I am a cardiology fellow at a large hospital. I plan to keep anonymity even though I don’t think there would be repercussions from my story, but in this day and age, you never know. I was on call recently and was paged by our ED about a teenager with chest pain. OK, teenager with chest pain, big whoop. They later described that this pain was positional in that it was worse while being recumbent and better with sitting forward, a hallmark of pericarditis. The kicker: He was diagnosed with COVID-19 about 20 days prior to presentation. While COVID-19 is not known to cause pericarditis — I did find one case on Pubmed — what is actually known? We’re developing new knowledge on this disorder every day.
This threw a ratchet into what we normally do as far as assessment and disposition. There was push-back on admitting the patient, despite not having URI symptoms, despite the diagnosis of COVID-19 over 14 days prior to admission, despite not being febrile. The general hospitalist team did not want this patient admitted at all costs.
Then came the issue with the echocardiogram. Normally, this would be performed either in our inpatient echo lab or I would lug a machine to the ED without a second thought. The inpatient echo lab, however, refused to perform the echo, expressing their concerns of exposure. All parties involved wanted this echocardiogram to be performed in the ED. This would fall on me, though I’ll admit, despite being out of the supposed contagion window, did I want to potentially get exposed? Trainees across the globe are dying from this virus. It’s not often performing an echo would put one’s safety at risk, but this is a new world.
I agreed to go assess the patient with our attending. Despite recommendations, I put on a surgical cap, eye protection, an N95 mask, gown, gloves, and shoe covers. The patient was there with his mother, who we could tell was distressed. She had been up all night. “No one will see him,” as he could not make a PCP appointment since they did not want to bring this exposure to their office. They had gone to other lower-tier EDs who refused to assess the patient because he was considered more “serious” due to his COVID-19 diagnosis. The virus is resulting in a delay of care and making routine medical tests more difficult to obtain.
If you contract COVID-19, you become infected with a symbolic plague. While COVID-19 is not anywhere near as deadly as “The Black Death” that killed 60 percent of Europe, the stigma is similar. If you have COVID-19, shut yourself away in isolation, leave us alone, and stay away. If you’re hospitalized, you will be mostly alone (visitation has been banned for all patients at our hospital, except for pediatrics who get one visitor per day).
Our hospital sent out an email that we should treat COVID-19 patients with dignity and respect, but are we failing at this objective? The patient with COVID-19 may be your friend, your neighbor, your employee, but that seems to fade away with the diagnosis. When you tell them that you’ll always be there for them, do you include an asterisk that says “virtually”? The Hippocratic Oath states that “I will keep them from harm and injustice,” but in this new world, are we falling short of this goal?
Please remember that patients with COVID-19 are human beings. Do not blow them off when they are in trouble. Remember your PPE, and remember we are all in this together.
The author is an anonymous physician.
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