Ripal H. Patel, MD, MPH, shares his experiences working as an emergency medicine physician during the COVID-19 outbreak.
Outbreak. Epidemic. Pandemic.
Sweating under my personal protective gear, I look wearily through the foggy face-shield to see the number of patients in the waiting room rising from 5, to 10, to 15, to 20. I sigh, my heart palpitating, wondering how I will get through this. Our carts are low on masks, we only have two isolation rooms, and testing is still limited. We are all scared. We are walking on a tight-rope — a system at near-capacity — hoping we can cross the wire, in deep fear that a surge may tip us over.
This was the reality coronavirus created.
Stepping into warfare
As coronavirus has continued to spread across the world — exposing the gaping flaws in our healthcare system and stretching our hospitals beyond their limits — I was supposed to be on vacation. This past week went from going to Belize to self-quarantining in my home. As my next locums assignment slowly inched closer, I watched in dread as my colleagues across the country were protesting the conditions and serious ethical quandaries we were placed in: lack of proper masks, shortage of gowns, dearth of respirators, and more chilling — limited hospital beds. We are not prepared, and I was about to step into warfare.
Coupled with this dread came my phone ringing off the hook. Non-stop. Locums agencies from all walks of life and all over the country were calling to connect me to hospitals in need, especially in the epicenters of the pandemic. Hospitals in sudden realization they were direly understaffed. Immediate licensing and credentialing in days. And the calls were in desperation.
Trained to parachute into any environment
My understanding of what locums is and what it entails has morphed and evolved as the years have progressed. Initially, locums was a lifestyle choice that also allowed me to pursue my passions — global health and teaching — while working in the community on my own time. I also harped on autonomy and being a free agent. I have long been enamored by being THE physician that can serve a rural part of our country, where specialists and resources were scant. I loved that idea, and I continue to worship that model to this day, a throwback to how my father used to practice in the Appalachians in the 1970s.
But a pandemic really shed another light on yet another incredible facet of locums work: we are trained — through this model — to parachute into any environment, EMR, or situation and be highly functional to optimize patient care. Need me in New York? I’ll be packed and on that flight. You have that Electronic Medical Record? I can learn it fast. That’s how you admit? That’s how my other hospitals do it. You’ve got that ultrasound machine? No problem, I’ll watch a YouTube video on how to operate it. No scribes? That’s not an issue, most of my places lack them. I am on my own for emergent airways and traumas? No sweat, that’s a typical day for me.
We don’t ask questions: as locums, we simply problem-solve. And then, we do.
How to join the ranks
All across the country my colleagues were calling me about how to get involved. As physicians, we always want to serve. As I explained to them that the concept of locums meant you simply and independently provided your skillset to another part of our country, they were eager to join the ranks.
In addition to the skills we locums bring, I emphasized the importance of the extra preparations I have always taken for any assignment (pre- and now post-coronavirus): proper PPE and equipment. I have been carrying additional N95 masks if necessary but having to find appropriate ways to reuse them until supply meets demand. More importantly, the most extreme presentations of corona have one unfortunate finality — intubation and placement on a ventilator. I encouraged all my colleagues to ensure they have a proper back-up, portable videoscope in the off chance (though unlikely) your hospital does not, as more and more studies are encouraging early intubation rather than high-flow oxygen of BIPAP (for fear of spread of virus particles).
Before any assignment, I would encourage anyone that wishes to join in this war against the pandemic to ask the recruiter these simple questions:
- What is the algorithm for who gets tested at the hospital?
- How is their supply of PPE?
- Are mechanisms in place for overflow, lack of ICU beds, and ventilators?
- What is the status for their testing/how many positive cases are they seeing a day?
- And finally, and most importantly, what is the back-up plan in case a physician gets ill and cannot relieve you?
We as physicians think we are superheroes, and to a large degree we are, but we must know our limits, and a 12-hour shift turning into a 24-hour shift because there was no emergency system in place for a provider not relieving you is simply not acceptable, both for you and for the safety of your patients.
Caring for yourself
I just finished a week in New Mexico this past week. I won’t lie, I was dreading each minute until I started, and I was anxious and nervous during each shift. But like anyone being called into an uncertain battle, we must be the beacons of confidence and reassurance to our colleagues and patients. This past week, and I imagine for weeks to come, I won’t be sleeping well and will live with background stress manifested within my body as eye-twitching and back spasms.
I highly encourage all my physician colleagues to continue making a point to cook their meals and eat healthy, trying to get at least 30 minutes in a day of exercise (I do 20 minutes of a workout on Beachbody.com and 10 minutes of resistance bands in my hotel room), and most importantly, calling/Facetiming our family and loved ones. We are social creatures, and in this era of self-quarantine and isolation to prevent spread, I am gravely concerned about all of our emotional well-being as we take on this tremendous stress.
I flew back from work on Friday and spent most of the day sleeping. I did not want to see my girlfriend or speak to anyone, simply because no one could comprehend what we are dealing with. And personally, I thought it wasn’t fair to make someone try to comprehend this. But we need them, now more than ever.
Each day I tell my residents and students we simply have to do the best we can with what we are given. Simple as that. And to all my locums colleagues, we will get through this. Together, we will get through this.