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Goddess of emergencies: bailing out the COVID-19 tidal wave : Emergency Medicine News


COVID-19, pandemic outbreak


It’s Christmas Day. I sent my fiancé Matt to work with Bojangles fried chicken and chocolate cake, but our brief afternoon phone conversation made it clear that none of his ER workers will have time to eat it. “Sandy, people are coming in carloads. I just had a family of five, all asymptomatic, all wanting COVID testing. At Christmas.”

He takes a big scoop of whiskey ice cream out of the freezer when he gets home on Christmas Eve. “You wouldn’t believe the disbelief of some of the unvaccinated patients with symptoms of COVID when I told them they had COVID. What did they expect?

He pours two fingers of scotch. “Others rush to the ER with minimal symptoms after positive home COVID tests because they’re anxious, want confirmation, or just need a work note.”

Matt sees 60 patients in a 12-hour shift on Boxing Day. He comes home two hours late and pours three fingers of scotch. “I had critically ill patients, but non-critical people who feared COVID were blocking our service. The press scared people. I told a 12 year old girl she had COVID, and she burst into tears and asked if she was going to die.

A few days later, while dithering my shower before the night shift, I see a social media post from Matt’s hospital system telling the public that hospitals are not COVID testing locations. Things are serious when a for-profit system publishes anything that might deter patients. I head to my night shift anticipating a shit show.

two mile run

I try to get a tidal wave of patients out of my waiting room with just my bucket for 12 hours. Juan at the lab tells us that the results will be delayed because the lab is flooded and he is the only technician. COVID swabs are so backed up that we can no longer tell patients to expect results within 24 hours. They now take several days.

I see yet another patient with fever, COVID symptoms and known exposure. I explain that we will treat his illness as COVID; a test won’t change what we do in the ER, and she vehemently demands a swab. “Last time I was here they sent the test.”

“Lady, the last time you came here, our labs and waiting rooms weren’t overwhelmed,” I said.

It’s hard not to upset people when they’re waiting for a test because that’s what we’ve done so far, when numbers allowed. She tramples.

By the time my relief comes, I’ve seen more patients than I’ve ever seen in a single night. My Fitbit tells me that I have covered more than three kilometers in the department.

Twelve hours later, after my less than restful daytime sleep, I’m back to do it all over again. This time I ask the triage nurse, “Please tell the patients that they will be seen by the clinician. A COVID test is at the discretion of their clinician as it is not a testing center. If they ask, give them a list of testing centers. I don’t want someone waiting hours to see me to be disappointed.

Crack the whip

My first patient, refreshing, is a laceration. She tells me about her three hours spent in our waiting room. “Everyone wants a COVID test. I told a man who looked absolutely fine that instead of continuing to back up the ER he could go to a testing center or take a home test. He took my advice. I’d give it a high-five, but I’m sterile.

Unfortunately, not everyone is as reasonable as my lacerated patient and the patient she redirected. The crowded waiting room looks like sticks of dynamite with extinguished fuses. Then we explode. The triage nurse flees the triage and grabs our department’s police officer, explaining that a patient called her a “little b—- white” and started punching the wall. When the officer comes to him, he throws chairs and scales his complaint from COVID symptoms to chest pains, demanding to be seen. After a non-ischemic ECG and the attention of the officer, two nurses and me, his fury died down. He was eventually diagnosed with COVID, like so many others.

In the early morning, a patient on dialysis with gastrointestinal bleeding, whose transfer to a higher level of care was organized the day before by the day doctor, is still waiting for transport. Transfers are usually blocked because there are no beds or EMS teams available. Amazingly, this patient has a bed and a team to take her. And the bed she’s going to go to is empty, but only two housekeepers work in the referral hospital, and they just can’t come around to clean it. When angry patients become verbally and physically violent with hospital staff, is it any wonder that hospitals are understaffed? And we haven’t even reached the peak of this Omicron push.

Fast forward to the first Monday in January. I sit down to write this article about our hellish Christmas trips, and Matt bursts into my office handing me his phone. “Look at this email I just received! »

All of the 9-5 admins who took advantage of their vacation are back at work and they’ve emailed Matt to let him know how many of his December cards didn’t have enough documentation. You’d think they could thank him for working over the holidays or mapping out as much as he could while seeing ridiculous volumes of patients amidst a wave without a scribe. No, COVID surge or not, they keep cracking the whip. Already demoralized troops are becoming more demoralized day by day. I fear for the next few months.

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Dr Simonsis a full-time nighttime emergency physician in Richmond, Va., and mother of two. Follow her on Twitter@ERGoddessMD, and read its past columns at