From the Desk of Dr. Louis M. Weiner

April was the cruelest month. After the peculiar high drama of March, when we grappled with a new reality, this most delightful month, typically filled with rebirth, walks on trails and trips to the park, cherry blossoms, the return of baseball, and ever-warmer days, was unprecedentedly taken away from us by an unseen, unpredictable assassin. Day after dreary day (even the weather mostly failed to cooperate) blended together. I am glad the month is over. For some reason, even though our hospitals remain full, I sense a coming easing of tension and less anxiety. Perhaps I am getting used to living under this cloud, but there are signs that the pandemic is regressing just a bit in New York, New Jersey and Philadelphia. Hope springs eternal.

Paradoxically, it has been an incredibly productive month. We rolled out a series of COVID-19 focused GUMC grants, and the work is getting done. The MedStar Georgetown Cancer Institute has been united as never before, as we align practices to cope with the pandemic and set the stage for future collaborations. I wrote a grant, we submitted a paper, and have several others in various stages of completion. I reviewed a CCSG for an upcoming virtual site visit, and learned how to do telehealth visits with my patients. I’ve even started cooking a bit — I used to do more, but had fallen out of the habit over the years. Harriet and I spend more time on Zoom with family and friends than I ever thought possible. It’s not like being with them in the flesh, but the visual contact sure helps.

Yeah, all that is good, but the month really stunk. I can’t wait for May to begin. And you will have the treat of a guest blog tomorrow from Kristi Graves, so my next blog will be on Monday. In the meantime, you know the drill. Wash your hands, stay safe and be well.

Lou

Was that not a great blog yesterday? It’s wonderful to get so many thoughtful and inspiring insights during this time. I never fail to learn from our patients.

I spent a lot of the day watching AACR presentations; I actually got to more talks this year than usual, since there were no side meetings to attend, other than the very informative GUMC Community Meeting on Tuesday afternoon. We are hungry for community, if 450 virtual attendees is any indication; the GUMC-wide in-person meetings rarely approach even half of that number.

Over the weekend we finally found out why my father was in so much pain. A CT scan revealed he had broken the femoral neck in his hip, and it was a displaced fracture. Even though he is 93 years old and has some serious comorbidities, there was no choice — he needed surgery. The alternative was being bed-bound for the rest of his life, in pain. So, he had surgery on Monday. Thankfully, he got through it well, and hopefully will continue to recover and return home after a brief stay in acute rehab. Most of the family joined him on a group FaceTime call on Tuesday evening, and his mind was as sharp as ever. We worry about his risk for COVID-19 infection in a health care facility, but such was our dilemma. Fingers crossed.

Many of you heard the sobering statistics related to COVID-19 in the DMV and in our hospitals, more specifically during Steve Evans’ presentation at the GUMC Community Meeting. I won’t belabor them here, except to mention that I then concluded it would be a long time until I got to visit my barber, and thus had no choice but to succumb to shears and clippers, courtesy of a very nervous Harriet. She is a wonderful artist, but is not an experienced hairstylist, even though this was the third cut she has done since we began social distancing. The first two cuts went very well. I will let you judge the quality of the third try.

It will grow back.

Be well, stay safe, and don’t worry about your hair.

Lou

Being a Cancer Patient in the Time of Coronavirus

As a patient fighting stage 4 GI cancer, I can tell you firsthand that the coronavirus certainly makes life extra difficult. As if I needed any more challenges! I have been under the expert care of Dr. John Marshall, Dr. Ben Weinberg and their Lombardi teams for the past seven years. I have been through innumerable chemotherapy regimens, six clinical trials, five major surgeries, and two courses of radiation. As difficult as it has been to go through all that, getting my chemotherapy under a pandemic has posed some interesting and unique challenges.

Going solo at my latest clinic visit.

