Reports from the Frontline

Monday, March 9^th, 2020

It’s hard to believe that just few days ago I came back from Cuba. The trip, as wonderful as it was, is suddenly feeling like a distant memory. As much as I’m trying to keep it cool and composed, there are moments when I get overcome with anxiety. The talk of the world is nothing but Corona. The number of COVID cases in the USA are rising and our conversations at work are becoming more and more about what to do when we get a surge of sick patients and how to preserve our PPE (Personal Protective Equipment) should it become scarce. This is definitely the biggest concern for doctors and nurses throughout the country right now. 

Our Whatsapp work group has been exploding recently. We talk about everything. We’re sharing our personal worries and concerns, exchange COVID stories from the media and bring up possible plans for action for our busy ED. Among the serious conversations dominating the group, someone sends a meme that makes me laugh quietly. I welcome the comic relief; without it I feel as if my mind would explode. 

But the overall mood is not jovial. We are learning of other health care workers throughout the country and beyond who have already been exposed to the virus and tested positive. Many physicians report in social media groups that they have likely treated positive COVID patients but were not able to test them, as the patients did not meet the current criteria for testing. We do not have proper testing procedures and not enough test kits in this country and this upsets me tremendously. Everyone in health care is at least a little bit worried at this point and most of us feel lost and unsure on how to proceed, especially since there are no clear recommendations provided to us at this time. Everything seems to be a work in progress. In situations like this one, you have to be open minded and quick to adapt to ever changing guidelines. We are hearing reports that Italy has closed its borders completely as they lose more patients daily. This is starting to feel a little bit surreal.

Saturday, March 21^st, 2020

I feel uneasy today, because I decided to purchase my own N95 masks which someone is selling for $80 per box, way over their usual price. The person quoted me for three boxes and I went with it, which came out to be $240 for 60 masks total. Jim (my partner) is unhappy about it, calling it “price gouging” and of course he is right about this. But I am doing this for my own sanity. Our biggest concern as ED physicians has been the possible lack of PPE and I just don’t want to have to face this situation. I feel like everyone is making preparations and I don’t want to be the last naïve doc left without any PPE because I did not think ahead of time. For some, this is a simple issue: if no one provides them with PPE, they will not be able to take care of patients. For me, this has more to do with having control over something in this crazy situation versus being at the mercy of others. Of course I want to do my job properly, of course I want to show up and serve those that need me the most. But I also want to be protected. If we do run out of PPE, what will we do? If we get sick, we cannot help anyone else. I don’t want to end up in such situation. I rather prepare ahead of time. This is what we, Emergency Physicians, are great at: anticipating potentially serious situations, preparing ahead of time to mitigate them and then responding to the best of our ability in the moment they happen. In this way, COVID is no different than any other situation we face in the ER on a daily basis.  

My phone today became a source of PTSD. Whether it’s social media or the news, the information currently being posted is incredibly stressful and anxiety provoking, especially FB and the media. Ironically, posts from distraught docs are a temporary bandaid to my feelings of isolation and loneliness, but after several minutes of scrolling I can feel my heart rate increase dramatically and my overall sense of uneasiness taking over. When my phone died today in the middle of a conversation with an anxious friend, I actually felt relieved and decided to leave it in another room for an undetermined period of time. This would normally be unheard of as I am attached to my phone like a calf to its mother. But in this situation I am putting strict restrictions on myself regarding the news, social media and actually anything corona related. Preserving my sanity truly relies on this. 

Sunday, March 22^nd, 2020

This afternoon I went to pick up the newly purchased masks. The seller asked me to meet him at a parking lot of a popular restaurant in the neighboring town. When I arrived, this restaurant, as most others, was closed and the parking lot deserted. It felt a little strange to be buying something from a complete stranger, at a deserted parking lot…Strange times call for strange measures I guess. He pulled up next to me in his car, took out several boxes out of his trunk and handed over the sixty masks without any issues. I feel relieved and super glad that I bought them. Somewhere in the back of my mind I feel much calmer now knowing that if we truly are hit like a wave and find ourselves without any PPE, I can reach for this emergency supply and help my colleagues too.

I have to work a night shift tonight (6pm-6am) and I’m feeling a bit apprehensive about it, but I’m also hoping to interview some of my colleagues and perhaps take a few photographs. I believe this particular time we find ourselves in is history in the making and must be documented as we see it…

Thursday, March 26^th

It’s amazing what a difference a few solid hours of sleep can make. Over the past several days, I have not been able to sleep well at night and kept dreaming about Covid. In addition, if I wake up in the middle of the night with a slightly dry throat, I immediately think I’ve contracted the virus. “So this is it, this is how it starts,” my mind tells me, taking me to the darkest places of my subconscious. I have trouble falling back asleep after that for a while. Last night however, I was able to get some proper rest and woke up feeling rejuvenated and ready to face whatever I needed to face this day. I felt more energized and joyful at the little things: my favorite music, a delicious smoothie I made at home, my sweet pups’ kisses. In this better state of mind, I am better able to serve my patients and to support my team. I must protect this state of mind at all costs. As part of keeping my sanity, I have started to limit my social media time and my consumption of the news. I now believe a healthy dose of no more than 30 minutes a day is sufficient. The rest I try to spend doing other things, like writing these thoughts down for example. I feel much, much better this way. 

