'Dr. House would be fired immediately': a Russian-speaking doctor told how COVID-19 is treated in America

Dr. Joseph Raskin lives in the small town of Albuquerque, New Mexico and works as an internist at the Gerald Champion Regional Medical Center in Alamogordo. Arguments and Facts.

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In the early 80s, he began his medical practice in Baku, then moved to Naberezhnye Chelny (then - Brezhnev), then to Israel, from there to America, where he moved from state to state.

Now Joseph Raskin lives in New Mexico in Alamogordo.

It is a town with a population of just over 30 thousand people in the south of the state.

The hospital has 40 beds, of which 10 are intensive care beds.

In November, he published the book "Notes of a Wandering Doctor", and regularly publishes posts on his Facebook with stories from life and about work in an American hospital.

Ruskin spoke about the pandemic, the work of a doctor in the United States and their health care system in general.

Hospital staff and COVID-19

Joseph Raskin said that today there are more than 650 hospitalizations with COVID-19 in the state, of which 200 people are in intensive care units.

He says that this is a lot, given that before that all the beds there were occupied.

There are about the same number of patients with coronavirus now as during the second wave in the fall of 2020.

The first wave of COVID-19 arrived in New Mexico rather late.

In the states, he appeared in the spring of 2020 in New York, and everyone was preparing.

“I took part in the headquarters meeting. In the summer we were already ready, trained nurses to work in intensive care, and began training doctors. In addition, we closed the hospital, that is, we practically stopped performing planned operations. And so we spent a month or two in full readiness, and nothing happened - the first wave of COVID-19 simply did not reach us,” the doctor recalls.

The wave hit New Mexico last October.

“And it was scary because there were no vaccines, recommendations from scientific communities, and so on. Although we already knew something: my chief medical officer and I were on the websites of intensivists in those cities where there was Covid-19. By that time, steroids had already appeared, they were trying to treat the cytokine storm, and the tactics of ventilation had changed. All this was collected and sent between doctors in Italy, France and here. In fact, the way we treat coronavirus developed quite quickly, even before these regimens were included in the recommendations of large communities,” says Raskin.

He put on three layers of protective clothing, an inflated helmet.

The equipment at his hospital was better than most large hospitals.

“But it was still scary and very depressing,” he recalls.

“All because there was a feeling: we are trying to treat patients, but the disease is taking its course, and people are dying, and quite young ones - 50-60 years old. Although they were overweight and had diabetes, they still had another 20-30 years to live. When I returned home from my weekly job for the first time (I work on a rotational basis), my wife said that in the 13 years that we have lived together, she had never seen me like this. But I always worked a lot and hard,” the doctor continues.

Later, scientists and doctors began to understand more about how the coronavirus flows, what to do with oxygen and how to ventilate, but the effectiveness of treatment has not changed much since then - the effectiveness of drugs is quite limited.

Raskin says he remembers vividly that after he got his second vaccine shot in January, his anxiety levels “just plummeted to almost normal.”

He said that today all the nurses in his hospital have either been ill or vaccinated - all major medical systems require vaccination, because medicine and the whole world have learned to function in the presence of COVID-19.

And it seems to him that it will not get worse.

How is the virus being treated now?

Now at his hospital, Ruskin and other doctors treat according to the recommendations of the NIH (the National Institute of Health is one of the governing organizations of American health care).

Only patients who require more than 4-5 liters of oxygen, who have risk factors for the development of complications and those who are already in poor condition from the very beginning, are placed in the hospital.

They all receive thromboembolic prophylaxis — the doctors give them long-acting heparin, an antiviral drug that appears to have very little efficacy, and steroids.

“We have discussions within the team about what the dose of steroids should be,” says Raskin.

There are doctors who, in addition to this, give vitamin C, vitamin D, but the basis of therapy is anticoagulation in one form or another and steroids.

Sometimes patients are given monoclonal antibodies.

Disease Predictions

Raskin says that in most cases it is possible to predict how the disease will proceed.

