Annie Slater MD

“Being brave isn’t the absence of fear. Being brave is having that fear but finding your way through it.”
-Bear Gryllis

 

Winter in the Emergency Department is chaos normally. Viral illnesses permeate our population, and the season is usually from November to March or later.  Young moms get nervous, fevers get really high, and our volumes skyrocket. We typically see relief in late April or June when the sun comes out and everyone can be outside a bit more.

Now that Coronavirus is on the horizon, things are different. We are in limbo, not really knowing what to expect.

I have fortunately been able to test the patients that come to the ER that are suspected COVID infections, and I have done so with a handful of kids. None of the tests I ordered became positive. It’s so hard, no one really knows what the mild COVID illness looks like. The flu? Sort of, I hear. According to reports, I know most cases are usually accompanied by a fever, but what if you only have a cough? Also, the reports say that most children are spared from the worst effects of the virus, but we don’t know how much they are responsible for spreading it.

I got sick on a Friday before I was supposed to work the weekend. Our hospital had just opened a drive-by testing for healthcare providers. I wasn’t sure if I should get tested. I felt really fatigued and only minimal cough. I normally would go to work under these circumstances. But these are not normal times. We have an ill-defined, but seemingly inevitable wave of tragedy that is about to hit our medical community. The old rules don’t apply anymore.

I decided that the best course of action was to assume I had it, stay home from work and get tested. It was more scary to potentially expose an entire ER of healthcare providers than to admit I was sick and stay home.  Fortunately my test was negative. I was sort of hoping it would be positive, just so I could say I had it, it was mild, and I recovered fully. I went back to work on Sunday. By now, things really felt different. The hospital is eerily quiet. It feels like  summer, from the number of patients, but very different in other aspects.

We are all holding our breaths. Waiting for the storm, bracing for impact.

I heard yesterday that an ER doctor from our community is ‘critically ill.’ He is reportedly only 40 years old. I am feeling with increasing dread that my job is dangerous. Honestly, I am not concerned too much about the health and safety of my children, as I commented earlier, the reports out of China have very few children getting seriously or critically ill.

But I am not immune, and I am in the eye of the storm.

I am becoming increasingly aware of how hard it is to practice ‘social distancing’ in the ER. We talk to our trainees, our nurses, our patients and our patient’s parents.  Our protective gear is there to protect us, but it is had to wear all the time.

By distancing ourselves with our protective equipment, we are also distancing ourselves from our patients, which is not traditionally what we try to do as doctors. You can’t express as much when your face is covered with a mask. Connection becomes that much harder, as my compassion and sincerity aren’t able to be communicated as easily. It is also really hard to hear with the noise of the fan on in our ‘respirators.’

I start to feel crazy, wiping everything down all the time. I start to get paranoid. Did I clean my workstation enough? Do I need to clean it again, every time I return? I now am spending more time cleaning than working, it seems. My hands are dry and cracked due to the amount of hand washing and antibacterial gel.

Then there is a kid who is unexpectedly ill with a respiratory illness. Maybe they have COVID, maybe not. Maybe you put all of the protective elements in place, only to find out that a colleague that you worked with a week ago is feeling sick, and the child is negative. Or a family member you recently had dinner with was around a person that tested positive. Am I now infected? Am I spreading this illness?

This whole event is becoming very real for me. I am starting to think about my own mortality and what would happen if I got sick. In China 4% of their confirmed cases were healthcare workers. Healthcare workers had a 15% chance of their illness being severe or critical. What are my risks? I have also heard that a recovery rate is only 5% if one is sick enough to need intubation, but I haven’t seen the data speaking to this specifically.

I feel deeply attached to my role in this pandemic, to be on the front lines, doing my best to stay strong, positive and tend to the patients that need it the most. What happens when we start to question this role? Is it better for me to triage and care for my patients, or my family? Can I do both effectively? What happens if I get sick? Will I be ok? What happens if we all get sick and can’t come to work?

I hear that the pediatric doctors will be pulled to care for more adults, there will be a sense of ‘all hands on deck’ if it gets to epic proportions. What about our mental health? What about our ability to stay resilient in times of crises? I understand that I and my colleagues are in the field we are because we like this atmosphere. But I also would like it to end quickly. The idea of weeks of this, massive amounts of patients, uncertainty, possibly working more than ever to tend to the ill is daunting.

I can imagine that too much stress and work could lead to the healthcare providers being prone to illness. A few companies, Headspace and Ten Percent Happier are providing free services for healthcare workers during this time. Many facebook groups are popping up, one for support of colleagues, the other to share clinical data and treatment modalities.

Life in medicine, as in other areas as well, will be remembered as ‘before the pandemic’ and ‘after the pandemic.’ We will never be as ill-prepared from a testing, staffing, availability of personal protective equipment, as we are in this moment.

I am taking it day by day, watching the trackers closely, anticipating that things are going to get a lot worse in the next few days to weeks. I hope all of you can stay safe, stay home, and get support or help if you need it. Don’t be afraid to stay home from work to get tested either, we are all in this together.

How are you coping? Please leave a comment about what the impact has been on you or your job, family, etc