Staying informed and centered in the time of COVID-19

Onward Together

Team Shout Outs . . . . . . . . . . . . 2

Clinical Updates from the Front Line . . . . . . . . . . . . . . . . . . 4

Join Our Wellness Activities . . . . 6

Caring for ourselves and each other . . . . . . . . . . . . . . . . . . . . . 7

Come join us:

Daily Breathing & Meditation with Bala Subramaniam via Zoom 6:45am, 8:30am, 4:30pm

Yoga with Jackie Everett via Zoom Thursdays at 6:30pm

Town Hall with Dr. Talmor: 5pm Mon., 7am Wed., 5pm Fri. (MDs & CRNAs only)

Administrative Town Hall: Every other week TBD

Workout with Brian Daugh-erty Tuesdays at 6:30pm and Saturdays at 9:00am

Calendar

In this issueA word from the Chief Danny Talmor, MD, MPH

Dear Friends:

We continue to see large numbers of COVID patients in our ICUs and ORs. The good news is that the numbers, while high, remain relatively stable and I am optimistic. There are approximately 240 COVID positive patients at BIDMC today and 77 in our ICUs. Our ICU numbers are creeping up since many patients require prolonged ventilation and extended hospital stays. Our hospital has among the best critical care units in the world and I can say with complete confidence we’re fully able to take care of these patients and those who will come to us in the next several weeks.

We continue to get transfers both from our own network and from hospitals across Eastern Massa-chusetts. Our expanded ICU teams are doing a stellar job across multiple new units. We’re now able to transfer some patients who don’t require ICU care to Boston Hope, the new surge hospital in the Seaport. Our department is supporting a 24-hour resuscitation team there for patients who deteriorate.

ICUs require ventilators, and ensuring an adequate supply has been a focus for the BILH system. A month ago we ordered 30 new state-of-the-art Hamilton G5 ventilators and we will receive these by next week. We are also getting 23 ventilators from the Federal government’s strategic national stock-pile. Finally, our neighbors across the street at Boston Children’s Hospital will be loaning us 10 new ICU ventilators. Taken together we can be sure that we will have the tools to continue to do the job.

Looking forward to better times, discussions have begun on how we eventually resume regular operations. This is tied to regional and national planning and there are many issues to consider. We will need to put our repurposed ORs and PACUs back together and figure out how to effectively test patients who come in for surgery. Testing is key; we need to ensure that patients can feel secure coming into the hospital and that staff can come to work without fear of being infected by a patient. Safe reopening will require careful thought and planning, but it will happen, and we are moving towards that end. It may not be at the same time across the network but wherever we open first, we will all pitch in and help as we get back to regular operations. More will follow about these plans as they come together.

In closing, I’m awed by how well our sites have come together, how the barriers have broken down and we are united in caring for our patients together. T.S. Eliot wrote, “If you aren’t in over your head, how do you know how tall you are?” In this crisis we have all learned how tall we can stand.

Please stay well,

Danny

Agile . Resilient . Connected . Balanced .

Department of Anesthesia, Critical Care and Pain Medicine

Week 5 | April 18, 2020

Official Boston coronavirus status: https://www.boston.gov/news/coro-

navirus-disease-covid-19-boston

COVID-19 Resources: Go to Anesthesia Intranet and the BIDMC Portal: COVID-19 Central

Arnold Arboretum, Boston, MA

Our ICU team is doing a remarkable job caring for patients, managing beds and bed flow, and keeping both COVID and non-COVID patients safe. Their teamwork has been amazing and I want to thank them all for their efforts. - Mary LaSalvia, MD

Maria Borrelli did an outstanding job and acted as the last line of defense against COVID. She single-handedly likely prevented exposure to another two dozen health care workers. Ku-dos Maria. You are a wonderful physi-cian. - Bala Subramaniam, MD

I want to thank the techs and Ed Plant and Bejan Abaspour who have helped us so much in regular circuit changes for the anesthesia machine / ICU vents daily in East and West PACU ICUs. I was so impressed by their dedication and work ethic and willingness to help out when we had the vent failures. Thank you again. - Shahla Siddiqui, MD

This is a picture that Kevin Phelan sent during a CRNA central line train-ing in preparation for ICU re-deploy-ment. He went above and beyond helping to coordinate ICU trainings for our team before the surge. - Kayleigh McDonald, CRNA

I also want to shout out to our amaz-ing ICU fellow Kaarin Michaelsen who continues to work tirelessly tending to the bustling West ICUs. Her commitment to these patients is truly unwavering. She was especially

receptive and supportive on my first overnight shift helping in the ICU/PACU and I want her to know that her expertise, patience and kindness is greatly appreciated. Gratefully,