Now it is already clear what groups there are: most of the patients are those who came to the hospital on 4 liters of oxygen, they are put in, monitored for a day or two, and if they do not get worse, then they are discharged on the same 3-4 liters.

And there are patients with risk factors who are admitted to the hospital on 40 liters of oxygen, and there it is difficult for doctors to predict something: such patients have excess weight, diabetes and other concomitant diseases.

If the patient needs up to 10 liters - this is normal oxygen, in this case, doctors can prescribe it to home or to a rehabilitation facility.

And all that is above is the so-called high-flux oxygen, which is supplied through special devices, and it can only be given in hospitals, but this is not ventilation of the lungs - the person breathes himself.

These patients have a much better prognosis than those who are ventilated.

But with this amount of oxygen, the patient remains in the hospital.

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At the moment, Raskin and his colleagues are going to analyze what they have developed during this time.

They want to see what can help predict the course of the disease, because for some unknown reason, a very small percentage of these patients will improve in 3-4 days, and in a small part it will worsen, and doctors will have to intubate and ventilate them.

Vaccination: for or against

Raskin says that the vaccine is not a panacea, but according to statistics, over the past three months, among the sick, it is hard enough to get to the hospital - 85% are unvaccinated, and in intensive care units, almost everything.

He says that in his hospital there were a few vaccinated people who were in intensive care.

This is confirmed by data from almost all over the world.

“Vaccination is not a panacea, but it is the most effective method of stopping a pandemic and a way of personal protection,” says Raskin. “The treatment we have today is an order of magnitude less effective than prevention.”

About the opponents of vaccination, the doctor said that they have always existed.

“Some people who fought against measles vaccinations do not get vaccinated themselves. The pandemic is causing existential dread in all of us. And my theory is that someone sublimates it into rational actions: wears masks, listens to all recommendations, observes quarantines and gets vaccinated. And anti-vaxxers direct it into the irrational; their behavior is more controlled by emotions - they are prone to magical thinking that there is no virus. Then they said that this epidemic was like a cold. And today they are struggling with vaccines,” he says.

Raskin believes that this is a very complex issue, and social psychologists will write many more doctoral dissertations on anti-vaxxerism, plus Russia has its own moments, the states have their own, but “in general, it’s all emotions.”

Raskin said that in the Russian community, everyone quickly quarreled over COVID-19.

So, his list of Russian speakers, whom he banned on these issues, is already approaching the list of his friends.

He said that in his state, most of them live in big cities and vote for Democrats, wear masks even more than necessary, and get vaccinated.

“But there are huge areas - all of rural America - where no one wears masks and no one gets vaccinated, although many people die there,” he added.

What about Sputnik V?

Raskin said that Sputnik V was made by strong professionals using technology developed in the West for a long time.

“And now more and more data is emerging that it works no worse than the main Western vaccines. The problem is that Russia does not have a culture of medical research by world standards: the first studies were done awry. However, if Russia opens up to Pfizer and Moderna, then it will be easier to travel, and the West will probably have more incentives to recognize Sputnik V,” he says.

Medicine in small and large cities

American medicine is highly regulated: pneumonia is treated equally in a large hospital in New York and in a facility with 20 beds.

“For example, in my 40-bed hospital there is a cardiologist who performs cardiac catheterization 24 hours a day. And, in principle, a patient with a heart attack receives exactly the same treatment as in a large center. This is true throughout rural America,” says Raskin.

But some services in small towns simply do not exist.

His hospital does not treat thrombolysis free in acute stroke.

The patient is diagnosed, a CT scan is performed and a video link is consulted with a neuropathologist, who is not in his hospital either.
Then the patient is put on a helicopter and sent to a big city, where an invasive neurology team is already waiting for him.

Therapist in the USA

Raskin says that the American therapist is trained to heal a lot on his own, to work in a polyclinic, hospital, intensive care unit and intensive care unit.

