Month: April 2020

for the long haul

I had a  night off the other evening and I was walking in the neighborhood in SF looking for coffee, a nightshifter’s perpetual quest, when I heard the sounds of a party.  People were yelling, drums banging, and I was completely confused.  I have gotten used to the quiet in the streets, the feeling that I am alone in the world, even outside.  I wondered, who is partying? in defiance of the distancing? I felt my anger rise at the disrespect, until I started hearing people shouting THANK YOU! and my heart shifted.  I realized this is the 7pm cheer for frontline workers it was the first time I had actually heard it.  I looked up at open windows with people in them clapping and cheering.  I sat down on a nearby stoop and cried, letting the gratitude wash over me.  I have been holding it together for weeks, I heard about the 7pm cheer, but hearing it in person was so encouraging.

These weeks have been exhausting.  while the ER is not seeing as many patients as we usually do the patients we do see have been changing.  There are very few traumas, no commuting= no car accidents,  no bars open= no falls and fights, there are fewer of the traumas of violence that we usually see.  These have been replaced with more people in respiratory distress, and more psych patients.  The virus is moving through the homeless population as well.   These patients come to us when there is nowhere else to go  and they stay with us because the psych ward is full and the shelters won’t take patients until they have a negative test.  There are special accommodations  for the homeless that are positive called COVID hotels but they only take people in the daytime. So we hold psych patients and the homeless as a social service.  This greatly reduces the number of beds available for the actual emergencies.

We have actually sent ER nurses up to the ICU every few hours to help with the turning of patients. The ICU is eerie, everyone in full PPE, talking to each other over the banana phones on speaker through the door to the patient room.  We carefully follow the step by step instructions to turn the patient while minding all the IV tubing carrying life supporting drugs and nutrition, the breathing tube, the feeding tube, the urine catheter and on some patients, the continuous slow dialysis lines. The patients are almost all latino, male and in their 40’s and 50’s.

In SF the curve has been flattened, the hospital can handle the number of patients coming in because the public has followed the recommendation to stay home and distance from each other. It is working for now, slowing the rate of infection and death, and bought us some time to learn how to best treat patients, and how to best prevent the spread.  It buys time to develop a vaccine, though we need a long time for that.

We are beginning to realize that this will be our normal for the months ahead until we come up with a vaccine or a lifesaving treatment. What looked at the beginning to be similar to the flu, has turned out to be so much more infectious and so much more deadly.  What looked like a purely respiratory infection has turned out to have dangerous effects on the heart, kidneys, brain, and blood. It is not easy to predict who is most at risk, though we know the age and chronic health conditions do increase vulnerability, there are deaths among the seemingly young and healthy.  We must stay the course until we learn more.

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Overwhelm

I love the adrenaline rush of working in the emergency room at a level 1 trauma center. I walk through the doors at the beginning of my night shift and enter another world, a world where keen observation precise and clear communication and  quick decisions can save someone’s life. The majority of people leave the ER alive and feeling better, some require follow up, long recoveries and rehab.  Some leave with their lives drastically altered forever.  Some though, never make it. It is part of the reality of where we work.  We witness much tragedy and violence, as well as love, appreciation and healing.  We are with people in some of their most vulnerable moments of their lives. Of course it takes a toll on us, we walk the line between opening our hearts enough to have compassion and keeping emotions in check enough to do our work and keep showing up.  We keep each other motivated, have each other’s backs, share humor, and stories of our lives and families outside of work, cheer each other on and commiserate and vent our frustrations and even share a few tears. We see so much, our hearts break, we breath deeply, maybe cry a little in the med room, and then go see our next patient.  When I walk out the doors in the morning, exhausted, calling “sleep well” and “see you tonight”, I leave that world behind and come home to regular life.  I may share a story or two with my family, but I have learned that most people don’t really want to hear details of how we had to go on lock down again after a gunshot wound was dropped at the door, or how I had to delicately determine if the woman asking me to find her husband, is the wife of the unidentified dead stabbing victim in room 6, or how my patient who had just been beaten and sexually assaulted was being harshly questioned by the police  because she allegedly hit her assailant with a bat. These stories stay inside the ED.  Before the pandemic,  the news didn’t usually cover what we do everyday.  We have been short staffed my entire career, and short of the resources we need to take care of the patients.  We are inundated with patients who are aggressive and violent, have drug addiction and mental health problems, are homeless  and without a way to stay clean and fed let alone take care of their chronic health conditions.   It is the balance of normal life outside the hospital that keeps us going and gives us the resilience to keep doing our work.

This pandemic however has been extremely challenging, in that there is no break when we go home.  The news is full of images of nurses and doctors taking care of Covid19  patients, talk about masks and ventilator shortages, counting of cases and deaths in China, Italy, Seattle, New York.  People are anxious, and concerned for their own health as well as their loved ones.  Social media is teeming with good information, bad information, advice, and some humor. There is no getting away from it. The first several weeks I found myself reading everything, and digging into the research as it was coming out, trying to understand for myself and my practice  and to be able to answer questions for my friends and family.  I quickly became buried in data, and the opinions of all the journalists and public figures.  The anxiety level at work is up as well, our preshift huddles are longer due to the daily changes in protocols as we prepare for the surge of Covid19 positive patients, and the shortages of PPE and equipment. Right now we have enough PPE, we get one mask and gown per shift, it is not ideal; they are supposed to be disposable every time you go in and out of a room. But we have them and we are protected for now. There is a sense of foreboding as we watch the number of cases and deaths go up around the country and wonder how long before our hospital is overwhelmed.  One of my coworkers described it as being in a building with an active shooter, you know they are out there with a loaded gun, you know they are coming through the building room by room and you are just waiting for the S#*$ to hit the fan.  It is going to happen, many more people are going to get sick, they are going to come to the hospital, when will it start?  will we be ready?  Right now it is eerily quiet.  Our regular patients are scared to come in, there are fewer car accidents, bar fights and drunken falls with the stay at home order.  The patients that do come in are real emergencies, today we put 5 patients on ventilators, and our ICU is full.

The rhythm of my days has not changed, I am not home with extra time on my hands. I am not going to lie, I am a little jealous of the people who can work from home, spending time with their families, planting gardens, reading more books, getting projects done, or even meditating more. I miss hanging out with my family. I miss coffee with my friends.  I miss going out to dinner, seeing movies, going to the theater and the opera.

I know I have been exposed to the virus, but I am more worried about bringing it home to my partner or kids, than I am about getting it myself. I have a pretty tough immune system, but my partner does not.  At this point we are not  quarantined from each other at home but it may come to that.  We all handle anxiety in different ways and I have had to learn to be more vocal about what I need to replenish during my time away from the ED.   What helps me is SLEEP!  Walks outside in the sunshine, playing my guitar and singing, watching sappy funny movies, talking on the phone with my friends and my kids. Just seeing my kids on a screen, live, in real time warms my heart and settles the protective mama bear in me.  We are lucky that we have some amazing technology to stay connected in so many ways. For this I am grateful.

Some links if you are interested:

How COVID-19 Actually Spreads (w/Dr. Gloria Hwang)

https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

The Four Possible Timelines for Life Returning to Normal