Practicing medicine during COVID challenging

Dr. Bonnie Carter has been in practice for about 17 years, but this about the craziest time she has seen. Recently Carter switched from Medical Center to Complete Care North, associated with Odessa Regional Medical Center and located at 980 87th St in Odessa. Carter said she arrived in November 2020. Carter, who provides family medicine, has been practicing in Odessa for four years and has family in Midland. The hospital is happy to have Carter aboard. “We are proud to have Dr. Carter join our care team at Steward Medical Group,” said Stacey Brown, president of Odessa Regional Medical Center, said in an email. “Our patients will benefit from Dr. Carter’s skills and expertise, as well as her commitment to providing care for patients of all ages in the community.” She observed that the COVID-19 pandemic is unprecedented territory. “The thing with COVID is there’s so much we don’t know and every day it’s constantly changing. And due to social media, there’s been an abundance of information, not always an abundance of correct information because every day there’s some new thing that somebody’s saying there’s a silver bullet that hasn’t been the silver bullet,” Carter said. “We get a lot of people coming in asking for specific therapies. Most of the time we get people coming in saying, ‘Oh, it can’t be COVID it’s just my allergies; it’s just sinuses. It’s COVID. COVID doesn’t act like a typical flu bug. I’ve seen people not have symptoms; I’ve seen people have loss of taste and smell; seen shortness of breath, cough, cold,” Carter said. She added that she’s not seeing as much fever now as she did in the spring. “Every day there’s changing in guidelines or recommendations to testing, to Telehealth,” Carter said. In the past, Telehealth was rare, but it has become much more common during the pandemic. It is challenging, though, because Carter said you can’t listen or examine a patient. You’re mostly relying on what they’re telling you. “In some stuff that’s OK, but in a lot of stuff it’s not. People have been scared to come to the doctor, so there’s been a lot of fear. We’ve seen people delay well-child exams because they didn’t want to come in. I’ve had patients that couldn’t get imaging studies or mammograms back in the spring when it first started and they shut everything down. I’ve had people delay those exams just for fear of not wanting to go to the hospital,” Carter said. She added that some specialists were not accepting new patients, as well. “It’s been an adventure, to say the least. Not to mention we have definitely been busy. We do COVID testing out here. We’ve been seeing healthy patients in the morning as far as our routine follow-ups like diabetes, hypertension. Then we do the sick, upper-respiratory symptoms in the afternoon to try and keep well people well and not expose them,” Carter said. She added that they conduct a lot of COVID tests in the afternoon and have seen “a lot of positives.” “You also have to deal with and face the fear of getting sick. There’s been lots of doctors, nurses, respiratory therapists and nurse practitioners that have gotten sick and then died of this throughout the country, so that’s definitely in the back of your mind. There’s a lot of anxiety about bringing it home to our families; not just us getting sick, but the potential of exposing our families and bringing it to them so that’s been a challenge,” Carter said. Along with health care providers, she said patients are more anxious and depressed because of a combination of economics, fear of getting sick and fear of family members getting sick. There are also people in nursing homes or assisted living that cannot see their families due to COVID. That affects their overall health, she said. “… You see a decline in their overall health because of the anxiety and depression. It’s not just limited to people who had preexisting anxiety and depression. I see whole lot of new anxiety and depression people that previously didn’t have problems,” Carter said. In addition to being worried about people putting off routine diagnoses, Carter said one of the things medical professionals saw early on was people not going to the emergency room with heart attacks and strokes. “They were coming in too late to intervene and they were seeing more people coming in DOA because they delayed going in with the chest pain … because of fear of COVID …,” she said. It’s a “weird disease,” Carter said, because you can have 10 patients the same age and have 10 different courses of the disease and 10 different outcomes. “With flu, everyone has the same type of presentation. COVID is all over the place and we’re seeing now the repercussions of people that have had COVID that have lingering issues like heart issues, lung issues, some neurologic issues. We don’t fully understand what kind of permanent damage that’s going to cause. We’re seeing people (where) it almost looks like asthma they have continued shortness of breath and get shortness of breath with exertion … I’ve had people with headaches, like migraine headaches,” she said. There have also been patients with persistent loss of taste and smell. Some people got it back, but maybe not completely. Pneumonia has been associated with COVID. “… There are the ones that get really, really sick and wind up in the hospital with COVID pneumonia and … other symptoms we don’t see that as much. Around two weeks in, they are having persistent shortness of breath and cough and their oxygen levels are low, but not low like (they) need to be in the hospital,” Carter said. “What we see is people coming back at 90-91 percent still having shortness of breath. You do a chest X-ray and it’s pneumonia. … A typical bacterial pneumonia looks like a wedge shape on an X-ray. It’s an area of what we call consolidation. The infected lung is full of infection, white blood cells, pus, the air sacs get full of the secretions. What we see with COVID is you actually see patchy fluffy infiltrates and that that are throughout the lung in all lung fields. A typical pneumonia, when I listen I can hear a pneumonia. People often have what we call rails or crackles when we listen … You often hear wheezing. (With) COVID, you don’t hear that. COVID you listen and it sounds clear. You may hear diminished air sounds, but you don’t hear the typical crackles and rails that you normally here. Many times I’ve seen someone who looks normal, other than the trouble breathing and their oxygen level being lower and then you do an x-ray and it looks horrible. Again, it didn’t read the book,” Carter said.