- Kayleigh McDonald, CRNA

Shout out to Taneshia Pina and T’Asia Zayas who gave onsite assis-tance for the virtual Harvard Anes-thesia Executive Committee meeting. Thank you! - Nora McCarthy

A big thank you to our critical care fellows (Sean Baskin, Andre Gosling, Annette Ilg, Kaarin Michaelsen, Andres Brenes, Sean Hersey and Stacey Keith) who continue to tire-lessly work around the clock in our now nine (!) ICU locations to provide the best care for our sickest patients. For the fifth week running of 24x7 coverage, the fellows have rolled with multiple schedule changes and an ever-growing volume and acuity with grace and ease. So lucky to have them on our team! - Ameeka Pannu, MD

Shout out to BIDMC GME Office: Thanks for providing lunches for the trainees working in the ORs/ICUs on the east and west campuses on 4/15/20 - MJ Cahill

WOW! Best newsletter ever. This is full of so much raw emotion, brilliant aca-demia, and the humbling teamwork that makes us great. So proud of our entire team, it takes a village or in this instance, the entire medical center. Thanks for your hard work. - Cyndi Casey, PACU Nurse

2 Onward Together | April 2020

Team

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Dear All,

William Osler said, “You are in this profession as a calling, not a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow men and women.”

These words never felt more real.

We know the hours are long and filled with anxiety and emotion, and the work is diffi-cult. Yet, hearing bells ring when patients get extubated, talking to them for the first time in weeks, and seeing them go home is a true joy and a privilege.

Thank you for your hard work, tremendous clinical care, teamwork, compassion and professionalism. Because of you:

• We have successfully extubated 32 patients thus far

• 15 of these patients are now HOME! The other 17 are recovering on the medical floors.

Thank you for all that you do. It is an honor and a privilege to work side by side with you.

Thank you. -Molly Hayes and Todd Sarge

Expressions of gratitude in the com-munity are heartwarming acknowl-edgement of the dedication and sacrifice of our frontline staff and a reminder that we're all in this together. If you spot one or make one, we'd love to post it!

“ When are we walking?”

Angus Mclaughlin Stevens, Trish’s pup

April 2020 | Onward Together 3

Shout out to all staff volun-teering at Boston Hope Hospital: Our department is heavily at Boston Hope, the surge hospital that was set up in the Seaport district. Akiva Lei-bowitz is part of the leadership team and was charged with set-ting up the acute care services. Boston Hope admits low acuity and homeless patients as well as people discharged from regular hospitals. Some of these patients may deteriorate and need acute resuscitation. Akiva has enlisted physicians from our department to provide this service. Contact Akiva if you’d like to help. He is already receiving tremendous feedback on how important our participation has been for these patients. Your help makes a dif-ference. - Danny Talmor, MD

Thank you:

Katerina WilsonJohn Kaminski Victor PolshinRuma BoseAkiva LeibowitzNadav LevyLindsay RubensteinParagi RanaAidan SharkeyGalina KorsunskyPhilipp Fassbender

A recent COVID case briefing on GI with (staff from Anesthesia Left to Right) John Kowalczyk, Galina Korsunsky, Ina Harten, Ashley Lowery

Thank you all, great work today. All our practice payed off- proud to work with such an amazing team!! - Dr. Veronica Kelly

That is great! -Dr. Douglas Pleskow

This is a nice picture of the BIDMC teamwork it takes to get a high risk patient done safely. Thanks to everyone for their excellent work today. - Dr. Tyler Berzin

We greatly appreciate the continuous support from our Clinical Engineer team and Anesthesia Techs. The 24/7 Anesthesia Tech coverage is a tremendous help, especially at nights and weekends! We cannot thank you enough. - Yunping Li, MD

While our entire network is stepping up, I want to offer an extra shout our for the extraordinary work of Cam-bridge Health Alliance (CHA) and BID-Plymouth. CHA sees some of the hardest hit people in the state. They are on the front line doing a terrific job under enormous pressure. Without their support our hospital would have been overwhelmed. At Plymouth, Dan Walsh implemented the proning protocol, which is a complicated, labor intensive proce-dure, but it ramps up their ICU to care for patients as well as we do here in Boston. Thank you again CHA and Plymouth! -Danny Talmor, MD

Dr. Maxine Liang is rotating on OB this month. She donated a box of 95N masks to us. The PPE is most valuable gear for healthcare providers to fight coronavirus. Thank you, Maxine, for keeping us safe! - Yunping Li, MD

I would like to shout out to MJ Cahill for being a supportive member of the administrative team, telling great stories, and sharing pictures of her cats. I really appreciate you and the support you’ve been providing to the team overall. Thanks for everything.