This picture is especially typical for the American hinterland, where hospitals are small, and physicians are engaged in many of them.

At his hospital, he treats neurological patients, although there is a neurologist in the city with whom he can consult, but the answer from him can come only after 24 hours.

In addition, together with surgeons, he deals with patients with hip fractures and other cases requiring surgical intervention.

“In principle, I can look at the fundus of the eye at a very, very primitive level, but I will see what the therapist needs. Although in big cities the patient will be examined separately by a cardiologist because he has chest pain, an infectious disease specialist because he has pneumonia, and a pulmonologist,” says the doctor.

“There are areas of medicine where you have to be able to do pretty much everything, for example, in family medicine. In good places, these are people who know gynecology, can treat children, even very small ones, deliver births and fix fractures,” continues Raskin.

There is such an area as emergency (emergency medicine), which was created so that the doctor in the emergency room can treat everything and provide first aid to almost everyone.

“I was once on a rotation at one of the emergency medicine hospitals in New York, and there the emergency medicine doctor was able to perform a thoracotomy - open the chest - on an admitted patient with an acute injury and begin to repair large vessels while the vascular surgeon was running to him. That is, there are areas of medicine where universalism is the standard,” he says.

“As for Dr. House, he worked in a hospital that didn’t exist. This clinic in the film was in Plainsboro, New Jersey, and I lived across the street from this place, and there was no hospital there at that time. And in general, he worked in some pretty fantastic department,” says Raskin.

"I think Dr. House would be kicked out of work in any American hospital in about 15 minutes," - said the doctor.

The doctor comes to work at 7 in the morning, when the day shift, in which there are 3 therapists, gathers.

The night shift doctor arrives, who tells who he received and what was happening.

As a rule, a surgical team is also present at this time, with which general patients and plans are discussed.

It takes 15-20 minutes.

Then he runs to the intensive care unit until the night nurses are gone.

If there is something urgent, he has time to discuss it with the nurses - day and night.

After that, he begins bypassing from the intensive care unit, goes to the regular department.

In dockyard times he had 6 to 12 patients, now between 10-15.

This is a reasonable load by American standards.

If a catastrophe occurs, the patient enters in shock, then he can deal with it for several hours and not watch anyone else.

“Everyone else lies still and waits for me to free myself. But, as a rule, by 2 o’clock in the afternoon I have time to see everyone, make notes, and talk with consultants. And then for the rest of the day, until 7 pm, I sit filling out documents for patients - this is a process when you study the medical history, delve into the literature. But now with Covid, my rounds can take place until 5-6 pm,” says Raskin.

He adds that the national average for a general practitioner working in a hospital, in the US he is called a hospitalist, earns about $ 220-270 thousand a year.

Communication with relatives

The first level is when relatives call the hospital and talk to the nurses.

And the second - with the doctors. But every doctor tries to talk to the relatives of those patients who themselves are not able to.

“If I have a patient lying down and can understand what’s happening and talk to his family on the phone, I’m not very worried. But if he is on a ventilator, the family calls the nurses 7 times a day, then I usually talk to a family representative. And if things are really bad, then even now, in the conditions of coronavirus, I go to the administration, organize a meeting between the family, whom we bring inside the hospital, me, a nurse and sometimes a social worker. Communication with relatives is a fairly large part of my daily work,” says Raskin.

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This is the rule for the American system. The patient must know what is going on. The nurse always tells what injections she gives him, what pills she gives.

"It's part of the culture of medicine that differs from country to country," he says.

When is the end?

“The problem is that this is a pandemic. Therefore, it goes up in some parts of the world, and down in others. In New Mexico, we have a feeling that a plateau has arrived; there are southern states where the wave passed earlier and the number of cases is decreasing. But now “omicron” has arrived, about which we still know little, but its infectiousness is apparently higher. In general, we haven’t passed yet,” says the doctor.

“It is important that the world has learned to function in a pandemic. The apocalypse has not come, and my feeling is that it will never come,” he concluded.

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