COVID 19 Hits home
I work as an emergency room physician. Before the current pandemic, I had few worries about going to the ER. In fact, I like the pace, variety, and decision making. I like taking time to listen to people who come to the ER, sometimes to people who don’t have anyone else who will listen to them. I like my coworkers. They are my friends. I’ve bought backyard chickens from some of them, introduced some to area trail runs with others, and attended birthday parties and celebrations with them. I am a family man myself with four children, all under the age of twelve. I look out for all of them--kids, co-workers, patients--and they look out for me. I like it that way.
Last week, for the first time as an emergency medical physician, I worried about how my work would affect my family directly. I received an unexpected phone call from our chief medical officer early Saturday morning. He went right to the point: test results for a patient I had seen a week ago just came back positive for COVID-19. The patient had been in and out of the hospital in recent weeks for shortness of breath related to his chronic illness so this seemed like just another routine visit. However, after my shift ended he continued to decline and was placed on a ventilator due to shortness of breath. As his condition deteriorated during the week, he was eventually tested for the coronavirus. The patient is fighting for his life with COVID-19, my medical colleague said. “How are you feeling,” he asked.
I wasn’t fearful about my own condition, but I worried about my children, my co-workers, and my other patients. Instead of just watching my kids on their bikes that morning, I studied them. I quizzed them about how they felt. I took their temperature. They seemed okay. I called co-workers and was assured that all personnel who had direct contact with the patient were being contacted. I didn't want to be an almarmist but I also didn't want to just pass it off, either.. It’s not in my nature. I tried to recall this particular patient, the conditions, the details. It's always the details that matter. I never take anything for granted. I always sweat the small stuff.
Then, it came to me. I had met the patient as the EMS crew transferred him to a bed. Simultaneously, they were telling both a nurse and me about the patient's symptoms. He had a chronic heart condition--congestive heart failure with fluid build up in his lungs and legs.
He was complaining about shortness of breath. No fever. No cough. No body aches.
He had been in the hospital a week before to treat recurrent symptoms of heart failure. He said he had gained 10 lbs in the week since being discharged. This classically meant he was holding onto excess fluid. He had shortness of breath but that was nothing new to him. He has been on supplemental oxygen for years. Feeling short of breath to him was practically second nature, as ordinary as, well, breathing. An x-ray showed what appeared to be a pulmonary edema, consistent with his known heart disease. In fact, insidiously, it was an early sign that COVID-19 was simmering despite no other other tell-tale signs.
But what else? What other details? Then, it came to me. That was the first day our staff routinely began using surgical masks in the ER for ourselves and our patients. It didn't guarantee anything, but it may have prevented us from getting sick or even saved the lives of someone we love. We had started wearing masks in time. We had what we needed when we admitted an undiagnosed COVID-19 patient.
Currently an apocalyptic calamity rages in New York as providers have no option but seemingly to attempt to save a burning building from the inside. In many hospitals equipment, supplies, and resources are running perilously low. Meanwhile other emergency departments and hospitals across the country have some excess capacity and could help. But red tape, bureaucracy, and even hoarding seems to prevail.
While sharing equipment and supplies sounds easy on the surface, no doubt every hospital is concerned about running short themselves if they send supplies elsewhere. What if participating hospitals suddenly have a surge in new patients? Will they get loaned equipment or needed supplies returned? Even today, money is transferred seamlessly across state lines through bank transfers and books are sent easily across the country through interlibrary loan systems but there is no established system or process for sharing medical equipment or supplies. Could we not work out a similar process to share medical devices and resources?
In the past week, I tried to rally local administrators to send excess or unused medical supplies to New York without a hint of system wide buy in. State and county medical associations gave no clear answer on what it might take. And local elected officials did not return phone calls.
Meanwhile, there are dozens of well-stocked but darkened and unused rooms in the emergency department of local hospitals across Middle America. Will they need them? Will they need more? Without clearly identified needs, frantic efforts continue in many States by repurposing hallways and parking garages as temporary treatment areas to handle the potential surge of respiratory patients. We don’t really know what is coming as we stockpile equipment and supplies while simply preparing for the worst. Meanwhile, New York City, not Rome, is burning.