-Dawn Ferrazza

It was a heart-warming experience being on the airway team with Shaz Shaefi. He is a role model in ev-ery way who wants the best for his patients and colleagues. He cares so much about the safety of his col-leagues and went above and beyond to protect them. May the forces be with our ICU teams. Thanks,

- Sugantha Sundar, MD

Thanks to Kristin Stiles for her wonderful instruction, kind words and encouragement during yoga this week. It was relaxing, peaceful, heal-ing—and a great workout. 20 people benefited... the perfect remedy after a long day. Thanks also to Scott Zimmer for coordinating the event and to Justin Stiles for being the willing model—maybe the hardest job of all. -Heather Derocher

A reminder to all physicians:Dr. Pamela Peck is available for mental health and moral support.

Pager: 38261 Phone: 617-667-0651

How intubation went from a common hospital procedure to a critical function in addressing COVID-19 WBUR – April 17, 2020

Daniel Talmor, MD discusses the intubation process amid the COVID-19 pandemic. https://www.wbur.org/commonhealth/2020/04/16/covid-19-coronavirus-intubation-ventilators

4 Onward Together | April 2020

Dr. Haering: The West PACU ICU is very active as a COVID unit. Care is being pro-vided by our CRNAs and residents under the supervision of an ICU attending.

-Floor managers, front desk staff and anesthesia staff are reviewing all patients' OMR, POE and lab results for COVID sta-tus prior to each surgery. (This process is time consuming and may need to be repeated several times as patients await surgery, but is important as we try to protect our staff and other patients.)

-Talis is moving forward despite the pandemic with a "go live" planned for May. Daily training is now occurring in the Fishbowl.

-New devices that sterilize N95 masks, courtesy of Rami Burstein, have been placed in various departmental locales. Dr. Sundar: Process work this week included discussion with nursing on post-case protocols and donning/doffing of gowns, and clarifying with EVS the pro-cess for cleaning of routine and termnial cleaning of rooms.Dr. Sarge: ICUs are very busy with over 100 patients.- RB6 pod is opening up. The TSICU will go back to being a "clean" and the West PACU will be a COVID unit.

- We have received additional Hamilton G5 ventilators with more on the way this weekend.

- Floors are also full as we increase ICU space and decrease med/surg beds.

Dr. Simopolous: Ramping up telehealth in Boston, Milton and Needham. Volume remains stable in the low 50s.

- Restructuring supprt staff after redeploy-ment of some staff.

- Brian Duckman is working with Shannon Cameron on billing.

- Dr. Gill will be helping out in Needham- We're aligning treatment approach with Dana Zelkind at NEBH.Dr. Li: Obstetric Anesthesia:

- Labor & Delivery unit continues to prepare for COVID patient surge. As a re-ferring medical center, we accept COVID pregnant women from network hospitals.

- Since April 1st, Obstetric Anesthesia has taken care of 14 COVID and 21 PUI pregnant women.

- One of our three L&D ORs is a dedicated COVID/PUI OR. We now have a second hybrid OR – for STAT cesarean delivery or to be used as a COVID backup OR.

- In order to best care for all COVID/PUI and other healthy patients on L&D, we're using a Feldberg OR for our scheduled daily cases. Dr. Ramachandran: Key updates: 1. Please refer to our new approved workflow decision-support document to help define our approach to COVID and non-COVID patients (link: https://anes-thesia.bidmc.harvard.edu/AnesPortal/Documents/2020_Covid_19/COVID%20and%20non-COVID%20workflow%20decision%20support.pdf)

2. A new virtual pager has been created to simplify the task of reaching the AOC 24/7. It will point to the floor manager during the day and the call AOC after 5pm.3. All of the most up-to-date Anesthesia COVID resources can be found online in our Anesthesia/Periop COVID PPGD Manual as well as on the Anesthesia In-tranet. (link: https://apps.bidmc.org/cms/display.asp?c=1347)4. To account for our new workflows due to COVID, we’ve added additional comments and documentation options in AIMS. You can now indicate the COVID status of your patient under Medical History and can specify if the patient by-passed preop holding or recovered in the OR due to COVID precautions.5. You can now request CME Credit for Wednesday town-hall meetings via the CME Request Form found on the Anesthesia Intranet. (link: https://app.smartsheet.com/b/form/6066a0a6a77b4d398003901ded794a4b)

Clinical Updates from the Front Line West PACU ICU

RESEARCH UPDATE: Dr. Robson: Currently, we are planning on how best to reopen the Basic Research Laboratories, after the current COVID-19 disease surge and how best to restart investigation once new case numbers are decreasing. These issues are under discussion. Many of the research staff are still working from home still but several are now assisting in clinical diagnostics and returning to help in clinical research.