Recently I came to the clinic for my regular doctor’s visit prior to my biweekly chemo infusion. My temperature was checked immediately upon entering the building, and a mask was offered to me, although I had brought my own mask to be extra safe. (Note: Subsequent doctor’s appointments for me have been “televisit” in order to maximize safety for patients and staff.) Dr. Weinberg greeted me with a polite bow, as handshakes are obviously verboten, and he patiently waited as I got my wife, Lorraine, on the phone to participate in the visit. This was the first doctor’s visit and infusion that Lorraine had missed in seven years, but she was determined to be a part of it, even if it had to be by phone. Dr. Weinberg reminded me how careful I need to be during this time due to my immunocompromised state. “Stay at home!” was his mantra. The meeting went off without a hitch, and Dr. Weinberg wrote up the orders for my infusion. I was encouraged by all the precautions that doctors, nurses and technicians at the clinic were taking to keep both themselves and patients as safe as possible from the coronavirus.

Next stop: the infusion center and another coronavirus temperature screening. I was nervous about navigating the day ahead without my wife. Chemotherapy can often be a long, exhausting day, and Lorraine has been my bedrock at every prior infusion for seven years. We always keep each other company with crossword puzzles, and by streaming movies. But more importantly she gives me the confidence and positive vibe to make it through the day.

Lorraine and me on the Chesapeake Bay.

Going solo requires some creativity. Despite not being physically together, we did a crossword puzzle together over the phone; I had made photocopies of the Sunday crossword so we could both work on the same one as we talked. I wish I could say that the day passed uneventfully. Unfortunately, I had an infusion reaction to the chemo. My hands got extremely itchy and red; my tongue became difficult to control, so I slurred my words. Thankfully, I had the presence of mind to hit the emergency call button that the infusion nurse had placed next to me. Immediately, four nurses came running into my room. Within seconds, they gave me a shot of Benadryl, and when that didn’t make the reaction go away, a shot of steroids. The infusion was stopped for a while, then, when it was safe, restarted at a very slow rate.

What a day to be without your caregiver! Lorraine was not on the phone with me when I had the allergic reaction, so as soon as I stopped slurring my speech, I called her and filled her in on what had happened. She was relieved that the worst had passed, but upset that she had not been there to help. She was as appreciative as I was of the quick thinking and professionalism exhibited by the infusion nursing team. Equally important was the empathy the team showed for both of us. That has been one of the constants that has kept us at Lombardi for the past seven years. You can tell that the doctors and nurses, and the entire staff, really care about you as a person. When you are fighting a deadly disease, you want to feel like you are not in this alone. And during these “extra difficult” times, there’s no team I’d rather have on my side.

One last thought: Cancer care can’t stop during a pandemic. No matter how afraid I might be of venturing out into a hospital in these troubled times, as a stage 4 cancer patient, I need to be on my regular chemotherapy in order to keep my cancer at bay. My experience at Georgetown has been nothing but positive, as it is clear they are taking this pandemic with the utmost seriousness. I’m no expert, but it does seem to me that my team has found a way to practice “safe medicine” by maintaining strict protocols, and planning creatively for workarounds to keep everyone safe. And that gives me peace of mind as I get mentally ready for next week’s chemotherapy.

Stay safe everybody!

Allan Butler
Georgetown Lombardi cancer patient
Butlerfilms@gmail.com

This dreary Sunday afternoon matches the moods of so many of us, as we officially enter into the phase of quarantine fatigue. We are at or near our coronavirus infection peak here in DC, though our hospitals continue to fill up, largely reflecting the infections that occurred a few weeks ago. I shudder to think of what might have happened in the absence of social distancing, and worry about what might happen if we let down our collective guard. I am not alone in these concerns, I am sure.

Our Isabelle

We took a bit of a gamble this weekend. On Friday evening we stopped by the front yard of Ken and Sarah’s house in Bethesda, duly garbed in our masks and armed with various forms of disinfectant. Our grandchildren were happy to see us in the flesh, but poor little Isabelle was a bit spooked by the masks; when we showed her our faces, she smiled and laughed. As we were leaving (after only a few minutes), she looked at us expectantly and invited us to come into the house, expecting us to do so, as we have countless times. When we could not do that, her 2-year-old heart was broken, and so were ours. Her older brother and sister, wiser in the ways of the world at the ripe old ages of 4 and 7, respectively, completely understand what is going on. But Isabelle does not, and there is no good way to explain things to her.

So, we went over again on Saturday, this time for a socially distant walk/scooter ride through their neighborhood. It was lovely, but it left us sadder than had we not come over. Video screens are great, but nothing quite beats cuddling on the couch with the people you love — no matter how old you are.

