What has changed for emergency physicians?  Not much.

“You are a hero! “

“Thank you for all you are doing!”

It is overwhelming and tremendous; it is touching and heartwarming; it is genuine and sincere.  The outpouring of support and love for health care workers and first responders has been a bright light in the dark days of the coronavirus.  But I have been forced to wonder: What has really changed?  OK, before you get outraged by that statement, hear me out.  I know we are in an unprecedented time of a global pandemic, the magnitude of which most have never seen in their lifetimes.  I am aware that hospital systems are overwhelmed, we lack the resources we need to care for patients, and we are at greater risk to contract this virus than most other threats we have ever faced.  So, yes, I am aware of the gravity of the situation and how this is different.  But I ask again, what has fundamentally changed?  Is our risk suddenly a surprise?

Every day, every damn day, we go into work, pandemic or not, and put ourselves at risk.  We walk into our unsecured emergency departments to care for patients carrying guns, knives, brut physical strength, and lawsuits demanding that we adhere to their demands.  Almost every emergency worker I know has been faced with an armed or violent patient and has been threatened in more ways than one.  What has been done to protect us?  Patient satisfaction scores and slaps on the wrist if people are not happy with their stay in Hotel Emergency Department.

Every day, EM workers and health care workers throughout the hospital face the risk of being vomited on, coughed on by someone carrying tuberculosis, spit in the face by an uncooperative intoxicated patient, contracting HIV, or Hepatitis while performing potentially life-saving procedures, or being exposed to shingles while pregnant. Does that ever make the news? No.  Instead, we are thought of as greedy, entitled, and a part of the problem in our health care system.

Every day, we face more red tape, hoops to jump through, wrath from consultants, and disrespect for being “just” an ER doctor.  We are thought to be “less than” when compared to our specialist consultants.  We are regarded with such condescension, that when someone is simply a nice, normal person, it makes the rounds in the ER like national news.

Now, there is a pandemic.  Patients are actually grateful for us.  The hospital relies on us.  Our colleagues throughout the hospital even treat us differently.  We are suddenly recognized for what we do and respected for our abilities.  We are resuscitative specialists.  We are disaster specialists.  We are given immense gratitude for being on the “front lines.”  You can’t go 10 minutes without hearing those words, as if they were just created.  Guess what? We have always been on the front lines.  We have always been at risk of exposures.  We have always been at risk of harm.  We have always been stationed at the hospital gates acting as a bulletproof vest for the people of the hospital who sit comfortably protected by the man-made shield that is the people of the emergency department.

But where is our shield?  Where is the protection for any health care worker, EM or not? Why do we get relegated to reusing single-use masks for COVID-19 positive, negative, or unknown patients?  Why must we try to find our own PPE, competing with our fellow colleagues before they buy up the stock?  Why must we turn on the news to find that our President doesn’t believe in our needs for PPE and ventilators, that we may be getting blocked from our resources because he has beef with our governor?  This is actually what is making us more superhero-like, because we persist on despite any political games and injustices doled out to us.

The world is at war, and we are the first line of defense.  Soldiers are given body armor and helmets.  Doctors stand exposed.  We may get sick, we may get injured, we may get tired, and we may face incredible amounts of disappointment and despair, but we stand, and we fight. Naked. We stand naked without the exterior protection to protect us from this invisible, microscopic assassin.  We stand naked without anyone fighting for us.  But, again, how is that different from any other day?  We face the same uncertainty, risk, and decisions every day we walk through the hospital doors.  Just on a different scale.  All of our other daily smaller battles have prepared us for this grand war.  This is what we do, what we are trained for.  We know how to be calm in a storm, how to handle a crisis with ease. That is our specialty.  No one else can do this.

The scale of this pandemic is unprecedented; its effects will be with us for the remainder of our lives and will affect our practice and decision making for years to come.  But the failures in our system have always been there, just now making headlines because of the scale.  Why do things always need to get to epic, rather pandemic, proportions before eyes can be opened?  Maybe now our protection will be of priority?  Our field will be respected?  Our voices will be heard?

Likely wishful thinking.  But what I do know is that we will still show up, we will still care for our patients, all patients, regardless of the risk to ourselves.  We will continue to be innovative in finding the answers to problems ourselves.  We will find our own PPE, and make do with what is rationed because that is what we have to do.  That is what we always do.  We deal.

So, again what has actually changed?  Not much, really.  But hopefully, after this is over, a lot will.

The author is an anonymous physician.

Image credit: Shutterstock.com

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