• Collaborators in the Departments of Anesthesia, Emergency Medicine, Pulmonary Critical Care, and Acute Care Surgery con-tinue to plan and implement studies on experimental therapeutics for COVID-19 including hydroxychloroquine, inhaled nitric oxide, interferon beta-1a, tPA, and convalescent plasma. Further studies are in planning to address the substantial activation of coagulation and concurrent inflammation in COVID-19 patients.• Severe acute respiratory syndrome coronavirus 2 virus (SARS- CoV-2) is the focus of sustained investigation with new efforts un-derway to determine population studies prior to relaxation of social distancing rules and “stay at home” rules. Important advances are being made in the understanding of mechanisms of infection with introduction of rapid techniques of virus detection, which are going to be essential to long term clinical practice. • There are CDC-based proposals for application serological tests for SARS-CoV-2 with development of basic parameters for laborato-ry testing e.g. with ELISA or other approaches, which will be refined over time. See https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html and also https://partners-source.mediasite.com/media-site/Play/e6a249b266db409089ced386e802b0f41d.

• We have a set plan in place to measure IgM/IgG/IgA antibodies to SARS-CoV-2 in a sequential manner in ASYMPTOMATIC healthcare providers at risk; and to further screen by RT-PCR as indicated. Dr. Stefan Riedel (Clinical Microbiology Labs) and we are doing the preliminary validation of assays manufactured and supplied by ANTAGEN using positive patient sera and historic controls in the USA (sera pre January, 2020 when there was no disease here). We still plan to have our own Departmental testing rolled out in waves every 2-4 weeks and we will start when we are permitted to by the institution.. These tests will be entirely voluntary and performed by research study staff on site. • PI’s and staff are participating in the formation of “Biorepositories for Potential and Confirmed COVID-19 Cases” with the Massachu-setts Consortium on Pathogen Readiness within the HMS Ever-grande COVID-19 Response Fund. Other Departmental facilities are being examined for sample and data storage. • Vaccine development is an area of major importance and with rapid developments. There are around 115 total vaccine candidates are in early stages of development; with 78 confirmed as active projects globally.

April 2020 | Onward Together 5

BID-Plymouth UpdateErin Burns, MD Chief of Anesthesia BID-Plymouth

Plymouth is a164-bed community hospital with a 14-bed ICU. Our team includes 8 anesthesiologists and 14 CRNAs. Our OB service does around 900 deliveries per year. We have a lot of PUI and COVID+ patients on the floors. In the ICU we've only had 2 intubated patients.

We've been busy at Plymouth with COVID preparation and patient care. Some highlights include:

• Completed Boston COVID simulations and adopted their procedures and protocols for airway management.

• Trained for Donning and doffing in Plymouth.

• Established an airway team.

• Transitioned CRNAs to in-house call with anesthesiologists.

• Built a negative pressure OR with temporary walls to establish a COVID OR in OR7, including donning and doffing area.

• Distributed two ventilators to Milton and four to Boston.

• Set up the PACU with anesthesia machines for surge.

• Converted OB to a negative pressure room for COVID labor and delivery with negative pressure, donning and doffing.

• Worked with Dan Walsh and also Brian O’Gara on using anesthesia machines as ventilators and the management of these patients. They've been awesome to work with!

BID-Plymouth Critical Care Update

Dan Walsh, Director of Critical Care, BID-Plymouth

We're doing some big things in ICU. We worked on pron-ing protocol and simulation, worked with a nurse educator in training the nursing staff. We successfully proned one patient, which significantly improving oxygenation to avoid transfer to Boston. Our first intubated patient for COVID was transferred to Boston early on in this ramp up of the COVID situation. This patient has since been extubated and is out of ICU. I’ve done a lot of work coordinating with the ICU team and Erin, all the anesthesia folks and the hospitalist department in preparation of a surge. So far, we’ve been spared critically ill patients here, and have 20-30 COVID+ patients on floor, only a handful in our ICU, with only one requiring ventilation.