Amidst all the loss, be it cruel or simply wistful, I am sustained by the sure knowledge that I will never again take the simple act of hugging my grandchildren for granted. This is the hidden gift of coronavirus — it reminds us every day of the things that really matter in life.

I’ll be spending the next two days juggling work responsibilities with attending the virtual AACR meeting.

Stay tuned for a special guest blog on Tuesday from a Lombardi patient, reflecting on the challenges of receiving care during this time.

Be well and stay safe.

Lou

An email from AACR CEO Margaret Foti highlighted that organization’s plans to replace its usual in-person annual meeting, scuttled this year by COVID-19, with two virtual annual meetings, the first on April 27-28, and a second on June 22-24. There is already an impressive number of people signed up for next week’s meeting. You can register (free) and get more information here.

I no longer watch the daily press briefings about the coronavirus, though I still watch the news. I am simply exhausted, and imagine some of you are as well. So I’ll just focus on what I did on Thursday. I had a clinic, though it felt oddly dystopian. One patient came in for an actual visit, and the rest were seen through the MedStar telehealth platform. The clinic space and hospital hallways were eerily quiet, and everybody — everybody — was wearing a mask. I wore a new shirt from the top of a scrubs uniform I purchased (the bottoms undoubtedly had been designed for a circus clown). After the clinic ended I drove home, and in what has become common practice for clinicians in the age of COVID-19, stuffed my clothes into the washing machine, showered and changed into fresh clothes. Then, it was back to work.

Prior to my afternoon in the clinic, I enjoyed the morning data meeting, which was followed by a lab meeting. My days are pretty full, and I am finding it hard to get to all of the pending work — grants, papers, grant reviews — that must necessarily wait their turns as I deal with the urgent matters before me. It will all get done, but I need to practice what I preach, and here comes my sermon for today: take care of yourself.

In this odd time, I hear from so many friends and colleagues that the incoming work is a tsunami, relentless and unyielding. Home and work are, at least for now, fully merged. Those of us with limited prior experience in working from home need to recalibrate the meaning of work-life balance, especially in an environment where life does not include restaurants, travel, outdoor activities, sports and many accoutrements of what we consider to be the good life. So, each of us will need to find our own balance points. I am working very hard, but must always remind myself that the work is endless, and some of it can wait until tomorrow.

But I still have a bit of work to do. I’ll do better tomorrow, I promise.

Have a great weekend, stay safe, wear your masks when you go outside, and be well.

Lou

Harriet and I took our daily two-mile walk after I finished a brutally challenging workday. It was a bit chilly, largely due to the fading sunlight and a breeze that felt more like October than April, but the sky was blue, the streets were empty, and spring blossoms were everywhere. Yet, the enemy is truly upon us.

A feature on the NPR website titled “Tracking The Pandemic: How Quickly Is The Coronavirus Spreading State By State?” displays both incidence and deaths by state. While DC is not a big numerical contributor, it has a very high incidence on a per capita basis compared with all but a few states. Granted, some of this is a sampling artifact (DC contains no rural areas), but the numbers do not lie. Neither do the inpatient census data in our region’s hospitals, including here at Georgetown. So far, our hospitals are up to the challenge, and we have the necessary tools, the PPE and, most importantly, the incredible people to handle the steadily increasing load. But, for perhaps the first time since the pandemic was first detected, my vague, existential concerns have morphed into a more sinister, tangible entity. I know this situation will improve, but I am girding for some heavy seas.

In this I am not alone. Here is an excerpt from John Marshall’s daily report from Wednesday. Read this and be reminded why he is such a treasure — a true Georgetown legend. Enjoy.

…No one knows when our numbers will flatten and start to actually fall. As I am sure you all have been watching, while not a surge, certainly our numbers both at MGUH and the DMV have been on a steady increase, unrelenting so far.

During the DOM division chiefs’ meeting today, we heard Chip Read, Princy Kumar and Mike Molineaux describe what their teams are doing each day, how they have prepared, how they have stepped up, without any outward expressions of hesitancy or self-concern — regardless of what they may be feeling inside. Chip described the enthusiasm of the C63 nursing staff, trained for neuro ICU care, now fully engaged as a COVID ICU.

