Cardiac arrest. I am ready. Infant with a fever and seizing. I know what to do and how to reassure his parents. Unresponsive heroine overdose. I know how to treat her. Arterial bleed from a dialysis fistula. I have done this before. A two year old with an unknown foreign body up her nose. I can get it out. A teenager suffering from depression now with suicidal thoughts. I can help. A belligerent intoxicated patient with a bloodied face. I can manage. A fish hook accidentally caught in the scalp or dog bite to the ear. I can fix it. A mother with ongoing bleeding after giving birth. I can take care of her. No matter the unexpected nature, however things went terribly wrong, I am ready. I got this. I am steady, prepared, and nothing can possibly shake me, because there is a plan for every possible scenario.
Before I even step foot in a patient’s room, the chief complaint written down at triage has created at least two dozen pathways in my mind. Like a choose-your-own-adventure, of sorts. Within ten seconds of being in the room, that choose-your-own-adventure has been widdled to one pathway with a few minute adjustments.
This is the world of emergency medicine. Day in, day out. We open our arms wide to the wildly unpredictable open fire hose of anything and everything that comes through our doors. We are prepared for the unexpected. We absorb information, we assess, we create a plan, and we act. All before you finish your initial story of telling us why you are here.
We are the experts at being prepared for absolutely anything. There is a calm steadiness that allows us to work deftly under pressure, to adapt to absolutely anything, against time with efficiency and precision.
I do not know how to start to explain how COVID-19 derailed me more than anything has in my over a decade of practice.
Let me take you back to March.
A searing pain cuts through my left eye and spears through to the back of my neck. I wince and squint to keep the light out. My head is heavy, throbbing. The pain gives me sweats and makes me sick to my stomach. I want to curl up in my bed and not move, stay in the dark. Stay in the silence.
This is how the beginning of this pandemic started for me. Sleepless nights leading to crippling migraines. My mind racing long after the house was in a silent slumber. A feeling as if I was on a ship built for a quiet fishing lake in the middle of the thundering ocean watching the looming clouds around me turn that ominous dark gray, bright flashes of muted blinding lightning, the wind starting to pick up, tiny ice cold pelts of rain whipping against my skin. It’s a feeling as if you are trying to stabilize on this tiny rocking ship, ill-equipped, knowing the storm is inevitable, and preparing with the flimsy life jacket and buoy at your side, knowing that this will not be enough, knowing you will soon be gasping to stay afloat.
There were so many texts and messages from friends, close and distant, asking me how things were. How I was feeling through all of this. I stared at these messages, wondering how to answer. Knowing my voice was reflexively one of reason, one of calm, one of steadiness. But now, I felt undone. I felt unsteady. I felt scared. I felt paralyzed. I did not know where to start to explain what was keeping nights long and the storm untamed.
That is what it felt like when this went from surreal to reality.
I am that person that lays down, head hits the pillow, and I’ve long been in a deep sleep ten minutes later. Since this pandemic came to be, this has been far from the case. A million thoughts come alive in my mind and light up behind my closed eyelids as I try to will myself to sleep. But it doesn’t come, and next thing I know, it says 5 am on the clock. I start thinking about my work day ahead and start mentally and emotionally preparing. To distract from my mounting anxiety, I pour over articles, what little research there is, methods and protocols at centers ahead of us in this pandemic. I read as much as I can to learn as much as I can. This is the only way I know how to best prepare right now.
There is tightness in my chest as I drive to work. It’s a feeling I am not familiar with. Nothing about work gives me anxiety. There is always a path. There is always a method. There is always a way to get from chaos to stability. I have trained for it all. No patient walking through those doors is one I cannot care for. I have always felt well equipped. There is a plan A, plan B, plan C, plan D to every condition. I have a plan for everything.
But this. This is different. There are guidelines on disaster relief, mass casualty protocols. Every year we manage the influx of seasonal viruses. We manage the surge of influenza illnesses. But a novel pandemic. Where do we begin?
I am starting with my basic building blocks to create my plan A. I go back to my training and experience. Start from the beginning. I can stabilize any patient, but with what resources? With what action plan? With what first back-up plan, second back-up plan, third back-up plan? What is the best way to resuscitate a patient from this illness? How will I keep my staff safe? How will I keep myself safe? How will I keep my family safe? How do I do this if I don’t even have the equipment I need? The testing I need? Everything is on shortage. How will I ration out in an emergency? This is the fuel to the fire of my anxiety.
I stand tall, I move with purpose, but inside, there is a small rocking ship bracing for a storm it is not equipped for.
This was a little over two months ago. It’s hard to believe how far we have come in a little over two months. With immediacy, but with what felt like the energy it would take for a thinly assembled group of people to move a heavy piece of machinery from a locked position, all hands came together, and pushed forward—straining, using every muscle, demanding forward movement. We scrambled to gather information. We scrambled to understand as much as we could about this new illness, about how to manage it, how to treat patients inflicted with it, how to protect and keep ourselves healthy so we could keep working. We scrambled to understand the magnitude of its affect on our country and on the world. We scrambled to know how to best prepare our emergency departments, our hospitals, our community, ourselves.
Every day, protocols change. Every day, new information is learned. Every day, protocols and management of patients is developing and becoming more streamlined. We realize what resources and equipment is needed, and we are procuring, stocking up, making ourselves as well equipped as possible and ready for every possible circumstance. We are troubleshooting and fine-tuning. We were fortunate enough to have the ability to do these things, rather than being overwhelmed by volumes of acutely ill patients.
Every day, we learn more about this virus. We are learning, unfortunately from those that have been undone by it before us. We are learning how it affects the lungs, the immune system, the cardiovascular system, and all other organs. We are seeing what therapies and management strategies have been most effective. We are building our best practice, our best protocols. There may be some trial and error. But with our unquestionable commitment, our unwavering dedication to what we do, we are steadily starting to put down the brick pathways that we can walk on safely. We are accumulating knowledge, resources, safety equipment, plans of action.
All of this has been made possible by the guidelines set forth by our state government encouraging social distancing, staying at home, discouraging gatherings. This has given us time to build an infrastructure that allows us to care for all of you. I know it has been beyond challenging. It has been hard to keep away from the people you love. The people that make your life whole. It has been hard to give up all the daily little things that bring us joy. But in doing so, you have given us—your medical community—the time we need to develop the best and safest way to take care of you, should you need it. This gift of time has been invaluable.
I will continue to go into work with my colleagues by my side. We will continue to dedicate our time and efforts to you. But now, I will do it with far less anxiety, better rested, better protected, and with a plan, a back-up plan, and a back-up, back-up plan to do the best I can for you.
What I came here to say, is thank you. Thank you for every sacrifice you have made to help you and I and our family and loved ones stay as safe and as healthy as we can. We may still have a long way to go, but I want you to know your sacrifices have not gone unnoticed. You have allowed us to make large strides in managing this pandemic. Regardless of who we are, we are in this together.