ER physician with Munson Healthcare in Cadillac and Grayling. 

"This is what I signed up for. I became a physician because I want to help people," Bonanni said. "In many ways, those of us that are on the front lines are very honored by all the support we're getting from the community and from our [hospital] administration and are really hoping that we can make a difference to get this disease to slow down and eventually stop."

The Munson Healthcare facilities where Bonanni works had not seen any confirmed coronavirus cases as of Wednesday, but as doctors prepare to treat patients, they're also preparing to become COVID-19 patients themselves. She says even considering that concept is tough. 

"[Doctors] don't want to detract resources from their own patients. I have physicians who tell me that if they test positive, they will just stay home, that they won't come and take a ventilator." - Dr. Rana Awdish

"It is a terrifying idea to think that we will not be able to take care of the community and each other because in many ways, that's how we define who we are," she said. "You take that away from us, or even worse, you put us in a position where we feel as if we are adding to [the problem] or making someone ill or causing someone any suffering, it goes against every fiber of who we are and why we do what we do." 

Detroit has been hit hard by coronavirus, with hundreds of cases so far. Awdish says her colleagues who have already worked with coronavirus patients have developed systems for how and where they remove clothes after a shift and how best to clean themselves before going into their own homes. Some are making plans to sleep in their garages or at motels to avoid spreading the virus to their families. 

"There are single mothers who who worry about that in a different way. There are nursing mothers who have decided to stop nursing their children. Everyone is thinking about contingency plans for their contingency plans," she said. 

"They don't want to detract resources from their own patients. I have physicians who tell me that if they test positive, they will just stay home, that they won't come and take a ventilator, if we don't have enough. It's incredible. This profession and what it brings out in people. It's really humbling."

Disclosure note: Henry Ford Health System is one of Michigan Radio's corporate sponsors.

Doug Tribou joined the Michigan Public staff as the host of Morning Edition in 2016. Doug first moved to Michigan in 2015 when he was awarded a Knight-Wallace journalism fellowship at the University of Michigan in Ann Arbor.
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