Charting in uncharted territory: Scribing during COVID-19

On Friday, March 27, 2020, California went on lockdown in the face of the COVID-19 pandemic. It changed every Californian’s life, including my own. As the newly appointed chief scribe, the possibility that I would be jobless by the time Monday rolled around, was the last of my worries. What would happen to the patients who depended on our care? Or the physicians, nurses, and administrators that kept the center afloat? I waited the weekend out to see whether or not I would have to go into work on Monday. However, that call never came. “Scribes are essential” the physician I work for announced during morning rounds. “This is uncharted territory, and we are in a constant flux of change, but we are all here, and we are going to do what we can for our patients.” I am one of the few scribes who has been working throughout COVID-19, and this is my experience.

The change in our daily lives was instantaneous. I used to walk through the doors of the hospital and smile at the volunteer at the front desk, comment on the weather or recent sporting events, then open up my computer and begin a full day of seeing patients and charting. Now when I walk up to the entrance of the hospital, there are no volunteers to greet me. Instead, there is a nurse at the front who greets me. I can’t see her smile, it’s hidden behind an N95 mask, but I can tell from the wrinkles by her eyes, she’s smiling. I can also tell she is tired, and I am probably the last person she will see before her shift is done, and another nurse takes her place. “Are you coming to work?” she says. I smile, one she can see because I haven’t put on my PPE yet. “Yes,” I responded. “Any symptoms,” she starts, as she gathers the thermometer that has been recently sanitized. “No,” I say.  She puts the thermometer to my forehead and rolls it around the surrounding area before it beeps. “98.7, you’re good to go.” I sanitize my hands, shaking them to dry faster so I can don the face mask she has prepared for me. “Thank you, have a good day!” I say with a smile, but she can’t see that now.

The thought never crossed my mind to voluntarily complete my charting at home, even when I was given the option. Accurate documentation of patient-physician interactions is not something I can accomplish from the comfort of my bedroom. Not many scribes can say the same, many furloughed or fired from their positions as they became potential liabilities to the hospital. But I didn’t know I would also have a target on my back at the same time. I have been on the receiving end of many stares and people frantically moving away from me, thinking I am COVID, that my blue scrubs are the disease. These days I have been asking more questions to myself and to the health care professionals I work with: How do we dispel fear in our society? Our ED department has seen a significant decrease in admits, where are the patients who are having strokes, heart attacks, appendicitis, and other health complications going if not to the emergency department? Why are patients, who are in septic shock, being placed into COVID wards for rule out when infected wounds are the main problem?

Many of our patients are afraid to come to their weekly appointments because they believe the hospital is highly infectious, but in reality, most of the positive COVID patients are in their own homes, isolating themselves. I’m not sure how hospitals will be able to overcome this stigma and proceed as they once used to. As of May 4, elective surgeries are being allowed at 50 percent on a preliminary basis, giving us a sense of hope that we can overcome this challenge. “How are you doing today?” The nurse at the front asks me, “I’m charting in uncharted territory.” I respond. We both laugh, both hopeful we can see each other smile once again.

Gazal Homayouni is a medical scribe.

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