Cambridge Health Alliance UpdateJoe Mackey, MD Chief of Anesthesia, CHA

Cambridge Health Alliance (CHA) is an alliance of three hospitals: Cambridge, Somerville, and Everett Hospital. Somerville is a small hospital that used to be full service but with the Alliance consolidation of services now serves as a clinic building with an ER that is transitioning to an urgent care center at the end of the month. The Alliance serves the city/towns of Boston north metro areas: including Cambridge,Somerville, Medford, Malden, Everett, Chelsea, Revere, and Winthrop. CHA is a teaching venue for HMS, HSPH, HSDM, and Tufts UMS. BI is one of our Clinical partners and also MGH and Children’s. Normally CHA only has about 60-70 med/surge beds across all 3 hospitals with about 6-8 ICU patients per day.

As of April 15th 1,025 patients have tested positive across CHA—and we had 70 hospitalized patients, and 19 in ICU. Cambridge ICU and PACU are now full; Everett has one bed available. We will expand ICU capacity at Cambridge PACU from 7 to 12 with the latest wave coming from Chel-sea and Everett. Our CRNAs are now doing 24/7 in the ICU with the anesthesiologists and working with the hospitalist and critical care doctors.

Amid all this we continue to provide our regular services. We do about 1,200 labor and deliveries annually and have had a few COVID+ patients deliver. We continue to provide low volume anesthesia services for surgeries. Originally, we had three ORs across the alliance available for surgeries but reevaluated and are now using one OR across CHA to

consolidate manpower. We can still use the OR at Everett for emergency procedures.

We have also formed an intubation and lines team. ED does their own but we help when needed. This allows the hospital to redeploy hospitalists and family medicine docs to function in the hospital and clinics. While we typically don’t have 24hr coverage at Everett, we put an in-house anesthesiologist there to take the pressure off the physi-cians and are doing lines and intubations there as well.

CHA has doubled the capacity of the hospital and tripled and soon quadrupled the capacity of patients we care for in the ICUs. We’ve also implemented protocols BIDMC created and use them across the institution. It has been a very busy time, an interesting time, and this hospital has been tested in ways it didn’t expect, but the anesthesia team and everyone have stepped up in a big way. It has been really meaningful that CHA is viewed as a partner in the network because without that support and the ability to transfer patients to BI, Lahey, and Mt. Auburn, we would be completely overwhelmed.

“BI has been taking between 1-5 patients a day from the CHA hospitals and for our whole team to be part of that frontline project is really something all of us can be proud of. Thank you to the team and to the Baptist CRNAs who are being credentialed to help out CHA.” -Danny

6 Onward Together | April 2020

Monday Tuesday Wednesday Thursday Friday Saturday

Daily Breathing Meditation

6:45am https://zoom.us/j/455443909 Meeting ID: 455 443 909

8:30am https://zoom.us/j/834606825 Meeting ID: 834 606 825

4:30pm https://zoom.us/j/936723705 Meeting ID: 936 723 705

Workout with Brian Daugherty6:30pm https://zoom.us/j/99862061479

Meeting ID: 998 6206 1479

Password: 379338

Tai Chi with Jamee Culbertson6:30pm https://zoom.us/j/92012030341

Meeting ID: 920 1203 0341 Password: 614327

Yoga with Jaclyn Everett6:30pm https://zoom.us/j/92012030341

Meeting ID: 932 7924 2328 Password: 285049

Happy Hour7:30 after Yoga

Workout with Brian Daugherty9am https://zoom.us/j/92032095151

Meeting ID: 920 3209 5151 Password: 614327

Please join our Department’s Wellness Activities Health is wealth. Invest some time each day to keep your body and mind healthy.

Join our New Fitness Exercise GroupJoin our group: “Boston-Area Anesthesia Fitness Fanatics” on the FREE Strava app.

How’s your fitness level five weeks into sheltering in place? Some-times it’s hard to motivate yourself to get that daily activity your body needs and craves. We have a solution! Join your peers to track your exercise whether it be walking, biking, running, yoga, skiing, weights, or something else. It’s super easy, and really fun and motivating to see your colleagues’ activities and share comments. Stop surfing In-stagram and get moving by joining our Strava club at: https://www.strava.com/clubs/baaff. Now—this is social media with a purpose!

Strava is one of the most popular apps that allows people to record their exercise activities and share them with friends (you have complete control over posting and who can see your activities). You can add de-scriptions and photos to your activities to provide additional evidence of your exploits, and see what your friends, colleagues, and even profes-sional athletes are doing for exercise. It’s a great motivational tool since you not only see what others are doing, but how they are doing it. The Strava app is free and available on Android and Apple devices, and if you use heart rate monitors, bike trainers, foot pods, etc., you can pair them with the app, but they’re not required — the only requirement is to have fun!

A big thanks to Beth Hill for suggesting a fitness group and to Cullen Jackson for setting this up!

