Five Questions for a Frontline Physician

In this historic week — when the U.S. has reached the grim milestone of 300,000 people dead from COVID-19 and the first frontline workers are vaccinated — CHI’s blog takes a turn away from the statistics and policy analysis to capture a human perspective.

Jeff Bontrager, MD, is an Internal Medicine Hospitalist with Midtown Inpatient Medicine in the Denver metro area. He primarily works at SCL Health Lutheran Medical Center in Wheat Ridge. A hospitalist is a physician who specializes in inpatient treatment. Dr. Bontrager cares for patients during their stay in the hospital, developing care plans, managing medications, monitoring, and diagnosing, among many other responsibilities.

I connected with Dr. Jeff Bontrager in 2016 after a (fortuitous) misdirected email. Recently, I reached back out to Dr. Bontrager over Zoom to get his perspective as a physician on the local frontlines of the battle against COVID-19.

CHI Jeff: What has 2020 been like for you?

Dr. Jeff: The year started off with my youngest son being diagnosed with a rare form of aggressive cancer called Burkitt lymphoma at age 10. Around the time the pandemic hit Colorado, my wife and I pretty much lived at Children’s Hospital Colorado where he was receiving care. We both gave up many of our professional responsibilities while he was receiving chemotherapy and other treatment, though I continued practicing as a hospitalist. The pandemic made things even more chaotic and hard for our family. We are very fortunate to have a supportive community of family and friends who helped us get through, and we are thankful that my son is finished with treatment and his health is pretty much back to normal now.

From my perspective as a hospitalist, the hospital was eerily quiet in April. It wasn’t the sprint that we were expecting. When the COVID-19 numbers went down in the summer, our trepidation relaxed a bit.

Things picked up in November, and we are now feeling the surge, though I wouldn’t call it chaotic yet. It feels like mile 18 of a marathon. You’re tired but hitting your stride and morale is pretty good. You just don’t know if the marathon is going end at mile 26.

I am fortunate to work where I do. It has a very healthy physician culture which has sustained us. Rapid COVID tests have been a breath of fresh air. And we have sufficient PPE [personal protective equipment] that we know is effective. Out of my hospitalist group of 45 physicians, only one has become infected, and it’s possible they were infected in the community, not the hospital. 

We are feeling the surge even more, however, as we go through the holidays. The hospital is already at the highest census I’ve seen during my nine years working there.

CHI Jeff: I am curious about access to care for people with non-COVID conditions. For example, I’ve heard that emergency department (ED) use went down during the pandemic. To what extent have you experienced that?

Dr. Jeff: Although we currently have a high census, people are still getting the inpatient care they need safely due in part to careful separation of COVID and non-COVID patients. And yes, I know anecdotally we saw a decrease in ED use during the early part of the pandemic. A lot of people were just staying away from the hospital, hopefully finding the care they needed elsewhere. Traffic volume on the roads was down so trauma cases were down. And mask wearing, hand washing, and social distancing had an impact on other viruses like influenza, adenovirus, and human metapneumovirus — which can cause respiratory disease.

One other thing I’d like to mention. Our physician group also provides backup to West Pines Behavioral Health, which is the mental health unit of SCL Health. While I don’t have hard data about this, we have observed considerable substance use during the pandemic. Unfortunately, the sentiment among patients tends to be one of despair: “I’m sad, I’m bored, I’ve lost everything,” and they turn to substances.

CHI Jeff: What are the greatest COVID-related challenges you’re facing as a hospitalist?

Dr. Jeff: I would point to three big challenges. First is that COVID patients tend to require longer hospital stays on average than other patients. A bacterial pneumonia may require three or four days in the hospital, for example, but for COVID-19, it can be weeks. It takes a lot of patience.

The second challenge happens when a COVID-19 patient is ready to be discharged. If they are too weak to return home, it may be difficult to find a skilled nursing facility or rehab center for them to go to as skilled nursing facilities and rehab centers are strained as well.  

The third challenge is the isolation. A hospital patient with COVID-19 doesn’t have 12 people surrounding them. There are no visitors. If you’re 80 years old and have dementia and are not sure why you’re there, it’s hard and confusing. It’s hard for families. It’s really hard to see someone on FaceTime crying with their families. Sometimes patients die without any of their friends and family at the bedside.

CHI Jeff: What’s the vaccine outlook from your perspective?

Dr. Jeff: SCL has a batch coming, and I’m scheduled to get my first dose on Friday.  

I’m optimistic about the vaccine. It does come with some logistical challenges. For example, fever is one of the possible side effects, especially with the second dose. It’s not an infection; rather, it’s the immune system’s way of ramping up. If you get the vaccine and then have a fever, it’s hard to know whether you should come to work, so ideally, you’d get the vaccine before a period when you can stay home.

CHI Jeff: Besides the vaccine, what is your greatest source of optimism?

Dr. Jeff: Gratitude, for one. I’ve had more people say thank you to me in the last eight months than in the last eight years.

Going through my son’s cancer treatment, it was shocking to me to be on the other side. As the father of a patient, it was so important to me for someone to just sit with us for 10 minutes, to offer a toothbrush, or a kind word.

The biggest gift of this year has been the gift of time. Of clarity about what’s important. I’m hopeful that as a society, we’ll remember those lessons from this period of history.

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