Archive: Daily Archives: April 20, 2020

COVID-19 Policies & Thoughts

For urgent or compelling needs, our office is open for face-to-face (with a mask), hands-on (with gloves) good old fashioned in-person office visits and examinations for the most accurate diagnosis and the most effective treatment. If and when you need us for urgent issues, we will take your temperature, have you wear a mask, and gel your hands. And when you leave the exam room it will be disinfected with 70% alcohol. Dr. Holmes is seeing patients with urgent needs in the office on Monday and Wednesday mornings and afternoons as well as Friday mornings. Please call 919-782-9003 to schedule an appointment.


In these COVID-19 days, it is very challenging being an ENT or any surgical subspecialist. The conditions of the virus are limiting patients coming to see us and patients having needed procedures.

What most surgeons do is necessary of course, but most is also elective, meaning it can wait a few weeks. Now breathing problems, bleeding, or pain move these issues to the front of the line.

To preserve masks and other PPE, operating rooms and hospitals are limiting surgery to only urgent cases, defined as needing to be done in next 30 days or there will be harm to the patient’s health.

A special nuance of this virus is that it lives in the lining membranes (mucosa) of the nose and sinuses, as does any respiratory virus. This one then goes down into the lungs. Any procedure done in the nose or sinuses can potentially release the virus into the air and infect any unprotected healthcare worker in the room. We have learned this the hard way in China, Italy, and France with many ENT docs getting severe infections and dying. For this reason, most of the nasal and sinus procedures we do routinely are being delayed until this crisis is over. If urgent or emergent, the patient must undergo testing that shows that they are COVID-19 free. And just now rapid tests have been developed. We will see how long it takes to produce and disseminate them. So far I haven’t had an emergency case, but I do have an urgent case this week and will wear appropriate N95 mask.

For these very important reasons, ENT docs in the country are closing or severely limiting their practices to prevent viral spread. We, at ENT & Audiology Associates, are open for urgent appointments, in other words, it just can’t wait.

Back in 1918 when the flu was pandemic, most docs were general practitioners and were overwhelmed with patients. But in 2020, unless and until we are needed to staff COVID-19 hospitals (like what happened in China), we ENT docs
and other surgery specialists (neurosurgery, orthopedics, plastics, urology, ophthalmology, etc) are wondering when this will end and what will be the status of our practice and our employees (nurses, receptionists, billing, etc.) when the dust clears.

So, bottom line is we will be there for you if necessary. Call first if you have cough or fever or shortness of breath or recent loss of smell (due to virus zapping your smelling nerves), so we can advise you properly. Please note that we will take your temperature upon arrival, and that all staff will be wearing masks, and we’ll ask you to put one on also.

Also please note that audiology support is the bare minimum.

Stay at home if you can, stay safe always.

Book Club, or Docs Read

One of the challenges of practicing medicine today is the relative isolation of doctors from other doctors, especially referral sources and recipients of those referrals.

In times past, a new doctor in town would join the local medical society to meet the other community docs, and express their desire to join into the medical community (primary care and specialists alike). The specialists would present their availability for consultations and referrals, while the primary care docs would pull shifts in the emergency room (now emergency department) to make their presence known and gather unassigned (those without a doctor of their own) to recruit to their new office.

And many of the doctors in the community would round on their inpatients and see each other in the physician lounge. Or take part in grand rounds (lectures, talks, medical education) to meet and greet.

And the third avenue for collegiality was the local medical society dinner meetings with one’s spouse. I assume many practices did business on the strength of the relationship of the spouses (most likely women suiting the era, who may or may not have had professional careers of their own).

But of course, times have changed. Many aspects of medicine have changed. Forever altered by hospitalists (relegating most docs to their office only and never coming to the hospital), emergency physicians (a specialty of their own), change of demographics with many more female physicians and of course doubly employed spousal partners (and the rise of the male medical spouse).

This leaves the local medical society to find relevance. Many have not and have folded. Some have embraced the need for docs to meet together and sponsor quality quarterly educational meetings.

Our local Wake County Medical Society has decided that one of its major missions is to create venues for conversation and collegiality and communication between docs, and their families. Hence the many social programs of exploring the many cultural opportunities Raleigh and Wake County afford.

And then there is the BOOK CLUB!!! Ta da!!! Trumpet call please!!!

We have a solid group of docs, around 10 or so, that faithfully read the offering and bring insight, opinion, personal experience, enlightenment to a quarterly meeting, with a humble meal, comfort food.

Fiction and nonfiction.

Medical and anything but medical.

Purview the list:

Dopesick, Beth Macy
Underground Railroad, Colson Whitehead
Kids These Days, Malcolm Harris
The Immortal Life of Henrietta Lacks, Rebecca Skloot
Things That Matter, Charles Krauthammer
Astrophysics for People in a Hurry, Neil deGrasse Tyson
The Beekeeper of Aleppo, Christy Lefteri
The Great Influenza, John Barry

A quarterly meeting with a simple dinner, breaking bread and discussing themes and motif. And trust me all have read the book, it is after all a type A kind of club.

I have been inspired after reading Tyson’s book to study astronomy further with an online course from UNC, astronomy 101 with lab. Got an A in both.

The flu pandemic of 1918 puts our current Coronavirus in perspective, and begs us to ponder what is next, even as we struggle with this virus.

Dopesick, about the opioid crisis, which has taken a back seat to the virus.

Henrietta Lacks, whose breast cancer cells have advanced all forms of medical research.

Underground Railroad, facing our ugly past, personalized it seems, like no other portrayal of the beast of slavery.

Reading together and coming together, supping, and dissecting a book TOGETHER.

Such power, such meaning, such connection.

I look forward to every book and can’t imagine missing these times.

One day I will leave the office practice and the OR, and I will retire and not actively practice medicine, but I so look forward to continuing the exploration of literature and writing with my physician colleagues.

Anyone up for poetry?