Tuesday was National Doctors Day, a day to salute all physicians, including those on the front line during the COVID-19 pandemic.

When several Butler County family care doctors left their private practices several years ago to become full-time hospitalists at Butler Memorial Hospital, they had no idea they'd be the main decision-makers regarding patients caught in a deadly pandemic.

Dr. Mark Carlsson explained that he and his colleagues oversee the care of every patient admitted to the hospital from the time they arrive in a bed until they are discharged.

He said the job of the hospitalists at Butler Memorial during the coronavirus pandemic was the same, but about half their patients were COVID-19 admissions.The other half were mainly those who had ignored symptoms of stroke, heart attack and other illnesses because they wanted to avoid the hospital because of the pandemic.“At the peak, a lot of elective (procedures) kind of fell off, and a lot of people who would have routinely come in with certain symptoms didn't seem to come in for a while,” Carlsson said.He said three of the six hospitalists saw COVID-19 patients each day in the units designated for patients with the virus.Those doctors had to don a gown, disposable gloves, eye protection and either an N95 mask or a powered air-purifying respirator (PAPR), which are large hoods covering the entire head, Carlsson said.He said the PAPRs provide added protection to the wearer, but the noise they generate can make it difficult to hear patients.

Carlsson said most specialists spoke to patients through the window between the hallway and the patient's bed to avoid contact with the virus, but not hospitalists.“Being the primary caretakers, we were the ones who actually saw them,” he said.He said physical therapists would prescribe exercises through the protective barrier of the patient's window that the patients could complete inside their rooms.Carlsson said many patients, whose symptoms in normal times would have sent them to the intensive care unit, remained in regular rooms on the highest oxygen flow through a CPAP machine, or continuous positive airway pressure machine, normally used for sleep apnea in an attempt to keep them off a ventilator. “We were taking care of a lot of sick patients on high oxygen flow,” Carlsson said.The process of putting on and removing the protective equipment required in seeing COVID-19 patients lengthened the workdays of the BMH hospitalists, as they also had to chart each patient's progress and treatment, talk on the phone with families, and meet with the shift's team of nurses and others regarding the day's game plan in caring for COVID-19 patients.“There were some very long days,” Carlsson said. “Just the mechanics of going in the rooms was very time-consuming. You can't just walk down the halls and go into the rooms.”Regarding COVID-19 patients on a ventilator, doctors look for two things, Carlsson said.The first is their oxygen level.“Seeing their oxygen requirement decreasing is a good sign,” Carlsson said.The other is the patient's functionality, meaning whether they are getting out of bed, eating, washing themselves and performing other basic self-care tasks.He said some patients who came from nursing homes were not able to eat and drink, even though they could tolerate breathing a high level of oxygen without being on a ventilator.“So it's not just oxygen, it's functionality too,” he said.He said for those on a ventilator, a stroke or pulmonary embolism produced by a blood clot was a constant concern.One benefit in caring for all COVID-19 patients at BMH is the cohesive group that formed among all medical professionals caring for them. “It really helped cement a lot of things,” Carlsson said of the communication between doctors, nurses, respiratory therapists and others.“On New Year's Eve, I pronounced three death certificates,” Carlsson said. “Just me, in one day.”But other COVID-19 patients, like a husband who walked down the hall to his wife's room for lunch each day, busied themselves while resting by reading or pursuing other low-impact activities.“There were plenty of people sitting up and talking, who were just on a little bit of oxygen,” Carlsson said.The only visitors allowed inside the hospital were those making an end-of-life visit.

When doctors knew a patient had just days or even hours to live, close family members could come inside the hospital and put on protective gear to say goodbye to their family member.Some elderly COVID-19 patients who had do-not-resuscitate orders died while on a CPAP machine because they could not be put on a ventilator, Carlsson said.“December was bad,” he said.Carlsson said he hopes people will make their health a priority when they're young so they do not develop obesity, high blood pressure and other conditions that can lead to the underlying health problems later in life.“There were very few marathon runners who were admitted with COVID-19,” he said.As for himself and his family, Carlsson said although his wife and daughter are nurses and his son is in the restaurant business, all managed to avoid contracting COVID-19.“I was careful with my shoes and clothing and things,” he said. “Fortunately nobody got COVID-19.”Ken DeFurio, BMH president and CEO, called the team of hospitalists at BMH and at Clarion Hospital front-line heroes.“Dr. Carlsson and his colleagues weathered the worst of the pandemic storm,” DeFurio said. “They made sure that patients had the latest treatments and therapies, and they supported nursing and all hospital staff in caring for these patients.“Our community is forever grateful to Dr. Carlsson and his physician teammates.”

Dr. Mark Carlsson