The Conversation is operating a sequence of dispatches from clinicians and researchers working on the frontlines of the coronavirus pandemic.
Inside, as typical, affected person beds are close to capability, and the emergency division is crammed with not solely the standard mixture of sufferers with trauma, stroke, chest ache and different considerations, but in addition dozens of individuals nervous they could have COVID-19.
I’m an emergency and critical care physician who cares for sufferers within the emergency division and intensive care models at Seattle’s Harborview Medical Center, a public hospital with 413 beds owned by King County and staffed by medical doctors from the University of Washington School of Medicine.
UW Medicine has seen dozens of COVID-19 circumstances for the reason that first affected person arrived right here in late February.
Everything feels completely different within the hospital now. Door entrances are locked, streets outdoors are quiet, the constructing feels empty given the shortage of holiday makers and outpatients but in addition bustling with a distinct type of power.
As emergency and significant care medical doctors and nurses, we take into consideration and practice for some of these conditions usually, however no person expects to be the epicenter of a pandemic within the U.S. But right here we’re, and because of this, my colleagues and I’ve been working to seek out out methods to assist not solely our sufferers but in addition different medical doctors across the nation who will quickly expertise what now we have, in the event that they haven’t already.
Within a number of days at Harborview, we went from regular operations in late February to fascinated with the right way to defend ourselves, our colleagues and our sufferers with each encounter. Every time I see a brand new affected person, the primary query I ask myself, no matter why they arrive in, is: “Could this be COVID-19?”
If the reply is sure, I start the laborious means of “donning” private protecting gear, transferring the affected person to one in all our few isolation rooms, after which “doffing,” or eradicating, private protecting gear. These phrases had been barely in my lexicon two weeks in the past. My largest worry is lacking a case and doubtlessly exposing a whole lot of different well being care employees and sufferers. In the final week, I’ve discovered myself placing on private protecting gear for nearly half of all affected person encounters.
In the emergency division, this implies not solely having suspicion with each cough and runny nostril, that are so widespread this time of yr, but in addition contemplating whether or not sufferers who are available after automotive crashes, falls and even cardiac arrest might also be contaminated. This is in direct rigidity with the information that sources, like private protecting gear, testing and isolation rooms, are finite.
In the ICU, beneath regular circumstances, essentially the most rewarding components of my job are spending time on the bedside with critically unwell sufferers and having deep conversations with households, studying concerning the affected person and what they worth. This not solely helps me make medical choices consistent with what my sufferers care about, however it additionally permits me to kind essential human connections that make the job gratifying.
These interactions are deeply troublesome now and sometimes relegated to transient visits in full private protecting gear or cellphone interactions. Instead of sitting nose to nose with sufferers, I now name their cellphones from outdoors of their room, making a private connection that a lot tougher. Face-to-face household conferences have been moved to phone or telemedicine as properly. Being within the ICU is lonely sufficient for sufferers; however that feeling of being alone needs to be that rather more profound with customer limitations and well being care employees having to take additional precautions to maintain themselves protected.
My colleagues and I are nervous, however in odd methods distinctive to well being care suppliers who have a tendency to fret about others greater than themselves. I’m extra nervous about operating out of protecting gear or getting sick and never having the ability to care for sufferers. I’m additionally nervous about bringing the virus into my dwelling, the place I’ve a 1-year-old daughter and a 4-year-old son. Fortunately, kids haven’t but been closely impacted by this illness, however my 70-year-old mom additionally lives with my spouse and me, and he or she is in a higher-risk age group.
After listening to about well being care suppliers getting sick, I, like a lot of my colleagues, have reminded my partner about my preferences if I had been to develop into critically unwell.
In these difficult weeks, one factor I didn’t count on was the overwhelming variety of emails and texts from buddies and colleagues all through the nation, who acknowledged that, whereas Seattle was first, their day with COVID-19 was quickly to come back.
As a consequence, a number of colleagues and I started to gather “lessons learned” on our department’s website. Fortunately, UW Medicine has additionally been beneficiant about sharing all of our protocols in order that others can profit from our expertise. Some of those are fundamental, like coaching everybody to make use of private protecting gear, however the variety of tips and protocols that we’ve needed to quickly develop has been staggering, reminiscent of altering how we safely place respiration tubes with out exposing ourselves.
To the general public, I would like everybody to know: We’re prepared for this and we’re right here for you, however we can’t do it alone. We want your assist in so some ways.
Our well being system is already taxed and busy; our hospital runs over 100% capability most days, even earlier than COVID. Please comply with native public well being tips about social distancing and hand hygiene.
Please don’t use or purchase private protecting gear. Not solely is it typically not efficient when reused, however it’s in brief provide. Donate it to well being services you probably have it. If we get sick, we are able to’t look after you.
Lastly, be variety and affected person. We’re on this for months, at greatest. We want all of the help we are able to get.
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