These days, the majority of patients I see on my shifts in the emergency department are Covid-19 patients.
In the ER, these patients range from people with mild fevers and slight Covid cough to people who are struggling to breathe, some of whom we put into a medically induced coma, intubate, and place on a ventilator within minutes of arrival.
As medical director of an emergency department, I’m a front-line physician treating people coming through the doors of the ER. I also help the hospital coordinate policy and procedure, staffing, resource availability, and Covid response.
I have seen enough Covid patients over the past nine months to know that the virus doesn’t discriminate, and it constantly surprises.
The running joke among ER doctors last spring — when we were in the early stages of the pandemic and trying to figure out how to best diagnose and treat the disease — was that we had to assume everyone coming in to the ER had Covid. “Stubbed your toe? Probably Covid.” “Heart attack? Probably Covid.”
It turns out, we weren’t far off.
People who were in the ER for completely unrelated issues, like a kidney stone, would get an X-ray or a CT scan that would catch a little bit of their lungs, and to our surprise, they would have Covid pneumonia, despite never having a cough or trouble breathing.
What was, on one level, initially fascinating to me as a doctor — a brand-new illness that didn’t act like anything we had ever seen before and presented new diagnostic and treatment challenges — is not so endearing nine months later.
Over capacity
There are several things that scare me about Covid, now more than ever.
With a completely overwhelmed healthcare system, doctors won’t be able to take care of many of their patients. As an ER doctor, I am trained to save lives. But I may not be able to prevent my patients from dying, because our healthcare system is becoming completely overwhelmed by this pandemic for a second time.
We are facing a Covid surge that is dwarfing the initial months of the pandemic. This isn’t just my melodramatic fear. Already, many hospitals in the Chicago area are over capacity with Covid patients.
At West Suburban Medical Center, our intensive care unit (ICU) is full more days than not. We can’t transfer patients to other hospitals because they are full as well.
If the ICU is full, these patients end up staying in temporary beds in our emergency department, behind closed glass doors, on ventilators with nobody at their bedside.
They are at a higher risk of dying simply because we can’t provide them with the same care they would get in an ICU, as we’re almost always stretching our ratio of nurses to patients in order to take care of the next five Covid patients coming in the door.
In fact, one such patient recently died in my ER after being there for two days. He should have been in the ICU, but we had no ICU beds, and neither did all of the other hospitals that we desperately called. His last words before he suddenly worsened and died were that he was feeling better, and he wanted to thank the doctors and nurses taking care of him.
These things take their toll on us, as frontline healthcare workers. You may have read the New York Times profile of Lorna Breen, MD, the ER doctor in New York City who committed suicide in April, possibly due to her feelings of hopelessness and the psychological after-effects of contracting Covid-19 herself. Breen was a friend of mine and a mentor when I was a resident. While she serves as a public face of the tolls Covid-19 is taking on healthcare providers, there are thousands of others like her who are also struggling.
Sounding the alarm
We, as a society, have the ability to change the course of this pandemic, but we’re losing our fortitude when we need it most.
There’s a thing in medicine called “alarm fatigue.” In the ER, there are different alarms going off all the time. Some are as harmless as a patient pressing their call bell for a warm blanket, and some are as dire as a heart monitor warning of an impending cardiac arrest. The sheer volume of constant noise desensitizes us and risks us missing a critically important warning.
After nine months of the pandemic, we have societal alarm fatigue. We are getting tired of constantly hearing about Covid. Tired of being at home. Tired of not seeing friends and family. Tired of keeping our kids home from school.
In a ruggedly individualistic society like the United States, it can be difficult for us to make significant individual sacrifices to protect the wellbeing of others. We so easily forget to listen to the alarms sounding around us.
Many people aren’t concerned that Covid-19 will affect them or their loved ones. Chances are, it won’t. But like any disease, it doesn’t affect you until it does. All of us are probably no more than two degrees of separation from somebody who has either gotten severe, irreversible disease or died from Covid.
Making a difference
Without a large-scale campaign to limit spread, our healthcare system is going to be completely overwhelmed by Covid patients in the next month or two. While I hope our area can quickly flatten our local curve, I fear that it will be a long winter.
Like everyone else, I am tired of Covid-19. I’m exhausted. I’m tired of my kids not being able to hug their grandparents. I’m tired of remote learning. I had Covid myself back in May, and up until then, I was tired of constantly worrying that I would carry Covid-19 home from work and infect my family. I’m tired of this virus completely upending our lives and our society.
Doing the things that are asked of me as an individual in order to help society at large is exhausting. But what transcends all of this is the knowledge that even in the face of something so huge and overwhelming, I have the power to make a difference, however small it may be.
If I can do my part to make a small difference, then a handful of us can make a bigger difference. And a community of us might make a big enough difference that we can flatten this curve.
David Anthony, MD, MPH, is medical director of the emergency department at West Suburban Medical Center in Oak Park.