Introducing Tai Chi with Jamee CulbertsonWe are happy to announce a new wellness activity - virtual Tai Chi, led by certified Tai Chi instructor Jamee Culbertson. The first session is on Wednesday, April 22 at 6:30 pm. Tai Chi is very gentle and appropriate for all fitness levels. Now is the perfect time to learn something new so check it out!

Tai Chi is a Chinese martial art that uses slow, soft, flowing movements, along with breathing and imagery, to relax and energize the body, mind and spirit. It enhances and balances the flow of internal energy (qi), which can boost daily energy levels, increase a sense of well-being, and help ward off illness.

Tai Chi has been shown to provide a variety of benefits:

- Improves stress resiliency and well-being

- Helps manage symptoms of insomnia and other sleep disorders

- Improves balance and gait to help prevent falls

- Improves symptoms in cardiac disease

- Improves symptoms in some neurological conditions

Hope to see you Wednesday!Tai Chi instructor, Jamee Culbertson, is an Internationally Certified Alexan-der Technique Instructor. She is part of the Boston Healing Tao Instructors involved with the Harvard University Tai Chi Study for Cardiac Rehab 2015-16 and on-going studies.

The increasing wellness activities happening in our department have resulted in many emails, calendar meeting invites and Outlook calendars overrun with events. In order to help reduce the volume of communication and manage calendars, we have started the Anesthesia Wellness Calendar, a separate calendar in Outlook listing all wellness activities that will allow you to view all activities and populate your calendar with events that you choose to join. See the step-by-step PDF instructions to access the Wellness Activities Outlook Calendar included in the newsletter email.

Child care supportOption 1: Child care assistance is offered by some of our staff and their family members. Visit the Anesthesia Intranet home page. Option 2: Harvard University graduate students are providing emergency babysitting and other aid for staff at Boston hospitals. Click here to learn more about the process and apply for assistance: https://docs.google.com/forms/d/e/1FAIpQLScGm_lxpr1a_HNb9lz36fEsFkjsvG02UqyGEgiwkuxpjriN0A/viewform

Caring for ourselves and each other Stay informed: Harvard Health Publications Blog

This is a fantastic resource of helpful tips during COVID-19https://www.health.harvard.edu/blog/2020/4

• COVID-19: If you’re older and have chronic health problems

• What you need to know about COVID-19 if you have diabetes

• 6 self-care steps for a pandemic--always important, now essential

• Intimacy, Sex and COVID-19

• Keeping teens home and away from friends during COVID-19

• Not a staycation: Isolating at home affects our mental health (and what to do)

Coping with stressOur clinical staff is performing superbly during the COVID crisis and providing expert care for patients. But it is a stressful time and the stakes are high, so it’s important to practice self-care as well and have strategies to keep your work and life in bal-ance. Here are some tips from your colleagues on how they are keeping it all together:■ Get up an hour early to get organized and motivated. Keep control of your day.

■ Try to keep emotional responses in check so they do not drive your actions.■ Be less reactive, more patient.■ Maintain the same daily schedule and get dressed for your day.■ When working at home try to set a start time and end time so you can take time

for yourself.■ Maintain regular communications with your work partners.■ Be understanding of other people’s stress but don’t take it on.■ Exercise both first thing in the morning and last part of the day—even for 10 min.■ Acknowledge the difficulty of managing workload, a team, children and time for

yourself. Set priorities to get necessary things done and make sure to carve out time for other things.

■ Show patience toward your co-workers.

Things to do when spending lots of time at homeLet’s face it. This sheltering in place can be hard and many of us are getting edgy and restless from the confinement. Here’s some ideas on how to pass the time:If you are home with your family, perhaps buck the routine and host an elegant family dinner. Get out your best dishes and glassware, get dressed up. You can make a fancy meal or it can be something simple and by all means let your family help with the cooking so it’s a team effort. And if they are old enough let your kids be the servers. Make a nice toast and enjoy!You can also take a few minutes (or hours depending on how many you have) to do some house keeping: deleting all the old photos on your phone, going through stacks of old magazines and papers and putting the ones you are done with in the recycle bin, and bagging unused clothing for donating later.Jigsaw puzzles are very family friendly projects because you can all get involved and see how fast you can finish. And you are flexing your brain as well!Want to spend the afternoon in a National Park without leaving your home? You can follow park rangers to some exciting and stunning adventures in Carlsbad Caverns in New Mexico, Bryce Canyon in Utah, Dry Tortugas in Florida, and many more. Check it out and take a virtual vacation. You’ve earned it! Visit Google Arts and Culture: http://www.tinyurl.com/VR-nationalparks