We heard how our own Mike Atkins and Pashna Munshi have helped lead the research efforts across our institution, working tirelessly to select and open the best trials for our patients.

Dr. Weiner led our weekly oncology systemwide call, hearing how each cancer team at each of our hospitals is coordinating care to deliver the best and safest care possible, the crisis bringing us together like never before.

Claudine Isaacs and I had a chance to discuss the benefits of telehealth live on a Facebook chat, with Claudine recognizing that with telehealth inpatient visits, we actually come out from behind our masks and can really “see” our patients, critical to so many discussions we are called to have each day. I did an end-of-life televisit, only my second televisit so far, that felt more like a house call that I so often wished I could make, but now I can.

Our residents and many fellows have had their training curriculum totally disrupted, from electives being canceled to no real outpatient clinics to two-week-on-one-week-off schedules.

For the first time, I felt the pandemic today — until today I had been only an observer, a planner, preparing. Our colleagues are doing incredible work, not asking anyone to thank them, not complaining of being tired.

I don’t really know what we will be called to do, or even if we will ever be called. Maybe I am the last one among us to feel what I felt today, having just snuck back in from sabbatical. But one of the reasons I have always loved working at Georgetown is the amazing people we get to work with, side by side. And that includes all of you.

Until tomorrow,

John

Until tomorrow.

Stay safe and be well.

Lou

Today, I’m sharing Chris Gallagher’s thoughts on cancer care in the era of COVID-19 as published recently in his blog. Here’s the link. As many of you know, Dr. Gallagher is MWHC Medical Director of Cancer Services.

Have a great day, stay safe, and remember to wash your hands.

Lou

Grateful to Health Workers

My recent near experience with COVID-19, as a proud heath-worker, spouse and father, was filled with nothing short of profound gratefulness on many fronts!

When I started to develop symptoms concerning for COVID-19, I called the MedStar Occupational Health Line. I found their associates to embody the spirit of cura personalis in their responsiveness, knowledge and compassion. The associates advised me to go for COVID-19 testing. Again, the caregivers at the MedStar Georgetown COVID lab were simply superb!

I then went into immediate self-isolation in a previously prepared quarantine room. Special thanks to my wife, who had diligently worked on preparing what we now call “the Q-room.” To overcome the understandable trepidations of self-isolation, I spent my time working hard, reading, reflecting, and above all being grateful and thankful.

My wife and I also spent significant time explaining to our three kids (virtually of course) why and how to go into quarantine during these difficult times. The artwork (see photo at right) put together by my three kids was truly inspirational in keeping me grounded, and our family connected. I am grateful to the rapid and professional response when I received the call from another experienced and highly compassionate caregiver from MedStar Occupational Health that I tested negative for COVID-19. My family is truly grateful for the amazing work being done by our caregivers who are so bravely serving on the front lines.

In this spirit, I urge you to express your gratitude for the sacrifices and dedication of our amazing caregivers by making a gift today or sharing kind words (more information can be found on this MedStar webpage). Gifts made to the Associate Emergency Support Fund will be directed for immediate use in helping the brave caregivers who are putting themselves in harm’s way every day to treat those who need it most. Gifts to support the COVID-19 Critical Needs Fund will be used to immediately assist with the unplanned expenses associated with our response efforts, including enhancing specialized testing sites, ensuring we can provide appropriate personal protective gear for our dedicated caregivers, and expanding our testing result capabilities — a major challenge currently being faced across the nation.

Stay safe and be well!

– Waddah Al-Refaie

And so it goes. I note interesting signs of cultural accommodation to our temporary new reality. Remote shopping is thriving, though Harriet spends a lot of time doing what she and her friends call “foraging” — going to preferred vendors and sites to accumulate whatever is needed — paper goods, fruit, toiletries — to maintain our sheltered existence. We get dinner delivered a couple of nights every week, which is good for us and for the restaurants we are patronizing. We have regularly connected with friends and family in the “Zoom-iverse,” and in many ways this has been an unanticipated benefit of our physical isolation. We almost paid a visit to our oldest son’s backyard today, but he was not feeling completely well, so we postponed our visit. Of course, he and we are on the lookout for COVID-19 systems (his younger brother tested negative about a week ago, though he subsequently had to operate on a virus-positive patient). Our only family health issue is the ongoing, gradual deterioration of my father. He hurt his leg somehow, and now is not able to walk. In any other time, we would have driven up to visit, but we live in the time of coronavirus. Happily, he has become fairly adept at using FaceTime.

