Our Work As Anesthesiologists In The Post-Normal Era

Traffic is non-existent. Schools are closed. Restaurants are only offering take-out and delivery. Parking lots at strip malls are empty on weekends. Only a limited number of people at a time are allowed inside the grocery store.

Welcome to the post-normal era since the COVID-19 pandemic hit the scene in Northern California.

One day we will look back at this time and realize how much it changed everything. Simple things like a handshake or sitting together with a colleague during a lunch break will hopefully never be taken for granted again

The California Governor has issued a statewide order to shelter in place. It’s only natural that the husband and father parts of me consider staying home like everyone else.

But I’m not like everyone else, and none of us in health care are. We are considered “essential,” which is why we continue to go to work day-and-night while the rest of our society shelters in place in a monumental effort to “flatten the curve” of COVID-19.

I have always liked this blog by Dr. Kathy Hughes about working at hospitals around the holidays and being essential. Hospitals at that time of the year are actually festive places. It’s different now. There are no holiday potlucks in the ward lounges to bring people together. There is no celebrating. Yet, we all understand that we are needed and share the burden of being essential together.

Our work as anesthesiologists has changed. We no longer perform elective surgeries in our operating rooms. The weight of our role as specialized physicians has shifted from perioperative and pain medicine to emergency response, critical care, and crisis management. We are at particularly high risk since COVID-19 is a respiratory disease. Every time we are called to perform tracheal intubation in an infected or suspected patient who is coughing and having trouble breathing, we are staring down the barrel of a gun.

Protecting ourselves is a priority because our expertise is a limited resource. If we get sick, we can’t help others, and we risk spreading COVID-19 to our families. Personal protective equipment or PPE is a necessity, and multiple layers are required by anesthesiologists and other airway management personnel given the high-risk procedures we do in these patients. It takes time to put on PPE, but there can be no shortcuts when it comes to safety. Slow is safe, and we need to remember that there are no more emergency intubations in this post-normal era.

Being essential in the hospital is not limited to just the health care professionals, of course. The engineers, the technicians, the housekeepers, the cafeteria and food service workers–they are the unsung heroes of the hospital during this pandemic. Without them, our facilities and our health care workers would cease to function. Whenever I see them, I thank them for the work they are doing to support us on the front lines of patient care. We share stories of how things used to be and give each other some encouraging words.

It is surreal to get up, get ready for work, have a cup of coffee as part of my normal morning routine, drive through deserted streets, and walk into the hospital, not knowing what the day will bring. We have a job to do, and that calling to help humanity drives us to keep coming to work. We chose medicine, but medicine chose us too.

Edward R. Mariano is an anesthesiologist. He can be reached on his self-titled site, Edward R. Mariano, M.D. and on Twitter @EMARIANOMD.

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