Has your bike been sitting around – give it a run!Biking is not only terrific exercise, but it’s a feel-good activity for spring when the weather is warmer but not too hot. It is low impact, builds strong legs, and im-proves heart health. When I bike outside on a lovely day I get the added benefit of feeling a bit like a kid again and going back to that time, being carefree, and savoring the breeze in my face. So maybe it’s time to dust off that bike that’s been sitting around all winter, pump up the tires, don your helmet (please wear a helmet!) and get those legs pedaling. If you haven’t biked start with short stretches and then build up gradually. Biking is a great family activity to share with kids too! Remember - if you are sharing the road with cars use proper hand signals when turning, respect traffic lights, and stay safely on the margins of the road. If you live in or near the Boston area, there are some beautiful places to bike if you want to avoid the roads. Here are some bike trails you may want to check out. https://fitt.co/boston/articles/the-best-bike-trails-and-bike-rides-in-boston -Ann Plasso

Employee Assistance ProgramIf you are struggling, please consider tak-ing advantage of this important resource.

BIDMC’s Employee Assistance Program (EAP) is here for you during this crisis and committed to helping all BIDMC staff who reach out to them. It is a free, confidential benefit to help employees and their household members balance work and family issues. Services include free counseling, referral information, and free legal and financial advice. Counseling can be done by telephone during this time when social distancing is required. For a confidential consultation or to make an appointment, please call 800-451-1834.

Op-ed by Dr. Somnath Bose

Check out this short op-ed penned by our own Dr. Somnath Bose for BMJ.https://blogs.bmj.com/bmj/2020/04/15/somnath-bose-coronavirus-is-changing-healthcare-from-within/

April 2020 | Onward Together 7

Team Stiles leading this week’s yoga session.

8 Onward Together | April 2020

Join Dr. Bala Subramaniam’s Resilience Study Building Resilience during COVID-19 times for healthcare associated workers

You are invited to participate! We are conducting a study to determine the effect of resilience-building programs on several aspects of wellbeing, includ-ing stress, coping, and work engagement during the COVID-19 pandemic in healthcare associated workers. You are all healthcare associated workers at the forefront of the crisis, and we would like you to participate.

Participants will be asked to complete a survey at the time of consent and perform resilience-building activities such as deep breathing exercises and meditation to help mitigate the stress you are dealing with. Throughout the course of the study, 15-minute surveys will be employed to capture your responses. Learn more at the following link: https://is.gd/building_resilience. This is a great opportunity for each of you to provide your feedback, and we hope you will consider participating in this study!

-Balachundhar Subramaniam, MD MPH Director, Center for Anesthesia Research Excellence (617) 632-8070 bsubrama@bidmc.harvard.edu

Helping Hands Gift Card CampaignMany people have reached out to ask how they can help members of our community who are directly impacted by COVID. Given that the usual mechanisms of support (eg: sending a meal, offering to help with children, errands, etc.) are more challenging during these times, we are launching a campaign to collect donations of gift cards from colleagues, friends and family.

These will be sent to affected members of our team as a way to help make life a little easier while managing the impact of COVID. This is also a way for us to help support businesses during this time. Think of cards that can help ease the burden – grocery stores, restaurants, Amazon, pharmacies, child-oriented activities to help keep them busy (Lego, Build a Bear etc), pampering (Lush, David’s Tea, etc) – use your imagination—anything will be appreciated!

More information coming soon, but for now please consider sending gift card donations in increments of $25 and $50 – though any denomina-tion is welcome!

Mail to: Dawn Ferrazza, 300 Brookline Ave., Yamins 210, Boston, MA 02215. Drop off: Yamins administrative manager/director.Schedule pickup: Call T’Asia Zayas to schedule a West/East/Pain pickup.

To acknowledge our thanks please include name and address of the donor (although anonymous donations are also welcome). Stay tuned for more ways to get involved!

Wellness Survey Results

The good news is that the vast majority of our depart-ment members feel very supported during this crisis and find our efforts to boost morale and provide clini-cal updates useful. Most appreciated are Dr. Talmor’s Town Hall, clinical information and protocols emailed on a regular basis, and the weekly newsletter. Our new wellness activities tailored for sheltering in place are also a big hit.

Our new “Wellness Buddies” system received mixed results, with some staff benefiting and other less so depending on their particular groups. We enrolled the entire staff in this program and the desire to engage in this type of activity varies among individuals. We plan to reevaluate the program and identify how it can work better for staff who want to participate.