April 2^nd, 2020

I haven’t written anything down in this journal for a while. Perhaps because I had a few days off from work and took the time to clear my mind and stay off the corona topic entirely. Today I peaked at the news again. We have now exceeded 1 million cases of confirmed COVID infections throughout the world. China is no longer the leader in this. United States has taken that position, followed by Italy, Spain and now even Germany. I am wondering how much higher these numbers will rise…I’m tempted to place bets, but I don’t want to make light out of this situation. Sometimes it feels like the apocalypse has come and it will destroy the world as we know it. If it doesn’t end it, it will change it for sure.

Reports coming from New York are absolutely heartbreaking. I talk with my physician colleagues and friends from the area on regular basis. Despite the dire conditions in their already overcrowded EDs, they remain super strong and keep showing up in good spirits! They are working in an incredibly tough environment, seeing hundreds of COVID patients a day, a significant number of which are very ill and admitted to the ICU. There are special morgues set up just outside the hospitals to store the growing number of patients that had succumbed to the illness. I can vividly imagine what is going on there, because I had lived and trained in New York City for 14 years of my life. The city is close to my heart. At times, I feel a mixture of guilt and shame for not being there right now to help. We don’t have it as bad here in Florida, at least not yet. We are seeing patients, but the overall volume of people seen in the ED has decreased somewhat. Most people are afraid to come to the hospital at this time and rightly so. We appreciate all those who are taking the quarantine seriously. Social isolation seems to be the only way so far to combat the virus. 

On a positive note, local communities nation wide have shown tremendous support for health care workers everywhere. We have restaurants dropping off free meals for us and local churches offering prayer (and snacks!) to get us through the day. In big cities like New York, there are cheers and applause heard throughout the city, as residents show up at 7PM to support all health care workers on the frontlines of the pandemic. I must say, for the first time since becoming a physician, I feel appreciated and know that my presence actually matters. I feel tremendous gratitude for the community standing behind us and cheering us on.

April 7th, 2020

We have set up a system to help with the process of seeing potential COVID patients in our ED. I know a lot of people have been working hard behind the scenes to streamline and make this as efficient as possible. We currently have a special tent set up outside that accommodates all the potential, but not critically ill corona patients. If someone is noted to be very sick, they come inside the ED and are placed in negative pressure rooms to minimize exposure to others. This model has been implemented in many hospitals across the country and it works very well in my opinion. I am incredibly glad my hospital made this plan come to life as well.

In terms of my shifts, we are seeing increasing numbers of COVID cases, but the overall volume is not overwhelming. Adherence to social isolation rules and avoiding the Emergency Room unless absolutely necessary is contributing to this volume drop and making it easier for us to take care of COVID patients as we have more time to devote to their care. I must say, I never knew how much time donning on and donning off the entire PPE takes. In order to do it properly, you have to follow proper procedures and be extremely careful not to self contaminate during the process. This can become very time consuming, especially with back to back patients. I believe that this is one of the reasons why so many health care workers on the frontlines have contracted corona virus across the world. During times of chaos, it is very easy to become complacent and screw up this meticulous procedure, putting yourself greatly at risk. This is why the lower ED volumes help us out in the end.

April 15^th, 2020

I must admit, I am doing a lot better mentally these days. I am not sure what it is, perhaps a combination of having enough PPE at this point and feeling more confident “on the frontlines” (aka the ED) as well as taking proper care of my mental well being, both at work and at home when I am off. Limiting my news and social media time has had the greatest positive impact I believe. It is not that I am against social media, quite on the contrary. Social media is what allows me to stay connected, to share my story such as this one, to find inspiration from others…But unfortunately, whenever I scroll, I see that negativity in that space is much more prevalent than anything else, so limiting my exposure and being selective about how much time I spend online has helped preserve my sanity tremendously. 

The volume in the ED remains low, which is a sign that people continue to social distance and stay at home, taking the quarantine seriously. That re-assures me and I appreciate all those who are doing their part. I am certain it is not easy to do this, especially that we do not know how much longer the pandemic will last. Everyone is fighting their own battle, everyone has to overcome different obstacles in this fight against corona. Knowing that we are in this together is the silver lining in this situation. 

Something good yet unexpected has happened yesterday: a box of COVID antibody test kits arrived at our house with the morning mail. Jim had purchased it few weeks ago online, but due to its demand, I didn’t think we would get it so soon. More curious than anything, myself and a few colleagues performed the test on ourselves at work. The kit looks a bit like a store bought pregnancy test: you have to obtain a sample of blood, drop it into the appropriate slot on the kit followed by two drops of serum and then watch it slowly move across the strip until it hits the control line. When the control line changes from blue to red, you know that at least the test has been done correctly. Anyway, this antibody test can show you whether you have current exposure to corona and/or whether you have the antibodies to it or not. So far I have neither corona nor the antibodies. At least this reassures me that I have been wearing my PPE correctly 🙂

With that thought in mind, I am off to my shift, ready to face whatever comes my way. I hope that no matter what, I am able to help somebody or at least inspire somebody to stay strong and to keep fighting the good fight. Whether we like it or not, we are witnesses to history in the making. Eventually this too shall pass, as nothing lasts forever. And what we can hope for is that when we do come out of this, we come out stronger and changed for the better.