Life in the emergency department during COVID: a rural physician’s perspective

“Do you think we should prepare a will?” I vividly remember saying these words to my wife, also a physician, as we drastically saw COVID cases rise in early March 2020. Just months ago, we heard about the novel coronavirus now known as SARS-CoV-2 but did not grasp the world-changing consequences it would have. Living in Western New York, we were not immediately hit with a surge of cases like our colleagues in New York City, but we could read the writing on the wall.

As the terrifying news continued to come out of NYC, the then epicenter of the pandemic, we knew we needed to prepare for the coming surge. I started searching the internet looking for personal respirators and other protective equipment needed in the coming days to months. I bought what I could as many around the country were acting similarly. I had many discussions with my wife and elderly in-laws that live with us… would I need to quarantine myself to a part of the house? Would changing before entering and showering be good enough? I knew that I could never forgive myself should I infect and potentially kill my family members. We had plans, and those plans had plans. To sum up how I felt during those early days: I was terrified.

As the days continued and my organization prepared for the worst, I also had to deal with my job’s administrative part. As the director of an urgent care, where we expected many patients to be funneled, there were countless meetings, strategy calls, etc. The guidance was ever-evolving as we continued to learn from our struggling colleagues downstate. I must say that I am grateful and thankful for the pre-planning and guidance from my organization… many friends across the country were not being treated as well. The one other question always in our minds as our EDs remained empty, “Where are the rest of the patients?”. Heart attacks and strokes do not cease in a pandemic. Are all these people quietly suffering and dying at home because they are too afraid to come to the hospital?

The days became weeks and then months, and this new reality became the routine. Countless different gowns and masks were used as the country continued to lack proper protective equipment. The protocols improved, the workflow, while still challenging slowly got better. Still in my mind with every patient I saw was, “Could this be the patient that gives me COVID?” Another disturbing trend was starting to emerge: the distrust and animosity toward the medical profession. Gone from heroes to patients saying, “I hope you all are telling the truth, I hope you are right about this.” How hurtful it was to hear this sentiment from the patients we gave up so much to treat.

I am grateful that I work in a small rural hospital that is like a family. I am grateful that my organization has done everything in its power to protect us… but I hope we can do better. I hope medical workers have enough left within them to give their all for the coming months. Now we are in November with cases on the rise throughout the country: I hope we are more prepared. As the medical community, we do everything we can to protect our patients, our loved ones, and ourselves. Life in the emergency department during COVID has been some of the most emotionally and physically taxing of my career, but I remain optimistic that there is hope.

Andrew Tisser is an emergency physician.

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