There were some areas of concern. Some staff want more streamlined email communication with the same information provided with fewer messages. In addition, some wanted more information on the department’s financial outlook, salary and benefits. There was a desire for more clarity on current clinical protocols and the effectiveness of their implementation across our community centers. Finally, there were comments suggesting an anonymous wellness line so staff who are struggling can speak to someone confidentially. We are working on addressing these requests.

We are thrilled that staff feel supported and our goal is to continue and strengthen that support during this crisis and beyond. We thank you for your feedback – we are listening to your concerns and plan to use this information to strengthen our Wellness Program even further to support your work life and emotional well-being. -Matthias Eikermann, MD, PhD

Independent Activities: Building Resilience: 3-minute practice to expand lung capacity and improve immunity: https://www.youtube.com/watch?v=kWEIJs5FFjA&feature=youtube

4-minute practice to balance the mind: https://www.youtube.com/watch?v=q5m6tMjcF8k

5-minute yoga practices: https://isha.sadhguru.org/us/en/yoga-meditation/yoga-program-for-beginners/yoga-videos

15-minute meditation: https://vimeo.com/311808615 (Please note this video also has the introduction to what this is about) or https://youtu.be/wHnl_XugJy

Inner Engineering Online: A seven-module course each lasting 90 minutes embedded with various meditative practices. It is being offered free currently for all health care workers. Inner Engineering is a technology for well-being derived from the science of Yoga. It is offered as a comprehensive course for personal growth that brings about a shift in the way you perceive and experience your life, your work, and the world that you live in. Inner Engineering offers a unique opportunity for self-exploration and transformation, leading to a life of fulfillment and joy. https://www.innerengineering.com/?jwsource=em. Credentials: https://www.innerengineering.com/sadhguru

Vast Majority of colleagues feel very supported by Department Leadership.

PHOTOS OF THE WEEK

Onward Together CONTRIBUTORS THIS WEEKDanny Talmor | Simon Robson | Susan Kilbride

Dawn Ferrazza | Brian Duckman | Valerie Banner-GoodspeedKrish Ramachandran | Bala Subramaniam

MJ Cahill | Todd Sarge | Yunping LiEswar Sundar | Mike Haering | Tom Simopolous

Scott Zimmer | MJ Cahill | Trish Stevens Cullen Jackson | Beth Hill

SEND YOUR IDEAS & CONTRIBUTIONS TO:

hderoche@bidmc.harvard.edu.

We invite everyone to contribute to this wellness publication. Sharing ideas and supporting each other builds community—making us

stronger together.

Please let us know your suggestions for how we can support each other through COVID-19.

PRODUCTION TEAM Communications Director Heather Derocher

Communications Specialist Ann Passo

Academic Editors Alan Lisbon Matthias Eikermann

Past newsletters https://portal.bidmc.org/Intranets/Clinical/Anesthesia-and-Critical-Care/Wellness-News.aspx

FAVORITE BOOKS: Send your recommendations to MJ Cahill.

CODE GIRLS by Lizia Mundy An impeccably researched non-fiction account of the thousands of American women who served as Army and Navy code breakers during WWII and their innumerable and almost entirely uncredited contributions to winning the war.

SAPIENS: A BRIEF HISTORY OF HUMANKIND by Yuval Noah Harari It's hard to summarize, but I guess it's about the evolution of mankind and the more significant developments of society.

THE SWEET LIFE IN PARIS by David Lebovitz If you like Paris and eating French food/pastries, you'll like this book. Plus recipes are at the end of every chapter. Oui oui!

SALT: A WORLD HISTORY by Mark Kurlansky An engaging chronicle of the most important rock in the history of humanity.

THE HAPPINESS PROJECT by Gretchen Rubin I like that it helps reframe Happiness in terms of an individual being active in the pur-suit of happiness as opposed to being passive and expecting that you either are happy or you are not. It frames happiness as some-thing you are in CONTROL of—which I think is especially important right now.

FAVORITE RECIPE: TOP SECRET PISTACHIO CAKE

“This is my go to recipe when I need to bring something to a party, or to make for holidays to give away. It is a moist delicious cake that

people seem to love! And shhhh, it's so easy!” -Beth Hill

1 Box Moist Vanilla Cake Mix

3 Eggs

2 Boxes Pistachio Pudding

1 Cup Club Soda

¾ Cup Vegetable Oil

½ TSP Baking Powder

Add all ingredients in a bowl and mix well.

Use a well-oiled Bundt Cake Pan for best results.

Cook at 350 for 45-55 minutes (check with a toothpick around 35 minutes).Let cool and sprinkle confectionary sugar over the top.

April 2020 | Onward Together 9