I was about to step out for an evening shift when I caught a small quiver in my wife’s lip as she was saying good-bye. This drew me up short. I could tell that she was worried about me; it occurred to me she had a point. I’d had about a week off, and in that time, my co-workers had begun seeing more and more COVID-19 patients. Now, it was my turn. It’s been a long three weeks since then. When I head to the hospital, it’s the same old ER, with the same docs, nurses, techs, respiratory therapists, and secretaries. The work, though, the many familiar habits of patient care I’ve gotten to know these past eight years are utterly changed. The ER now is like a different specialty—on a different planet. As a medical student, I was attracted to Emergency Medicine because of the variety. Every day, patients flooded in with anything from gunshot wounds to testicular pain (and, once, both of these) to earwax. By law, we had to see them all, and did our best to help. Individual shifts could be stressful, or tedious, or depressing, but the next one was always different. That kept it fun. Nowadays, nobody’s coming to the ER to have their ears rinsed out. I see far fewer patients, but they’re sicker, and they do worse. My colleagues still laugh, smile, and crack the occasional joke, but we’re not having fun. It caught up to me driving home from an early COVID-19 shift. I recalled how one of our techs, worldly as they come after twenty years in the ER, asked me out of the blue whether it was normal that she was having bouts of anxiety before her shifts now when she’d had nothing like it before. I told her yes, that I suspected all of us were having those feelings. Certainly, I’d noticed a quiet strain pervading just about everything lately. But it was only in the car, tears welling in my eyes at some stoplight, that I was able to name the feeling we were all trying to work through. It’s horror. I try not to dwell on it, but experiencing horror is fundamental to the practice of medicine. Whatever your specialty or role, you’ll occasionally see something truly awful, and that can’t help but affect you. Ideally, this helps develop the mental and emotional tools necessary for clinical work, though too much “badness” can also be traumatic. In my experience, this is a spectrum, not an either/or proposition. Today, there’s badness everywhere we look: COVID-19 is a terrible disease. It attacks the lungs, the kidneys; patients can spiral down incredibly quickly. Those suffering from it are scared; it hurts to breathe, and no family can be there to comfort them. Those of us caring for them must do so covered by protective gear, so patients can barely see the human in front of them. Worst of all, until an effective treatment is found, we have little to offer other than supportive care. Communication is a challenge. Several of our rooms have loud, whining fans to create negative pressure, keeping the room’s air from going out to the rest of the ER. My mask muffles my voice; the face shield causes harsh echoes; I have to shout to be heard over the fans. Standing in an enclosed room with a coughing, infected patient, I can’t help feeling exposed. One man, in particular, kept pulling his mask down to interrupt as the interpreter was relaying what I’d just said. I had to ask him to pull it back up; then, I’d repeat my question or try to answer his. It happened again and again until I was practically frantic to get out of there. “This sucks,” my wife pronounced as we regrouped one night, about a week into all this. It’s a synthesis I can’t improve on or contest. The ill and their families are suffering the most, but she shouldn’t have to worry about her husband being safe at work, nor should any friend or family of those in healthcare. There are a few silver linings, though. I could start and end with my wife and kids—I’m ridiculously lucky. Supportive texts and emails have been warm, frequent, and deeply appreciated—even if I can’t answer right away. Restaurants and other organizations and individuals have dropped meals and treats off at the ER; I wish I could thank them all. Others have donated PPE, whether bought or homemade. On-shift, the customary, inter-specialty grumbling and sniping have vanished. Instead, we check up on each other when we call. Then there are the pictures and testimonials that have been shared by colleagues past and present. They aren’t just inspiring; they’re awe-inspiring. All that compassion and competence and sheer will are just what is needed to help our patients fight this. The first sci-fi book I ever read was called Armor. It’s far from a classic, but there’s one quote from it that I still think of decades later: You are what you do … when it counts. Now, more than ever, it counts. We can wash hands, wear masks, and, most importantly, stay home until this beast of a disease is under control. Whatever divides us, the practice of medicine makes clear that there is one characteristic, one feature or bug, that absolutely all of us share: mortality. I hope we can use that to support and be truly, obsessively human to each other in dark weeks to come. Then we can start to see past today’s horror, this icy chill engulfing our Spring. Here’s to brighter days ahead. Thomas Seufert is an emergency physician who blogs on Medium @rarelyread. Source
