In forty-eight hours, I went from thinking SARS-CoV2 might skip over my county to wondering if I just got SARS-CoV2 in my dick. The case report writes itself: Novel mode of transmission of SARS-COV2: a case report of penile acquired disease transmission in a health care worker following exposure in an aerosolized environment.
It is easy to imagine the atmosphere is alien and deadly; full of aerosolized poison spraying out of the ET tube in the patient’s room. I remind myself that this is just a virus and it must follow the rules of transmission, the trusty old PAPR and Tyvek suit will keep me safe, right up until the moment it doesn’t. I squat down to move the catheter bag, and the crotch of the Tyvek suit blows out into an eight-inch gash.
I immediately begin to rethink my decision to not wear much under the suit to stay cool. What level of PPE do Fruit of The Loom Cool-Mesh briefs offer? Intact skin is not an exposure, but what about genitalia in an aerosolized environment? My partner should be awarded partner of the year – she tapes up my blown-out undercarriage with Gorilla Tape and as nurses look through the glass and wonder what the fuck is happening there. The patient is unaware of my exposure (double-entendre) thanks to propofol.
Two and a half days later I wake up at 02:30 with a pounding headache. I am going to vomit, not right away, but it is inevitable. It is going to happen. All future light timelines lead to emesis. I tell my wife I am going to isolate in the guest bedroom. The sweating commences. Maybe I can make it to the bathroom before vomiting. I can’t. I exit to the kitchen sink; the bathroom is too far away. Trying to vomit quietly, while not waking a sleeping two-year-old is no easy task.
The doubt creeps in—few people have spent 4 hours with a patient on a ventilator with SARS-CoV2 in the back of a metal box at this point; how good is a ten-year-old PAPR? Are the filters expired? Do filters expire? The rest of the night is a fever dream of alternating shivering and sweating, thinking how I do not want to end up on a ventilator and wondering who I trust to intubate me. It is light outside before the headache abates, allowing me to sleep a few hours.
A New Paradigm. With the outbreak of SARS-CoV2, the healthcare paradigm is evolving. Those who are locked into black and white thinking and rigid structures are going to have a bad time, a really bad time. I’m not saying we need to fabricate trash bag intubating bubble helmets for our healthcare workers, or form death squads, but we have to be agile. We must be able to adapt and to evolve. We must be able to intake new information and update our beliefs. A constant, endless, ever-moving OODA feedback loop. Waiting on multiple levels of bureaucracy to impart changes is no longer going to work. Clinging tighter to “the rules” when you are shown that “the rules” are not working is slow suicide or at best some kind of sanctioned Russian Roulette leading to an evolutionary dead end.
Healthcare has left the linear, ordered world and entered the VUCA world.
“Things Done Changed.” – The Notorious B.I.G.
What is VUCA? It is an acronym for volatility, uncertainty, complexity, and ambiguity.
It is making hard decisions on the fly, deciding on course of action with nothing more than some fuzzy details and weighing risks versus benefits, deciding just how hypoxic a patient can be, and of course, there is the incident where I exposed myself to several nurses in a med-surg room converted to an ICU room and maybe got SARS-CoV2 in and around my penis.
VUCA is the forecast for the next few weeks or months ahead. The sooner we realize where we are, in a world dominated by VUCA, the sooner we can begin to acclimate and to operate in these conditions.
If you are in a leadership position be aware that this VUCA world is an uncomfortable place not just for you but for many of your employees. In addition to the discomfort you feel (or at times—straight-up horror) you need to watch for the people in your charge as well. They are going to be anxious, irrational, mad, confused, frustrated and depressed about having the black and white rug of cause and effect thinking pulled out from under them. There are only shades of gray now. Continue reading “Genital SARS-CoV2, VUCA and Why Splashless Bleach Will Kill You.”