Being an ER Doctor During the Covid Pandemic 5/2021

I am going to tell the trial and tribulations about being an ER doc during the pandemic. Not exactly a destination adventure.

The pandemic started for us in a rather benign way. Most of the information we were getting was from the news agencies about the issues New York was having. However, they put Navy Hospital Ships in the Long Beach Harbor well before the massive influx of patients with COVID.

We started seeing patients with COVID in October 2019, and the treatment was limited. Too much political influence on how we should be treating the disease. Hydroxychloroquine or not, Steroids or not, Azithromycin or not, just too many issues. If you used any of those treatments that were not designed or considered 'off label' treatments, you were scolded by higher ups (government) and even pharmacists or even our own peers for using those treatments. Odd, because we often use medications or treatments that are 'off label'! We are doctors and know the risk and benefits of using those medications. Sometimes I would feel that people were scared and wanted some prescriptions just to think they got something from our profession. Kind of like a placebo effect, assuming it wouldn't' be an effective at all. Ther weren't any governmental or other influences that would restrict our ability to practice or even write for any prescriptions before COVID. The director of one hospital I worked at found out that I had prescribed Hydroxychloroquine for one patient who actually asked for it. He read me the riot act! I wasn't going to acquiesce either!

Soon enough we had patients with COVID, who received no treatments in the past, that were coming into our ERs really sick and near death! It makes me angry when I think of how many patients were turned away without any treatments and now are coming back nearly dead already! Within days we were seeing one to two patients/hour and it didn't matter which hospital I was at. It seemed like almost every patient was sick with COVID and near death.

In the beginning, the thought pattern was not to put the patient on life support (intubation and subsequent ventilator). Data seemed to suggest that it would make them worse. So, it was avoided until absolutely necessary. When patients were put on life support, it meant they would likely die. It was a death sentence! I remember the AIDS pandemic. People were thought of as having a highly contagious disease and health workers did not understand the disease at all. Many considered it a death sentence, and it was! One of the residents where I trained was diagnosed with the virus and he committed suicide! It was terrible! This virus is very similar in the perception of the public and indeed, COVID IS highly contagious! We had to dress up with gowns, gloves, caps, N-95 face masks that usually took several minutes before and after seeing any patient for fear they may be contagious. Indeed, I lost many of my co-workers to the disease! During my residency in a trauma facility, oftentimes a near death patient would be 'dropped off' and their ride would drive away quickly. We would grab the patient not knowing what was wrong with the patient except for the obvious trauma the patient was dropped off for. You can't do that during this pandemic. You need to dress up each time that happens, losing valuable time to save the patient. I suppose in the long run, you can't risk your life too. You just lose that valuable time!

Soon enough we had run out of ICU beds because they were full of the COVID cases. The hospitals would rig the telemetry units as make shift ICU units. Soon enough those were full too! Hospitals soon became overwhelmed by the numbers themselves. Each of the hospitals were at capacity. Of course by now, the Naval Hospital Ships had been reassigned. We are now in the beginning of December. The ERs were the last hospital haven to go. Pretty soon patients that required ICU treatments were boarded in the ER as well. Hospitals started purchasing tents. These tents were like MASH units, Yes, we had patients that were being housed in the parking lots in our MASH unit tents!

Staffing was an extreme issue. Nurses did not want to put themselves at risk and we needed well trained nurses to accommodate these extremely ill patients. We would frequently run out of supplies as well. Too many times staff members were asked to attend to patients without proper equipment or dress. I feel guilty, because anytime I didn't have equipment, all I had to do was say so and the proper equipment would be found for us. The staff wasn't afforded that privilege. Hats off to the ER and ICU nurses who frequently put themselves at risk for the sake of their patients.

This went on for two months before things calmed down. The average patient that use to come to the ER did not come, There was a fear, which still exists, that you might get the disease if you go to the ER. ER docs have taken a significant pay cut as a result of this crises. Nurses, on the other hand, were given 'crises pay', which often was double the amount they receive normally. As a divorcee, normally I would have to work the first 5 shifts a month to pay the alimony that my ex somehow believes she deserves. Now with the pay reduction, I have to work 7 shifts a month (12 hour shifts).

My day would require changing into gowns, gloves, caps, facemasks often 30+ times per shift. I had to attend to codes on the floor. These were COVID patients that were not on life support that now needed to be put on life support. The dress involved with that was even more aggressive. The shielding me from secretions from the patients contaminated air was cumbersome. Try to intubate a patient with these contraptions! Difficult at best. December and January were the worst months. 45-50 codes per month not including my ER duties.

Fortunately things have calmed down since then, however, I have still semi-retired as a result of the amount of work and energy that was required of me during those days. That kind of work level is for the younger more energetic docs just out of residency. So now, I work about 10 shifts a month and 10 hour shifts instead. Yeah!!!

Things are a lot more relaxed regarding the COVID situation Things have not picked up in the ERs where work at. We are still at about 75% of where we were volume wise before COVID. I don't work on a per patient basis anymore either. That was how I was paid during the crises. My income dropped by 30% as a result. Now I am just paid a straight hourly rate.

I am more relaxed and have more time to spend on exploring new adventures! On my bucket list: Iceland and the Antarctic! This are things I hop to accomplish in the next year! Of course, writing will become more regular too.

Cheers! Carpe Diem