We are lucky: I have a job, and this social isolation represents a profound inconvenience, but not an existential threat. However, the economic consequences of this crisis have disproportionally burdened people who lack the financial resources to withstand months without paychecks. How will they feel about social isolation when they have no food to eat because they cannot work? How does that change their perceptions of risk? This crisis demands skillful management on so many levels.

I think this will be an important week in the DC area with respect to the load of the pandemic. By the end of the week we will know if we are headed to a true surge (I tend to think not), a decline in new cases (I am hopeful, but not necessarily optimistic in that regard) or a continued plateau (this is my best guess). Irrespective of the outcome, I see no rapid end to social isolation. Obviously, events of the past few days indicate that parts of the country are actively or actively considering ways to “re-open,” in some cases gradually, in others rather abruptly. I find it remarkable that such decisions are not based solely on fundamental scientific principles and public health expertise. It seems inevitable to me that rash, accelerated returns to “normal” will undermine the benefits of social distancing before we have sufficient widespread testing, useful therapies and effective vaccines. Rinse, wash, repeat. How many cycles of this can we endure without permanent damage to our society, to say nothing of the terrible human toll?

It seems as if this crisis is poised to crack wide open this country’s pre-existing cultural and political fault lines. On one hand is the very real American self-perception that we are a nation of individuals with rights to do as we wish, without interference. If exercise of those rights causes harm to others, that is acceptable, because without those rights there is no freedom and then there is no United States. In this world view, so-called “experts” primarily want to impose their rules on individuals in order to curtail those rights.

On the other hand is the post-Enlightenment belief held by most Americans that while individual freedoms are incredibly important, they do not outweigh an individual citizen’s obligation to the rest of society if the exercise of an individual right poses a threat to that society. The trick is to find the proper balance between those starkly different views. In this moment, understanding that orchestrated protests against social distancing are likely politically motivated, we as a society must confront the question of whether we follow the advice of experts and continue social distancing measures, and begin what likely will be a gradual return to a full, new normalcy.

Make no mistake — how we proceed from here will be the focus of political cudgels wielded by candidates for public office in November. Will there be enough testing? How will the pandemic’s impact be felt in different states and regions of this country? Will there be a second wave, and how bad will it be? Who will be held accountable, and why? I do think that most Americans will be moved to support science-based solutions, but the vocal minority will be heard, and might get its way, depending upon who does the better messaging.

I am not Nostradamus, but I do know this: The science of epidemiology teaches us to maintain social distance until the pandemic has begun to wane, and should guide our actions as our political leaders begin to relax restrictions. Our health system has responded magnificently to the unprecedented challenges posed by COVID-19, and it will continue to do so. Science will find more effective therapies for SARS-Cov-2 in the near future, but antivirals are unlikely to render the disease completely harmless any time soon, if therapies for influenza are any guide. A preventive vaccine is nearly inevitable, and anti-vaxxers aside, will be widely adopted to provide protective herd immunity. We just need a little time to make this all happen.

I also know that I have a very busy week ahead. I hope you have a great week, too. Please stay safe, and be well.

Lou

It is so reassuring when familiar work activities creep into my daily routine — even when they are modified through the miracle of videoconferencing. My workday started with the Cancer Data meeting, and it was wonderful to get lost in science. Our community remains strong. Later in the morning, I saw patients using a video telehealth link. It was almost normal. Can you imagine how awful this time would be if we didn’t have the ability to connect with colleagues, friends and loved ones using video communications?

The intensity of work modulated just a bit, as the deadline for submissions for NCI Provocative Question grants was pushed back from April 25 to June 2. I am grateful for the breathing room.

Meanwhile, back to coronavirus. There is a lot of noise on TV, but the ICUs still have lots of patients. Please be careful, stay safe and have a good weekend. We will get through this.

Be well.

Lou